A still from Affinity Senior Care's podcast show Connecting the Community with Chris, with podcast host Chris Zayid in conversation with Dr. Kwartowitz and Dr.Gibson.

Knee Deep in Recovery: Unraveling the Path of Knee Replacement Surgery

Welcome to “Connecting the Community with Chris,” where we explore the world of healthcare and well-being. In today’s episode, we delve into the journey of knee replacement surgery, from decision-making to recovery. Joining us are Dr. Mark Kwartowitz and Dr. Victor Gibson from the Lederman Kwartowitz Center for Orthopedics and Sports Medicine, bringing their expertise and experience to the table. Let’s uncover the mysteries of orthopedic medicine and embrace a healthier future.

Watch the full podcast or read the transcript below:

Chris: Hello. Welcome to Connecting the Community with Chris. We have an exciting podcast today with two very special guests, Dr. Kwartowitz and Dr. Gibson. We will be discussing knee replacements and the road to recovery following surgery. Dr. Kwartowitz is a founding partner of the Letterman Kwartowitz Center for Orthopedic and Sports Medicine in West Bloomfield and specializes in orthopedic surgery for seniors. Dr. Gibson joined the practice in 2022 with over 12 years of experience and an excess of 5,000 procedures performed. Both physicians specialize in knee replacement surgery. Now, Dr. Kwartowitz, please tell the public and everyone of what inspired you to become a physician.

Dr. Kwartowitz: Well, I think my first inspiration was my father. He was a physician, so that’s really all I knew. So, when I decided to go to medical school, what I loved about orthopedics was there was a problem, you fixed the problem, and then people got back to doing what they love to do. So, whether it’s a fracture, a ligament, tendon injury, or arthritis, most of the time we can take care of the problem conservatively sometimes surgically and get these people back to doing the things they love to do.

Chris: Thank you. That’s great. And Dr. Gibson, what inspired you to become a physician?

Dr. Gibson: Well, my background was a little bit different. I actually had nobody in my family that was in medicine. And when I got out of high school, I got a job working as an orderly at the hospital, and that was my first exposure to the health care and the medical field. I knew right then that is kind of what my passion was. I was always interested in science in high school, and it kind of led me down this path to be able to provide service and care for patients in a way that’s meaningful to me.

Chris: Thank you for joining us, both of you. We’re honored to have you. So, we’ll dive into our first question today. With Dr. Kwartowitz, we’ll start with you is, what is orthopedic medicine?

Dr. Kwartowitz: Orthopedic medicine and surgery is really the treatment of the musculoskeletal system, treating the joints, the ligaments, the muscles, the tissues, the tendons of the entire body.

Chris: And how can orthopedic issues with people over 55 be prevented?

Dr. Kwartowitz: Oh, gosh, that’s a good question. Sometimes people, there’s a genetic component to developing arthritis. Well, you can’t necessarily prevent that, but there’s a lot of things. One, weight control. So as people go up and downstairs, you double the weight that you place through your joints, especially your knees. So, maintaining proper weight control. And now what we’re realizing is a more functional strengthening routine can make a big difference. And what does that really mean? It means getting into a regular routine of flexibility, stretching, strengthening exercises of the entire body, and some people say CrossFit or TRX bands, all these things to maintain the flexibility. So, what we see in people 55 and older are really these overused injuries or weakened warriors that dive into maybe an activity without doing preventative exercises.

Chris: Okay, so then when do you see it necessary to actually have a knee replacement then?

Dr. Kwartowitz: So, for a knee replacement, it really becomes a matter of how it affects the things that people need to do, have to do, and want to do. In our office, the things that we can do to prevent a knee replacement from a patient standpoint is maintaining weight control, flexibility, anti-inflammatories. In our office, we do things such as cortisone injections, viscosupplementation, which is a synthetic lubricant to help cushion the joint. Sometimes, bracing will allow people to do the activities they love, such as pick a ball or golf or tennis. And then ultimately, if those things don’t work, then people have to decide if they’re ready.

Chris: I’m hearing a lot from you is that you need stay active, especially those retirees, if they’re not doing anything, it’s important to have a active lifestyle.

Dr. Kwartowitz: Absolutely. Yes. When people come into our office, especially the ones that are in their 80s and 90s, and they just are spry and active, I always ask them, what’s their secret to looking so good and maintaining their activity level? And I already know the answer, and that answer is staying active, being motivated to do something every day instead of being sedentary.

Chris: That’s great. And so, can a partial knee replacement be actually performed?

Dr. Kwartowitz: Absolutely. Absolutely. So, when you divide the joint, the knee joint, into three parts, you have the inside of the knee, the outside of the knee, and then the patellofemoral joint where the kneecap is. If there is isolated arthritis to only one part of the knee, absolutely. Those people are great candidates for a partial knee replacement. It’s like, why replace the entire knee when only one part is affected? It’s a faster recovery, smaller incision, and a faster surgery and recovery, for sure.

Chris: Then what would you say will determine a patient that needs a partial knee replacement versus a complete knee replacement?

Dr. Kwartowitz: Really if it’s diffuse arthritis. So, if there is arthritis throughout the entire knee, then a partial knee replacement is not going to be a good option. But if it’s through the inside and outside as well as the patellofemoral joint, or people have a malalignment where they’re significantly bow-legged or knock-need, and a partial knee really isn’t going to be an option. So, alignment issues and also diffuse arthritis throughout the entire knee. If it’s localized to one area, then a lot of times that’s a good option is a partial knee replacement.

Chris: Great. And so, what can be expected on the day of surgery? And we’ll talk to Dr. Gibson to help us out and guide us in this straight direction. So, let’s say now it’s time to have surgery, what do we expect?

Dr. Gibson: Sure. So once the decision is made to have a knee replacement, whether it’s a total or partial knee, typically all that planning starts before the day of your surgery. We have a great surgical planner here and a great team that’s going to work with you to make sure that we have health clearance,  medical clearance, that you’re healthy enough to have the surgery. Then usually the day of surgery, you’ll come in, you’ll meet with the pre-op team. Dr. Kwartowitz or I will come I’m going to meet you and talk to you if you have any questions before the surgery. Most surgeries are probably about an hour to an hour and a half, give or take. And then I would say the majority are being done outpatient, so you would be able to go home the same day if everything runs smoothly.

Chris: And so, what is the average time would you say the recovery is for your patients?

Dr. Gibson: Well, I think there’s actually two parts in recovery. There’s this early recovery that probably happens when the first 2-3 months. I typically tell my patients, expect to be somewhere between 70 and 85 % in that first 2-3 months. They will tend to plateau for a little bit and really to get that 100%, most patients, I will tell them to wait to about six months to a year before they really reach their full potential.

Chris: And that dives into the next question about the healing process. Can you tell us, during a knee replacement, what would be the healing process?

Dr. Gibson: Well, so typically, when you go through the recovery afterwards, the physical therapy is probably the most important thing in terms of have a good outcome. So, we want to get you in the therapy right away. And so that usually starts with home therapy. You’ll transition to outpatient therapy. And that’s all about range of motion, getting your strength back. And so during the time, when they come for their office visits, Dr. Kwartowitz and I are monitoring their progress. We’re on the sidelines, but we’re the coach making sure that everything’s headed the right direction. And if any changes would need to be made, we’ll do that. But typically, to have a good outcome, it really is going to be a maximum effort with physical therapy.

Chris: How long is a patient typically under the care for a nurse after surgery?

Dr. Gibson: Well, I would say when I first started and came into practice 2010, there was a lot of hands-on nursing care after someone had a joint replacement. That has changed quite a bit since we do outpatient joint replacement. And so really, the home therapist does a lot of the similar things that a nurse would do. And so there really isn’t hardly any nursing care once you leave the hospital.

Chris: And so how long does an artificial joint last, typically, for your patients?

Dr. Gibson: Yeah, I tell patients to expect about 15 to 20 years. Obviously, we don’t have a crystal ball, but we’re just going based on the literature. 20 years, the survival rate of the implant is probably about 80 to 90 %. So, you can get longer than 20 years, but usually 20 years is a good number that I tell patients.

Chris: Now, is there anything else the patient should know about coming to your practice? And what differentiates the practice over here from the others in the area?

Dr. Gibson: Well, I think patients should know. This is what I really enjoy about this practice is that for example, I specialize in knee and hips. But if you happen to have… I see patients all the time and they may complain about their back. We have physicians here that can take care of back problems. We have physicians that can take care of a neck or shoulder or hand. And it’s nice to have it all in one building and have it at reach. And so, patients aren’t having to travel several miles away to go see another specialist. So, we really have the majority of things covered from an orthopedic standpoint for the patients.

Chris: Thank you, Dr. Gibson, for joining us. And Dr. Kwartowitz, also wanted to ask you, what differentiates this practice from the area?

Dr. Kwartowitz: Oh, I think we have a very boutique-like practice in that we treat all our patients like family. I think it’s very conservative in that we try to keep people out of the operating room, but when the time comes, we’re there to perform the surgery, but we have a lot of modalities. We have physical therapy on site. We have laser treatment, which helps with inflammation and pain in our therapy. As I talked about for the knees and joints, we have viscosupplementation, which is a synthetic gel, which can help with pain relief, cortisone injections, physical therapy. So, a lot of things that we try to do before we talk about surgery.

Chris: Well, I am honored to have both of you. And I know this is not the last time we’re going to be talking about orthopedic surgery and helping our community make sure they’re healthy, safe, and have an active lifestyle as well, too.

Also Read: Is Orthopedic Surgery Always the Answer? Dr. Lederman Weighs In!