1 00:00:05,235 --> 00:00:07,285 - This is the Becker's Healthcare Podcast, created 2 00:00:07,285 --> 00:00:08,445 by the team of Becker's Healthcare, 3 00:00:08,605 --> 00:00:10,325 a multimedia company devoted to the people 4 00:00:10,345 --> 00:00:11,645 who power us healthcare. 5 00:00:11,915 --> 00:00:14,765 Four new 15 minute episodes are released daily containing 6 00:00:14,925 --> 00:00:17,285 industry news analysis and thought leadership from powerful 7 00:00:17,285 --> 00:00:19,605 healthcare decision makers Support our show 8 00:00:19,705 --> 00:00:22,525 by leaving it a five star rating and review on Apple Podcast 9 00:00:22,745 --> 00:00:24,005 or other platforms you use. 10 00:00:24,155 --> 00:00:26,005 It's a chance to tell us what you like about the show 11 00:00:26,025 --> 00:00:27,245 and act on your feedback. 12 00:00:27,245 --> 00:00:29,205 Thanks for listening. Now here's the episode. 13 00:00:30,715 --> 00:00:33,085 - This is Laura Dedo with the Becker's Healthcare Podcast. 14 00:00:33,625 --> 00:00:35,685 I'm thrilled today to be joined by Dr. David Homesley, 15 00:00:35,865 --> 00:00:37,685 an orthopedic surgeon at Novant Health. 16 00:00:37,905 --> 00:00:39,085 Dr. Homesley, it's a pleasure 17 00:00:39,085 --> 00:00:40,245 to have you on the podcast today. 18 00:00:40,945 --> 00:00:41,955 - Well, thanks for having me 19 00:00:42,935 --> 00:00:44,515 - Now, I'm looking forward to our discussion. 20 00:00:44,635 --> 00:00:45,995 I know we'll talk a lot about some 21 00:00:45,995 --> 00:00:47,955 of the new technology in the orthopedic space, 22 00:00:47,955 --> 00:00:50,675 especially robotics and how the technology's evolving. 23 00:00:50,895 --> 00:00:52,755 But before we dive into those questions, 24 00:00:52,815 --> 00:00:53,795 can you tell me a little bit more 25 00:00:53,795 --> 00:00:55,035 about yourself and your background? 26 00:00:56,015 --> 00:00:59,265 - Yeah, I, um, I've been in practice for about 20 years 27 00:00:59,485 --> 00:01:03,505 and I trained at the, uh, Rothman Institute, did 28 00:01:04,965 --> 00:01:07,605 residency and fellowship there and finished in 2003. 29 00:01:08,145 --> 00:01:12,605 And, um, I've been in Charlotte since 2004, um, 30 00:01:12,615 --> 00:01:15,525 where I'm, uh, the chair of the orthopedic department 31 00:01:15,525 --> 00:01:19,365 of Novant Health, uh, Presbyterian Medical Center, uh, 32 00:01:19,365 --> 00:01:20,725 here in Charlotte, North Carolina. 33 00:01:20,825 --> 00:01:24,605 And it's a big health system that's a non-for-profit, uh, 34 00:01:24,625 --> 00:01:28,765 system that, um, supplies, uh, healthcare 35 00:01:28,945 --> 00:01:31,605 and services to communities in Charlotte, Winston, 36 00:01:31,605 --> 00:01:33,205 and Wilmington, North Carolina. 37 00:01:34,865 --> 00:01:36,155 - Well, that's amazing to hear. 38 00:01:36,215 --> 00:01:39,195 And you know, it seems like a huge, uh, department 39 00:01:39,255 --> 00:01:40,755 to really be overseeing. 40 00:01:40,855 --> 00:01:43,435 Um, from your perspective, could you talk a little bit about 41 00:01:43,575 --> 00:01:44,635 how you're using robotics 42 00:01:44,695 --> 00:01:46,795 and how that's changed the field of orthopedic surgery? 43 00:01:47,065 --> 00:01:49,755 What have you seen as the advantages of using robotics? 44 00:01:51,485 --> 00:01:54,945 - Um, I, I think that, you know, it's an evolving field. 45 00:01:55,265 --> 00:01:57,225 I, I think that it's, I think 46 00:01:57,225 --> 00:01:58,865 that the technology has improved 47 00:01:59,545 --> 00:02:01,385 a lot over the last 10 years 48 00:02:01,405 --> 00:02:05,425 or so, where it's a lot more efficient and it's giving, uh, 49 00:02:05,565 --> 00:02:09,145 or I think it can give surgeons data in the operating room 50 00:02:09,145 --> 00:02:10,825 that can make choices 51 00:02:11,765 --> 00:02:14,465 or decisions for the patient, um, 52 00:02:15,185 --> 00:02:16,905 specifically given their anatomy and, 53 00:02:17,245 --> 00:02:20,785 and what their deformity is for, um, in, in particular 54 00:02:20,785 --> 00:02:22,185 for like knee replacement planning. 55 00:02:25,715 --> 00:02:27,245 - Well, that's fascinating to hear, 56 00:02:27,385 --> 00:02:28,765 and certainly as you mentioned, I, 57 00:02:28,765 --> 00:02:32,165 I know the technology has really evolved over the, um, 58 00:02:32,665 --> 00:02:36,245 the past few years, especially to get to a place 59 00:02:36,245 --> 00:02:37,565 where it's very sophisticated 60 00:02:37,625 --> 00:02:40,165 and I hear it, you know, it can definitely be more precise 61 00:02:40,165 --> 00:02:42,845 even than it was, you know, five, 10 years ago. 62 00:02:43,155 --> 00:02:44,965 From your perspective, having all that data 63 00:02:44,965 --> 00:02:47,805 and information, how does it change the way you think about 64 00:02:48,125 --> 00:02:49,645 patients and, and, um, the level 65 00:02:49,645 --> 00:02:50,765 of care you're able to provide? 66 00:02:52,155 --> 00:02:55,405 - Well, I think, I think what I like about it is that, 67 00:02:55,465 --> 00:02:57,405 you know, when we do a knee replacement 68 00:02:58,465 --> 00:03:00,685 and, you know, he is trying to get a good, 69 00:03:00,685 --> 00:03:04,005 well-balanced knee, um, that's essentially centered 70 00:03:04,005 --> 00:03:05,645 underneath the hip and above the ankle. 71 00:03:05,825 --> 00:03:09,005 And I think that we have really good accurate, uh, 72 00:03:09,005 --> 00:03:11,285 alignment rods and tension devices to achieve that. 73 00:03:11,305 --> 00:03:14,245 But I think what the robotic surgery does is it really helps 74 00:03:14,315 --> 00:03:18,845 with the, um, equating that, I guess, 75 00:03:19,235 --> 00:03:20,405 idea of feel factor 76 00:03:20,545 --> 00:03:24,565 and tension devices to essentially numerical data 77 00:03:24,675 --> 00:03:27,045 that then you can kind of translate into not only 78 00:03:27,045 --> 00:03:29,365 what you're feeling but what you're seeing on the computer 79 00:03:29,365 --> 00:03:32,005 screen in real time, that then you can position 80 00:03:32,585 --> 00:03:33,605 the femoral component 81 00:03:33,945 --> 00:03:38,005 and the tibial component to kind of match 82 00:03:38,315 --> 00:03:42,325 that patient's, um, soft tissue laxity 83 00:03:42,425 --> 00:03:46,725 or their knee, uh, motion, um, by not having 84 00:03:46,865 --> 00:03:49,925 to potentially take more bone 85 00:03:50,145 --> 00:03:53,805 or, um, release more tissue or and accommodate for that 86 00:03:53,805 --> 00:03:56,565 before, even before you starting the surgery. 87 00:03:58,905 --> 00:04:00,595 - Well, that's fascinating to hear and, 88 00:04:00,615 --> 00:04:04,115 and really seems like a cool, um, technology to have, 89 00:04:04,425 --> 00:04:07,475 have patients, uh, really appreciated having their, 90 00:04:07,475 --> 00:04:09,195 their robot as part of the surgery? 91 00:04:09,375 --> 00:04:11,355 Or is that something, you know, um, 92 00:04:11,355 --> 00:04:12,995 that some are a little bit nervous about? 93 00:04:14,195 --> 00:04:16,115 - I think, I think a lot of them like it 94 00:04:16,145 --> 00:04:19,595 because they, I think they just feel that it kind 95 00:04:19,595 --> 00:04:20,595 of gives you more data 96 00:04:20,775 --> 00:04:23,475 and I think they, you know, um, 97 00:04:23,805 --> 00:04:26,315 maybe trust the surgery just a little bit more. 98 00:04:26,675 --> 00:04:29,035 I mean, I, I I will say that, you know, 99 00:04:29,035 --> 00:04:32,155 when we we're doing surgery on patients, a lot of it, a lot 100 00:04:32,155 --> 00:04:36,755 of what we do is from the confidence of, 101 00:04:36,775 --> 00:04:38,155 of the patient with the surgeon 102 00:04:38,255 --> 00:04:39,955 and that they have a more confidence, 103 00:04:40,435 --> 00:04:42,115 I feel like they're gonna do better 104 00:04:42,175 --> 00:04:44,115 and then they're not questioning as much. 105 00:04:44,175 --> 00:04:46,675 So I think if they, they feel like, and I do, 106 00:04:46,675 --> 00:04:47,795 and I do feel the, 107 00:04:47,855 --> 00:04:50,275 the robotic surgery does give you more information 108 00:04:50,275 --> 00:04:53,155 to be able to make better decisions about, like I said, 109 00:04:53,155 --> 00:04:54,435 with the balancing of the knee. 110 00:04:54,435 --> 00:04:56,795 And I think that if you kind of explain it, explain 111 00:04:56,795 --> 00:04:59,635 to the patient that way, they, they feel more comfortable, 112 00:04:59,635 --> 00:05:01,835 comfortable about, um, their outcomes. 113 00:05:03,295 --> 00:05:04,745 - That makes a lot of sense, you know, 114 00:05:04,845 --> 00:05:07,985 and really it seems like it would be, um, a valuable tool 115 00:05:08,085 --> 00:05:10,625 to have, as you mentioned in the operating room. 116 00:05:11,045 --> 00:05:14,745 Um, from your perspective too, is it now, you know, 117 00:05:14,975 --> 00:05:17,945 most surgeons are learning about the technology 118 00:05:17,945 --> 00:05:18,945 and learning about robotics 119 00:05:18,945 --> 00:05:20,025 when they're going through training. 120 00:05:20,565 --> 00:05:23,985 Um, how does that really affect new surgeons coming up now, 121 00:05:24,125 --> 00:05:25,665 um, and really being able 122 00:05:25,665 --> 00:05:28,585 to use the technology appropriately and, 123 00:05:28,605 --> 00:05:31,105 and, um, be able to include 124 00:05:31,105 --> 00:05:33,065 that within the care that they're delivering? 125 00:05:33,085 --> 00:05:35,905 Do you see this as eventually becoming a standard of care 126 00:05:36,045 --> 00:05:38,385 or how do you see robotics, um, moving forward? 127 00:05:39,735 --> 00:05:41,305 - That, that's a, a great, 128 00:05:41,405 --> 00:05:44,465 and I would say tricky question, uh, to 129 00:05:45,125 --> 00:05:48,545 answer in the sense that that, you know, the, 130 00:05:48,565 --> 00:05:50,825 the robotic surgery doesn't really do the surgery. 131 00:05:51,025 --> 00:05:53,265 I mean, you have to know how to balance a knee 132 00:05:53,265 --> 00:05:57,125 because, you know, I, I think that with the, the training 133 00:05:57,675 --> 00:06:01,765 that we do through courses, um, through, um, 134 00:06:01,785 --> 00:06:03,365 if you're already out in practice and, 135 00:06:03,465 --> 00:06:05,925 and you, you do it, I would encourage a, you know, 136 00:06:05,925 --> 00:06:09,965 to either, um, definitely, uh, work with a, a lab 137 00:06:09,965 --> 00:06:11,485 where you can do it on cadaver 138 00:06:11,785 --> 00:06:15,365 and if you have the opportunity to scrub with a, a surgeon 139 00:06:15,365 --> 00:06:17,365 that's experienced to definitely do that 140 00:06:17,365 --> 00:06:21,045 because what you'll probably find is, is based off 141 00:06:21,045 --> 00:06:23,165 of your exposure and your experience. 142 00:06:23,405 --> 00:06:25,805 'cause you know, I've, I've been doing 'em for five years 143 00:06:25,865 --> 00:06:29,045 and I've done probably, I've done over a thousand of them 144 00:06:29,505 --> 00:06:31,765 and every knee's a little bit different. 145 00:06:31,905 --> 00:06:34,365 But what I think, what's what I have found is, is that 146 00:06:34,365 --> 00:06:35,365 with the robotic surgery, 147 00:06:35,955 --> 00:06:39,405 what I have found is very consistent with it, I find is, is 148 00:06:39,405 --> 00:06:43,005 that the numbers that I'm seeing in the operating room 149 00:06:44,055 --> 00:06:46,675 are probably particular to me in 150 00:06:46,675 --> 00:06:48,035 what I do in the operating room. 151 00:06:48,175 --> 00:06:51,515 And I think if another surgeon was doing the same robotic 152 00:06:51,575 --> 00:06:53,075 system, they looked at those numbers, 153 00:06:53,265 --> 00:06:56,275 they may not quite be the same based off of 154 00:06:56,345 --> 00:06:59,675 what their exposure is and how they like their knee. 155 00:06:59,785 --> 00:07:01,635 Some docs like their knee a little bit tighter 156 00:07:01,735 --> 00:07:04,275 or some like a little bit looser based off of 157 00:07:04,445 --> 00:07:05,715 where their starting point is. 158 00:07:06,175 --> 00:07:07,635 Um, so, so I do find there's 159 00:07:07,635 --> 00:07:08,755 definitely a learning curve from there. 160 00:07:08,935 --> 00:07:11,875 And so it is definitely something to where 161 00:07:12,475 --> 00:07:16,275 I think in the orthopedic training, you definitely gotta 162 00:07:16,785 --> 00:07:19,115 have a lot of experience, you know, with the surgeon 163 00:07:19,175 --> 00:07:21,635 who doesn't do the robot to understand how 164 00:07:21,635 --> 00:07:24,195 to balance the knee because there'll be some nuances 165 00:07:24,195 --> 00:07:27,395 that even when you do the robotic surgery, you'll get 166 00:07:27,395 --> 00:07:28,715 to the end and you'll still have 167 00:07:28,715 --> 00:07:30,835 to do some little tweaking with the balancing. 168 00:07:30,955 --> 00:07:33,435 I, I find though, with the robotic surgery, 169 00:07:34,135 --> 00:07:35,515 I'm finding I'm doing that less 170 00:07:35,615 --> 00:07:37,275 and less with the robotic surgery. 171 00:07:37,295 --> 00:07:39,795 So when I get to the end and I'm trialing it, I'm not having 172 00:07:39,815 --> 00:07:42,515 to do, um, recutting it 173 00:07:42,655 --> 00:07:45,475 or doing soft tissue releases where sometimes 174 00:07:45,475 --> 00:07:48,035 with the manual you may have to do that. 175 00:07:48,295 --> 00:07:50,355 And, and also what's neat about the robotic surgery, 176 00:07:50,575 --> 00:07:53,315 if if you feel like you can't, you're not gonna be able 177 00:07:53,315 --> 00:07:54,715 to accommodate it with a soft tissue release 178 00:07:54,715 --> 00:07:55,875 or you're not happy with something. 179 00:07:55,935 --> 00:07:58,395 What's neat about the robotic surgery is that if you have 180 00:07:58,395 --> 00:08:01,915 to go back and recut something, it's, it's, um, 181 00:08:02,825 --> 00:08:05,035 even more accurate of recutting than having 182 00:08:05,035 --> 00:08:08,795 to put the cutting black, cutting blocks back on the knee 183 00:08:08,895 --> 00:08:10,515 to, to refashion the cut. 184 00:08:11,015 --> 00:08:13,475 Um, so I think some, there's some advantages to the robot, 185 00:08:13,475 --> 00:08:15,155 but it, but it's not the end all be all. 186 00:08:15,235 --> 00:08:18,155 I mean, you, you have to understand kind of the mechanics 187 00:08:18,155 --> 00:08:22,035 of the way your knee, the way you like your knee replacement 188 00:08:22,215 --> 00:08:25,795 and how the numbers that you get on the robotic surgery 189 00:08:26,305 --> 00:08:27,555 translate to what you do. 190 00:08:29,885 --> 00:08:30,855 - That makes a lot - Of sense. That 191 00:08:30,935 --> 00:08:31,775 answered the question . 192 00:08:31,965 --> 00:08:33,695 - Yeah. Yeah, no, I appreciate that. 193 00:08:33,875 --> 00:08:36,335 Um, and I appreciate you getting into the nu nuances of it 194 00:08:36,335 --> 00:08:38,295 because certainly, you know, there's a lot 195 00:08:38,295 --> 00:08:41,175 to think about there and um, as you mentioned, being able 196 00:08:41,175 --> 00:08:43,015 to understand the procedure, um, 197 00:08:43,315 --> 00:08:45,095 in each surgeon's a little bit different in 198 00:08:45,095 --> 00:08:46,255 how they prefer things to go. 199 00:08:46,435 --> 00:08:48,855 So, um, that, that's really helpful information. 200 00:08:49,275 --> 00:08:52,095 Now broadening it out a little bit, when you look at, um, 201 00:08:52,415 --> 00:08:55,685 yourself and in, um, the orthopedics department at Novant, 202 00:08:55,745 --> 00:08:56,965 how are you thinking about growth 203 00:08:56,985 --> 00:08:59,045 and adding value to the organization overall? 204 00:08:59,635 --> 00:09:02,165 What do you really see as being areas where you're going 205 00:09:02,165 --> 00:09:04,365 to spend most of your time on over the next year or two? 206 00:09:05,405 --> 00:09:09,245 - I, I would say I, I think most of it is, is, is just 207 00:09:09,905 --> 00:09:13,085 taking care of taking, uh, good care of patients. 208 00:09:13,285 --> 00:09:17,725 I, I think that, um, you know, the, the, um, the thing 209 00:09:17,725 --> 00:09:19,925 with the robotic surgery, I think is, it's a, it's a, 210 00:09:19,955 --> 00:09:22,525 it's a really, um, neat technology 211 00:09:22,745 --> 00:09:25,045 and I think that as the, the word gets out 212 00:09:25,045 --> 00:09:27,325 and patients, you know, learn about it, you know, 213 00:09:27,325 --> 00:09:29,445 I think it is something that that helps, um, 214 00:09:29,835 --> 00:09:31,085 with, with the outcomes. 215 00:09:31,305 --> 00:09:34,725 And I think it's, it's neat to stay on top of the, 216 00:09:35,065 --> 00:09:36,085 the technology 217 00:09:36,385 --> 00:09:40,125 but also to explain to patients too that in hip 218 00:09:40,125 --> 00:09:42,285 and knee replacements we've got such good technology, 219 00:09:42,915 --> 00:09:45,965 it's hard to say what the, the newest stuff 220 00:09:45,965 --> 00:09:47,325 that's coming out's gonna be the best for them 221 00:09:47,325 --> 00:09:51,765 because we need about 10 years of data to show that 222 00:09:51,765 --> 00:09:54,845 what we've been using is, is good and, 223 00:09:54,985 --> 00:09:56,885 and is better than what we're currently using now. 224 00:09:56,905 --> 00:10:00,045 And I think we're getting, we have enough data now to show 225 00:10:00,045 --> 00:10:03,045 that with the robotic surgery, it's definitely the same 226 00:10:03,665 --> 00:10:05,645 as the traditional way of doing it. 227 00:10:06,025 --> 00:10:07,285 And I think as we kind of move forward, 228 00:10:07,285 --> 00:10:09,965 we're probably gonna find that I think it's, you know, 229 00:10:10,015 --> 00:10:14,005 it'll be, um, if not equal, better in the sense 230 00:10:14,005 --> 00:10:16,285 of consistency, consistency for patients. 231 00:10:16,425 --> 00:10:19,805 So I think, I think that part's neat, neat for patients, 232 00:10:19,805 --> 00:10:21,085 you know, just trying to stay, staying up 233 00:10:21,085 --> 00:10:23,845 with the technology and you know, just kind of explaining 234 00:10:23,845 --> 00:10:25,605 to patients what's out there because they do get a lot 235 00:10:25,605 --> 00:10:27,325 of information off the internet. 236 00:10:27,325 --> 00:10:31,005 And part of our job that's frustrating is it is sometimes 237 00:10:31,285 --> 00:10:33,405 'cause of what comes out in the, in the internet is just to 238 00:10:34,115 --> 00:10:37,485 explain it to 'em in a, you know, in a, um, in a way 239 00:10:37,485 --> 00:10:39,445 that they understand that that's kind of best for them. 240 00:10:40,655 --> 00:10:42,175 - I can imagine that there, you know, 241 00:10:42,175 --> 00:10:43,655 sometimes it's misinformation 242 00:10:43,715 --> 00:10:46,535 and sometimes the marketing hyperbole that gets in there. 243 00:10:46,835 --> 00:10:49,415 Um, you know, and it can become tiring to, to continue 244 00:10:49,415 --> 00:10:50,655 to explain that to patients. 245 00:10:50,675 --> 00:10:53,135 But such an important lesson in, in part 246 00:10:53,135 --> 00:10:54,415 of your interactions with them. 247 00:10:54,955 --> 00:10:57,455 Um, you know, do you ever get patients coming in asking 248 00:10:57,455 --> 00:10:58,895 about robotics or really 249 00:10:58,895 --> 00:11:00,135 wanting that to be part of their care? 250 00:11:01,135 --> 00:11:02,945 - Yeah, I think they do because they, they, they, 251 00:11:03,015 --> 00:11:04,705 they're starting to hear about it more 252 00:11:05,165 --> 00:11:08,105 and they just kind of wanna know, um, what's out there 253 00:11:08,105 --> 00:11:09,825 as far as the tech technology goes. 254 00:11:09,965 --> 00:11:13,025 And I think part of that is a little bit word of mouth. 255 00:11:13,025 --> 00:11:16,305 Sometimes it's even, um, you know, um, 256 00:11:17,175 --> 00:11:20,145 with the patients, um, being referred for from their, um, 257 00:11:21,055 --> 00:11:25,785 doctors and um, you know, kind of just wanting to know kind 258 00:11:25,785 --> 00:11:27,625 of what's out there to give them the best possible 259 00:11:27,625 --> 00:11:28,665 outcome that they can get. 260 00:11:28,965 --> 00:11:30,785 And I think, I think that one 261 00:11:30,785 --> 00:11:34,025 of the neat things about working at, um, Novant is, 262 00:11:34,025 --> 00:11:38,865 is they kind of all, uh, um, you know, working as a team to, 263 00:11:38,885 --> 00:11:41,065 to try to make the best possible results 264 00:11:41,065 --> 00:11:42,105 they can for the patient. 265 00:11:42,405 --> 00:11:44,585 And you know, that kind of starts from the nurses, 266 00:11:44,725 --> 00:11:47,105 the physical therapists, the anesthesiologists, 267 00:11:47,105 --> 00:11:48,905 and you know, I think that gives us some really good 268 00:11:49,145 --> 00:11:52,105 outcomes to where, you know, we've, we've become, um, 269 00:11:52,425 --> 00:11:54,525 a partner with, uh, Carrum Health, 270 00:11:54,695 --> 00:11:57,525 which is like a digital health company that kind 271 00:11:57,525 --> 00:12:00,485 of looks at the top 10% of providers, you know, 272 00:12:00,485 --> 00:12:01,925 based off of their outcomes. 273 00:12:02,025 --> 00:12:03,765 And we've been lucky and, 274 00:12:03,945 --> 00:12:05,645 and fortunate to be able to partner with them. 275 00:12:05,945 --> 00:12:09,965 And so that's gathered more patients too, um, with, for, um, 276 00:12:09,985 --> 00:12:11,045 hip and knee placements. 277 00:12:13,905 --> 00:12:15,385 - Absolutely. That's great to hear. And you know, 278 00:12:15,605 --> 00:12:17,385 you also mentioned some of the misconceptions. 279 00:12:17,405 --> 00:12:19,145 Is there one common thing 280 00:12:19,145 --> 00:12:21,185 that people come in thinking that just isn't true? 281 00:12:22,615 --> 00:12:24,335 - I would say as far as a knee replacement goes, 282 00:12:24,365 --> 00:12:26,935 they come in thinking that the knee is gonna, you know, 283 00:12:26,995 --> 00:12:28,015 fix all their problems 284 00:12:28,015 --> 00:12:30,615 and once we put the knee in it is gonna feel like a normal 285 00:12:30,925 --> 00:12:33,455 knee and they'll never know it's a knee replacement. 286 00:12:33,595 --> 00:12:36,375 And what I try to explain to patients is regardless of 287 00:12:36,755 --> 00:12:39,135 how well aligned or how well balanced it is, 288 00:12:39,165 --> 00:12:41,575 they'll probably always know it's an artificial knee. 289 00:12:42,095 --> 00:12:44,375 'cause it just doesn't move like a normal knee, regardless 290 00:12:44,395 --> 00:12:45,655 of the implant that you use. 291 00:12:46,155 --> 00:12:49,615 Um, it's, you know, obviously usually better than the 292 00:12:49,615 --> 00:12:52,175 arthritic knee, um, where you can, you know, 293 00:12:52,395 --> 00:12:55,655 do activities on it, um, that, um, you know, 294 00:12:55,655 --> 00:12:57,455 that they can't do on their arthritic knee. 295 00:12:57,835 --> 00:13:00,295 Um, and so that's something they've gotta, uh, uh, try to, 296 00:13:00,495 --> 00:13:02,375 I try to, uh, explain to the patient 297 00:13:02,465 --> 00:13:04,695 where the hip replacement, a lot of patients, you know, 298 00:13:04,695 --> 00:13:06,575 they'll forget which hips replace 299 00:13:06,575 --> 00:13:07,855 and the rehab's not as hard 300 00:13:07,915 --> 00:13:10,215 and other than some maybe numbness over the incision, 301 00:13:10,485 --> 00:13:12,215 they'll may forget which hips replaced. 302 00:13:12,675 --> 00:13:14,695 But a knee, a knee, the complexity of it's just 303 00:13:14,695 --> 00:13:17,095 so much the way it moves, it's so hard to reproduce 304 00:13:17,095 --> 00:13:18,735 with a knee replacement that most patients will kind 305 00:13:18,735 --> 00:13:19,975 of know it's an artificial knee. 306 00:13:21,415 --> 00:13:23,315 - Got it. That, that's really interesting to hear and, 307 00:13:23,315 --> 00:13:24,875 and definitely, um, good to know. 308 00:13:25,535 --> 00:13:28,355 Now, is there any other technology that you use and, 309 00:13:28,375 --> 00:13:29,995 and really feel like is cutting edge 310 00:13:29,995 --> 00:13:33,275 or on the forefront of, of, uh, where orthopedics is headed? 311 00:13:34,515 --> 00:13:39,155 - I, I, I, I've, I've probably over 10 to 13 312 00:13:39,215 --> 00:13:42,715 or 14 years I've been using, um, um, uh, 313 00:13:43,145 --> 00:13:44,355 with some knee replacements. 314 00:13:44,705 --> 00:13:47,395 I've been using uns cemented knees or pre FITT knees. 315 00:13:47,655 --> 00:13:49,595 Um, I've had really good results with those. 316 00:13:49,935 --> 00:13:52,555 Um, and those are, you know, when we do a knee replacement, 317 00:13:52,595 --> 00:13:56,115 a lot of times we'll cement it to the, um, end of the femur 318 00:13:56,115 --> 00:13:57,555 and the, the tibia. 319 00:13:58,015 --> 00:13:59,475 Um, but I've been also, 320 00:13:59,495 --> 00:14:00,635 but I've been doing a lot of, um, 321 00:14:00,635 --> 00:14:03,235 what's called press fitt knees, where there's bone on growth 322 00:14:03,235 --> 00:14:04,555 so you don't have to use cement. 323 00:14:05,055 --> 00:14:09,195 Um, and I, I like that technology a a lot, um, and it, 324 00:14:09,195 --> 00:14:11,275 and it's been good to me 325 00:14:11,275 --> 00:14:13,035 and my patients, so I've continued to do those 326 00:14:13,055 --> 00:14:14,155 and been doing, um, more 327 00:14:14,155 --> 00:14:15,875 and more of those, uh, CrossFit needs. 328 00:14:17,165 --> 00:14:18,175 - Well, that's awesome to hear. 329 00:14:18,175 --> 00:14:19,215 Thank you for sharing that with us. 330 00:14:19,435 --> 00:14:20,655 Now, before we wrap up, 331 00:14:20,835 --> 00:14:23,455 I'm wondering are there any other areas where you see it 332 00:14:23,455 --> 00:14:25,015 as being really primed for growth 333 00:14:25,075 --> 00:14:27,055 and development in orthopedics going forward? 334 00:14:28,495 --> 00:14:31,625 - I, I think, I think that, um, you know, I, 335 00:14:31,745 --> 00:14:35,425 I think it's just, it's, it's something where, like I said, 336 00:14:35,575 --> 00:14:37,145 with the hip and knee replacements, 337 00:14:37,405 --> 00:14:39,825 our technology's really good currently where we think, 338 00:14:39,925 --> 00:14:42,865 you know, hopefully they're gonna last 20 to 30 years. 339 00:14:43,005 --> 00:14:46,185 So it's hard on new technology to come out to, 340 00:14:46,205 --> 00:14:47,665 to jump on that bandwagon. 341 00:14:47,665 --> 00:14:50,185 And I think that, you know, a lot of surgeons did 342 00:14:50,185 --> 00:14:50,945 with the metal and metal 343 00:14:51,005 --> 00:14:52,485 technology with the hip replacements. 344 00:14:52,685 --> 00:14:53,805 'cause in the lab, you know, 345 00:14:53,805 --> 00:14:55,045 it looked like it was gonna do well 346 00:14:55,065 --> 00:14:57,405 and then there are patients that didn't do well with those. 347 00:14:58,025 --> 00:15:00,405 Um, so I think that, you know, it's being careful 348 00:15:00,665 --> 00:15:03,365 but also kind of looking at, um, 349 00:15:03,865 --> 00:15:05,005 the outcomes of the patients. 350 00:15:05,005 --> 00:15:07,205 And I, I think that, you know, kind of back 351 00:15:07,205 --> 00:15:08,885 to the question you just asked me, the other, 352 00:15:08,885 --> 00:15:11,205 the other thing I'd find, not necessarily technology, 353 00:15:11,905 --> 00:15:15,645 but um, it's more, uh, too of what are the 354 00:15:15,645 --> 00:15:17,725 outside modalities that we can utilize 355 00:15:17,905 --> 00:15:20,125 to help the patient have a better outcome 356 00:15:20,435 --> 00:15:22,445 with their physical therapy and activity level. 357 00:15:22,825 --> 00:15:24,765 And so I think that's kind of a team approach 358 00:15:24,905 --> 00:15:29,405 and doing things like, um, you know, peripheral nerve blocks 359 00:15:29,425 --> 00:15:32,685 and regional anesthesia, um, different types of, um, 360 00:15:33,465 --> 00:15:36,845 you know, uh, medications that we use, um, interop 361 00:15:37,345 --> 00:15:39,565 and post-op to help the patient be able to kind 362 00:15:39,565 --> 00:15:42,525 of do their physical therapy a little bit easier, um, 363 00:15:42,735 --> 00:15:44,085 which can improve their outcomes. 364 00:15:44,995 --> 00:15:46,085 - Fantastic. Well, Dr. 365 00:15:46,085 --> 00:15:48,605 Homesley, thank you so much for joining our podcast today. 366 00:15:48,605 --> 00:15:50,725 This has been really a fun and interesting conversation 367 00:15:50,745 --> 00:15:52,605 and I look forward to connecting with you again soon. 368 00:15:53,155 --> 00:15:54,485 - Sure. 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