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Hi, everyone. I'm Brian Zimmerman with Becker Healthcare

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care. Thank you for tuning into the Becker

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healthcare care podcast series.

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Today, I'm pleased to be joined by doctor

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Jesse Ot,

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Orthopedic surgeon with Ortho Carolina.

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Doctor Ot. Thank you so much for being

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on the podcast today.

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Thank you for having me It's a pleasure.

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Yeah. Let let's get into it. And to

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to get us going here, doctor Ot toro,

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could you just begin by sharing a bit

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more about yourself, your professional background role in

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Ortho Carolina.

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You bet. Thank you. That's a that's an

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awesome question to get started.

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My name is Jesse Ot t. I am

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a hip knee replacement specialist.

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We typically focus on patients with end stage

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joint disease, and

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who

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have failed conservative treatment. These become our candidates

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for joint replacement.

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Typically, the patient that we treat has osteoarthritis,

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which

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occurs just basically based on wear and tear

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that joint throughout life, our typical patient population

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is between the age of 65 and 75.

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There are are cases

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in which the joint will fail prematurely.

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And so we'll end up having to replace

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the joint in a younger patient. This occurs

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in the setting of previous injury or a

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con def

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or even infection. And so this is

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probably accounting for about 90 at 99 percent

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of our patient population. And

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I practice out of Ot Carolina. It's a

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private practice in Charlotte.

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North Carolina.

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We have

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all sub specialties

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accounted for within our company and

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I have a unique opportunity to work at

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a center that focuses on primarily joint replacement.

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And so 1 of the unique things about

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my practice is We have a group of

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8 surgeons who all our fellowship trained in

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joint replacement.

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We do surgery.

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We teach, and we also are on the

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cutting edge of research. And so we stay

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involved

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in all aspects of of joint replacements

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from

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from clinical all the way to development

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thank you again, doctor Ot for being on

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the podcast, and I think that that background

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would be really useful,

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context for our listeners as we move through

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the conversation today. So

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the the next question I wanna put to

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you is sort of thinking about how joint

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replacements are increasingly

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migrating today As as we're all well aware

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of.

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I'm curious as this transition has been been

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going about, what challenges that might have presented

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to you as you perform procedures.

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Particularly hip pla.

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How are you addressing those challenges? And and

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maybe what role does technology play and in

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helping you navigate these these this increase this

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influx of procedures.

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What a wonderful question.

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There's been a fringe of surgeons over the

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past... 20 years who have realized the benefits

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of

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outpatient joint replacement.

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A lot of us,

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who who grew up in academic centers.

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Were pretty skeptical about outpatient joint replacement.

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We were late adopters

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a couple of things have happened with time.

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1 is, we've done a lot of research

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looking at patient optimization and how this affects

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outcomes. Post operative. And 1 of the thing

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that has...

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At its come to the forefront is that

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outpatient joint replacement can be done safely if

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performed in a patient who's optimized from a

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medical standpoint. And so that's 1 thing.

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So we started to accept this as a

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standard of care. The other thing that occurred

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is during Covid,

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the whole nation was in a crisis that

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And this is a crisis where hospitals were

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either unavailable because of treatment of Covid or

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patients were unwilling to have surgery in the

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hospital little. And so in order to address

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the demand of arthritis,

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we all basically

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it'll overnight

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became experts in outpatient joint replacement.

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Arthritis is a disabling

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problem

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and

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in order to meet the needs of our

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patients, we had

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basically to adopt an outpatient practice

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or else we weren't gonna be able to

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care for our patients. And so those 2

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things have really

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created a situation where out patient surgery is

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now becoming the standard of care.

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1 of the challenges without patient surgery is

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that the patient doesn't have

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a hospital

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as a backup plan. And so

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these patients must go home. And so we

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have to be very strict about our pre

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optimization criteria

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1. And then 2, we have to do

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surgery very efficiently

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so that we can get it done during

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business hours. 1 of the things about a

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hospital is that you have shift nurses

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who can

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help you finish your day if you end

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up running late, But at a surgery center,

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you know, the place closes... The place closes

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down, and you have to get your surgery

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done efficiently.

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Technology has been tremendously helpful for us.

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And

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we

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utilize technology in many aspects of hip replacement

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in particular. Some surgeons used in robotics.

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Some surgeons are using special imaging techniques,

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other surgeons are using.

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Something that we'll probably talk about a little

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bit later, and that's automated

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instruments to help with particularly challenging steps of

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the surgery to make it go more smoothly.

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Yeah. Let let let's get to that. Let's

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let's talk about those tools there. And, I

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we appreciate you. You also

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giving giving us your background of that experience

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of of Covid really pushing you all to

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figure this out. I am sure you're grateful.

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You're on the other side of that learning

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process. Am I am I correct? Doctor Art

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there?

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Absolutely. It's it's my preferred site of care

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now for my joint replacement patients. I've really

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become a believer,

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you know, I'm I'm a skeptic by nature.

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A scientist by background. And so I question

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data as it comes out,

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really had to see it for myself, and

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and and I will

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acknowledge that that I prefer to do surgery

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in the outpatient setting when it's safe.

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Yeah. And appreciate you going into some details

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about your evolution there as well.

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So let's get to those the those automated

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instruments now. Can you tell us about some

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of the advantages you've observed with automated infection,

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for example, especially as it related to

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just surgical practices, the experience for you and

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and for the patients as well.

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That's great. So total hit and total knee

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art pla

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are labor intensive surgeries.

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We've really crafted our science to the point

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that

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we can do it very efficiently, but that

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does not mean it's easy to do.

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Every surgery I sweat,

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every surgery

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take a light toll

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on my body as the day progresses.

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And so

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I take advantage of

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multiple different types of aids to help reduce

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the labor burden on my body.

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We have position that help hold the patient

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that frees my hands to focus on the

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surgical steps.

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We have retract that hold themselves in place

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and that reduces

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the work burden on my assistance.

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Automated impact has has been a game changer

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for me.

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Bone is a hard substance as you know,

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and the skeleton needs a lot of preparation

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in order to septic an implant, both on

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the ace tab side and on the fe

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side.

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The automated

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infection device

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for

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preparation of the femur has taken a tremendous

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burden off of my shoulders

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to get through the surgery.

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And, literally,

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you know, swinging a 3 pound mall is

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is taxing.

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There have been studies that have been done,

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and surgeons will swing that mall

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up to a hundred times per surgery. And

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so if you extrapolate that over over a

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day, that's 800

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times that you are raising the instrument and

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lowering it mostly with the use of your

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shoulder, and that takes a tremendous toll on

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on the Delt Toilet and on the rotator

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cuff. What the automated bro system does is

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it takes that work away from me and

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it automate it

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so that

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at the end of the day,

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I'm not fatigued.

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And that's the long and the short of

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it. So that's what it does for me,

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for my patient, what we've seen

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is that it's safer. The automated

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device delivers

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a measured

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calculated and precise

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force with each cycle.

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And so

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it's a very predictable tool. It

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becomes

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actually easier to use than

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manual instruments.

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And so you get a more predictable fit

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of the implant And and

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I don't know if this has been shown,

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but I think we will be able to

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show this soon.

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It will result in, less skeletal trauma. So

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fewer

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intra fractures

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if we look at this over time.

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And so patient surgery becomes safer.

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Yeah. It's very interesting. It it gonna be

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interesting to to to see how this continues

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to play out as more

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folks adopt this this tool. This device, which

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I believe it's the the Ham device. Right?

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Is what's called?

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That's right. Yep. That's right.

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Doctor Ot romero, I guess, then what would

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you say or what advice would you give

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to another surgeon who might be considering using

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the the hammer device or, you, like, has

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some he there. How do how do you

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see you you just alluded to there? It's

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it's potential in the future to

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to

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perhaps make surgery safer.

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How do you see this sort of playing

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out in the long run as

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more folks adopt this tool? That's great. Adoption

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of any new technology

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requires

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2 critical components. 1 is a need and

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2, all leap of faith.

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And so the need would arise if a

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surgeon feels their their shoulder becoming fatigued.

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As surgeons aged, this becomes more apparent.

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If you look at work related injuries,

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or occupational injuries and orthopedic surgeons,

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there's a high burden of rotator cuff injuries.

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And so as surgeons age,

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know, the decisions that they made and the

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practices that they've utilized throughout their careers

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start to take effect. What I would say,

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to that surgeon, I you know, who's later

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in their career is this will make surgery

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easier for you. And what I would say

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to a younger surgeon is

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this will help

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preserve your rotator cuff throughout your career. So

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you're not having to worry about

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trying to figure out a different way to

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do surgery later on in your career because

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the rotator cuff is disease.

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When you get started, what I would recommend

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is practicing in a Cad cadet first just

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to get the feel of the instrument. But

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the instrument comes extremely intuitive. After just a

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couple of uses,

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the surgeon will become familiar with the the

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hap and the feedback that it provides.

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It didn't take me very long to become

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comfortable that really 3 to 5 cases,

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and it became, my preference and in fact,

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if I don't have the device, I I

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will not do hip replacement now.

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Not.

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I appreciate you coming on once again to

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to talk about your experience with this device

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and sort of your evolution over the years

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as a as a orthopedic surgeon. And it

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it was truly a pleasure to to get

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to speak with you today. Is there anything

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we didn't cover today or final thoughts or

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something you might want to re emphasize for

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our listeners before I let you go?

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Yeah. 1 thing that we didn't cover is

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especially in anterior hip replacement, inter fe fracture,

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and fe side

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complications,

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are the worry, and there have been multiple

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studies that have shown slightly higher rates of,

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inter fe fractures

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or early post operative fractures

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when a surgeon will use the direct anterior

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approach. We think a lot of this is

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because of faulty technique truly.

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With automated bro

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systems, and the hammer is a great example.

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I think that when a surgeon gets through

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their learning curve, this will eliminate

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that risk in anterior surgery,

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and it will make it safer for patients.

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Well, doctor Ot,

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appreciate the closing thoughts and 1 final thank

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you again for for coming on the podcast

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today. It was a it a pleasure to

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speak with you.

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Yeah. Thank you very much. It was a

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pleasure as well.

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Thank you. I I'd I also wanna thank

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Z Bio for sponsoring this episode. You can

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tune into more podcast from Becker Healthcare care

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by visiting a podcast page. Have wonderful for

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rest of your day, everyone.