The Joint Replacement Podcast

Maxwell Courtney, MD joins Episode 46 of The Joint Replacement Podcast for a wide-ranging conversation about arthroplasty, research, health policy, and one of the biggest challenges currently facing joint replacement surgeons.Dr. Courtney is Division Chief of Adult Reconstruction at Rothman Orthopaedics, an accomplished joint replacement surgeon and researcher, and Chair of the AAHKS Advocacy Committee. He was also my chief resident during my orthopedic training at Penn and someone I have looked up to throughout my career.We discuss Max’s path into adult reconstruction, building a successful surgical practice, mentorship, research, evidence-based medicine, and how joint replacement has transformed over the past decade through TXA, multimodal pain management, rapid recovery protocols, and outpatient surgery.Then we turn to the proposed Medicare reimbursement cuts facing total hip and knee replacement. Max explains how CMS and the AMA RUC value physician work, why increasingly efficient outpatient care has triggered another review of arthroplasty codes, and why much of the postoperative work performed by modern orthopedic teams may not be captured in the current reimbursement system.We also discuss Max’s recent trip to Washington, DC, his conversations with members of Congress, the AAHKS strategy to push back against the cuts, the potential consequences for Medicare access and private practice, and his prediction for what may happen when the final 2027 Medicare Physician Fee Schedule is released.This is an important conversation about not only what surgeons are paid, but how reimbursement policy may shape patient access, physician independence, and the future of joint replacement in the United States.

Dr. Jesse Otero, MD, PhD joins The Joint Replacement Podcast for a deep conversation about complex joint replacement, periprosthetic joint infection, research, and building a career around the patients other surgeons often find most challenging.Jesse shares the unconventional strategy he used to build a busy practice early in his career, including calling local surgeons and offering to take the revision, infection, and complex cases they did not want to manage. His first 17 cases were infected revisions, helping establish a career focused on being the surgeon other surgeons call when a case becomes difficult.He also tells the deeply personal story of his grandfather’s knee replacement complication and subsequent infection, an experience that helped redirect his career toward solving the devastating problem of PJI.We then discuss how the OrthoCarolina PJI program developed a registry containing approximately 5,500 patients, how a busy private practice can still produce high-level clinical research, and why standardizing care can transform everyday clinical practice into a research engine.Finally, Jesse breaks down their prospective randomized multicenter trial of one-stage versus two-stage exchange for chronic periprosthetic joint infection headed by his colleague Thomas K. Fehring, MD. Among 232 randomized patients, infection-free success at two years was 97% after one-stage exchange versus 91% after two-stage exchange, with the trial demonstrating noninferiority of the one-stage strategy when performed using their rigorous protocol.A fascinating discussion about surgical complexity, research, complications, resilience, and what may be the next major evolution in treating infected hip and knee replacements.

Disclosure: Dr. Matthew Sloan serves as a paid physician consultant and key opinion leader for ZetrOZ Systems, manufacturer of SAM ultrasound technology.Can sound waves actually help treat arthritis?Dr. Matthew Sloan is joined by George Lewis, PhD, CEO of ZetrOZ Systems, to discuss Sustained Acoustic Medicine (SAM) and the evolving role of therapeutic ultrasound in treating knee arthritis and musculoskeletal pain.They break down how therapeutic ultrasound differs from the ultrasound used for medical imaging, what ultrasound may be doing at the tissue level, and why delivering treatment for several hours at home is fundamentally different from the short ultrasound sessions traditionally used in physical therapy.The conversation explores who may benefit most from SAM, including patients with mild to moderate osteoarthritis, whether it has a role in bone-on-bone arthritis, and an important distinction between preserving a joint and actually regrowing cartilage.They also compare ultrasound with cortisone injections, hyaluronic acid, PRP, TENS, laser, red light, and other nonsurgical treatments; discuss its use in professional athletics; review cost and insurance coverage; and address potential risks and contraindications.Finally, Dr. Lewis shares the story behind developing a wearable therapeutic ultrasound device and his vision for where nonsurgical arthritis treatment may be headed.If you have knee arthritis and are looking for options beyond medications, injections, or surgery, this episode provides a detailed look at one of the technologies trying to fill that gap.#wearableultrasound #medtech #innovation #ultrasoundtech #kneeoa #arthritispain #painrelief

What happens when orthopedic trauma and joint replacement intersect?Dr. Matthew Sloan is joined by Dr. Alon Antebi, a fellowship-trained orthopedic trauma surgeon whose practice spans complex fractures, pelvic and acetabular trauma, primary and revision joint replacement, and outpatient surgery.Dr. Antebi discusses how surgeons decide whether to fix a hip fracture or replace the joint, when a partial versus total hip replacement may be appropriate, and why acetabular fractures present an entirely different reconstructive challenge.They also explore Dr. Antebi’s nearly two decades of experience with the direct anterior approach, his early adoption of outpatient hip and knee replacement, bilateral joint replacement, and how he selects patients for same-day surgery.The conversation goes deeper into some of the most challenging cases in orthopedics: converting previous fracture surgery to a hip replacement, dealing with retained hardware and altered anatomy, and treating patients with post-traumatic arthritis after major injuries.Finally, Dr. Antebi and Dr. Sloan discuss how joint replacement has changed over the past 20 years, the financial pressures facing orthopedic surgeons and private practices, and why patients who have been told their hip or knee is “too complicated” may benefit from seeking another opinion from a surgeon experienced in complex reconstruction.A wide-ranging conversation about trauma, joint replacement, outpatient surgery, and the evolution of modern orthopedic care.

What does a surgical technologist actually do during surgery, and how much does the team behind the surgeon affect what happens in the operating room?In this episode of The Joint Replacement Podcast, Dr. Matthew Sloan sits down with Alyssa Ellis, CST, CSFA, creator of Beyond Assisting, for a behind-the-scenes look at life in the OR.With more than 17 years of operating room experience, Alyssa explains the difference between a surgical tech and surgical first assistant, how the sterile field is created and protected, how great techs anticipate a surgeon's next move, and what separates an average surgical team from a truly high functioning one.They also tackle one of the biggest challenges facing operating rooms today: staffing. Alyssa discusses traveling surgical techs, staff turnover, training, compensation, appreciation, OR culture, and why experienced team members cannot simply be replaced without losing something important.Then the conversation turns to orthopedics: What are total hip and knee replacements like to scrub? Are revisions more fun than primary joint replacements? What makes a surgeon good to work with? What happens when something goes wrong during surgery? And if Alyssa could scrub only one operation for the rest of her career, which would she choose?Plus, the important questions: Who controls the OR music? Which specialty has the most fun? What drives surgical techs crazy? And what is the grossest operation to scrub?A fascinating look at the people patients may never remember meeting, but who play an essential role in keeping them safe during surgery.