Dr. Wang explained one variation in hip replacement surgery is the surgical approach, which means where the incision is made. Traditional hip replacement incisions are placed towards the back of the hip and we call that a posterior approach. In an effort to lessen muscle cutting and soft tissue damage, some other incisions are used. These include the mini-posterior, lateral, and anterior incisions. If the surgeon is able to minimize the incision, the patient should recover faster and have less discomfort.

Dr. Wang added that no matter what kind of incision, the best results of hip replacement come from proper positioning of the implants, and various approaches can achieve that. A big question among surgeons is how to properly position the hip replacement. To try to place the implants more accurately, surgeons are using some newer technologies, including computer navigation, robotic assistance, and live imaging during surgery. These methods could lessen the risks of dislocation or leg length differences, and increase patient satisfaction with their hip replacements.

This article appeared in the print edition on February 7, 2021.

HSS believes the best orthopedic care begins with the proper diagnosis and a comprehensive treatment plan delivered by top medical talent every step of the way. The goal is to continue to provide unmatched, personalized care to improve mobility and restore quality of life for its patients. 

Read the full article at Questmag.com. This article also appeared in the February 2021 print issue.

Additional coverage: Beckersspine.com.

When asked what attracted him to his new role at HSS Florida, Dr. Roche noted, “With the timing of COVID, the fact that we were evolving into a more ambulatory approach for a lot of cases, and with HSS developing a center in Florida, all the pieces aligned. HSS was looking for someone to run its joint program and grow its presence in Florida. I felt it was the perfect time in my career to take this opportunity.”

Dr. Roche explained there is a lot of momentum that will continue to drive outpatient care, particularly if surgeons can continue to show the outcomes are just as good. Surgeons are also being driven by patients, as they are requesting the best technology for the best outcomes, including everything from sensor-assisted surgery to robots. “It's going to be exciting over the next couple of years integrating robots, not only into hospitals, but into ASCs [ambulatory surgery centers],” he said. Dr. Roche continued to say remote patient monitoring with wearable sensors and other communication links are the future. “As patients are going home the same day it's still our role to ensure their recovery goes as seamlessly and as safe as possible. I think you're going to see the use of wearables and different telehealth integration to keep an eye on patients to make sure they're not having any complications along the way.”

“’Robotics’ resonates with patients as the most advanced technology available. I think the next stage, what I would call digital orthopedic healthcare, is going to center on improved real-time connectivity with our patients,” cited Dr. Roche. “The next extension of intraoperative sensors and wearables will be implanting sensors within the implant or joint when you do the surgery. I believe the next evolution of care over the next three to five years is delivering intelligence through data. In five years, I think every instrument we use to perform surgery and every implant we use will be smart — they will be data-producing devices."

Read the full article at Beckersspine.com.

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Dr. Wang explainedd advancements in surgical technique, anesthesia, and pain management have led to a significant decrease in the length of stay post-surgery over the past decade. Outpatient joint replacement, or same-day hip and knee replacement enables patients to go home on the same day of their procedure. The potential benefits of outpatient surgery include decreased medical costs, lower risk of infection, quicker return to normal activities and higher patient satisfaction, he noted. Candidates for outpatient joint replacement are reasonably healthy, have active, independent lifestyles and a good support system at home to help them ease into daily activities, counseled Dr. Wang. 

Additionally, outpatient joint replacement begins before the surgery itself, with a great focus on patient education, expectations and making sure the home is ready for the recovery period, he continued. The day of the surgery will sometimes include a physical therapy session to make sure the patient is ready to leave the hospital. Once the patient is home, home health services will provide continued nursing care and physical therapy, as needed. Patients are usually walking the day of surgery and return to most normal activities within a few weeks, added Dr. Wang.

This feature appeared in the print edition on December 20, 2020.

The main reason for fasting before certain procedures is to protect your lungs from potential damage, explained Dr. Wang. “Normally, your body is able to prevent your stomach contents from entering your lungs,” he said. “When under anesthesia, your body is less effective at preventing that. When food, liquids, or stomach acid enter the lungs, doctors call it ‘aspiration.’ This is rare, but it can be very dangerous and lead to a serious infection and lung damage.”

Any procedure that requires anesthesia, including local anesthesia (e.g., wisdom teeth removal) and general anesthesia (for something like a knee replacement) this requires fasting. There are often pre-surgery tests which may also require fasting, cited Dr. Wang. Your doctor will advise you about all procedures and tests that require a certain window of avoiding food and most drinks. Beyond that, “it is best to just follow a balanced, nutritious diet prior to surgery and follow fasting instructions.”

If you’re told to fast, you shouldn’t eat solid foods during that window of time. But because water and clear liquids are quickly absorbed by the stomach in a relatively short amount of time, patients are often allowed to drink clear liquids up to two hours before surgery. “The line’s drawn when you cannot see through the liquid,” he said. “Milk products have protein in them and that increases the time that the liquid spends in your stomach. The goal is to have an empty stomach immediately before surgery,” said Dr. Wang.

Dr. Wang advised if you do break your fast before a surgery, let your surgeon and anesthesiologist know as soon as possible. “These fasting guidelines were designed with patient safety in mind,” he said. “Violation of the recommended fasting windows add risk of stomach contents entering the lung when a patient undergoes anesthesia. When these fasting guidelines are not followed, the anesthesiologist will compare the risks and benefits of proceeding, with consideration given to the amount and type of liquids or solids ingested.”

Dr. Wang shared most patients undergoing elective orthopedic surgery are able to tolerate light meals right after surgery. “When the anesthesia type is regional anesthesia or sedation, patients often resume eating and drinking normally in the recovery room.”

Read the full article at TheHealthy.com.

Dr. Wang noted that people start “prehab” and do exercises to prepare for knee replacement surgery. These exercises strengthen the muscles around the knee, so recovery is easier, he explained. The procedure itself takes about an hour. “It’s not a longer surgery anymore,” said Dr. Wang, as surgical techniques have improved over the years so there’s less disruption to the muscles and tendons. Advances in anesthesia and pain control make recovering from knee replacement surgery easier as well.

In four to six weeks a lot of the range of motion starts to come back. Most people return to driving after knee replacement surgery and managing their daily routines and errands in one to two months, cited Dr. Wang. People also want to know how long a knee replacement usually lasts. “It’s like asking how long a car lasts — you have to look at probabilities,” said Dr. Wang, who tells his patients it’s likely their implants will last 20 to 30 years. However like any mechanical device, your knee replacement will wear out sooner if you put more stress on it (e.g., running and high-impact activities). “I don’t necessarily mind patients trying to get back to what they loved,” noted Dr. Wang.

Read the full article at Today.com.

HSS is eager to bring its medical services to the growing, aging and affluent Florida community. Last year, 3,000 Florida residents traveled for care to HSS in New York. "We want to deliver care closer to where people live and work,” said Mr. Shapiro. HSS also hopes to be a destination center for all sports medicine needs in the Southeast U.S., including professional athletes as well as teenage athletes, cited Justin Oppenheimer, senior vice president and chief strategy officer at HSS.

David W. Altchek, MD, sports medicine surgeon at HSS, will serve as the Medical Director of HSS Florida. Joining him is HSS orthopedic trauma surgeon, Nicholas Sama, MD, as associate medical director for inpatient services; sports medicine surgeon Ryan W. Simovitch, MD, as associate medical director for ambulatory services; hand an upper extremity surgeon, Michelle G. Carlson, MD; sports medicine surgeon, James B. Carr II, MD; physiatrist Kathleen L. Davenport, MD; and hip and knee surgeon, John L. Wang, MD.

Read the article at Palmbeachpost.com. This article also appeared in the February 2 print edition. 

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