Dr. Karkare was interviewed by Catholic Health Services of Long Island, talking about hip & knee replacement surgery. Are you looking to increase your mobility, decrease the pain in your hips or knees and improve your quality of life? Well then, you may be a candidate for knee or hip replacement surgery. There are over a million of the replacement surgeries performed each year, right here in the United States.
Interview with Dr. Karkare:
Jane Hanson: Hello, everyone. Thanks so much for joining us. I’m Jane Hanson. The joint replacement program at St. Charles Hospital offers nationally ranked outstanding patient care. Their program stays in the leaning edge of total joint replacement procedures and is tailored to meet each individual’s specific needs. Joining me today from St. Charles Hospital’s orthopedic surgeon, Dr. Nakul Karkare. Welcome and thank you so much for being here. It’s a pleasure to have you.
Dr. Karkare: Thanks for having me.
Jane Hanson: We’re talking specifically about hip replacements with you. Are you seeing more and more of them necessary these days?
Dr. Karkare: Yes, we are. As the body ages, the hair, color changes. We get cataracts and guess what? The joint wears down.
Jane Hanson: We need new hips.
Dr. Karkare: A lot of those baby boomers are needing more and more hips and knees.
Jane Hanson: Is that because we’ve been a lot more active or is it because it’s genetic, or what is it?
Dr. Karkare: We call it multifactorial, which means, there are many reasons. For most patients, there is a genetic predisposition and that is the cause of arthritis and [inaudible 00:02:18] majority of patients.
Jane Hanson: How do you know when it’s bad enough that you need to have your hip replaced?
Dr. Karkare: That’s a great question. We keep it easy in orthopedics. I follow the three-strike rule. First and the most important strike is, the patient telling me that the pain interferes with their activities of daily living. They cannot do what they want to do on a daily basis because of the pain. That’s the first and the most important strike. The second strike is that the x-ray shows arthritis. The third strike is on clinical examination. I know that the pain is coming from that joint. Only if these three strikes come together, we discuss joint replacement surgery.
Jane Hanson: Now, you do a rather unusual and you’re known for the kind of hip replacement you do that is called the anterior approach which is different from the past.
Dr. Karkare: Traditionally, the hip replacement was done through a posterior approach which means the surgeon went from behind to access the hip joint. That involved cutting a lot of muscles. Because of that, the rehabilitation was a lot longer. The patient had to follow something called a hip dislocation precautions. Which means, that the ball can’t pop out of the socket. What that meant to the patient was that, they have to use a high toilet seat after the surgery for about 6-8 weeks. They should not be crossing their legs after the surgery again, for the same amount of time and they should be keeping their knees apart.
They should be sleeping with a pillow in between the knees to prevent the ball from popping out of the socket. There are other advantages too, of an anterior hip replacement. Because absolutely, no muscles are cut during the surgery at all. We go between the muscles and do the hip replacements, so the rehab is a lot faster. The literature has shown that patients get rid of their assistive devices like walker and a cane much sooner than the traditional approach.
Jane Hanson: You’ve got this little dude at here. This is actually what you put into somebody’s body.
Dr. Karkare: This is a real hip, yes. The hip is made of two components. One is the ball which goes on the upper side of the hip. This is something that goes inside the thigh bone. We put in the cup, we put in the stem and then, we put it all together.
Jane Hanson: It’s amazing. People can regain all their activities very quickly afterward, which is amazing.
Dr. Karkare: Absolutely. Hip replacement is one of the most satisfying surgeries in orthopedics.
Jane Hanson: It’s no wonder you like to do a hip surgery so much. The patients are always satisfied.
Dr. Karkare: Exactly. The experience after getting a hip replacement is a lot different than getting a knee replaced. I tell my patients, getting a hip replacement doesn’t speak to somebody who has a knee replaced. After the knee replacement, I tell my patients, you’re not going to be happy at a month. You see light at the end of the tunnel at 6 weeks. Then, you’re significantly better at three months. After hip replacement, the first time they put their foot on the floor, they realize the difference. They’re walking the same day of surgery with a walker. Then, they progress on to walking with a cane on the other side. Then, to no support at all. They’re significantly better within days.
Jane Hanson: You know, my brother had both of his hips replaced and he was told by his doctor that he would have to wait a significant period of time between the two surgeries. You actually now, and he was done three or four years ago. You now can actually do both hips at once.
Dr. Karkare: Absolutely. Now, we have to be very careful of who’s the right candidate to get both hips replaced. Surgically, it’s very easy to do them both at the same time. What we worry about is the medical aspect of things. If a patient has cardiac problems if there are severe lung problems. Then, we prefer to do one hip at a time or one joint at a time. Simply because we worry about how the heart and lung will react to getting both hips done. It’s a lot of surgery for the patient.
Jane Hanson: Yeah. It sounds like it. At St. Charles, you’ve got a really fine reputation for your orthopedic work. Did it take some time to develop that reputation and why do you think you guys get such a good wrap out there?
Dr. Karkare: It’s important to choose a hospital who had joint replacement surgeries are done in a large volume. Literature is clear. The larger the volume, better the outcomes. As an example, at St. Charles Hospital, we have a pre-operative class. In which, I encourage the patients to go there. They learn of what is involved in their hospital state. What is going to go on? What are they going to do when they go in. What is going to happen the day of surgery? We do a lot of discharge planning even before the patient goes to the hospital. Most hips go home. We evaluate if they have tears, so they know in their mind that if they have stairs, they should be able to go up and down stairs before they go home as an example.
Jane Hanson: Sure. Just thinking about simple things that could be a hassle afterward but if you prepare ahead of time, then, it eliminates the potential for something not so good happening or something.
Dr. Karkare: Absolutely.
Jane Hanson: That’s great. Well, congratulations on and all the great stuff you do.
Dr. Karkare: Thank you.