The newest episode of The Joint Replacement Podcast features an engaging discussion with Dr. Jeremy Gililland, Professor of Orthopaedic Surgery and Chief of Adult Reconstruction at the University of Utah. Before becoming one of the country’s leading hip and knee replacement surgeons, Dr. Gililland trained as a mechanical engineer—a background that continues to influence every aspect of how he approaches patient care, surgical planning, and innovation.
Our conversation explores how engineering principles intersect with modern orthopedic surgery, the future of robotic-assisted joint replacement, and the lessons patients should understand before choosing a surgeon.
From Mechanical Engineering to Orthopedic Surgery
Many orthopedic surgeons have an affinity for engineering, but Dr. Gililland actually began his professional journey as a mechanical engineer before attending medical school. That foundation gave him a unique perspective on biomechanics, implant design, and problem solving.
Engineering encourages understanding how individual components interact within an entire system. The human hip and knee are no different. Successful joint replacement requires restoring alignment, balancing soft tissues, recreating normal biomechanics, and selecting implants that function together over decades.
Rather than viewing surgery as a series of isolated technical steps, Dr. Gililland describes approaching every operation as a complex engineering problem where careful planning leads to reproducible outcomes.
Why Modern Joint Replacement Has Improved So Dramatically
Joint replacement has undergone tremendous evolution over the past two decades.
Today’s patients benefit from advances including:
- More durable bearing surfaces
- Improved implant fixation
- Better understanding of hip and knee biomechanics
- Enhanced perioperative pain management
- Earlier mobilization
- Robotic-assisted surgical planning
- Data-driven outcome analysis
These improvements have transformed recovery after both hip and knee replacement while continuing to improve long-term implant survivorship.
Robotics: A Tool, Not a Replacement for Surgical Judgment
One of the central themes of our discussion is robotics.
Patients frequently ask whether robotic surgery performs the operation independently. The answer is no.
Instead, robotic systems allow surgeons to:
- Build a patient-specific surgical plan
- Precisely prepare bone
- Improve implant positioning
- Better evaluate soft tissue balance
- Reproduce planned corrections consistently
Dr. Gililland emphasizes that robotics enhances the surgeon’s ability to execute a carefully developed plan—it does not replace experience, decision-making, or technical skill.
Technology is only as effective as the surgeon using it.
Engineering Better Implant Positioning
Accurate implant positioning influences numerous aspects of recovery and long-term success.
Proper positioning may improve:
- Joint stability
- Range of motion
- Wear characteristics
- Implant longevity
- Soft tissue balance
- Patient satisfaction
While no technology guarantees perfect outcomes, improved precision can reduce variability and help surgeons consistently reproduce optimal alignment.
Cemented vs. Cementless Joint Replacement
We also discuss one of today’s most common questions in arthroplasty:
Should implants be cemented or cementless?
The answer depends on multiple patient factors, including:
- Bone quality
- Age
- Activity level
- Anatomy
- Implant design
Modern cementless fixation has become increasingly popular because biologic bone ingrowth can provide durable long-term fixation in appropriately selected patients. However, cemented fixation continues to play an important role and remains an excellent option for many individuals.
Rather than one technique replacing another, today’s surgeons have more tools available to individualize treatment.
Managing Complex Revision Surgery
Not every joint replacement is straightforward.
Dr. Gililland routinely manages complex revision procedures involving:
- Failed previous replacements
- Infection
- Periprosthetic fractures
- Bone loss
- Implant loosening
- Instability
Revision surgery often requires substantially more planning than primary joint replacement.
Preoperative imaging, implant selection, reconstructive strategies, and contingency planning all become increasingly important when restoring complex anatomy.
The Future of Orthopedic Innovation
Innovation continues to accelerate throughout orthopedic surgery.
Emerging technologies include:
- Artificial intelligence
- Machine learning
- Advanced robotic systems
- Improved navigation
- Smart implant design
- Digital planning software
- Patient-specific instrumentation
- Predictive analytics
Rather than replacing surgeons, these technologies increasingly support better clinical decision-making and more individualized patient care.
Training the Next Generation
As Chief of Adult Reconstruction, Dr. Gililland spends significant time teaching residents and fellows.
Academic surgery requires balancing:
- Clinical excellence
- Education
- Research
- Innovation
- Mentorship
Training future orthopedic surgeons ultimately improves patient care for decades to come, making education one of the most impactful aspects of an academic career.
Advice for Patients Choosing a Surgeon
One of the most important messages from this episode is that patients should look beyond marketing or technology alone.
Instead, consider:
- Experience with your specific procedure
- Communication style
- Comfort answering questions
- Hospital resources
- Team approach to recovery
- Long-term follow-up
Robotics, surgical approach, and implant selection all matter—but the relationship between patient and surgeon remains one of the strongest predictors of a positive experience.
Final Thoughts
Dr. Jeremy Gililland brings a unique perspective to orthopedic surgery by combining engineering principles with years of clinical experience in adult reconstruction. Whether discussing robotics, revision surgery, implant selection, or resident education, his approach consistently emphasizes thoughtful planning, precision, and patient-centered care.
If you’re considering hip or knee replacement, work in orthopedic surgery, or simply enjoy learning how technology continues to reshape medicine, this is an episode you won’t want to miss.
Watch Episode 32 of The Joint Replacement Podcast on YouTube or search “The Joint Replacement Podcast” wherever you listen to podcasts.
References
- American Academy of Orthopaedic Surgeons. Total Hip Replacement. https://orthoinfo.aaos.org/en/treatment/total-hip-replacement/
- American Academy of Orthopaedic Surgeons. Total Knee Replacement. https://orthoinfo.aaos.org/en/treatment/total-knee-replacement/
- American Association of Hip and Knee Surgeons. Hip Replacement. https://hipkneeinfo.org/hip-care/hip-replacement/
- American Association of Hip and Knee Surgeons. Knee Replacement. https://hipkneeinfo.org/knee-care/knee-replacement/
- Evans JT, Walker RW, Evans JP, et al. How long does a hip replacement last? Lancet. 2019;393:647-654.
- Evans JT, Walker RW, Evans JP, et al. How long does a knee replacement last? Lancet. 2019;393:655-663.
- Abdel MP, et al. Current concepts in robotic-assisted total hip and knee arthroplasty. J Bone Joint Surg Am. 2023.
- American Joint Replacement Registry (AJRR). 2025 Annual Report. American Academy of Orthopaedic Surgeons.
- American Academy of Orthopaedic Surgeons. Clinical Practice Guideline: Surgical Management of Osteoarthritis of the Knee. Updated 2022.
- National Institute for Health and Care Excellence (NICE). Joint replacement (primary): hip, knee and shoulder. NICE Guideline NG157. 2020.
- Berry DJ, Lieberman JR, Azboy I, et al. Revision total hip and knee arthroplasty: current concepts. J Am Acad Orthop Surg. 2023.
- University of Utah Department of Orthopaedics. Adult Reconstruction Division and Fellowship Program. https://medicine.utah.edu/orthopaedics