Modern orthopedic care is no longer simply about deciding whether a patient does—or does not—need a joint replacement. Today, surgeons have an expanding spectrum of options that can include hip arthroscopy, osteotomy, cartilage restoration, partial knee replacement, total joint replacement, robotic technology, and increasingly sophisticated outpatient recovery pathways.
In Episode #38 of The Joint Replacement Podcast, I sit down with Atul Kamath, MD, for a wide-ranging discussion about that entire continuum of hip and knee care.
This episode also has a personal connection for me. Dr. Kamath was one of my attendings during my orthopedic residency at the University of Pennsylvania and one of the first surgeons to introduce me to the anterior approach to total hip replacement. It was fascinating to reconnect years later and discuss how much our field—and the technology surrounding it—has changed.
The Anterior Approach: How Hip Replacement Has Evolved
One of the major themes of our conversation is the evolution of the anterior approach to total hip replacement.
Dr. Kamath discusses how his technique has changed over his career, including improvements in surgical efficiency, soft-tissue handling, fluoroscopy, instrumentation, and technology. In his current practice, he describes performing the vast majority of his primary hip replacements on an outpatient basis, including more complex cases.
But an important message from our discussion is that the surgical approach itself is only one part of the equation.
Experience, surgical technique, implant positioning, soft-tissue management, patient selection, anesthesia, and the entire recovery pathway all contribute to the final result.
Rather than viewing one approach as universally superior, patients should understand why their surgeon uses a particular technique and how consistently that surgeon can execute it.
Technology Is Changing Joint Replacement
We also discuss the rapid expansion of technology in orthopedic surgery.
Over his career, Dr. Kamath has incorporated technologies ranging from intraoperative fluoroscopy and image-based planning to optical navigation, artificial intelligence-based tools, and robotic systems.
Knee replacement has undergone a similar transformation.
Robotic-assisted surgery can allow surgeons to execute a preoperative or intraoperative plan with a high degree of precision and potentially individualize implant positioning and alignment to the patient rather than relying exclusively on traditional standardized targets.
The literature increasingly supports improved accuracy with robotic-assisted knee replacement, although whether that precision consistently translates into superior long-term patient outcomes remains an important area of ongoing research. Recent randomized-trial meta-analyses have demonstrated fewer alignment outliers with robotic TKA, while differences in many patient-reported clinical outcomes remain smaller or inconsistent.
That distinction is important: technology is a tool, not a substitute for understanding anatomy, biomechanics, surgical technique, and how to manage unexpected findings during surgery.
Should Surgeons Still Learn Manual Joint Replacement?
As robotics becomes increasingly common, we discuss a question that will become even more important for the next generation of orthopedic surgeons: how much traditional manual surgery should surgeons still learn?
Dr. Kamath points out that younger trainees may now enter fellowship with extensive robotic experience. But understanding the fundamentals remains critical.
Technology can enhance the surgeon’s ability to plan and execute an operation, but the surgeon still needs to understand what the technology is trying to accomplish—and what to do when the plan needs to change.
The future of joint replacement is therefore unlikely to be surgeon versus robot. It is more likely to be experienced surgeons using increasingly sophisticated technology to make surgery more precise, reproducible, and individualized.
Joint Preservation: Not Every Young Patient Needs a Replacement
Perhaps the most interesting part of this episode is Dr. Kamath’s perspective as a surgeon who works across both joint preservation and joint replacement.
He describes hip disease as a continuum.
Chronologic age alone does not determine the correct operation. The condition of the cartilage, underlying anatomy, location of damage, activity level, functional limitations, and patient expectations can all influence treatment.
For example, a young patient with hip dysplasia and relatively preserved cartilage may be very different from another patient of similar age who already has diffuse, advanced arthritis.
In selected patients, a periacetabular osteotomy (PAO) can change the orientation of the acetabulum and improve the mechanics of a dysplastic hip while preserving the patient’s native joint.
Long-term research supports PAO as an important joint-preservation procedure in appropriately selected patients with hip dysplasia, while also showing that outcomes depend heavily on factors such as age and the amount of arthritis already present.
Hip Arthroscopy vs PAO vs Hip Replacement
This leads to one of the more difficult areas of modern hip surgery: determining whether a symptomatic patient should undergo hip arthroscopy, an osteotomy, or eventually a hip replacement.
Dr. Kamath emphasizes the importance of cartilage quality.
A highly active patient with preserved cartilage and a correctable structural problem may be a candidate for joint-preservation surgery even at an age when another patient might be treated very differently. Conversely, once arthritis becomes moderate, diffuse, and global, the potential benefit of preservation procedures becomes much less predictable.
This remains an evolving area of orthopedics. A recent systematic review comparing hip arthroscopy and PAO for borderline hip dysplasia found improvements following both procedures but concluded that the available evidence does not establish a single universally preferred treatment.
The correct procedure depends on identifying the actual source of the patient’s symptoms and matching treatment to the underlying anatomy.
Osteotomy or Partial Knee Replacement?
The same preservation-versus-replacement discussion applies to the knee.
For younger patients with arthritis isolated to one portion of the knee, options may include cartilage procedures, an osteotomy to redistribute forces across the joint, or partial knee replacement.
Dr. Kamath continues to use osteotomy extensively, particularly in patients in their teens, 20s, and 30s when the goal is to preserve the native knee for as long as reasonably possible. He also discusses how 3D planning and patient-specific technology have made osteotomy increasingly precise and customized.
For an appropriately selected patient in their 40s or 50s, however, a partial knee replacement may offer a different balance—preserving much of the native knee while allowing immediate weight bearing and potentially a faster recovery.
There isn’t one operation that is best simply because a patient is “young.” The decision should reflect the pattern of arthritis, alignment, ligament function, activity demands, expectations, and the patient’s priorities.
Can PRP or Stem Cells Regrow Cartilage?
We also tackle a question that patients increasingly bring to the office:
Can an injection regenerate an arthritic joint?
There is tremendous interest in platelet-rich plasma (PRP), stem-cell-based interventions, hyaluronic acid, and other biologic treatments.
Dr. Kamath’s approach is pragmatic. There may be situations—particularly earlier in the disease process—where biologic interventions have a role in symptom management. But patients should be cautious about claims that an injection can reliably reverse severe structural arthritis.
For a knee with advanced deformity, bone loss, and severe arthritis, he explains that he would steer a patient toward treatments supported by the severity of the underlying disease rather than an expensive intervention with little realistic chance of restoring the joint.
This is an important distinction between treating symptoms and actually restoring damaged articular cartilage.
What About Avascular Necrosis of the Hip?
We finish with another challenging problem: avascular necrosis, or osteonecrosis, of the femoral head.
Treatment depends substantially on the stage of disease.
Before collapse of the femoral head, joint-preserving procedures such as core decompression may be considered in selected patients. Once significant structural collapse has occurred, total hip replacement often becomes the more predictable and durable option.
This is another example of why timing matters so much in orthopedic care. The appropriate treatment can change dramatically as the structural condition of the joint progresses.
The Bigger Picture: Personalized Hip and Knee Care
The central theme of this episode is that modern orthopedic surgery is becoming increasingly personalized.
The question isn’t simply:
“Are you old enough for a joint replacement?”
A better set of questions is:
What is actually wrong with the joint? How healthy is the remaining cartilage? Is the problem focal or diffuse? Can the mechanics of the joint be corrected? What does the patient want to return to doing? And which treatment provides the most predictable balance between preserving the native joint and restoring quality of life?
Technology is giving surgeons increasingly powerful tools to answer and execute those decisions. But thoughtful patient selection and shared decision-making remain just as important as the technology itself.
That combination—better diagnostics, joint-preservation options, personalized joint replacement, robotics, and modern outpatient care—may ultimately define the next generation of hip and knee surgery.
Watch or Listen to Episode #38
Watch or listen to my full conversation with Dr. Atul Kamath on The Joint Replacement Podcast, available on YouTube, Spotify, and Apple Podcasts.
Learn more about Dr. Kamath, his practice, and his approach to hip and knee care at Kamath Orthopedics.
This article is intended for educational purposes only and does not constitute individualized medical advice. Treatment recommendations vary based on diagnosis, examination, imaging, medical history, and individual patient factors.
References
- MacLeod JS, et al. Periacetabular Osteotomy Leads to Improved Long-term Patient-reported Outcomes: A Systematic Review. Orthopedics. 2025.
- Tan SHS, et al. Hip survivorship following the Bernese periacetabular osteotomy for the treatment of acetabular dysplasia: A systematic review and meta-analysis. Orthop Traumatol Surg Res. 2022.
- Comparing outcomes of hip arthroscopy and periacetabular osteotomy for the treatment of borderline hip dysplasia: a systematic review. J Hip Preserv Surg. 2024.
- Robotic assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomised controlled trials. J Robot Surg. 2024.
- Robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of alignment accuracy and clinical outcomes. 2025.