The Joint Replacement Podcast with Matthew Sloan, MD
Choosing whether to undergo a hip or knee replacement is one of the most important healthcare decisions many patients will ever make. Yet despite the success of modern joint replacement surgery, patients are often faced with conflicting information about recovery, implant longevity, injections, robotics, and the future of arthritis treatment.
In Episode 24 of The Joint Replacement Podcast, Dr. Matthew Sloan sits down with fellowship-trained adult reconstruction surgeon Dr. Blair Ashley of Main Line Health to discuss the questions patients ask every day in clinic.
From deciding when surgery is appropriate to understanding the latest innovations in orthopedic surgery, this episode provides practical, evidence-based insights for patients considering hip or knee replacement.
When Is the Right Time for Joint Replacement?
One of the most common misconceptions is that surgery should be based solely on an X-ray.
As Dr. Ashley explains, while imaging helps determine whether a patient is technically a candidate for surgery, the decision ultimately comes down to quality of life.
Hip and knee arthritis are rarely life-threatening conditions. Instead, joint replacement is designed to restore function, reduce pain, and help patients return to activities they enjoy.
Patients should generally consider surgery when:
- Arthritis is clearly visible on imaging
- Non-surgical treatments have failed
- Pain is affecting daily activities
- Quality of life has significantly declined
- They are prepared to commit to the recovery process
Do Cortisone and Gel Injections Work?
Before surgery, many patients explore non-operative treatments.
Dr. Ashley outlines a stepwise approach that often includes:
Conservative Treatments
- Activity modification
- Anti-inflammatory medications
- Topical treatments
- Physical therapy
- Bracing
Corticosteroid Injections
Cortisone injections can provide meaningful pain relief by reducing inflammation within the joint. They are often the first injectable treatment offered for osteoarthritis.
Hyaluronic Acid (Gel) Injections
Gel injections may provide symptom relief for some patients, though results can be unpredictable, particularly in patients with advanced bone-on-bone arthritis.
Neither treatment reverses arthritis or restores cartilage. Instead, they are designed to help manage symptoms and potentially delay surgery for some patients.
What About PRP and Stem Cells?
Patients frequently ask about platelet-rich plasma (PRP), stem cell treatments, prolotherapy, and other regenerative medicine options.
While research in biologic therapies continues to evolve, Dr. Ashley notes that there is currently insufficient evidence to recommend these treatments for advanced hip or knee arthritis.
The American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines do not currently recommend biologic injections as standard treatment for advanced osteoarthritis because of inconsistent evidence and lack of standardized preparation methods.¹
For patients with end-stage arthritis, joint replacement remains the most predictable and effective treatment option.
How Long Does a Hip or Knee Replacement Last?
One of the biggest concerns patients have is implant longevity.
Modern research suggests that most contemporary hip and knee replacements continue functioning well for 20 years or longer.² ³
Dr. Ashley generally counsels patients that:
- Most implants last 20–25 years or more
- Longevity depends on activity level
- Higher-impact activities may increase wear over time
- Younger patients should understand the possibility of future revision surgery
Fortunately, advances in implant design, materials, and surgical technique continue to improve long-term outcomes.
How Painful Is Recovery?
Patients often worry most about recovery.
Dr. Ashley emphasizes that recovery experiences vary significantly between individuals, but generally:
Typical Recovery Timeline
First 2 Weeks
- Walker use
- Swelling and inflammation peak
- Focus on rest and gentle mobility
Weeks 2–6
- Transition to a cane
- Gradual increase in activity
- Significant improvements in pain
3 Months
- Approximately 90% recovery for many patients
- Return to many recreational activities
1 Year
- Full recovery and continued improvement
As Dr. Ashley notes, surgery remains a significant physical stress on the body. Even though many procedures are now performed on an outpatient basis, patients should respect the recovery process.
Returning to Golf, Pickleball, and Exercise
One of the most rewarding aspects of joint replacement is helping patients return to activities they love.
Most patients can safely return to:
- Walking
- Cycling
- Hiking
- Golf
- Pickleball
- Swimming
Higher-impact activities such as distance running, competitive sports, or activities with substantial fall risk may require additional discussion with a surgeon.
The goal of surgery is not merely pain relief but restoration of function and quality of life.
The Biggest Mistake Patients Make After Surgery
According to Dr. Ashley, the most common mistake is simple:
Trying to do too much, too soon.
Many patients feel significantly better within the first month and attempt to accelerate their recovery by increasing activity too quickly.
However, deep tissue healing continues long after the skin incision appears healed.
Overexertion can contribute to:
- Increased swelling
- Pain flare-ups
- Delayed recovery
- Falls or complications
Successful recovery requires patience as much as effort.
How Should Patients Choose a Joint Replacement Surgeon?
When selecting a surgeon, Dr. Ashley recommends considering:
Fellowship Training
Look for surgeons who have completed specialized fellowship training in adult reconstruction or joint replacement.
Surgical Volume
Research consistently demonstrates that higher-volume surgeons often achieve better outcomes and lower complication rates.⁴
Communication
Patients should feel comfortable asking questions and discussing concerns.
Shared Decision-Making
A good surgeon explains options, risks, benefits, and recovery expectations rather than simply recommending surgery.
Experience with Your Condition
Patients with complex deformities, prior surgeries, or revision procedures may benefit from surgeons with additional expertise in those areas.
Robotics and the Future of Joint Replacement
Robotic-assisted surgery continues to grow rapidly throughout orthopedics.
Dr. Ashley believes robotics may ultimately help surgeons better understand alignment, soft tissue balancing, and patient-specific factors that contribute to satisfaction after knee replacement.
Future innovations may include:
- Improved robotic planning
- Better implant personalization
- Enhanced data collection
- Artificial intelligence-assisted decision making
- Infection-resistant implant coatings
While robotics continue to evolve, surgeon experience and thoughtful patient care remain the most important factors in successful outcomes.
Will We Ever Cure Arthritis?
Perhaps the most fascinating discussion centered around the future of arthritis treatment.
While biologic therapies, tissue engineering, and cartilage regeneration remain active areas of research, both surgeons acknowledged the enormous challenge of recreating a healthy joint surface.
Cartilage restoration is not simply about growing cartilage cells—it requires recreating a durable, highly organized tissue capable of surviving decades of mechanical stress.
For now, joint replacement remains the gold standard treatment for end-stage arthritis.
But future breakthroughs may one day help prevent arthritis before joint replacement becomes necessary.
Watch the Full Episode
🎥 Watch on YouTube:
https://youtu.be/SU4UChZBqfs
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References
- American Academy of Orthopaedic Surgeons (AAOS). Clinical Practice Guideline for Management of Osteoarthritis of the Knee.
- Evans JT, Walker RW, Blom AW, Whitehouse MR, Sayers A. How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports. Lancet. 2019.
- Evans JT, Evans JP, Walker RW, et al. How long does a hip replacement last? A systematic review and meta-analysis. Lancet. 2019.
- Katz JN, Losina E, Barrett J, et al. Association between hospital and surgeon procedure volume and outcomes after total hip replacement in the United States.