Episode 29 of The Joint Replacement Podcast
The pace of innovation in hip and knee replacement surgery has accelerated dramatically over the past decade. Patients are recovering faster, spending less time in the hospital, using fewer opioids, and returning to active lifestyles sooner than ever before.
In Episode 29 of The Joint Replacement Podcast, I sat down with Dr. Eric Cohen, an adult reconstruction surgeon at Brown University Health and Assistant Professor at the Warren Alpert Medical School of Brown University, to discuss the technologies, surgical strategies, and recovery protocols that are reshaping modern joint replacement.
From same-day surgery to robotic assistance, infection prevention, revision surgery, and artificial intelligence, this episode offers practical insights for both patients and healthcare professionals.
Meet Dr. Eric Cohen
Dr. Eric Cohen specializes in:
- Primary hip replacement
- Primary knee replacement
- Complex revision hip and knee replacement
- Robotic-assisted joint replacement
- Periprosthetic joint infection
- Complex reconstruction
During our conversation, he shares how growing up in a military family and living near Landstuhl Regional Medical Center in Germany inspired his career in medicine before ultimately leading him to orthopedic surgery and adult reconstruction.
Same-Day Joint Replacement Has Changed Everything
Perhaps the biggest change Dr. Cohen has witnessed isn’t one specific implant or robot.
It’s the evolution toward same-day joint replacement.
Years ago, hip and knee replacement patients routinely spent several days—or even weeks—in the hospital.
Today, many patients safely return home just hours after surgery.
According to Dr. Cohen, this transformation wasn’t driven by a single innovation but by the combination of:
- Better patient education
- Improved anesthesia
- Modern regional nerve blocks
- Multimodal pain management
- Earlier mobilization
- Enhanced recovery pathways
Together, these improvements have dramatically improved the patient experience.
How COVID Accelerated Outpatient Joint Replacement
Although outpatient arthroplasty was already growing, COVID-19 dramatically accelerated adoption.
Hospital bed shortages forced surgeons and health systems to rethink recovery pathways, while changes in Medicare reimbursement made outpatient total hip and knee replacement more practical.
Dr. Cohen explains how this period permanently changed the way many surgeons approach postoperative care and discharge planning.
Who Can Go Home the Same Day?
One of the biggest misconceptions is that age alone determines whether someone qualifies for outpatient surgery.
According to Dr. Cohen:
- Overall medical health matters more than chronological age.
- Pulmonary disease is often more limiting than age.
- A strong support system at home is essential.
- Safe recovery planning begins before surgery.
Even many patients in their eighties can safely recover at home when appropriately selected.
Preparing Patients for the Best Outcome
Optimization before surgery remains one of the most important ways to improve outcomes.
We discuss:
- Body mass index (BMI)
- Diabetes control
- Smoking cessation
- Medical optimization
- Care partner involvement
These factors significantly reduce complications and improve recovery after hip and knee replacement.
Returning to Sports After Joint Replacement
Many patients ask whether they’ll be able to remain active after surgery.
Dr. Cohen’s philosophy is straightforward:
Joint replacement should help patients return to the activities they enjoy—not limit them.
He encourages patients to return to hiking, biking, swimming, golf, travel, and recreational sports once healing is complete while emphasizing reasonable precautions during the first several months as bone grows into cementless implants.
Modern Pain Management Without Heavy Opioid Use
Pain management continues to evolve rapidly.
Dr. Cohen discusses a comprehensive multimodal strategy that includes:
- Acetaminophen
- NSAIDs
- Regional anesthesia
- Oral tranexamic acid (TXA)
- Limited opioid prescribing
- New non-opioid medications such as suzetrigine (Journavx®)
The goal is effective pain control while minimizing nausea, constipation, sedation, and opioid dependence.
Robotic Surgery and Artificial Intelligence
Robotic-assisted joint replacement has become increasingly common, but Dr. Cohen emphasizes that surgeon experience remains more important than any individual technology.
Rather than replacing surgeons, he believes robotics and artificial intelligence will:
- Improve surgical planning
- Enhance precision
- Analyze large datasets
- Personalize treatment
- Improve surgical education
- Provide better intraoperative feedback
He also discusses how virtual reality and simulation may fundamentally change resident and fellow education over the coming decade.
Preventing Infection
Periprosthetic joint infection remains one of the most devastating complications after joint replacement.
We discuss the multiple evidence-based strategies used to minimize infection risk, including:
- Medical optimization
- Glycemic control
- Nasal decolonization
- Chlorhexidine skin preparation
- Timely antibiotics
- Modern antimicrobial dressings
Dr. Cohen explains why preventing infection is far easier than treating one and why optimization before surgery is so important.
Revision Surgery: The Toughest Cases
Revision hip replacement presents unique technical challenges.
Dr. Cohen discusses:
- Massive acetabular bone loss
- Custom implants
- Well-fixed femoral stem removal
- Surgical planning
- Managing complex reconstruction
He also shares how continually visiting other surgeons and learning new techniques has shaped his own evolution as an arthroplasty surgeon.
Choosing the Right Joint Replacement Surgeon
When asked what advice he’d give a family member needing joint replacement, Dr. Cohen recommends looking for:
- Fellowship-trained surgeons
- High-volume joint replacement specialists
- High-volume hospitals
- A surgeon with whom patients feel comfortable communicating
Technical expertise and trust both play critical roles in achieving an excellent outcome.
Final Thoughts
Modern joint replacement has advanced tremendously over the past decade.
Today’s patients benefit from:
- Faster recovery
- Same-day discharge
- Better pain control
- Improved implant technology
- Robotic assistance
- Lower complication rates
- Earlier return to activity
As Dr. Cohen explains throughout this episode, the future of hip and knee replacement isn’t about one breakthrough—it’s about combining many small improvements to create dramatically better outcomes for patients.
Watch Episode 29
🎥 YouTube: https://youtu.be/wiWMultbZaI
🎧 Search “The Joint Replacement Podcast” on Spotify, Apple Podcasts, or wherever you listen to podcasts.
References
- Sloan M, Cohen E. The Joint Replacement Podcast, Episode 29: Eric Cohen, MD. Podcast transcript.
- Evans JT, Walker RW, Evans JP, Blom AW, Sayers A, Whitehouse MR. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. The Lancet. 2019;393(10172):647-654.
- American Academy of Orthopaedic Surgeons (AAOS). Total Hip Replacement and Total Knee Replacement patient education resources.
- American Association of Hip and Knee Surgeons (AAHKS). Patient education resources on hip and knee replacement recovery and optimization.