Episode 26 – The Joint Replacement Podcast
When most people think about a successful hip or knee replacement, they imagine a perfectly positioned implant or a postoperative X-ray that looks flawless. But according to Dr. Wayne Moschetti, Division Chief of Adult Reconstruction and Fellowship Director at Dartmouth Health, that’s only part of the story.
In Episode 26 of The Joint Replacement Podcast, Dr. Moschetti explains why modern orthopedic surgery is shifting its focus toward something far more important: how patients actually feel and function after surgery.
Success Isn’t Measured by X-rays Alone
Hip and knee replacement are among the most successful procedures in all of medicine, with decades of evidence demonstrating excellent implant survivorship and dramatic improvements in pain and mobility. Yet even when implants are perfectly positioned and functioning well, some patients remain dissatisfied.
That’s where Patient-Reported Outcome Measures (PROMs) come in.
Rather than asking, “Did the implant last?” PROMs ask questions that matter directly to patients:
- Has your pain improved?
- Can you walk farther?
- Are you sleeping better?
- Have you returned to activities you enjoy?
- Has your overall quality of life improved?
These measurements are increasingly becoming one of the most important ways orthopedic surgeons evaluate the success of joint replacement surgery.
What Are Patient-Reported Outcome Measures (PROMs)?
PROMs are standardized questionnaires completed directly by patients before and after surgery.
They help surgeons objectively measure changes in:
- Pain levels
- Physical function
- Overall health
- Mental well-being
- Satisfaction with surgery
- Ability to perform everyday activities
Examples include:
- PROMIS (Patient-Reported Outcomes Measurement Information System)
- HOOS (Hip Disability and Osteoarthritis Outcome Score)
- KOOS (Knee Injury and Osteoarthritis Outcome Score)
- Forgotten Joint Score
Today, PROMs are routinely collected by many orthopedic practices and are increasingly incorporated into national quality improvement initiatives, including the American Joint Replacement Registry (AJRR) and Centers for Medicare & Medicaid Services (CMS) quality programs.
Setting Expectations Is One of the Most Important Parts of Surgery
One of Dr. Moschetti’s biggest messages is that expectations often determine satisfaction.
A hip replacement can dramatically reduce pain and restore function, but it doesn’t recreate the joint you had at age twenty.
Patients hoping to:
- Run ultramarathons
- Perform deep squats
- Return to high-impact sports
- Resume intense CrossFit training
may not achieve those exact goals after surgery—particularly after knee replacement.
Instead, most patients experience tremendous improvements in:
- Walking
- Hiking
- Golf
- Cycling
- Swimming
- Everyday activities
- Sleep quality
Having honest conversations before surgery helps patients understand what joint replacement can—and cannot—do.
When Is the Right Time for Joint Replacement?
One question orthopedic surgeons hear every day is:
“How do I know when it’s time?”
Dr. Moschetti emphasizes there is no perfect age for surgery.
Instead, timing depends on:
- Persistent pain despite nonoperative treatment
- Loss of quality of life
- Difficulty sleeping because of arthritis
- Inability to participate in activities that matter most
He encourages patients to work through appropriate conservative treatments—including physical therapy, weight management, medications, and injections—but also reminds patients there is no prize for suffering longer than necessary.
When arthritis consistently limits your life despite reasonable treatments, joint replacement often becomes the best solution.
Outpatient Joint Replacement Has Changed Everything
One of the biggest changes during Dr. Moschetti’s career has been the rapid transition toward outpatient surgery.
Years ago, patients commonly:
- Stayed in the hospital for several days
- Required blood transfusions
- Had surgical drains
- Used urinary catheters
- Went to rehabilitation facilities
Today, advances including:
- Tranexamic acid (TXA)
- Modern anesthesia
- Multimodal pain management
- Early mobilization
- Enhanced recovery protocols
allow many patients—even those in their 80s—to safely return home the same day after surgery.
Why Are Some Patients Still Dissatisfied?
Despite tremendous advances, approximately 10% of modern knee replacement patients remain dissatisfied, even when no mechanical problem exists.
Reasons may include:
- Unrealistic expectations
- Persistent stiffness
- Residual discomfort
- Mental health factors
- Other musculoskeletal conditions
- Pain originating outside the knee
For patients with painful replacements, Dr. Moschetti stresses the importance of identifying a specific diagnosis before considering revision surgery.
Evaluation typically includes:
- Detailed history
- Physical examination
- X-rays
- Blood work (ESR and CRP)
- Joint aspiration when infection is suspected
- Review of prior imaging
The goal is always to determine why the joint hurts before recommending another operation.
The Future: Artificial Intelligence and Personalized Outcomes
Perhaps the most exciting discussion during the episode centered around the future of orthopedic surgery.
Dr. Moschetti believes combining:
- PROMs
- Imaging
- Wearable technology
- Electronic health record data
- Artificial intelligence
may eventually allow surgeons to predict outcomes before surgery with remarkable accuracy.
Imagine entering your medical information into an AI model that estimates your likelihood of achieving an excellent result after joint replacement—or identifies areas that can be optimized beforehand.
While we’re not there yet, the field is moving rapidly toward more personalized, data-driven care.
The Importance of Choosing the Right Surgeon
When patients ask what matters most, Dr. Moschetti offers a simple answer:
Choose a surgeon you trust.
While patients often focus on implants, robotics, or surgical approach, research consistently shows that surgeon experience and hospital volume are among the strongest predictors of successful outcomes.
Technology continues to improve orthopedic surgery, but communication, experience, and shared decision-making remain irreplaceable.
Final Thoughts
Joint replacement has never been safer or more successful.
But as orthopedic surgery evolves, success is no longer measured solely by implant longevity or X-rays.
Instead, the question has become:
Did surgery allow patients to return to the life they wanted?
That’s the philosophy driving modern joint replacement—and it’s one of the reasons Dr. Wayne Moschetti has become a national leader in patient-centered orthopedic care.
If you’re considering hip or knee replacement, this episode offers invaluable insights into what truly defines success after surgery.
Watch the Full Episode
🎥 Episode 26: Dr. Wayne Moschetti – Measuring Success After Hip & Knee Replacement
Available now on The Joint Replacement Podcast YouTube channel and wherever you listen to podcasts.
References
- American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Knee (Non-Arthroplasty) Clinical Practice Guideline. Rosemont, IL: AAOS; 2021.
- American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Hip Clinical Practice Guideline. Rosemont, IL: AAOS; 2024.
- American Joint Replacement Registry (AJRR). 2024 Annual Report. American Academy of Orthopaedic Surgeons.
- Centers for Medicare & Medicaid Services (CMS). Patient-Reported Outcome Measures (PROMs) Overview.
- National Institutes of Health. PROMIS® (Patient-Reported Outcomes Measurement Information System). https://www.healthmeasures.net/promis
- Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJ. Patient satisfaction after total knee arthroplasty: Who is satisfied and who is not? Clin Orthop Relat Res. 2010;468(1):57–63.
- 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. Lancet. 2019;393:647–654.
Podcast content summarized from Episode 26 of The Joint Replacement Podcast featuring Dr. Wayne Moschetti.