What does a joint replacement surgeon learn when he becomes a joint replacement patient himself?
In Episode 36 of The Joint Replacement Podcast, I sit down with Farzin Kabaei, MD, a board-certified orthopedic surgeon in Los Angeles specializing in hip and knee replacement, complex joint reconstruction, and orthopedic trauma. Dr. Kabaei trained at Albert Einstein/Montefiore before completing fellowship training at Cedars-Sinai, and his current practice incorporates robotic-assisted surgery, outpatient joint replacement, and the treatment of complex problems including prior trauma, deformity, infection, and failed joint replacements.
But what makes this conversation particularly interesting is that Dr. Kabaei doesn’t discuss joint replacement only from the surgeon’s perspective. After a lifetime of orthopedic injuries and multiple operations, he eventually became a knee replacement patient himself.
From a Teenage ACL Injury to Knee Replacement
Dr. Kabaei’s experience with knee problems began at only 16 years old, when he tore his ACL and meniscus. At the time, his ACL was removed rather than reconstructed and he underwent a subtotal medial meniscectomy. Combined with his naturally varus—or bow-legged—alignment, he developed significant medial compartment arthritis at a remarkably young age.
As his symptoms progressed, he eventually underwent a high tibial osteotomy (HTO) performed by Dr. Brian Cole in Chicago. The goal of an HTO is to realign the leg and shift forces away from the damaged portion of the knee toward healthier cartilage.
The procedure bought him approximately 15 years before his arthritis eventually progressed and he underwent knee replacement. His experience included numerous orthopedic procedures involving his knee, Achilles tendon, and other injuries.
Living through those recoveries profoundly influenced the way he now speaks to patients about pain and surgery.
“I probably have had more surgeries than you, and I understand what you’re going through.”
For a surgeon accustomed to treating pain, personally experiencing prolonged pain, swelling, disability, and recovery provides an entirely different perspective.
How Do You Know When It’s Time for Joint Replacement?
One of the most common questions patients ask is: How bad does my hip or knee have to get before I should have surgery?
Dr. Kabaei emphasizes that the answer cannot come from an X-ray alone.
Severe arthritis on an X-ray does not necessarily mean someone needs joint replacement. Many people can have substantial radiographic arthritis while remaining active and relatively comfortable. Conversely, arthritis can become extremely limiting when pain begins controlling everyday decisions.
Dr. Kabaei describes the transition as occurring when patients begin organizing their lives around their joint—thinking about the knee or hip every morning, avoiding walking, struggling with basic activities, or changing plans because of pain.
This fits with the broader concept of shared decision-making in joint replacement. Current ACR/AAHKS guidance emphasizes considering symptoms, radiographic disease, prior treatment, individual risks and benefits, and patient preferences when deciding when to proceed with surgery.[1]
An X-Ray Doesn’t Decide Whether You Need Surgery
A recurring theme in our discussion is an important one for patients:
We don’t replace X-rays. We treat people.
Dr. Kabaei points out that if we X-rayed a large group of older adults, many would demonstrate arthritis despite having little or no meaningful limitation.
For patients who remain active and functional, he encourages getting as much useful life as possible from the natural joint. Exercise, cycling, swimming, weight management, activity modification, and appropriate nonsurgical treatment may help some patients continue doing the things they enjoy.
However, there is an important distinction once someone has symptomatic moderate-to-severe arthritis, has already tried appropriate nonsurgical care without adequate relief, and has decided to proceed with joint replacement. Current ACR/AAHKS guidance conditionally recommends against requiring an arbitrary additional delay simply to repeat physical therapy, anti-inflammatory medication, walking aids, or injections.[1,2]
In other words, there isn’t a universal checklist or X-ray threshold that determines the perfect day for surgery.
Hip Replacement and Knee Replacement Are Different Experiences
One of the most interesting parts of the episode is Dr. Kabaei’s distinction between hip replacement and knee replacement.
He describes total hip replacement as an exceptionally successful operation and is often more encouraging when patients have severe hip arthritis that has substantially changed the way they move—even when they have gradually adapted and no longer describe their primary complaint simply as “pain.”
Loss of hip motion can affect seemingly simple activities such as putting on shoes, walking normally, exercising, and performing daily tasks. Hip osteoarthritis can substantially affect pain, function, and quality of life, and total hip replacement remains an important treatment for appropriately selected patients with advanced symptomatic disease.[3]
With knee replacement, Dr. Kabaei emphasizes expectations even more strongly.
A knee replacement can dramatically improve arthritic pain and restore function, but the goal should not necessarily be to recreate the knee someone had at 19 years old. Patients may remain aware of the artificial joint, and symptoms such as numbness around the incision, difficulty kneeling, intermittent swelling, or other sensations can persist.
Dr. Kabaei knows this firsthand.
Despite occasionally noticing his knee replacement, he has been able to return to activities that severe arthritis had taken away—including completing a multi-day hike at Machu Picchu.
For him, that difference is what made the operation worthwhile.
What Does a Knee Replacement Surgeon Look for in His Own Surgery?
Another fascinating question is how an orthopedic surgeon chooses his own knee replacement surgeon.
Dr. Kabaei ultimately chose his partner, who performs robotic-assisted knee replacement.
His increasing experience with navigation and robotic technology had helped increase his confidence in the ability to execute a surgical plan and objectively measure implant positioning during surgery.
He describes one of the benefits of technology as access to real-time objective information rather than relying exclusively on visual estimation and conventional instrumentation.
Importantly, robotics is only one component of modern joint replacement. Surgical technique, patient selection, anesthesia, pain management, rehabilitation, implant selection, perioperative protocols, and appropriate expectations all contribute to recovery. AAOS clinical practice guidelines similarly evaluate knee replacement as a multifactorial procedure rather than attributing outcomes to any single technology.[4]
Recovery Begins Before Surgery
Having gone through knee replacement himself, Dr. Kabaei became particularly interested in everything surrounding the operation—not just what happens in the operating room.
Before his own surgery, he focused on nutrition, hydration, exercise, preparation, and obtaining the equipment he thought would make recovery easier.
He also incorporated techniques such as meditation and breathwork into his personal recovery strategy as part of an effort to manage stress, sleep, and his perception of pain.
That experience eventually contributed to his development of The Recovery Box, a collection of recovery-related products and strategies that he began incorporating into his practice.
The broader message is useful regardless of any particular recovery protocol: joint replacement is a process, not simply an operation.
Preparing physically and mentally for surgery, understanding what recovery will involve, and having realistic expectations can be just as important to the patient experience as understanding the technical details of the procedure.
What About Cortisone, Gel Injections, and PRP?
We also discuss nonsurgical treatments for knee arthritis, including corticosteroid injections, hyaluronic acid injections, and platelet-rich plasma (PRP).
Dr. Kabaei shares how his own opinions changed after personally trying many of these treatments during years of living with arthritis.
His experience also illustrates why injection decisions should be individualized. The effectiveness of nonsurgical treatments can vary considerably depending on the severity of arthritis, symptoms, patient goals, and previous response.
Once advanced arthritis is producing substantial symptoms despite nonsurgical care, however, repeatedly postponing an otherwise appropriate joint replacement simply to continue additional treatments may not provide additional value. This is reflected in current ACR/AAHKS recommendations for patients who have already failed appropriate nonsurgical management and have chosen arthroplasty.[1,2]
Anterior Hip Replacement and the Bikini Incision
Dr. Kabaei also discusses the evolution of his anterior hip replacement practice.
After transitioning toward the direct anterior approach, he began refining different aspects of the procedure and eventually incorporated a transverse or “bikini” incision for selected patients.
Rather than running vertically along the front of the hip, the skin incision follows a more natural skin crease. Dr. Kabaei emphasizes that the difference primarily concerns the skin incision; deeper surgical anatomy and safe tissue handling remain critical.
He does not use the incision for every patient, but views it as another option for appropriately selected individuals, particularly those concerned about scar appearance.
The Surgeon as the Patient
Perhaps the most valuable part of this episode isn’t about a particular implant, robot, injection, or surgical approach.
It’s about perspective.
Surgeons spend years learning how to diagnose disease, perform operations, manage complications, and guide recovery. But experiencing surgery personally introduces lessons that are difficult to obtain from textbooks or even thousands of operations.
Dr. Kabaei knows what it’s like to wonder whether surgery is really necessary.
He knows what prolonged arthritis feels like.
He knows what it’s like to prepare for a knee replacement, wake up afterward, work through recovery, and wonder when the knee will finally start feeling better.
And today, he knows what it’s like to live with a knee replacement.
That experience has shaped a simple message for patients: don’t make the decision based on fear or an X-ray alone. Understand what your joint is preventing you from doing, explore reasonable alternatives, set realistic expectations, and when the time comes, make an informed decision with a surgeon you trust.
Watch or Listen to Episode 36
🎙️ The Joint Replacement Podcast — Episode 36
When the Joint Replacement Surgeon Becomes the Patient | Farzin Kabaei, MD
Watch or listen on YouTube, Spotify, Apple Podcasts, and your favorite podcast platform.
Learn more about Dr. Farzin Kabaei and his practice at:
www.robotichipandkneereplacementla.com
References
- Hannon CP, Goodman SM, Austin MS, et al. 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective. J Arthroplasty. 2023;38(11):2193-2201. doi:10.1016/j.arth.2023.09.003.
- American Association of Hip and Knee Surgeons (AAHKS). Optimal Timing of Total Hip and Knee Arthroplasty. 2023.
- American Academy of Orthopaedic Surgeons (AAOS). Management of Osteoarthritis of the Hip: Evidence-Based Clinical Practice Guideline. Updated 2024.
- American Academy of Orthopaedic Surgeons (AAOS). Surgical Management of Osteoarthritis of the Knee: Evidence-Based Clinical Practice Guideline. Published December 2, 2022.
This article and podcast are intended for educational purposes only and should not be considered individualized medical advice. Treatment recommendations vary based on each patient’s diagnosis, medical history, symptoms, examination, imaging, and goals.