Your Health Matters with Dr. Rick Schultz
Your Health Matters with Dr. Rick Schultz—Extended Interview
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which direct listeners to get “the rest of the story” at the hospital website, with a companion 10-minute feature show, which includes a transcript, great for the hearing impaired, information seekers and ESL.
But, wait, there’s more! That same 10-minute feature show is also broadcast nationally on RadioMD, WomensRadio and American Forces Network radio, in addition to posting on the Life Love & Health site, all driving SEO.
On The Path Productions produced 40 Your Health Matters interview programs for Scott & White Healthcare (Temple TX), primarily with physicians discussing service lines that played to the unique mission and strengths of the organization. All interviews were of broadcast quality versus telephone calls, enabling the combining of various recordings into longer form shows.
Guest: Dr. Rick Schultz; Host: Christopher Springmann
Christopher Springmann: Why do people wait so long to seriously consider having a total hip arthroplasty—that’s a hip replacement. After all, with over 300,000 hip procedures in America every year, and a 95%-plus favorable outcome rate, why wait? You’re listening to Your Health Matters from Scott & White Healthcare. I asked that question of Dr. Richard Schultz, Director of the Orthopedic Division at Scott & White Healthcare’s Round Rock Clinic.
Dr. Rick Schultz: Fear is a lot of it. It’s a big surgery. It’s a major undertaking. And so people tend to try to put that risk off, which certainly is a reasonable thing. By far and away the most common diagnosis is osteoarthritis, or wear and tear arthritis. By the time people are seriously thinking about a new hip, it not only affects their daily life, but it affects their sleep patterns. Many of these people are very sleep deprived, which brings on depression and other types of issues.
CS: But Doctor, if I consult with an orthopedic surgeon, that automatically means surgery, right?
RS: The vast majority of patients that I see with hip complaints don’t need surgery, and it’s not the right thing for them to do. At least not at that point.
CS: You can hear our entire interview with Dr. Richard Schultz on hip replacement at the Scott & White Healthcare website SW.org. I’m Christopher Springmann, and this is Your Health Matters.
Guest: Dr. Rick Schultz; Host: Christopher Springmann
Christopher Springmann: You are listening to Your Health Matters, and I’m Christopher Springmann with reliable healthcare information from Scott & White Healthcare, one of America’s most admired healthcare systems. We’re speaking with Dr. Richard Schultz, an orthopedic surgeon with Scott & White Healthcare.
Dr. Rick Schultz: We’ve seen patients spend about half as much time in the hospital. Our average stay is now less than two days. One of the things that we strive for and are able to achieve is our patients go home after their surgeries. It’s very common now for patients to come in and have their sutures removed in a ten-day to two-week window. For those people to no longer be using their walking aids.
CS: Dr. Rick Schultz is Director of the Orthopedic Division at Scott & White Healthcare’s Round Rock, Texas, clinic. He’s also an Assistant Professor of Surgery at Texas A&M College of Medicine. Certified by the American Board of Orthopedic Surgery, Dr. Schultz has been with Scott & White Healthcare since 1991, when he began his specialty training at the clinic in Temple. Today Dr. Schultz talks about the direct anterior approach, also known as DAA, the total hip replacement. Now before we get in to the details of that procedure and how advantageous this can be for a patient, I’d like to ask you a couple of true or false questions. You ready?
RS: Ready to go.
CS: THA, or total hip arthroplasty, is one of the most successful operations in America with a 95%-plus success rate meaning a highly positive outcome that meets or exceeds everyone’s expectations, both yours and the patient. True or false?
RS: That’s true.
CS: Whoa! In fact, according to the American Academy of Orthopedic Surgeons, there are over 300,000 hip replacements performed in the U.S. every year. And two-thirds of those are on women. True or false?
RS: That is also true.
CS: Oh my goodness. You’re doing quite well here. True or false, Doctor? Many, many patients who have a hip replacement have been known to say, after the fact, “Oh, why did I wait so long to have this done?” True or false?
RS: That is true. That’s a very common comment.
CS: Why is that? Why do people wait so long?
RS: Fear is a lot of it. It’s a big surgery. It’s a major undertaking. And so people tend to try to put that risk off, which certainly is a reasonable thing. Many times, too, they’ve been advised, you know, by their physicians and by their surgeons to try to put that risk into the future, potentially gaining some benefit from new technology or other types of advances. So there’s probably several pretty solid reasons why they wait.
CS: And here’s another true or false question. There seems to be a prevailing idea among many patients, or potential patients, that if I go to see a surgeon about a hip problem, then suddenly, they are going to sign me up an operation. Now, that is not necessarily the case, is it, Doctor?
RS: I would say the vast majority of the time, with orthopedists across the nation, that the majority of our discussions are how to manage their hip and other problems conservatively, without any type of surgery. And the vast majority of patients that I see with hip complaints don’t need surgery, and it’s not the right thing for them to do. At least not at that point.
CS: Now, let’s talk about who’s a candidate for hip replacement. And frankly, what symptoms people have that may compel them to have either one or more hips replaced. Aside from the fact that–well, perhaps the fact that movement is painful. And their mobility and quality of life are both compromised.
RS: By far and away the most common diagnosis is osteoarthritis, or wear and tear arthritis. There are certainly other causes of pathology about the hip that cause people to have a lot of pain and does impact their quality of life. But osteoarthritis is, by far and away, the most common. But many times, by the time people are seriously thinking about a new hip, it not only affects their daily life, their ability to get in and out of bed, walk to the kitchen, go to the store. But it affects their sleep patterns. Many of these people are very sleep deprived, which brings on depression and other types of issues. So this really becomes an enormous impact on their quality of life.
CS: I’m Christopher Springmann. And I’m discussing total hip replacement via the direct anterior approach with orthopedic surgeon Dr. Rick Schultz. Doctor, why is the anterior hip replacement more advantageous for the patient than a traditional approach?
RS: The less damage that we do, the easier it is for the patient to recover. There’s a lot of technical jargon and anatomical details. But essentially, the less muscles that we damage in the process of being able to see the hip well enough to replace it, the patient doesn’t have to spend time, energy and pain recovering from that damage and essentially healing that damage that needed to be done to expose their hip.
CS: And I understand, too, that with this procedure, fewer pain medications are required. Is that correct?
RS: That is very common. And it’s also cut our hospital stay in half. Our average stay is now less than two days. And that average stay was right around four days, previously. It’s also important when we’re just talking about average stay–many times surgeons will have the practice of a patient having a major joint reconstruction and then going from the acute state hospital, to a rehab hospital, where they may spend another few weeks away from home in a rehab facility. One of the things that we strive for and are able to achieve is our patients go home after their surgeries. It’s very common now for patients to come in to have their sutures removed in a ten-day to two-week window. For those people to no longer be using their walking aids. And very common at six weeks time, which would be a normal second follow-up for us, that these people are back to driving. If they are still working that they are back to work, at least part time. They are already planning their next trip to see their grandkids. You know, it clearly–regular life or an improved life is clearly in focus at six weeks. And again, this is probably about half the amount of time. Normally, we would have told people before the DAA approach that they shouldn’t make any plans like that for at least three months after their hip.
CS: These are very, very persuasive arguments for your procedure. How do patients respond to this?
Dr. Rick Schultz: They usually are overwhelmingly positive. We have many patients who are very well informed. And they’ve done their homework. They’ve many times been to one or two or more other surgeons in discussing this. And they are very well-schooled. And they have very pointed questions and this usually, you know, is something that is convincing for them. And so far we’ve been very happy with this. And our patients have, too. You need to have a good working relationship with your surgeon and trust them. And I think certainly I encourage all of my patients to obtain a second opinion or any other type of information they can. And I think that’s a very healthy and smart thing to do.
Christopher Springmann: Now I believe you said that with the DAA approach that there are no hip precautions to follow post-surgery, which means that the patient can cross his or her legs and bend at the waist without fear of dislocating the hip. Is that correct?
RS: It should be less common with that approach. Certainly it’s possible to dislocate your hip after a direct anterior approach. We certainly have to dislocate the hip during the surgery itself. But the precautions are minimized, I think, over the traditional approaches. And we certainly see patients being able to get back to that. I think common sense and always working your way back in to activities in a step-wise manner and under the guidance of your surgeon and therapist are always wise. But the restrictions, and because we do less damage around the hip, it is more unlikely for that hip to dislocate. It is more and more common to have people not willing to wait. Not willing to give up their career. Not willing to retire because of a hip that’s painful and worn out. Even if they’re not out there running around the block every day, they spend a lot of hours on their feet, and they’re doing things that 40- and 50-year olds are expected to do. And they really demand from us components that would allow them to support that type of lifestyle.
CS: More with Dr. Richard Schultz, an orthopedic surgeon with Scott & White Healthcare, after this break.