UP NEXT ON "CYCLE OF HEALTH."

GO WELL, FOLKS, HERE I AM AFTER GETTING A NEW HIP, GOING IN FOR A FOLLOW-UP CHAT WITH MY SURGEON.

HAPPY AS A CLAM ON MY BIKE.

IF YOU WANT TO LEARN ABOUT HIPS UNDERSTAND KNEE REPLACEMENTS, STICK AROUND.

WATCH THIS HIP ACTION.

♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ >> HELLO AND WELCOME TO CYCLE OF HEALTH, I'M DR. RICH O'NEILL.

TONIGHT'S TOPIC: ORTHOPEDIC SURGERY AND ROBOTS.

WELL, NOT TOO LONG AGO, MY HIP WAS SAYING OUCH, OUCH, OUCH, AND PHYSICAL THERAPY CAN NO LONGER QUIET IT DOWN.

MY ORDERS PEEDIC SURGEON SAID BONE ON BONE, READY FOR A NEW ONE AND SAID HIS ASSISTANT IS A ROBOT.

WE TALK ABOUT MY JOURNEY TODAY WITH THE MAN DIRECTING THE ROBOT AND EXPLORE THE PRECISION AND PERSONALIZATION ROBOTS ADD TO A SURGEON'S SKILL FOR BOTH KNEES AND HELPS.

LET'S MEET MY GUEST DR. TIMOTHY DAMRON, ORTHOPEDIC ONCOLOGY AND JOINT RECONSTRUCTIVE SURGEON AT UPSTATE ORTHOPEDICS AT SUNY UPSTATE ORTH PEED YOU CANS.

HOW DOES SOMEBODY KNOW THEY'RE READY FOR A NEW HIP?

>> I NEVER TELL A PATIENT THEY NEED TO HAVE A HIP REPLACEMENT.

HAVE YOU TO GET TO THE POINT WHERE YOU HAVE EXHAUSTED ALL OF THE OTHER MEASURES OF CARE, TAKEN ANTIINFLAMMATORYER TO ACTIVITIES, ON LOSE SOME WEIGHT.

DO INJECTIONS IN THE HIP BUT WHEN WE GET TO THE POINT WHERE IT IS AFFECTING YOUR LIFESTYLE AND YOU CAN'T WALK VERY FAR WITHOUT ANY PAIN.

>> THAT WAS ME, UP THE STAIRS, OUCH, OUCH.

>> SO THEN IT'S TIME TO CONSIDER IT.

AND HAVE YOU TO, AT THAT POINT, CONSIDER AM I WILLING TO TAKE THE RISKS AND GO AHEAD WITH THE SURGERY.

>> WHAT ARE THE RISKS OF A NEW HIP?

>> WELL, LIKE ANY SURGERY, INFECTION, WOUND HEALING PROBLEM, YOU CAN HAVE ANESTHETIC COMPLICATIONS BUT THESE ARE TINY RISKS.

SPECIFICALLY FOR HIP REPLACEMENTS EARLY ON, INFECTION IS THE BIG CONCERN.

AND AGAIN, SMALL RISK BUT THEY DO OCCUR.

THE BALL CAN POP OUT OF THE SOCKET SO DISLOCATIONS.

THERE CAN BE BE A DIFFERENCE IN THE LEG LENGTHS AT THE END OF THE DAY BUT WHEN WE LEARN WHO TO GET RID OF THOSE DIFFERENCES IN THE LEG LENGTH.

>> MY SON-IN-LAW HAD-- MY SISTER-IN-LAW HAD ONE DONE SIX OR EIGHT YEARS AGO AND ENDED UP WITH LEGS TWO DIFFERENT AND HAD TO PUT A LIFT IN HER SHOE.

>> RIGHT.

WE REALLY HAVE TO DO THAT-- WE RARELY HAVE TO DO THAT ANYMORE.

LONG-TERM DOWN THE ROAD, THE MAIN PROBLEM IS LOOSENING OF THE IMPLANT, THE INTERFACE OF THE BONE AND PROS TEASE IS, YOU CAN GET LOOSENING.

>> WHO IS A GOOD CANDIDATE FOR FOR A NEW KNEE OR HIP.

>> SOMEBODY WHO HAS BAD SEVERE OR MODERATELY SEVERE ARTHRITIS, BONE ON BONE OR CLOSE TO BONE ON BONE.

IT HAS TO BE SOMEBODY WHO HAS TRIED ALL THE CONSERVATIVE MEASURES FOR MORE THAN SIX MONTHS OR LONGER.

AND THAT IS SO FUNCTIONALLY DISABLED THAT THEY CAN'T EVEN WALK A QUARTER MILE WITHOUT PAIN.

ONCE YOU REACH THAT POINT, THEN YOU ARE A CANDIDATE AND THEN IT JUST BECOMES A DISCUSSION OF ARE YOU READY TO DO IT OR NOT.

BECAUSE AGAIN, I DON'T TELL PEOPLE YOU NEED TO HAVE IT.

IT'S NOT LIKE HAVING CANCER OR HEART DISEASE.

YOU DON'T NEED TO HAVE A HIP REPLACEMENT.

IT IMPROVES YOUR LIFESTYLE BUT HAVE YOU TO MAKE THAT DECISION.

>> I HAD ABOUT FIVE MONTHS OF PRETTY SERIOUS PHYSICAL THERAPY AND I WAS DISCIPLINE ABOUT IT.

PREVIOUSLY IT HAD WORKED, TWO OR THREE TIMES OVER THE LAST 25 YEARS AND THEN THIS TIME AROUND, IT DIDN'T DO ANYTHING.

I WAS RUNNING AND EVERY STEP HURT AND GOING UP THE STAIRS HURT.

WHEN I WENT TO MY PRIMARY CARE DOC TO TALK ABOUT WHETHER I NEEDED A NEW HIP, I ASKED HIM, HOW LONG DO THEY LAST?

AND HE SAID WELL, IT WILL LAST A LIFETIME.

THEN I WENT HOME AND I THOUGHT HE LEFT OFF THE PART WHERE HE DIDN'T SAY FOR SOMEBODY YOUR AGE.

SO HOW LONG DO THEY REALLY LAST?

>> WELL, YOU KNOW, FOR MOST PEOPLE, THEY DO LAST THE REST OF THEIR LIFETIMES.

TEMLY WE LOSE ABOUT A HALF TO 1% OF IMPLANTS A YEAR AND WHEN WE SAY LOSE, HAVE A MAJOR COMPLICATION THAT REQUIRES THE HIP BE TAKEN OUT AND MAYBE PUT BACK IN IN A DIFFERENT FASHION OR DIFFERENT TYPE.

IF YOU GET AN INFECTION, ONE OF THE MORE COMMON WAYS TO TREAT THAT IS TO TAKE THE IMPLANT OUT AND THEN TREAT IT WITH ANTIBIOTICS AND EVENTUALLY PUT IT BACK IN BUT THAT'S CONSIDERED A FAILURE SO YOU ARE LOSING THAT HIP REPLACEMENT.

THAT'S LIKE THE ONE HALF TO 1% EVERY YEAR.

BUT THE VAST MAJORITY OF PATIENTS DEGRADE.

SO, YOU KNOW, 20 YEARS DOWN THE ROAD, YOU KNOW, 85 TO 90% OF THE PATIENTS STILL HAVE THEIR HIPS.

>> SO I CAN HOPEFULLY BEAT THE ODDS AND BE IN THE 80% RATHER THAN IN THE 20% AND KEEP GOING WITH THIS HIP.

SO WHEN YOU SAY SUCCESS RATE, HOW DO YOU DEFINE SUCCESS?

GETTING THE HIP IN THERE AND THE PERSON IS PAIN FREE, WHICH IS TRUE FOR ME.

NO PAIN ANYMORE WHILE I'M TALKING OR I CAN BIKE, YOU KNOW, WHICH IS WONDERFUL.

I CAN RUN, BUT I KNOW IT'S NOT SUPPOSED TO BE A GOOD IDEA TO RUN BECAUSE YOU MIGHT WEAR IT OUT SUCCESS IS DIFFERENT FOR EVERY PERSON.

IT'S WHAT THE PERSON REALLY WANTS TO ACCOMPLISH.

FROM A SURGEON'S STANDPOINT, WE WANT TO SEE THAT THE PATIENT IS BACK TO THEIR NORMAL ACTIVITY, THAT THEY ARE NOT TAKING PAIN MEDICATION.

AND THEY DON'T NOTICE IT.

OTHER THAN SOMEONE ASKING, DID YOU HAVE A HIP REPLACE, THEY DON'T THINK ABOUT IT.

>> THAT'S TRUE FOR ME.

THE ONLY NOW FOUR MONTHS POST-SURGERY AS YOU KNOW.

THE ONLY THING THAT HAS BEEN HARD FOR ME, AFTER THE INITIAL FIRST MONTH WHEN IT WAS TOUGH WITH ALL SORTS OF STUFF, WE CAN TALK ABOUT THAT LATER.

BUT THE ONLY THICK THAT HAS BEEN HARD IS BENDING TOWARDS THAT FUTURE AND JUST THE OTHER DAY I WAS ABLE, AFTER A LOT OF STRETCHING AND I WAS ABLE TO TIE MY SHOE, WHICH WAS LIKE A PARTY, YOU KNOW, I WAS SO HAPPY THAT I COULD TIE MY SHOE.

IS THAT UNUSUAL THAT PEOPLE HAVE TROUBLE BENDING TO THAT... >> DID YOU TALK TO YOUR PHYSICAL THERAPIST ABOUT THAT?

>> YES.

>> WHAT DID THEY SAY?

>> THEY SAID IT WAS UNUSUAL.

>> WERE THEY TALKING ABOUT YOU OR POST-OP RECOVERY?

>> I TRY TO HAVE THEM-- I USUALLY REFER TO MYSELF AS UNIQUE DOCTOR, NOT UNUSUAL BUT PEOPLE SOMETIMES SAY I'M UNUSUAL.

>> MOST PATIENTS DON'T HAVE THAT PROBLEM AFTERWARDS, PARTICULARLY WITH AN ANTERIOR APPROACH, WITH THE POSTERIOR APPROACH, WE LIMIT THE DIFFERENT POSITIONS YOU ARE IN FOR THE FIRST SIX WEEKS OR SO AND YOU DON'T WANT TO GO INTO THAT POSITION, BUT WITHIN ANTERIOR APPROACH, YOU DON'T HAVE TO WORRY ABOUT THAT.

>> MEANING YOU PUT IT IN FROM THE FRONT, YOU DON'T DO INCISIONS IN THE BACK.

THAT'S THE POSTERIOR.

>> YES.

>> SO WHAT ARE THE BENEFITS OF THE ROBOTIC ASSIST?

>> SO BASICALLY WE ARE ABLE TO DO A REPLACEMENT VIRTUALLY BEFORE YOU GO IT.

WE GET A SCAT SCAN-- CAT SCAN AND THEN WE KNOW EXACTLY WHAT YOUR ANATOMY IS AND THEN WE CAN FIDDLE WITH IT ON THE COMPUTER AND WE CAN PUT IN A VIRTUAL HIP REPLACEMENT SO WE KNOW WHAT SIZE WE ARE GOING TO PUT IN, WHAT ORIENTATION.

THE ORIENTATION IS IMPORTANT BECAUSE OF STABILITY.

YOU WANT TO HAVE A HIP IN THAT WILL BE STABLE BUT AT THE SAME TIME NOT LIMIT YOUR RANGE OF MOTION.

AND THAT IS A VERY PRECISE THING.

SO WE CAN DIAL THAT IN VERY PRECISELY ON THE COMPUTER AND THEN JUST REPRODUCE IT IN THE OPERATING ROOM.

AND THE SAME THING GOES FOR THE LEG LENGTHS.

WE KNOW WITH THE C.T.

SCAN WHAT THE DIFFERENCE IS AT THE BASELINE AND THEN AT THE END, WE CAN FINE TUNE SO WE KNOW EXACTLY WHERE WE ARE ENDING UP RELATIVE TO WHERE WE STARTED AND TO THE OTHER LIMB.

SO LIKE WE ALLUDED TO EARLIER ABOUT THE LIMB LENGTH DISCREPANCY, WE CAN DIAL IT IN WITHIN A MILLIMETER USUALLY.

SO, YOU KNOW... >> A MILLIMETER THAT'S GREAT.

THAT'S AMAZING.

YOU ARE REALLY DOING A TRIAL RUN ON THE COMPUTER WITH THE EXACT MODEL OF MY HIP, OR NEIGHBOR'S AND YOU FIT IT IN THERE AND THEN YOU COME INTO THE OPERATING ROOM AND THE SAME IMAGE POPS UP.

>> YEAH.

>> AND THEN... >> WHAT WE DO FROM THERE, WE HAVE THE IMAGE ON THE SCREEN, THE COMPUTER KNOWS WHAT THE ANATOMY LOOKS LIKE BECAUSE OF THE CT SCAN BECAUSE THAT'S UPLOADED INTO IT BUT WHAT IT DOESN'T KNOW EXACTLY WHERE THAT IS IN SPACE SO WE CAN'T BRING THE INSTRUMENTS IN AND PUT THEM IN UNTIL THE COMPUTER KNOWS WHERE THE ANATOMY IS.

SO THEN WE HAVE TO PUT A RAISE INTO THE PELL MEDICAL ADVICE-- PELVIS A RAY IN AND THEN WE TAKE A TRACER THAT HAS A RAY ON IT AND TRACE OUT THE ANATOMY OF THE PELVIS ONCE WE HAVE EXPOSED IT AND THAT ALLOWS THE COMPUTER TO KNOW EXACTLY WHERE THE C.T.

SCAN PELVIS IS IN SPACE.

THEN ONCE IT KNOWS WHERE IT IS IN SPACE, THEN WE CAN JUST GO AHEAD AND BRING THE ROBOT IN AND ONCE WE GET IT CLOSE TO THE RIGHT POSITION, IT LOCKS IT IN AND THEN ALL WE NEED TO DO IS MOVE THE INSTRUMENT BACK AND FORTH.

>> THAT'S INCREDIBLE.

SO YOU ARE LINKING THE COMPUTERIZED IMAGE TO MY BODY IN THIS INDICATION AND YOU WHEEL THE COMPUTER IN, IT SAYS YOU ARE RIGHT THERE AND YOU ARE LOCKED INTO WITHIN A MILLIMETER ONCE YOU ARE LOCKED IN AND THE BODY AND COMPUTER ARE LINED UP, WHAT DOES THE ROBOT DO?

>> PEOPLE ASK, YOU KNOW, YOU SIT IN THE ROOM WITH YOUR COFFEE AND TOGGLE SWITCH.

>> AND THEN YOU GO OUT AND SEND THE BILL, RIGHT?

>> IT DOESN'T WORK THAT WAY.

IT'S CALLED HAPTO ROBOTICS.

WE USE THE ROBOT TO HELP US AND SO BASICALLY ONCE WE GET IT LOCKED INTO POSITION FOR THE REPAIRING OF THE SOCKET IN THE PELVIS, WE HAVE LIKE A CHEESE GRATER, YOU GO IN THERE... AND WE SQUEEZE THE TRIGGER.

IT HOLDS IT IN THE RIGHT POSITION.

WE MOVE IT INTO THE BONE.

YOU CAN SEE ON THE SCREEN WHAT BONE YOU HAVE TAKEN AWAY AND IT GETS YOU TO THE POINT WHERE YOU KNOW YOU ARE EXACTLY IN THE RIGHT POSITION AND IT DOESN'T LET YOU MOVE OUT OF BOUNDS.

IT KEEPS YOU IN THE EXACT POSITION THAT YOU DIALED IN ON THE C.T.

SCAN.

>> LIKE A VERY SOPHISTICATED LANE ASSIST ON MY NEW CAR.

>> I DON'T LIKE LANE ASSIST.

>> .

I DON'T LIKE IT BUT I LIKE THE ROBOT.

AFTER YOU PREPARE THE SOCKET, HAVE YOU TO TAKE THE IMPLANT AND PUT IT IN.

THAT IS DONE WITH THE ROBOT, TOO.

YOU TAKE OUT THE CHEESE GRATER AND PUT IN A THING THAT HOLDS THE SOCKET, THE METAL SOCKET, DIALS IT IN AND THEN IT'S GOT A TOOL OR SORT OF HIP PLATE ON THE BACK END AND YOU BRING IT IN AND LOCK IT IN POSITION BUT YOU STILL HAVE TO TAKE THE BIG MALLET AND HIT IT AND HIT IT INTO POSITION.

AND AGAIN, YOU CAN GET FEEDBACK FROM THE COMPUTER.

IT TELLS YOU HOW FAR HAVE TO GO TO GET IT DOWN.

WE WANT TO GET IT DOWN TO ZERO BUT WE CAN GET IT WITHIN A MILLIMETER.

>> THIS IS WHY, WHETHER I WHEN I CAME TO SEE YOU AFTER THE OPERATION AND YOU SAID TO ME, HOW ARE YOU FEELING?

AND I SAID TO YOU IF I CAME OVER THERE AND GAVE YOU A COUPLE OF GOOD PUNCHES, YOU WOULD KNOW EXACTLY HOW I FELT.

THAT'S WHY, BECAUSE YOU WERE HITTING ME WITH A MALLET.

ONE OF THE UNEXPECTED BENEFITS FOR ME OF THE HIP SURGERY WAS I HAD BACK PAIN AND THAT WENT AWAY FOR YEARS ON AND OFF I WOULD HAVE PAIN IN MY BACK.

I DON'T HAVE THAT ANYMORE.

>> DID THEY ADD THAT TO YOUR BILL.

>> NO, THEY DIDN'T DO THAT.

[LAUGHTER] AND DON'T TELL THEM ON THE WAY OUT THAT THEY SHOULD.

ONE OF THE THINGS THAT WAS SURPRISING TO ME IS THAT I WAS EXPECTING, YOU KNOW, I TALKED TO HALF A DOZEN PEOPLE BEFORE-- WHO HAD HAD THEIR HIPS DONE BEFORE I HAD THE OPERATION, INCLUDING MY BROTHER.

EVERYBODY SAYS IT IS AMAZING.

YOU HAVE THE HIP DONE, THREE OURS LATER YOU ARE WALKING AROUND ON THE FLOOR, YOU HAVE NO PAIN AND THEY DON'T TELL YOU THAT THE NEXT COUPLE OF WEEKS IS REALLY A PAIN, YOU KNOW, FOR ME, ONE OF THE THINGS FOR ME WAS MY LEG REALLY SWELLED UP AND IS THAT, AGAIN IS THAT AN UNUSUAL THING?

WHEN I WOULD STAND UP, IT WAS VERY PAINFUL FOR ME TO STAND UP BECAUSE THE FLUID, IT FELT LIKE IT WAS RUSHING DOWN TO MY ANKLE.

IS THAT TYPICAL?

>> EVERYBODY IS DIFFERENT.

EVERY POST-OP COURSE IS UNIQUE.

SOMETIMES A PATIENT WILL COME BACK FOR A SECOND JOINT AND I'LL JUST KIND OF SAY LISTEN, THE SECOND JOINT IS NEVER GOING TO BE LIKE THE FIRST JOINT.

EVERYBODY HAS NUANCES OR SYMPTOMS THAT THEY HAVE AND EVERYBODY IS DIFFERENT.

SO WHAT YOU EXPERIENCED IS UNIQUE TO YOU I PROBABLY HEARD OF THAT BEFORE BUT IT'S NOT THE USUAL POST-OP COURSE.

>> I WAS SURPRISED.

I THOUGHT I WAS TOO OPTIMISTIC.

I THOUGHT I WOULD BE BACK TO WORK IN A COUPLE OF DAYS AND THEN I HAD ALL THESE PHYSICAL THERAPY TOOLS THAT HELP ME PICK THINGS UP FROM THE FLOOR AND AND MY WIFE WOULD PUT THIS THING AROUND MY BACK WHEN I WAS GOING DOWNSTAIRS SHE COULD HOLD ON TO ME SO I DIDN'T LOSE MY BALANCE AND THAT TO WAS A SURPRISE TO ME.

IT TOOK LONGER TO RECOVER.

IT WAS TRUE.

IT WAS AMAZING TO BE WALKING AROUND A COUPLE HOURS LATER AND HAVE NO PAIN.

THAT PAIN WAS TOTALLY GONE.

AND THEN I THINK THE NERVE BLOCK WORE OFF AND WHEN THE NERVE BLOCK WORE OFF, IT WAS A DIFFERENT STORY.

>> I THE I WARN PATIENTS THE PAIN IS WORSE THE SECOND DAY BECAUSE THAT'S WHEN THE BLOCK WEARS OFF.

>> THAT WAS TRUE.

>> DOESN'T MEAN THERE IS A BEEN.

>> IT'S JUST THE BLOCK HAS GONE AWAY.

LET'S TALK ABOUT KNEE.

I HOPE I NEVER HAVE TO HAVE A KNEE, BUT YOU USE THE ROBOT TO HELP WITH KNEES, TOO.

HOW DOES THAT GOES?

>> WE USE THE ROBOT NOT ONLY FOR HIPS BUT TOTAL KNEES AND PARTIAL KNEES.

THERE ARE THREE COMPARTMENTS WITH THE KNEES.

WITH THE ROBOT, IT'S THE SAME PRINCIPLE, SO WE GET A CAT SCAN OF THE KNEE BEFORE HND WHAT-- BEFOREHAND.

WE HAVE THE ENTIRE LIMB BASICALLY.

WE HAVE THE WHOLE ACCESS OF THE LIMB.

AND THEN IT'S THE SAME PROCESS.

WE DO A VIRTUAL REPLACEMENT WITH THE SIZES AND POSITIONS ON THE COMPUTER BEFOREHAND AND THEY BE ONCE WE COME IN THE OPERATING ROOM, WE DO THE SAME THING, WE REGISTER THE LEG, REGISTER THE MOTION, THE CENTERS OF ROTATION, WE PUT A COUPLE OF PINS IN THE FEMUR, IN THE TIBIA, THEY HAVE A RAYS, THEY COMMUNICATE BY INFRARED AND THEN WE BRING THE SAW IN ONCE WE GET EVERYTHING REGISTERED AND THE ROBOT KEEPS US IN THE RIGHT POSITION.

WE MAKE ALL THE CUTS AND THEN WE JUST TRIAL EVERYTHING, ASSESS THE RANGE OF MOTION, STABILITY DURING THE PROCEDURE LIVE SO WE CAN... >> YOU CAN ASSESS THE RANGE OF MOTION OF THE KNEE.

>> STABILITY, ALIKEMENT,-- ALIGNMENT EVERYTHING.

IT'S A GREAT TOOL TO GET IMMEDIATE FEEDBACK.

>> SO I'VE HEARD FROM EVERYBODY I'VE HEARD FROM, INCLUDING MY SISTER-IN-LAW WHO I TALK ABOUT THE HIP EARLIER, SAYS EVERYBODY I'VE HEARD FROM SAYS KNEES ARE MORE DIFFICULT TO RECOVER FROM.

>> ABSOLUTELY.

I TRY TO EMPHASIZE TO MY PATIENTS THE THREE Ps WITH KNEES.

THREE Ps.

PAIN, BECAUSE THEY'RE VERY, VERY PAINFUL.

ONE OF THE MOST PAINFUL OPERATIONS YOU CAN HAVE.

YOU HAVE TO BE MENTALLY PREPARED FOR THE PAIN.

THEN PHYSICAL THERAPY, HAVE YOU TO WORK REALLY HARD IN PHYSICAL THERAPY.

KNEES TEND TO GET STIFF.

SO IT'S NOT LIKE HIPS WHERE YOU GET UP AND WALK.

KNEES GET STIFF UNLESS YOU DO THE PHYSICAL THERAPY.

HAVE YOU TO FIGHT THROUGH THE PAIN AND DO THE PHYSICAL THERAPY.

>> AND WHAT IS NUMBER 3.

>> PATIENCE.

>> YOU HAVE TO BE PATIENT TO WORK THROUGH IT.

I CAME UP WITH THE THREE PS AND ONE OF MY PATIENT SAID WHAT ABOUT PERSISTENCE?

PERSISTENCE.

>> BUT I CAN ONLY COUNT UP TO THREE.

>> SO YOU REALLY HAVE TO PERSIST.

IN FACT, MY SISTER-IN-LAW AGAIN SAID SHE USED TO GO TO PHYSICAL THERAPY AND CRY SOMETIMES IT WAS SO PAINFUL.

SO YOU REALLY HAVE TO DO THE DO.

YOU HAVE TO REALLY STICK WITH IT AND TOLERATE THE PAIN WITH THE HOPE THAT WILL YOU HAVE A GOOD RANGE OF MOTION AND NO PAIN LATER ON.

I HOPE I NEVER HAVE TO HAVE THAT DONE IT WAS DIFFICULT TO DO THE HIP.

BUT THE KNEE SOUNDS REALLY TOUGH.

I NOTICE MY INCISION IS LIKE ALONG THE BIKINI LINE.

I DON'T GO AROUND WEARING A SPEEDO BUT IS THIS THAT DIFFERENT THAN TYPICALLY?

I WOULD HAVE IMAGINED A VERTICAL INCISION.

>> FOR THE ANTERIOR APPROACH, SOME PEOPLE DO IT VERTICAL.

I DO IT THIS WAY.

I STARTED OUT DOING IT VERTICAL AND I FOUND THAT FOR THE SOFT TISSUES, IT'S EASIER TO NOT HAVE A PROBLEM WITH THE SOFT TISSUES IF I MAKE IT IN THAT ORIENTATION.

AND THERE ARE A LOT OF PEOPLE THAT DO IT THAT WAY AS WELL.

>> SO YOU MAKE THAT INCISION AND THEN YOU ARE ACTUALLY SEPARATING THOSE TISSUES TO WORK IN THERE, MAKING A SPACE.

>> RIGHT.

>> BUT ONE OF THE ADVANTAGES OF THE ANTERIOR APPROACH IS THAT YOU ARE NOT DETACHING MUSCLES FROM THE BONE.

SO WITH THE POSTERIOR APPROACH, YOU ARE DETACHING SOME OF THE MUSCLE INSERTIONS ON TO THE BONE AND THEN HAVE YOU TO REPAIR THEM AT THE END.

AND IF YOU DON'T GET A GOOD REPAIR, THEN IT CAN CONTRIBUTE TO INSTABILITY SO YOUR BALL HAS A HIGHER CHANCE OF POPPING OUT, JUST A LITTLE BIT HIGHER WITH THE POSTERIOR APPROACH OPPOSED TO THE ANTERIOR PROACH THEORETICALLY.

>> SO THAT-- I'M GLAD I GOT THE AN ANTERIOR APPROACH AND BIKINI INCISION.

>> AND THERE ARE THREE LITTLE D.O.T.S ON THE OTHER SIDE.

IS THAT WHERE YOU LINE UP THINGS FOR THE COMPUTER, CALL IT AN ARRAY?

>> RIGHT, SO WHEN WE DO AN ANTERIOR APPROACH, YOU ARE LAYING ON YOUR BACK, WE MAKE THE INCISION HERE AND PUT THE PINS IN A RIGID AREA OF YOUR PELL ADVICE.

-- THE PELVIS ATTACHED TO THE RAY ON THE COMPUTER.

THEY HAVE TO BE OUT OF THE WAY.

SO WE PUT THEM ON THE OTHER SIDE.

IF IT'S A POSTERIOR APPROACH, WE CAN PUT THEM ON THE SAME SIDE OF THE PELVIS BUT NOT IN THE WAY.

>> WE JUST GOT ABOUT TWO MINUTES LEFT.

ANY LAST THINGS YOU WANT TO TELL OUR VIEWERS ABOUT HIPS AND KNEES?

>> I THINK IT IS REALLY ADDED IF I HAD TO HAVE JOINT REPLACEMENT.

I WOULD HAVE IT WITH THE MACO PLASTY.

I REMEMBER WHEN WE USED TO DO THEM THE OLD FASHIONED WAY, LINING THINGS UP, EVERY ONCE IN A WHILE WOULD YOU GET AN X-RAY THAT AND THEN SAY IT IS NOT THE WAY I WANT IT.

THAT'S THE ADVANTAGE.

YOU ELIMINATE THE OUTLIERS BECAUSE IT'S VERY REPRODUCIBLE.

YOU GET THE SAME RESULT YOU DIAL IN ON THE CAT SCAN.

YOU HAVE THE FUNNIEST JOKE I HAVE EVER HEARD IN A DOCK ARE TO.

RIGHT AFTER THE OPERATION YOU CAME INTO MY ROOM AND I SAID HOW DID IT GO?

AND YOU SAID IT MAY HAVE BEEN MY BEST ONE EVER.

AND THEN YOU PAUSED AND YOU SAID TODAY ANYWAY.

AND THEN YOU SAID AND OF COURSE YOU WERE MY FIRST ONE, SO IT'S LIKE... [LAUGHTER] THAT IS PERFECT.

THAT'S JUST ABOUT ALL THE TIME WE HAVE DOCTOR.

I WANT TO THANK OUR GUEST DR. TIMOTHY DAMRON, PROFESSOR OF ORTHOPEDIC ONCOLOGY AND JOINT RECONSTRUCTIVE SURGEON AT UPSTATE ORTHOPEDICS NOW, LET'S TAKE A MOMENT TO LIGHTEN THE MOOD WITH A DASH OF HUMOR.

LAUGHTER DOESN'T JUST BRIGHTEN OUR DAY; IT ALSO COMES BEARING SCIENTIFICALLY-PROVEN HEALTH PERKS WHO IS THE COOLEST DOCTOR IN THE HOSPITAL?

>> I DON'T KNOW, RICH.

WHO?

>> THE HIP SURGEON >> THERE YOU GO.

>> HOW DO YOU FIX A BROKEN PUMPKIN?

>> I DON'T KNOW, RICH.

HOW DO YOU FIX IT?

>> WITH A PUMPKIN PATCH.

[LAUGHTER] IF YOU'D LIKE TO SUBMIT A JOKE TO BE SHARED DURING OUR "LAUGHTER IS THE BEST MEDICINE" SEGMENT OR TO SEE MORE OF OUR PROGRAM, VISIT WCNY.ORG/CYCLEOFHEALTH.

TO HEAR OUR NEW COMPANION COMMUNITY FM RADIO SHOW, CHECK UP FROM THE NECK UP, VISIT WCNY.ORG/COMMUNITYFM FOR 'CYCLE OF HEALTH,' I'M PSYCHOLOGIST DR. RICH O'NEILL.

ENJOY THIS WEEK'S MINI CHECK UP FROM THE NECK UP.

THANKS FOR CHECKING IN.

♪ ♪ ♪ ♪ >> HI, I'M PSYCHOLOGIST Dr. RICH O'NEILL WITH THIS WEEK' CHECKUP FROM OUR NECK UP.

WHERE THE HECK ARE MY CAR KEYS!

OR GROW THE HIPPO.

WELL, FOLKS, I REMEMBER BEING TAUGHT AS A KID THAT BRAIN CELLS DIFFER FROM ALL THE OTHER CELLS IN THE BODY DIE AS WE AGE.

AND NO NEW ONES GROW TO REPLACE THEM.

AND THAT WAS WHY WE SUPPOSEDLY LOST SOME THINKING ABILITY AND MEMORY AS WE AGE.

YOU REMEMBER THAT, TOO?

WATCH OUT THIS IS A TEST.

BUT NOW, RESEARCH SAYS WHOA NELLY, NOT SO FAST, NO THE TRUE!

FOR EXAMPLE, 1 DIS 0 SEDENTARY OLDER MEN AND WOMEN COUCH POTATOES HAD THEIR BRAINS MEASURED AND RANDOM RANDOMLY ASSIGNED TO BRISK WALKING FOR 40 MINUTES OR STRETCHING AND TONING FOR THE SAME AMOUNT OF TIME.

A YEAR LATER, THE WALKERS HAD 2% GROWTH OF THE PART OF THE BRAIN IN CHARGE OF LEARNING IN MEMORY.

THE HIPPO CAMPUS.

THAT'S WHERE HIPPOS GO TO COLLEGE.

MEANWHILE, THE STRETCHERS AND TONERS HAD A 1.LOG LOSS IN HIPPO SIZE AND THE WALKERS MEMORIES TESTED BETTER, TOO, ESPECIALLY SPATIAL MEMORY SUCH AS IN WHERE THE HECK ARE MY CAR KEYS?

AND REMEMBER, THIS WAS FROM JUST BRISK TOAD WILLING AROUND.

SO IF YOU WANT A BETTER CHANCE OF FINDING YOUR CAR KEYS AND MUCH MORE IMPORTANT, STAYING OUT OF THE NURSING HOME BECAUSE ACTIVE PEOPLE ARE LESS LIKELY TO GET ALZHEIMER'S, DON'T THINK EXERCISE.

THINK SFUNNERCISE, THINK NO PLEASURE, NO TREASURE.

IF BRISK WALKING ISN'T FOR YOU, GO SWIMMING, HORSE BACK RIDING, CHASING THE GRANDKIDS, WHATEVER YOU LIKE THAT GETS THE HEART RATE UP AND MAKE IT FUN.

COME TO THINK ABOUT IT, NEXT TIME WE LOSE OUR KEYS, WE CAN JUST GET A WIGGLE ON IT AS MY MOM WOULD SAY, AND ZIP AROUND LOOKING FOR THEM.

SO THE NEXT, NEXT TIME WE LOSE THEM, WE MIGHT REMEMBER WHERE THEY ARE.

HEY, GOT TO GO TAKE MY HIPPO FOR A WALK.

SEE YA.

I'M Dr. NECK-UP RICH, GROW THE HIPPO O'NEILL.

THANKS FOR CHECKING IN.