Session 62 Dr. Brock Howell is a community-based joint replacement trained Orthopedic Surgeon. We dive in and talk about his path and what you need to know about joints. Brock has been out of Fellowship now for two and a half years. Also, be sure to check out all our other podcasts on MedEd Media Network. [02:00] Interest in Being a Joint Specialist Throughout his third year of clinical training, Brock had no clue as to what he wanted to do. Although he found himself in between medicine and surgery. He knew wanted to go into surgery, just not what exactly in surgery he wanted to do. What he gravitated him towards orthopedics is that it's very tangible when for instance, you see a broken bone. And then it gets fixed. As opposed to things in medicine or GI where you tinker a bit and still have to wait for a result. Hence, there is that sense of instant gratification. As to why he chose joint replacement surgery, he liked that it's not a small surgery so you get to walk away and look at an x-ray and be able to change someone's life. Plus, you can do it in an hour or less. It's not a scope procedure where you just look at the sutures. And seeing patients before and after the clinic makes him happy. [05:05] Traits that Lead to Being a Good Joint Replacement Doc Brock says you have to be comfortable around older population. In some instances, you have to be real patient when it comes to those kinds of your patients. They would usually try conservative therapy for a long period of time before the surgery. That said, you have to be willing to go in and just make things work. You have to be able to adlib and be comfortable at times. "Sometimes in the big revision surgery, you're not necessarily knowing what you're getting into and you just have to be comfortable getting into a giant mess and trying to figure a way to get your way out." Revision surgery is where patient has already had a joint replacement. But for whatever reason, the joint replacement has failed. It could be that it's gotten infected or that the parts have come loose. A lot of times, you have to go in and deal with something someone else has been before. You may also have to get implants out of the bone whether they're grown into the bone like most hip surgeries or whether cemented in place. So you have to get implants out and deal with extensive bone loss. You'd have to get new implants in and use different types of implants into your normal primary or first time having a joint replacement surgery. So this is a big surgery and this can be tough. "It's a big surgery. It can be tough. You can run into a lot of things real fast and you just have to think on your feet to get your way out." [07:33] Situations Patients Need a Replacement Patients who undergo joint replacement would usually have undergone arthritis in the joint, whether primary degenerative osteoarthritis or something post traumatic for whatever reason. Brock often tells patients that it's not heart disease or cancer so it's not going to kill them. If they didn't have a joint replacement, they're not going to die. So he really doesn't rush anybody into it. He sees no reason to push someone into the replacement if they're not ready for it. Most patients coming in complain that they're not able to do the activities they want to do. They can't walk anymore or play tennis. So he leaves it up to the patient to assess their quality of life and if they're not able to handle it, then they could have the surgery done. [08:45] Community versus Academic As to why he chose community versus academic, the major factor was proximity to his family. He's in his hometown that he grew up in and his wife's family is less than two hours away. Also, you're an employee in most university setting practices so he wanted more of the private practice model where he could control things more on a day to day basis. Brock also cites the difference in the private practice as a joint replacement surgeon. You'd do a lot of primary joint rep