About once a month in my physical therapy practice, I hear something like ‘I need to have my knee replaced and my friend said I simply MUST go to the surgeon they went to in (insert downstate metro area here). Do you think I’ll have a better outcome if I go there instead of seeing someone local? You see the results from different surgeons, so I figure you would know.’

This question came up a few years ago when I was co-hosting a presentation on hip surgery with an orthopedic surgeon. His reply was brilliant, which I’ll summarize to the best of my recollection: ‘When I was operating in the UP, patients just had to go to Petoskey or Traverse City for the “best” surgeon. When I was in Petoskey, patients had to go downstate for it. When I was downstate, the Cleveland Clinic was the place to go. My colleagues there were asked if the pinnacle of care was out west at the Steadman Clinic in Colorado or at Mayo. People in Colorado were told that the best surgeons were in Houston. My Houston colleagues would be asked if California was where the true virtuosos operated. So, the “best” surgeon always seemed to be south for a stretch, then west, then south again, then west again.’ His coy smile by the end of that story punctuated his message.

After relaying that story to patients, I usually finish with something like ‘So no, I do not think you need to travel out of the area to find an excellent joint surgeon. When the logistics of traveling again downstate for follow-up care at 2 weeks and then 6-12 weeks post-op are considered, you can find great care locally, unless your knee is very complicated, or you need a revision of a previous surgery.’

However, since my guest for this column established his practice this past August, my answer is simply “No”.

Dr. Josh Anderson, MD, is an orthopedic surgeon at Bay Street Orthopedics who specializes in complex revisions of hip and knee replacements, so I reached out to him to hear more about his specialty.

Under what circumstances is a hip or knee revision typically necessary? With contemporary total hip and knee replacements, the most common reasons for revision surgery are loosening of the implants from where they are fixated to your bone, instability, and prosthetic joint infection. For instability following a total hip, this typically means recurrent dislocations. Instability after a total knee is when there is too much laxity in the knee. Patients typically do not trust their knee and have a lot of pain in the muscles around the knee.  While deep infections of a prosthetic joint can be quite dramatic in presentation, sometimes they are more subtle and present only with lingering pain.

How does a revision differ from the initial joint replacement surgery? It depends on what the indication for revision surgery is.  Revision surgery can be relatively straightforward but often it is more extensive from a technical standpoint.  Rehabilitation after a revision is typically very similar to what it was after the first-time hip or knee replacement in my practice.  Most often, I am removing some or all the main components of the initial replacement and putting in parts that are designed for revision surgery.

Does a surgeon need special training to perform a joint replacement revision? If so, what does that training entail? Typically, these are surgeons who went through a fellowship in adult reconstruction/total joints.  This involves an additional year of training specifically in hip and knee replacements and revisions of hip and knee replacements.  It provides an added level of expertise for these more complicated surgeries and problems.

Before you settled in the area, would local patients need to travel outside our area to get this level of care? For patients seeking a surgeon with subspecialty fellowship training in total joints, for patients requiring complicated revision surgery, or for patients requiring a more complicated first-time hip or knee replacement, yes. These patients often required referrals outside of this area and several hours of travel each way. Fortunately, I can now take care of these patients closer to home!

What is your favorite thing about your specialty? The impact I can have on my patients. Helping relieve pain, restore function, and get my patients back to the activities they want to participate in are the reasons I entered this field. Seeing this every day in my clinic is incredibly rewarding for my patients and myself. The biomechanics of hip and knee replacements as well as the technical aspects of the surgeries themselves continue to be exciting. The future of total joints is certainly bright. Additionally, I really enjoy helping patients who may not have had a good outcome with their first joint replacement and taking them through a revision surgery to deliver the best outcome.

What do you enjoy most about practicing in northern Michigan? The people. People in northern Michigan are very kind and compassionate. They are very resilient as well. This is something I see often after surgery. I am continually impressed with how quickly and how well the people of northern Michigan recover. Also, the beautiful scenery, water, wildlife, recreational opportunities, and sense of community can’t be beat. My family and I could not be happier to have settled here.