The Joint Replacement Podcast

Could better nutrition before surgery mean a smoother recovery afterward?

In Episode 60 of The Joint Replacement Podcast, Dr. Matthew Sloan welcomes Dr. Sagar Desai, a Toronto-based orthopedic surgeon specializing in foot and ankle reconstruction and founder of Proven Therapeutics.

Together, they explore an often-overlooked part of surgical preparation: nutrition.

How much protein should patients eat before hip or knee replacement? Can specialized supplements reduce muscle loss or complications? Should patients really fast from midnight before surgery? And what does the evidence actually show?

Dr. Desai discusses the science of immunonutrition, his experience developing a surgical nutrition supplement, and the challenges of translating research into clinical practice.

The conversation also explores total ankle replacement versus ankle fusion, the controversy surrounding surgical treatment of Achilles tendon ruptures, minimally invasive bunion surgery, and the unique demands of treating professional athletes.

Whether you're preparing for joint replacement, recovering from orthopedic surgery, or simply interested in optimizing surgical outcomes, this episode offers a wide-ranging discussion about preparation, recovery, and modern orthopedic care.

Guest: Dr. Sagar Desai

Host: Dr. Matthew Sloan

Learn more at MatthewSloanMD.com

Educational purposes only. Dr. Desai is the founder of Proven Therapeutics. Product-specific benefits have not been independently established in this episode.

Can an orthopedic surgeon design a better hip replacement implant than the major medical device companies?

Dr. Kurtis Biggs decided to find out.

In Episode 59, Dr. Matthew Sloan interviews Dr. Biggs, a fellowship-trained joint replacement surgeon from Naples, Florida, who developed his own femoral stem, taking it from a hand-drawn sketch at his kitchen counter to FDA clearance and implantation in patients.

They discuss why he believed traditional hip implants could be improved, how he designed the Xerxes femoral stem to better accommodate natural hip anatomy, and the challenges of developing and manufacturing an entirely new orthopedic device.

Dr. Biggs shares his early experience with approximately 130 implantations, including complications, revisions, and preliminary clinical observations.

They also explore how long hip replacements really last, whether cementless or cemented stems are better, the advantages and limitations of anterior hip replacement, and how large medical device manufacturers influence which innovations reach patients.

Most importantly, they confront a critical question: What evidence do we actually need before calling a new hip implant better than an established one?

An inside look at surgical innovation, medical device development, and the future of hip replacement.

Note: The Xerxes femoral stem has received FDA 510(k) clearance, but long-term clinical outcomes and comparative superiority remain unproven.

Learn more at MatthewSloanMD.com and subscribe to The Joint Replacement Podcast for weekly conversations about hip and knee replacement.

Are health insurance companies making money by denying patients the medical care they need?

Dr. Matthew Sloan welcomes Bryan Khoo, a Stanford graduate and incoming medical student at Washington University whose investigations into healthcare economics and insurance company practices have attracted national attention, including responses from Mark Cuban.

They explore why American healthcare continues to become more expensive, how prior authorization decisions are made, why some insurance denials are never appealed, and the growing controversy surrounding Medicare Advantage.

Bryan shares his perspectives on artificial intelligence in insurance reviews, post-surgical payment denials, corporate consolidation, physician reimbursement, and the future of independent medical practices.

The conversation also examines how insurance company financial incentives may influence patient access to surgery and what reforms could help restore the physician-patient relationship.

Who should control medical decisions: doctors or insurance companies?

Editorial Disclaimer: Specific insurance company and healthcare business names have been redacted from portions of this interview because Dr. Sloan and The Joint Replacement Podcast have not independently verified the underlying studies, statistics, or allegations discussed. The guest's research findings and opinions are his own and should not be interpreted as independently verified conclusions or established findings of misconduct.

Follow Bryan Khoo on LinkedIn and subscribe to The Joint Replacement Podcast for more conversations about healthcare, joint replacement, and medical innovation.

How can you tell whether a hip or knee replacement surgeon is actually good?

Dr. Matthew Sloan breaks down the five things patients should look for before choosing a joint replacement surgeon, including surgical volume, board certification, fellowship training, complication rates, revision rates, and the number almost nobody tells patients to ask about: patient-reported outcomes.

Patient-reported outcome measures track pain, function, and quality of life before and after surgery. They can reveal something an X-ray cannot: whether patients actually feel and function better after their joint replacement.

Dr. Sloan also explains why raw surgeon statistics can be misleading, how risk adjustment accounts for surgeons treating more complex patients, and why public reporting should avoid incentivizing surgeons to “cherry-pick” only healthier, lower-risk patients.

The episode also explores what a future national joint replacement scorecard could include: surgeon volume, training, complications, revisions, patient-reported improvement, and risk-adjusted comparisons with national benchmarks.

Until that kind of patient-facing system exists, patients may need to ask surgeons and health systems directly for their outcomes.

You can view Dr. Sloan’s own patient-reported outcomes at MatthewSloanMD.com.

The question to remember before surgery:

“Do you track patient-reported outcomes, and can I see them?”

Dr. Will Kang took an unusual path to orthopedic surgery.

Before becoming a physician, he was a classically trained violinist who earned a master’s degree in violin performance from the Cleveland Institute of Music and worked professionally as a musician. After years of intense practice and a repetitive-stress shoulder injury, he changed direction and ultimately became an orthopedic surgeon.

In this episode, Dr. Matthew Sloan talks with Dr. Kang about the similarities between elite musicians and athletes, repetitive-stress injuries in musicians, and what his experience as a patient taught him about treating musculoskeletal pain.

They then tackle some of the most common questions patients have about orthopedic care: When does an injury need evaluation? When do you actually need an MRI? Does every meniscus, labral, or rotator cuff “tear” need to be fixed? Which orthopedic operations may be performed too often? And when does surgery actually offer an advantage over nonsurgical treatment?

They also discuss cortisone, PRP, gel injections, regenerative medicine, exercise and joint health, and why significant arthritis on an X-ray doesn't necessarily mean you need a joint replacement.

The episode ends with three important questions every patient should ask an orthopedic surgeon before agreeing to surgery.

How do you know when it’s really time for a hip or knee replacement?

Dr. Matthew Sloan is joined by Dr. Randall Schultz, a board-certified orthopedic surgeon at Texas Orthopedics and creator of The Surgeon Unmasked. After more than three decades in orthopedic surgery and thousands of joint replacements, Dr. Schultz brings an especially unusual perspective to the conversation: he has also undergone a knee replacement himself.

Dr. Schultz shares what becoming a patient taught him about recovery, pain, expectations, and how difficult it can be to decide when surgery is finally necessary. He describes realizing that his own “world was shrinking” as arthritis gradually forced him to give up activities he valued.

They discuss:

• How to know when hip or knee arthritis is severe enough for surgery
• Whether you really need to be “bone on bone”
• Whether patients can wait too long for joint replacement
• Exercise, weight loss, cortisone, gel injections, PRP, and other nonsurgical options
• Partial versus total knee replacement
• How to choose a hip or knee replacement surgeon
• Whether surgeon volume matters
• Robotics versus computer navigation versus manual knee replacement
• Whether implant brands actually matter
• Anterior versus posterior hip replacement
• Subvastus and “minimally invasive” knee replacement approaches
• What knee replacement recovery actually feels like
• The role of the “quiet knee” approach after surgery
• Opioid-free joint replacement and realistic pain expectations
• What patients should understand before choosing surgery

Dr. Schultz also challenges some of the marketing surrounding modern joint replacement, arguing that technology and branded surgical approaches should not distract from the fundamentals: choosing the right patient, performing the operation well, and setting realistic expectations.

For patients considering hip or knee replacement, this episode offers the perspective of someone who has spent his career performing these operations — and has experienced knee replacement from the other side of the operating table.

Find Dr. Randall Schultz on YouTube at The Surgeon Unmasked and at TheSurgeonUnmasked.com.

Subscribe to The Joint Replacement Podcast on YouTube, Spotify, Apple Podcasts, or wherever you get your podcasts.

What happens to a joint decades before someone needs a replacement—and can we change that trajectory?

Duke orthopedic sports medicine surgeon Dr. Jocelyn Wittstein joins Dr. Matthew Sloan to discuss ACL injuries, post-traumatic arthritis, menopause, osteoporosis, cartilage health, and strategies for maintaining healthy bones and joints throughout life.

They discuss why ACL reconstruction does not eliminate the risk of arthritis, the importance of the meniscus, whether running causes arthritis, how menopause affects cartilage and joint inflammation, when women should consider bone-density testing, and how resistance training, nutrition, and activity modification may help preserve musculoskeletal health.

They also explore treatment options for mild to moderate arthritis, including anti-inflammatory medications, PRP, viscosupplementation, supplements, and how patients can decide which activities are still worth doing when a joint becomes symptomatic.

A fascinating conversation about what happens long before joint replacement—and the rapidly evolving science of preventing or slowing the path toward it.

Professor Fares Haddad joins The Joint Replacement Podcast to discuss how technology, robotics, and increasingly personalized surgical planning are changing hip and knee replacement.

We explore his career across arthroplasty, complex revision surgery, elite sports, research, and editorial leadership, and how his surgical philosophy has evolved toward three-dimensional planning, cruciate preservation, partial knee replacement, and functional alignment.

The centerpiece of the conversation is his recent randomized study of robotic-assisted versus conventional medial partial knee replacement. We discuss why partial knees may be particularly suited to robotics, improved implant positioning, differences in Forgotten Joint Score, criticisms of implant-to-implant comparisons, and whether increased precision is worth the added cost.

We also discuss the RACER trial, mechanical versus functional alignment, why precision alone may not improve outcomes if surgeons are aiming at the wrong target, and how predictive analytics could eventually help determine patient-specific implant positioning.

Finally, Professor Haddad shares his perspective as Editor-in-Chief of The Bone & Joint Journal on evaluating new evidence, answers whether robotic joint replacement is truly “better,” explains who may be a candidate for partial knee replacement, and describes why robotics may ultimately prove most valuable in complex hip and revision surgery.

“You’re too young for a joint replacement. Come back when you’re 60.”

Is that still good advice?

In this episode, Dr. Matthew Sloan breaks down how surgeons approach hip and knee replacement in younger patients and why chronological age is only one part of the decision.

We discuss why joint replacement was historically delayed in younger patients, how modern implant materials have changed expectations for longevity, and why a patient who has surgery at 40 still needs an honest conversation about lifetime revision risk.

We also explore the other side of the equation: what can happen when someone with severe arthritis spends years waiting. Loss of muscle, reduced activity, weight gain, poor sleep, inability to work or exercise, and progressive loss of quality of life all matter when deciding when surgery is appropriate.

Dr. Sloan also reviews conditions frequently seen in younger patients, including hip dysplasia, femoroacetabular impingement, avascular necrosis, previous ACL or meniscus injuries, fractures, and post-traumatic arthritis.

Finally, we discuss activity after joint replacement, revision surgery, and the key question younger patients should ask when they are told to wait:

“What exactly are we waiting for?”

The right time for joint replacement is not determined by a birthday. It is a balance between the severity of the disease, its effect on your life, the alternatives that remain, and the expected risks and benefits of surgery.

What does it really mean when your surgeon says you need “medical clearance” before a hip or knee replacement?

Hospitalist and internal medicine physician Tyler Thurman, DO (@hospitaldoctort), joins The Joint Replacement Podcast to explain why physicians often prefer the term risk stratification—and what they are actually looking for before a patient goes to the operating room.

We discuss cardiac risk, EKG abnormalities, blood pressure, diabetes, sodium, anemia, kidney disease, hip fracture timing, preoperative testing, and which medical problems truly justify delaying surgery.

We also tackle the sometimes very different ways orthopedic surgeons and internal medicine physicians think about patients.

Then things get less serious.

Tyler and I go through a rapid-fire orthopedic surgery vs medicine lightning round: Why do hospitalists care so much about sodium? Which lab value do orthopedic surgeons understand the least? Who is more dangerous—an orthopedic surgeon reading an EKG or an internist reading a postoperative X-ray? And what do hospitalists actually think about all those orthopedic medical-management consults?

A practical—and occasionally sarcastic—look at what really happens medically before and after joint replacement surgery.