Dr. Matt Russo (IRB) Study on the PortableConnect®
Toree: Hey, I’m Toree McGee, and this is the Rapid Recovery Report, sponsored by ROMTech, the modern technology of rehabilitation.
If you’re new here, we’re doing a series on Thursdays at 4:00pm Pacific, 7:00pm Eastern, where we talk to different guests. Sometimes it’s surgeons, sometimes it’s patients, sometimes their ROMTech experts. And we’re sometimes going to be talking about a very specific piece of equipment here, the ROMTech PortableConnect. There she is. Isn’t she a looker?
And you can check out a little bit more about us and about ROMTech, if you are not familiar, at our website, www.romtech.com. You can also follow our social links, and all of that is going to be in the description below.
Now, what I want to talk about today is our guest. So, why don’t we just get into it, and give you an introduction.
Orthopedic Specialist Dr. Matt Russo
Toree: Dr. Matt Russo is a man who is not afraid to stay out on the edge of technology, always looking down range to that next innovation, that next big idea that he can introduce to his patients to improve their lives faster.
Dr. Russo believes not only in big ideas, but also the unwavering foundational notion that all people should live without pain. His passion for change in the lives of his patients is what drives him every day.
Dr. Matt Russo, we salute you. How about that?
Dr. Russo: Wow, that was quite the introduction, Toree. Thank you. I kind of wish I would have seen that earlier, but that’s okay. Thank you for having me. That is quite the introduction, I guess. You got me ready, Toree.
Toree: We’re happy to have you. You’re based in Scottsdale, Arizona. And you’re a third-generation orthopedic surgeon, which is pretty cool. I saw your dad in that picture earlier.
Dr. Russo: Yeah, it has been pretty neat. I actually joined my dad just about five years ago. And he worked with his dad for about five years as well, before he retied as well. So, it’s been really fun. I actually been able to do a few surgeries with him. We’ve done a couple medical missions together, and things like that. It’s been a trip.
Evolving Orthopedic Technologies
Toree: Well, that’s what we like to hear, that they love it. Let’s switch gears a little bit, and have you talk about robotic technology that you’re currently using in your practice.
Dr. Russo: Yes. So, I’ve been all over the place with robotics, actually. When I first came out, I was a NAVIO user for a little bit. That’s a Smith & Nephews’ product. And then I got a little frustrated with that actually. Switched over to the Mako for a while. I still use the Mako for my partial knees, but I really am in love with my total knee system, which is made by Zimmer, it’s the Persona. And they just came out with the Rosa robotic system, so I’ve been using that now at the hospital, and not yet at our surgery center, just because of the cost right now, but we’re working on that.
Yeah, I think that it’s changed the way I do knee replacement, to some extent, really more focused on the gap balancing technique, rather than measured reception, even though my training was more of a hybrid of the two. So, I still use both concepts, but the true gap balancing is really more of the robotic method, so that you get a really nicely balanced knee in both extension and flexion.
Yeah, so I’m kind of always out there, trying different things and different technologies. I would agree with that. And this robotics, I think is here to stay. Sometimes, I’d do a knee without the robot, and I say, “Who needs this robot?” I got it. It’s perfect. But often, it does help us, and we can make less significant cuts, especially on the tibia, and to have a really nice balanced knee with a minimal polyethylene. And I think that’s an advantage.
Toree: Yeah, absolutely. So now, as far as robotics go, I know you think they’re here to stay. So, what does the future, in your mind, look like for orthopedic and that technology?
Dr. Russo: Well, what I found is that, as a younger surgeon, is that patients who look to me as their surgeon, high volume, younger surgeon, they’re expecting that I use robotic technology. It’s not even a question anymore. So, I think that’s part of the situation here, is that patients come to us, and this is really very much patient driven. So, we as surgeons, have to respond to what the patients are hearing about, learning about, and expecting from their surgeons. And I think without that push, we wouldn’t have gotten into this robotic realm as quickly, because the patients are educated, and they’re asking us. And so, there’s not a single clinic day that goes by that I’m not asked. Oh, you use a robot, kind of the thing. And so, we have to have that discussion.
I think using the ROMTech is just an additional way to show that we have all of these different things that we use and technology to help us with your recovery, both during the surgery with the robotics, as well as after with the telemedicine, and things like that. And the technology of the ROMTech would be the differing radius and all of that, I think, is really helpful to engage our patients, and have more confidence that they’re in the right hands.
PortableConnects IRB Study
Toree: That’s awesome. Well, we’re excited to kind of dig in, and start talking to you, because you are one of the first surgeons actually that was involved in our IRB study. And for those that are not medical, that’s Institutional Review Board study. And working with patients using our PortableConnect, versus using a CPM, a traditional passive motion device with physical therapy. So, can you talk a little bit about what you might have discovered during our study?
Dr. Russo: Yeah, so it was pretty interesting. We wanted to see if this PortableConnect device really changed our outcomes compared to what we were doing on a routine basis.
I do want to say we gave up the CPM machine years ago, and that’s that continuous passive motion machine. Not many patients were using it up to this study. So, that was our only kind of caveat, but it’s really the only thing out there that is similar to what PortableConnect can offer, as far as a home device that allows patients to improve their mobility.
A lot of patients come in, and they ask about the CPM machine, but because it really fail to hold up, and it was expensive, and all these other things in the past, we decided that that would be a good, at least comparative device for our patients.
So, yeah, we took our patients, and we added just for the normal routine of physical therapy, typically three days a week or so, outpatient, which is the way we do a knee replacement. And then we added a device on top of it. So, we didn’t just compare it with just the CPM, I think that would have been unfair.
And then the other group was we basically took away all of our physical therapy and everything we know about how to treat patients after surgery, and we said, “What if we just did the PortableConnect?” And our study results really actually were ended early, because of the profound effect. All the patients were getting higher range of motion scores, particularly in flexion, rather than extension, much earlier than the patients involved in traditional therapy, plus with the CPM. So, it was a great exciting moment for ROMTech.
Toree: Yeah, absolutely. That’s super exciting. I know you and a lot of surgeons think that physical therapy is still a really important option for patients, especially those who struggle with extension of the knee, but you had talked about flexion was great with ROMTech, extension is really important too when not using a PortableConnect. So, a physical therapist must come to the patient per patient, and work with them on range of motion, or they have to travel a while to go and see them. So, like definitive number of rehab sessions usually that is required for a patient.
Dr. Russo: Yeah. Even though the results show that physical therapy wasn’t necessary for patients if they get the ROMTech, I agree. I do think some patients still do benefit from a few physical therapy sessions. And so, we can limit the number of sessions, and so the patient isn’t as inconvenient to leave their home to go to a physical therapy location. Typically, we don’t have a physical therapist come to the house anymore, and kind of the home-based therapies with the physical therapist is something in the past. But now, we have the opportunity to deliver therapy with the PortableConnect device through the telemedicine option with the screen.
So, my protocol has added a few extension-type exercise to the patient’s routine while they’re on their own at home, because if you think about it, it’s just not fair. A physical therapy is only a couple of hours three days a week. This is multiple times a day. The patients can jump on their bike, and work on their motion, without having to go to the therapist. And so, it just makes sense that this would offer a higher advantage.
But getting the extension is something I stress with my patients. And then if I think they need a little bit more, then we send them to therapy as well. And so, I think that’s an advantage.
Toree: Yeah, absolutely. And giving patients that option to be able to not have to go somewhere if they don’t want to. If they’re in too much pain, if they don’t have somebody to drive them, and it’s their right leg, or right knee.
Dr. Russo: The other thing is partial knees as well I’ve been doing using the PortableConnect. And this wasn’t involved in the study in particular, because we were focusing just on the total knee replacements. But partial knees, I think, are great candidates to avoid physical therapy altogether. The range of motion does not tend to be too much of a problem with the partial knees, compared with the total knees, but it’s still part of their exercise routine. And my patients love it, love the ROMTech device. I don’t think we can ever go back.
PortableConnect for Better Morale
Toree: Yeah, absolutely. So now, to circle back, and we’ll talk about the IRB study again. Did you see a patient morale difference between those who use the PortableConnect versus PT, because that would have been like very first experience with that?
Dr. Russo: When we start to introduce the concept of the study to patients also, I think that this is probably the reason we had to end it early, because patients who are getting more and more information about what the ROMTech device is, the PortableConnect, were dropping out if they were selected to the CPM machine. And as it went further along, and the excitement was growing, showing clear differences in the early period, we didn’t necessarily divulge that to patients, but they wanted the new technology. And if they got it, they were excited, and they wanted to use it. If they didn’t, they didn’t want to be part of the study anymore, and they wanted me to give them the device anyway. And so, that’s what happened naturally.
And so, I think, because patients were talking to other family members and things like that, just my own referral system, patients tell their cousin, tells their aunt, and whatever. And suddenly, they’re in my office, and say, “Yeah, I heard you do this, and I heard you have a really cool bike.” And so, that’s part of what’s bringing patients back.
And if they have one done by me a year ago, and then they have this one, and they saw the difference, then they tell their friends, that kind of a thing. The answer is, absolutely, the moral difference is so much so that it was impacting the study that we have to cut it off. And so, I think that was part of the situation of why we needed to end it. It was a such a clear difference.
Toree: Yeah, that’s really funny. I probably would have been one of those typical patients.
Dr. Russo: Yeah, exactly. That’s everybody. And I live in Scottsdale. Yeah, they’re pretty specific.
Treating Patients like Family
Toree: So, in your bio, you placed a really strong emphasis on the importance of listening to patients and treating them like family members. Now, being a third-generation physician, is that something that was like passed down, and kind of beaten into you form the elders?
Dr. Russo: Yeah, I would say yes. I’m a part of a big group now, called Ortho Arizona. When I first joined my dad, just in our own little office, we were still a part of Ortho Arizona, but we had our own little office. That’s changed now a little bit. We’re in a bigger kind of facility. But our office was a very much family type feel. And so, patients that have been going to see my dad for a long long time, and now they’re seeing me. It’s a culture thing. Yes, I guess, I would say that absolutely influenced.
My fellowship actually was at the Anderson Clinic. And I don’t know if you’re familiar with them. They are also a father-son situation with the Enghs, as well as his brother, or his uncle now. So, there’s a lot of family dynamic there as well, which is why I was drawn to that sort of a fellowship in Alexandria, Virginia.
Yeah, it’s been a part of the way I practice medicine since I was even in my training.
Toree: Yeah, I love that. It’s always interesting when kids decide to go the route of what their parents did. Because I mean, you see the good, the bad, and the ugly. Like everything that your parents do for work, no matter what.
Dr. Russo: It wasn’t easy. It was not an immediate choice for me. I would have to say that. I was at engineering degree in college, and that situation just became more natural. I decided medicine is really great. My dad has a passion for this, and talking with my family and all that. it didn’t come lightly though. It was one of those, I’m not going to do the same thing my dad did. But eventually, I saw the light, and the way. It’s a great field, orthopedic specifically, but medicine also.
Toree: Good. Well, I’m glad you found it, and that you love it. It’s hard though. It’s a hard pill to swallow when your parents were right.
Dr. Russo: Yeah, he didn’t push it either, actually, which was good. Sometimes, he would say, ah, with the different dynamics and the culture of medicine now, and that’s continued as far as all the legal things, and kind of the difficulties we go through, especially now with Medicare changes, and things like that. It’s not as smooth a road as we want it to be, but still the patient’s satisfaction, the rewarding part is still there.
Keeping Active for Better Joint Replacements
Toree: Good. So, there are different things I know that contribute to needing surgery, and arthritis is usually a big one. So, how important is diet when it comes to the different things that you see, in like battling arthritis and everything really?
Dr. Russo: Yeah, that’s interesting you bring that up. Diet actually has really taken a much more of a forefront with patients in discussion, anti-inflammatory diet in particular, instead of having to take anti-inflammatory medicines and things like that. And holistic medicine, all of these concepts are relatively new compared to what your doctor tells you to do, that kind of thing.
Now, the whole culture of wellness, I think, is really impactful, and is really relevant with a lot of our patient population, which are younger now, patients who are considering joint replacement to continue their active lifestyle. And so, a lot of these patients are in the wellness, and it’s a big part of their lifestyle.
So, there is a part that is relevant with diet, and keeping you healthy and active, and mobile. And joint replacement just adds in there to keep your joints up to speed with how you feel, and how your body feels. So, I do think that’s a part of it, but I will see that, sometimes, these patients who are very healthy, very active, have the worst-looking X-rays. Meaning they have a lot of arthritis, but they’re able to push through. And I say, I don’t know how you’re doing it, but you have a tremendous amount of arthritis.
So, what I’m getting at is that I don’t think having a healthy diet necessarily removes your risk for developing arthritis and degenerative change, which is just normal wear and tear of your body, but it does help patients continue to stay active, mobile, healthier people. And then, the upside of that is if then you decide to do joint replacement, those patients who are active, mobile, healthy with really bad-looking X-rays do the best. And we have a lot of studies to support that, as far as their recovery, length of stay in the hospital or outpatient, all these situations, and just overall, recovery after surgery. So, I think that’s a benefit either way.
Toree: Good. I mean, logically, it makes sense. If you have a healthy body before surgery, you’re going to have an easier time recovering. It’s like if you get older, it’s harder to recover from things. If you’re a kid, you’re kind of at your healthiest.
Dr. Russo: That’s what I tell patients all the time, is that we want to catch them at the right moment. If patient comes to me, and they’re barely skidding by on their walker, I kind of cringe, and say, “Oh man, I wish you had come to me.” I’d say, “How long have you had that?” And they’d say, “Oh, well, it’s been six months.” And so, that’s getting kind of close to that time, where that’s a long time to be on assisted device. I’d rather get you right when you’re just needing it maybe, or right before you need it, and so you’d stay mobile and active, and then your recovery is that much smoother.
Less Time on Pain Meds
Toree: So, have you found patients that have used the PortableConnect versus like that CPM technology, in the study? Were they able to taper and stop with pain meds faster like normal?
Dr. Russo: Absolutely. So, that was one of our outcomes with the study as well, is how much pain medicine they were taking. Well, the data showed statistically difference between the patients with the CPM and the patients with ROMTech, as far as pain tablets, the number of pain tablets consumed.
I think one of the big reasons for that is what we would tell patients is when you feel like you need a pain pill, you can go that route, or sometimes, just get up, walk to the chair, recliner, or whatever, get on the device, and work it out. And that’s actually something patients say, “I’m so glad you told me that, because I did that, it really helps to keep the joint moving, and all I needed was Tylenol instead,” that kind of a thing. So, I think that that was a healthy message for patients, and it’s something they can do, because the device is there in their home.
Toree: Yeah, absolutely. And I mean, a lot of people, myself included, struggle with like heavy pain meds. They’re tough on the body. They’re tough on your stomach. And so, if you have an alternative,
Dr. Russo: Yeah, so we’ve done a lot of studies and research about our pain management threshold, this rapid recovery model. And that’s been a big push with total joint replacement. And this device fits in perfectly with that model.
For Those Considering a Joint Replacement
Toree: Awesome. Well, thank you for hanging out with us. And I’ve got one more question here for you, Dr. Russo. So, for those who are considering knee or hip replacement, what advice can you give them? And where can people find accurate info on the subject.
Dr. Russo: So, I have a lot of patients who come in, and they Googled everything. So, there’s a lot miscommunication out there, I would say, especially when it comes to recovery and things after joint replacement.
But my website is a good resource. I have a lot of different links from my website though, to other governing bodies. So, there it is on the bottom there. Yeah, the Facebook, that’s a more generic Ortho Arizona Facebook profile, not specific to joint replacement, but it has some information as well.
Specific for hip and knee replacement, the AAHKS website, that’s the American Academy of Hip and Knee Surgeons. It’s just AAHKS.org. So, we can edit that if that’s wrong. That’s AAHKS, as well as our academy website, which is the American Academy of Orthopedic Surgeons. We have a lot of patient education materials on both of those websites. You can watch videos of the procedure itself, if you’re so inclined and have the stomach for it. And a lot of information that is geared toward patients, rather than healthcare providers and surgeons, which obviously have different language and things to focus on.
But obviously, if that’s something you’re considering, then the ultimate would be just to schedule a visit, and we’ll chat about it.
Toree: Perfect. Well, thank you again so much for taking the time. You guys, be sure to visit Dr. Russo in his website at mattrussomd.com, and you need a knee, hip, anything replaced, or just somebody pretty cool to talk to that’s really knowledgeable in the medical field. Be sure to check him out.
Thanks again so much. You guys can also find out more information about us and ROMTech at Romtech.com. Follow us, subscribe to our links. And yeah, thanks again, Dr. Russo. We’ll see you next time.
Dr. Russo: Thank you, Toree. Thanks.
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