Orthopedic Surgeon Eric Slotkin on the Rapid Recovery Report
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Toree: Oh, my goodness, this really is out of control. Hi, I’m Toree McGee, and I’m another year older. And this is The Rapid Recovery Report, sponsored by ROMTech, the modern technology of rehabilitation. We’ll be doing this weekly series, if you’re new here, every week, every Thursday, and this is the only time that this overlay will be happening. So, we do this at 4:00pm Pacific, 7:00pm Eastern. And we talk to different guests, surgeons, ROMTech employees, patients.
And if you’re new to ROMTech and you don’t know who we are, feel free to look us up at www.romtech.com. We will probably be referring to our product, the PortableConnect, here during this podcast today just briefly. There it is right there. Ain’t she a beaut? And it’s a high-tech recovery device that’s geared at getting patients moving and on the road to recovery faster. So, again, follow us on our social handles, and check us out on the web to learn a little more about us.
Orthopedic Surgeon, Dr. Slotkin
But today, we’ve got a super awesome guest, I’m really excited about this, Dr. Eric Slotkin. He’s an orthopedic surgeon that specializes in complex total joint arthroplasties of hip, knee, shoulder. He’s a grad of the Philadelphia College of Osteopathic Medicine, and completed his residency at Pinnacle Health in Penn State Hershey Medical System in Pennsylvania. He completed additional fellowship training in adult reconstruction and joint replacement in the internationally known Cleveland Clinic.
Dr. Slotkin has numerous peer reviewed journal publications focusing on patient-specific techniques, minimally invasive surgeries to improve patient function and expedite recovery. And in addition to his surgical practice, he frequently serves as teaching faculty at various joint reconstruction courses. And he helps other surgeons with techniques and technologies on a national scale.
So, he’s skilled in cutting-edge arthroplasty techniques, and his surgical interests include minimally invasive direct anterior intermuscular hip replacement surgery, complex primary and revision hip and knee replacement surgery, hip preservation surgery, and both primary and reverse total shoulder replacement surgery.
So, we’re stoked to have you here, Dr. Slotkin. And I want to start this off by saying, you guys, Dr. Slotkin’s patients love him, and so do I. This is going to be a really fun one.
Dr. Slotkin: Well, I appreciate that, Toree. You did not tell me it was your birthday, so happy birthday.
Toree: Well, thank you. I feel like unless I’m turning 29.
Dr. Slotkin: Never.
Toree: That’s right. I’d rather spend it with you. Now, when we first spoke getting ready for this podcast here, you mentioned that you never really had a desire to do medical school when you were younger, so what was the reason, I guess, why you ended up in orthopedics, at the end of the day?
Dr. Slotkin: So, when I was in college, I had no idea what I wanted to do in life, and probably spent the majority of my first two years of college kind of experiencing college, and enjoying myself. But at the same time, I always kind of flocked more towards the sciences. And my wife will probably tell you, I still can’t balance checkbook or pay bills very well. So, science was always up my alley.
When I was in college, I used to do a lot of medical research. So, when I graduated, I decided that I was going to go with some friends up to Boston, and took a job doing more medical research. And when I did that, I got the opportunity to spend a lot of time kind of in the clinics, and really decided that I rather talk to patients than talk to petri dish. So, going into medicine kind of became sort of the new goal.
So, I had a sort of runabout way into getting into medical school, so I wasn’t that traditional, finish college, go right to medical school. I didn’t go to school until I was about four years out from college, before I went to medical school.
It was the right decision, because I ended up meeting my wife there, so I can’t really complain about it, but when I was in medical school, you kind of have to go through every single medical specialty, and I realized really quickly that I didn’t quite like taking care of sick people. So, my first clinical rotation was with a very prominent orthopedic surgeon in Center City, Philadelphia, and the first day that I was there, I think he did probably eight knee replacements, and I thought it was the coolest thing ever, and I was tainted and ruined for the next two years of medical school, because at that point, I was like, well, this is the greatest thing in the world, these patients aren’t sick. And you can do things to make them better.
As I kind of went through my training and everything, I realized more and more, at least when I was training through my orthopedic residency that at least the way that I thought about it. Like joint replacement is kind of where the cream of the crop for me, because I got to take a problem, fix a problem, still have a relationship with a patient for a really really long time, but not really manage something, rather like give them their life back. And that was kind of really the driving force between what I do, and still do. I mean, that’s why I have fun with my job.
Toree: That’s awesome. I love that. I wonder how many people wind up having an interest in the very first rotation that they have, and then they just hate every other rotation they got.
Dr. Slotkin: It really made like certain rotations that you have to go through difficult. My wife will tell you. So, we went to school in Philadelphia, one of the things we had to do is you have to do like they called it a community medicine rotation, so you had to spend time like preclinic type thing. And I had the pleasure of being in the preclinic with – it was myself and then five other female students who were all interested in like various specialties for like women care. And the majority of the things that came into this clinic were like things like that. So, I luckily got to kind of sit back, and I was like, listen, if somebody sprains an ankle, I’m happy to take care of them, but I think you guys are better suited for this stuff.
No, I think you’re right. I think there’s a lot of doctors out there that would tell you that there were aspects of their training in medical school that they just probably have eliminated from their thought.
Toree: Yeah, I thought. Now, talk about kind of treatments that you do specialize in, and the types of surgeries that you’re conducting more of these days.
Dr. Slotkin: So, in my practice, I specialize strictly in joint replacements. So, I take care of mainly problems with the hip, knee, and shoulder. But in my group, blessed I have six really good partners, and we all kind of subspecialize into different aspects of orthopedics, I’m kind of the de facto joint surgeon in the group. Two of my other partners specialize in trauma, and do some joint surgery, but that’s what I do. So, most of the patients that come to see me either have hip pain, knee pain, and smothering of shoulder pain, but they’re typically on some pathway where either the management of or the definitive treatment for will be a joint replacement.
So, I primarily do hip replacements and knee replacements. I do some shoulder replacements. I also do patients who have had previous joint replacements that have problems with their existing joint replacement. I kind of specialize in taking care of those problems as well. And sometimes, having to do what’s called a revision surgery, so revising or redoing part or all of their previous joint replacement that either wore out, or they had some kind of problem with.
I really try to kind of know my role and stay within that. Where I practice, the hospital is a level 1 trauma center, so all of us do take care of fractures and trauma stuff, but my elective practice is all primarily joint replacement surgery.
Toree: Okay. Now, I touched on this very briefly. So, we’ve actually read a lot of glowing reviews from patients of yours online.
Dr. Slotkin: Paid people to say nice things about me.
Toree: Stop. So, we did do our research on you, and you seem to have a really impressive list of peer reviewed publications on the topic of hip arthroscopy, which makes you quite the expert in this arena. So, hip replacement seems, I mean to me at least, a little scarier than a knee replacement. So, could you talk to us a little bit more about that, and why it’s such an important operation to have?
Dr. Slotkin: Sure. I actually think it’s the other way around. I think a hip replacement is a far easier surgery and recovering an operation, but part of the reason is – so most people that have a problem with their knee or with their shoulder is really easy to kind of compensate for that. So, you can hide that by leaning on the other knee, leaning on the other joints around there to kind of take the brunt or the force off of that.
The way that I explain it to patients is when you have a bad problem with your hip joint, it’s the one thing that connects the top part of you to the bottom part of you. So, when that hip doesn’t work, it doesn’t work for pretty much anything you want to do. So, as much as people try to hide it, it really gets in the way of almost all normal activities you do, from walking up and down stairs, to getting in and out of the car, to just sitting and like you’re sitting at your desk right now, to something as simple as just rolling over in bed.
So, hip pathology and hip arthritis can really significantly cause somebody discomfort, but more importantly, it really affects the quality of life and their function, and it’s very hard to hide.
So, when you talk about the success of operations as a whole, no one dies from arthritis. It’s a quality-of-life problem, not a quantity-of-life problem. So, there’s a reason why, pretty annually, hip replacements rank very very high on the list of all elective patient surgery. Whether it’s plastic surgery, cosmetic surgery, actually hip replacements are fairly fairly high up on that list of patient satisfaction.
And the reason is because when you – I always joke with patients, you could do hip replacement, put it in upside down and backwards, and they’ll still get better. And it’s true because that pathology really affects so much of their life that when you take it away, they just kind of raise through their recovery.
And then, within that, there are certain things that some surgeons, like I do, do with regards to how we do the technique that I think even facilitates and expedites that recovery even more. So, luckily, I think I do a good job, and patients benefit from it, so maybe that’s why they have nice things to say.
Toree: Well, whatever it takes, I guess.
Dr. Slotkin: Exactly.
Signs You Need a Hip Replacement
Toree: So, I’ve always heard, and I think most of us have, from surgeons and doctors, that surgery is always a last resort for treating like debilitating pain and other issues. So, what are the early signs that might indicate a patient would need a total hip replacement or a reconstruction?
Dr. Slotkin: So, the most common sign and symptom from something going on in the hip joint itself is actually pain that’s kind of deep down in the groin. So, a lot of patients are walking in my office, and they say, “No, no, no, it’s not my hip, it’s my groin.” They kind of point to the outside kind over their rear end. But the really true intraarticular, so within the joint, hip pain is mainly people who have pain in their groin.
And then the other thing that happens a lot is the nerves that kind of go around the hip joint itself, and down around the knee. So, a lot of people actually don’t even know they have a problem with their hip because they have pains in their knee that have nothing to do with the problem in their knee.
So, I, sometimes, will see patients for a second opinion who actually have had pain in their knee forever, and then they have a knee replacement, and then they still have the same pain in their knee. And here, we examine their hip, and their problem was with their hip all along. So, hip pain can kind of be really all over.
When it comes to the treatments for that, I kind of go back to what I said before, nobody really dies from arthritis. So, the surgery is the definitive treatment for it. It’s the only thing that we can do that’s going to cure them of their condition. Everything else that we can offer them, whether it’s physical therapy, activity modification, medications to kind of help with their symptoms, or even putting injections inside of the hip to help them with their pain, and to decrease the inflammation there, all of those things are always just geared towards managing your symptoms, trying to keep your pain level low, and your quality of life high. But the ultimate goal of all of that is, if none of those work, then surgery is the definitive option.
And some patients come in, and they don’t want to go through it. They have been dealing with it for long enough, and they say, listen, I’m not interested in trying more, I just want to be done with this. And nowadays, hip replacements are being done in patients younger than you and I, and the reason for that is the implants have gotten better, the technology has gotten better, the surgeries have gotten better, and there really is not the – for most surgeons kind of my age, there is not the mentality of, well, you need to wait as long as you possibly can. It’s more, okay, if you’re ready to go, like this is the one thing I can do that’s going to fix your problem. Let’s do it.
Toree: Yeah. So now, I mean, you’re seeing young folks that come in, and need hip reconstruction. Is that fairly rare?
Dr. Slotkin: It depends on how they get there. So, some people are born with kind of congenital problems that affect the hip joint. And because of those, and because we’ve gotten better at treating them at a younger age, the problems that they might have had a major operation years before they get to me, now they’re kind of managed more conservatively for a longer period of time, so I get them at a younger age, where their hip just fails, so instead of being 60 and 70, they’re 20 and 30. So, that’s kind of one subgroup.
And then the other group is kind of the patients that I was just kind of referring to, so not just the weekend warriors, but the high-level athletes, and people who really rely on their hips. And now, when they’re 40 and 50, and they have a true problem with their hip, and they come in to see me, I don’t turn around, and say to them, well, you’re way too young to have this operation. We have a realistic conversation about what they’re looking for, and if the operation is the best option for them to not just get back to their job or get back to their kids, or get back to the things that they can’t do anymore, but also to make sure that we’re giving them the best possible outcome for the next 20, 30, 40 years, because patients live a lot longer now.
So, the way that I always say it to the patient is I don’t have a crystal ball to tell you what’s going to happen with your hip replacement or whatever 30, 40 years from now. What I can tell you is, you have a problem now, the conservative things we’re doing don’t give you the results you’re looking for, and it’s your quality of life right now that’s suffering. So, why wait 10 years and give up the next 10 years of your life just so that you have something you don’t know how long it’s going to last anyway?
So, I just think a lot of it is kind of the mentality about how we do these things. And then also, 10, 15 years ago, the parts that we used only lasted 10, 15 years. Now, the technology has kind of caught up, the parts las longer, and most of them are geared towards younger individuals.
We have older individuals too. It’s not like they’ve changed total knee on young people. I mean, some hip replacements in patients who have triple digits. It’s a quality-of-life operation. It has nothing to do – I was telling their age is just a number.
Toree: Yeah, I feel that, especially today. And that kind of goes into something that we have talked about before, where there might be a little bit of – I don’t know if it’s misinformation or what it is, like misinterpretation. People think that having to get a joint replacement is going to limit their functions. I mean, that’s not the case at all, and that’s the opposite of what you preach.
Dr. Slotkin: No, I tell them the complete opposite. I say, listen, my job, if I did it right, is to give you a good joint back, so that you have no limitations. You can run a marathon, ski, hike, jump, dance, jump out of an airplane, whatever the activity is, if we did our job right, and we got you through the surgery the right way, and had you recover, you should be able to live the life you want. And I don’t sit there, and tell patients what they can’t do afterwards. I tell them, go ahead, and do what you can. And your hip, whatever is going on will tell you how much you can and can’t do, and what you got to change, but not me.
Dr. Slotkin’s Patients on the PortableConnect
Toree: That’s great. So now, after taking the plunge, and doing like a total knee or hip replacement, and rehabilitating, and recovery is like so critical to ensuring that your knees and your hips heal the way that they should. So, can you share any stories with us about how patients are recovering with the PortableConnect?
Dr. Slotkin: Yeah. So, two separate things there. So, one, the rehab side of it is, the way that I say it to patients is, listen, I can do the best job for you possible, but if you sit still for the next six weeks, and don’t move, you’re not going to move after that. Your new joint will not heal on its own. The muscles around it that we don’t do anything to are not going to recover on their own.
So, think of it in the same context of sticking a car in a garage for years. When you go to turn it on, it might and it might not. So, the therapy and the recovery, the rehab, like however a surgeon does it for their patients, whether it’s sending them to a physical therapist, or utilizing kind of technology like the PortableConnect, which I use mainly for my knee replacement patients, and I use it for some hip replacement patients who really require therapy.
Kind of the mentality around physical therapy, I think, took a hit with the pandemic, and just changed a lot. But I don’t think the pandemic changed it altogether. It was driven by patients. Most patients were looking for kind of alternative options, like way to maximize their recovery, minimize the inconvenience of it. And ultimately speaking, find a way to make it fun.
So, when I say to patients, listen, you’re going to do some physical therapy after you have your knee or hip done, and you can go and work with the physical therapist, and that’d be great, because it’s hands-on, and it’s face-to-face, but it’s only going to be an hour to an hour and a half, maybe three days a week. And depending on your insurance, you might have kind of a copay or whatever, but it’s not bad. It’s the gold standard, and that’s what people did.
But when I sell them on the option that, listen, instead of three times a week, you can do it multiple times a day, and you can do it at the convenience of your own home. And instead of a physical therapist really only overseeing what you’re doing three times a week, through technology, I can see what you’re doing in real time, I can see it every single time you get on the PortableConnect.
And then ultimately speaking, the patients kind of – it became less work and more play, because everybody likes to ride a bike. Even if you don’t like to ride a bike, it’s also easy to ride a bike, right? So, having something that I can say to patients, listen, this is going to come to your house, you’re going to have the ability to use it as frequently as you want to use it during the day. And every single time you get on it, I’m going to know, my team is going to know, in real time, how much you’re moving, how hard you’re working, how much activity you’re doing, how your pain is.
I mean, two sides of it. One, the patients like it because they know someone’s watching. And then two, the patients are afraid because they know someone’s watching. It’s almost like self-motivating, right?
Toree: Yeah.
Dr. Slotkin: So, anecdotally, and in my group, we’re actually doing some studies now, and trying to demonstrate kind of comparing this to the norms of physical therapy, kind of what’s better. Anecdotally, I have no qualm saying that the patients that I have that do it, and especially the patients I have that utilize the PortableConnect, and commit to utilizing it, that they truly do get through their rehab regimen much faster. They seem to have less pain, but I think they have less pain not because the bike is doing something fancy for them. They have less pain because they are actively engaged in their therapy, and they’re enjoying it, rather than going to physical therapy, where it’s more a task. This becomes part of their daily routine. So, they tend to be a little more compliant with the two, because of that.
So, since we kind of instituted in my practice, it’s been probably about six to nine months where we’ve really been heavily using it, and patients actually come in now requesting, because their friend had that, and they see how great their friend is doing. So, just the word of mouth of it has really kind of driven that along too. It’s been really good. We’ve been really happy with it, to the point that even my partners who don’t do joint replacements are trying to figure out how to utilize that for rehab from sports injuries, trauma injuries, things like that, because they actually see the benefit of it from the patients that I have. From that perspective, it’s been really good as well.
Toree: Yeah, that’s great. I mean, we’ve talked to lots of folks in trauma and in sports that are seeing great results too, but it’s nice to talk to someone who sees results in hips, as well as in knees.
Dr. Slotkin: I think it’s nice. No matter what you do, it’s always nice to be able to give patients options. I’ll be the first person to say it’s not the right option for everybody, and sometimes, some patients I look at, and I go, you know what, they’re going to have a harder time with this. Either they’re not technology driven, or they have more of a complex situation, but the patients that it is right for, which tend to be the majority, but the patients it is right for, they do great with it.
Toree: Good. So, do you have any other opinions about how you’re personally experiencing the technology as a surgeon that’s overseeing your patients?
Dr. Slotkin: I think you kind of touched on this. So, a lot of the publications I’ve done and a lot of the work I do outside of the surgeries I do is kind of geared around the different enabling technologies we to have to kind of enhance how we do these operations, whether it’s things that happen before surgery, things in the actual operating room themselves, or things like this that can actually help on the postoperative side. I always say, and I’m a big fan of it, because I don’t think you’ll ever find a surgeon that would say that they wish they had less information about a patient or about a surgery or about how somebody’s doing. Most of us got into doing this, because we generally want our patients to do well.
So, the more information you can get out of technology, the better. It might not change your outcomes, but I think the better the experience is going to be on both sides of the coin, whether you’re the surgeon, or whether you’re the patient. And if any of that improves the outcomes even just slightly, then it’s all worth it.
That being said, I think the technologies have to be proven. You can’t just use something that somebody – it’s not snake oil, and we’re not the medicine man, but things that kind of demonstrate a clinical reason for using them and a good improvement. I mean, there’s a reason that most joint replacements now, the vast majority have done with some type of technology, whether it’s a hip replacement or a knee replacement.
And that’s the reason why even the postoperative therapy, I mean a lot of the ways that we kind of manage this stuff, whether it’s something like the PortableConnect, or whether you look at like Peloton and Mirror, and kind of all these other kind of – even though they’re not specifically geared for postoperative rehab, these are kind of the devices that most people are kind of moving towards, and getting out of the gyms, and getting more into these kind of interactive ways of recovering and exercising and recuperating. And I think nobody wants to feel like they’re going through it by themselves. Whether it’s real or not, gives you the impression that you are doing it kind of in a group or with other people, even if you can’t see, it’s that perception that I’m not alone in this, and I think that helps kind of the psychology of the recovery.
Toree: Yeah, absolutely. I totally agree with you. Well, we don’t want to take up too much of your time, Dr. Slotkin, but this has been really informative. You’re the first hip specialist really that we kind of had on here. It’s been lots of knees and sports, and it’s been nice to talk to somebody in like true total joint.
Dr. Slotkin: Thank you very much. And happy birthday. So, I’m sure once you get off of this, you can go and enjoy yourself.
Toree: Well, thank you so much. Is there anything that you want to plug in the meantime? I know you can visit Dr. Slotkin on social media, at his website. Everything is scrolling here along at the bottom.
Dr. Slotkin: Sure. The only thing I will say is that the website there, it’s Oarmd.com. Other than that, no. I think it’s thank you very much for having me on, and I really appreciate it.
Toree: Absolutely. Well, thanks again, and thanks to everyone watching. Be sure to follow our social channels and subscribe to our YouTube so that you can see more of these videos when we have them every week.
Thanks you much, you guys, and thank you again, Dr. Slotkin. You guys have a wonderful weekend.
Dr. Slotkin: Thank you.
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