Kerry Reller 0:28

All right. Hi, everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller, and today we have Dr. Kurtis Biggs. Welcome to the podcast.

Kurtis Biggs 0:38

Thank you

Kerry Reller 0:39

Yeah, so why don't you tell us a little bit about who you are and what you do, and we'll dive into our topic today

Introduction to Dr. Kurtis Biggs

Kurtis Biggs 0:45

Absolutely. Thank you for having me. I am a fellowship-trained orthopedic surgeon, specifically fellowship-trained in hip and knee replacements. I've been in practice now for 24 years and been in Naples area for 18 years. I find this to be the most fascinating corner of medicine for me personally. I had a nice early exposure to orthopedics when I was in my teens, and specifically hip and knee replacement, and that kind of guided me on the how do I get to do Job? And so when they said, "Hey, you've got to go to medical school to be a carpenter on people," there, there led my pathway. Man, that's a lot of years to do this. But it's been a wonderful experience, and I love where I am in Naples. It's where a lot of people remain active. They wanna continue to be active in their sports and leisure activities. And working with a great clientele and people that have great and high and very realistic expectations of returning to function. So I'm very proud to be serving this area.

Kerry Reller 1:41

Yeah, I think that's awesome. Usually we don't hear that people, knew at a young age what specialty of medicine necessarily

Kurtis Biggs 1:47

oh, yeah.

Kerry Reller 1:48

into. So you

Kurtis Biggs 1:48

for sure.

Kerry Reller 1:49

right away.

Kurtis Biggs 1:50

Right away I was like, "How do I get to do that?" And even a subspecialty within ortho this is what I wanna do, period. You just have to go through the hoops just through life,

Kerry Reller 1:59

absolutely

Kurtis Biggs 2:00

gotta do this to do this, and it's worked out all right

Kerry Reller 2:03

Very good. Yeah, I definitely bounced around, so I like the direct approach too, so that's awesome. So yeah, you have ag- not a totally unique practice, but you're really focusing on the replacement of the hip and the knees, and that's something that is very, you know, much needed as our population has developed over the years with a little bit more of weight problems and things like that. So I do obesity medicine, so we see a lot of these patients that, we have to get to a certain goal and things like that before we will send them back to you. So it's a, a good relationship for sure helping patients get to, like you said, move better and do the things that they wanna do and get back to life, right? So it's a I guess bidirectional relationship essentially. We appreciate that. So basically,

When Is Joint Pain More Than “Getting Older”?

Kerry Reller 2:48

like when I hear from patients, "My knees hurt all the time. I'm getting old. Isn't that normal?" Or when does this really become a problem in the patient's life where they might need to see someone like yourself?

Kurtis Biggs 2:58

Certainly. So there is some part of that is normal. Birthday and gravity has its effect on everyone, some more than others, and it has a lot of going into what did they do. Not just their weight, but what activities did they do? Were they active as a youngster? Do they have injuries that have had cumulative effects, or do they have one bad injury years ago that they did well with but has slowly developed into some form of post-traumatic arthritis? So that question comes up to the primary care and the patients themselves as they talk to each other on the pickleball courts and the golf courses of my knee's killing me. What are you doing?" "Oh you were limping last year, and now you're moving. What's your secret?" And so they communicate with each other, and then they talk to their primary cares. And when that starts to affect their not just needs but what they wanna really do those are some of the things that affect their decision-making and how far they go. And so when patients complain they see their primary f- usually the first time. They'll come in and "I think this is getting too much for me." And they'll go down that conservative pathway, and e- even as they come in for us down here, it's that, where are we? How is it affecting you? Where... What is it changing with your sleep? The, the quality of life and your relationships. Are you having to take medication on a daily basis to make this tolerable? Can you get up and down from chairs? Are you having difficulty with stairs, and can you get up and down off of a toilet? Those are things that y- when you can't do those or they're limited, that's when people start to really take some consideration of needing to talk to specialists.

Kerry Reller 4:20

So do you and your practice go through a conservative approach, or are you ba-

Kurtis Biggs 4:24

Absolutely.

Kerry Reller 4:25

the next person that they s- Okay, go

Kurtis Biggs 4:27

Absolutely. No,

Conservative Treatment Before Joint Replacement

Kurtis Biggs 4:28

probably 80% of our patients are not even surgical candidates, just on their physical examination and their radiographic exam. And so those are the, the patients that you try to keep any way possible to keep them out of an operating room. I, and I tell patients we operate on people, not pictures, and they may have really bad X-rays, but if they're still doing and they're tolerating and they're happy, do not touch that patient with a scalpel. It's just they don't, they're not happy in the end because they didn't make them enough of a change between how they were suffering and how much better they're doing. I like my patients to be miserable before they have surgery so that you can have a change that, which they appreciate. A- and there's, surgery's not without its problems. When we talk about hip replacements, you have 98% of people are happy with their hip replacement. Knee replacement, that number goes down into the high 80s, and so that means your 10 to 15% of patients who have a knee replacement aren't that pumped about what they have in the end. So you want it to be a big change, and you want it to be something that's necessary. We have some alternative treatment options. Long list of them, but the ones that are successful aren't very long. So we have a lot of information that's out there that gets people's hopes up about this magical thing they saw on Instagram. And so we have to spend a lot of time with education and creating realistic expectations of not only surgical, but conservative therapy, which is what most everybody gets.

Kerry Reller 5:48

So you mentioned X-rays, and the X-ray may not definitely correlate with the clinical picture or how the patient is feeling. Is there any utility for MRI, or do you guys end up doing

Kurtis Biggs 5:57

Absolutely.

X-Rays vs. MRI for Hip and Knee Pain

Kurtis Biggs 5:58

MRI, although the patients think that's, they should get one for everything, if it's a bad X-ray, I don't need that MRI. But if I have an MRI or if I have an X-ray that doesn't correlate to the symptoms they're having, I'll step that up and go into that MRI category. Because you can have pain that comes from a meniscal tear, some, as well as arthritis, as well as bone bruise or stress fractures from arthritis that may not need surgery, but it can identify your source of your pain. So MRI is useful, but it is not number one, but it is a, a useful adjunct for us to get more definitive differential diagnosis.

Kerry Reller 6:31

So you mentioned

Can You Wait Too Long for Joint Replacement?

Kerry Reller 6:32

you want the patient to be as miserable as possible. Is there anyone that maybe waited too long to have a joint replacement?

Kurtis Biggs 6:40

Not usually. That's incredibly rare. The most people that are limited by joint replacement are limited because of their medical issues, whether they have cardiac problems ranging from irregular heartbeats to congestive heart failures to previous stents and strokes. Those are the people that end up, horrible wound issues from diabetes. Those are the people that get ruled out, and that doesn't necessarily have to do with age or the severity of their arthritis. There are very rarely that we can't reconstruct something no matter how severe the arthritis is, as long as the patient is a candidate surgically on the medical side. So that's also part of the equation, is that people come in and they, they smoke, they have a BMI over 40, and they wanna... And, they have a weeping wound on their heel they want us to do surgery on them, but it's just, "My knee need- is hurt." And I'm like, "I... We shouldn't do surgery on you because of these other issues." What do you mean? Just fix my knee." Now, those are things that we have to address, and just like you, you spoke, we have to work with other providers to get the patient optimized Them a potentially a surgical candidate again.

Kerry Reller 7:41

Yeah, definitely way too much risk with active infections and uncontrolled

Kurtis Biggs 7:45

yeah,

Kerry Reller 7:45

things

Kurtis Biggs 7:46

that's a hard no

Kerry Reller 7:47

Would ever, like they waited too long where they've lost like muscle and mobility or conditioning, or is it typically-

Kurtis Biggs 7:53

Abso- absolutely. And so in those patients, I like to spend at least four weeks preoperatively trying to build them back up so assess their nutrition, what's their protein intake. We may even get a dietitian involved to make sure that they're getting the proper nutrients in the right ratios, and then getting into physical therapy for three days a week for a month leading up to surgery so we can build their muscle and tissue back up. And that leads into our postoperative recovery program, of which, for me, I give the patients a collagen protein peptide that they start a week before surgery. They continue it for a month after surgery, as well as amino acid supplements, so we can optimize their nutritional status so we can maintain muscle. Even the healthy patients that have total knees and hips, they'll get muscle atrophy postoperatively because of their nutritional status and inactivity. So we have to optimize what are they getting in so that they can get the best outcome.

Kerry Reller 8:40

Okay, those are gonna be important parts to bring up in a second, I think,

Kurtis Biggs 8:43

Yeah

Kerry Reller 8:44

But

Injections, PRP, Stem Cells & Arthritis

Kerry Reller 8:44

as far as the patient who is doing- wanting to do everything possible to not need a replacement at all cost, are there some things that are o- okay to do, like repeated injections or other procedures, or these kind of things stop making sense?

Kurtis Biggs 9:00

They eventually stop making sense because they don't have the same result. And I like to tell patients when they talk about injections, whether it's gel injections, whether it's cortisa- cortisone injections, whether it's PRP, stem cell injections that they all think is gonna save them there becomes, there's an effectiveness that, that just kinda limits what it is, th- what that outcome is. So we have to go through that process and injections don't last forever, and they're not indicated for every patient so there's different treatment outcomes and pathways for each of them. So conservatively, everything should start with a basic exercise program appropriate nutrition, try to optimize the patient as a whole t- in general. Then moving on to maybe some oral anti-inflammatory medications and then the considerations of injections, whether it's a, a stopgap like a corticosteroid injection or there's a, a need for consideration of gel or hyaluronic acid, which is a lubricant that's put into the knee. They can be helpful, but they all have their limitations. When we start getting into the biologics, whether it's a PRP, which is a product from the patient's own blood, a concentrated plasma that's injected into the joint. Terrific as an anti-inflammatory, it helps reduce pain, but it does not recreate cartilage despite marketing and advertising. And then patients wanna talk about stem cells, whether it's a placenta graft from another, from a box, or it's their own bone marrow aspiration that's concentrated stem cells. That also does not create cartilage. There is no recreation. And there's also the, the, the Instagram fans who go and they say, "Oh, in Germany they're injecting this hydrogel and it's recreating cartilage." And there's a big difference between growing cartilage in a spot defect versus a knee that's fully encased in osteoarthritis and full thickness loss in multiple areas. So a lot of our time is spent in education to create that realistic expectations and what it is that you're getting at and what you're looking for.

Kerry Reller 10:52

We've actually had some recent episodes on regenerative medicine and they, are saying something similar to you. We're not really trying to fix, complete osteoarthritis, but the inflammatory part can definitely be helped.

Kurtis Biggs 11:03

we can. And we're getting pretty good at controlling some of the inflammatory process using your own natural substance to make that happen, and those are fascinating and quite they're spectacular, but they're not the panacea of what we want them to be,

Kerry Reller 11:15

I think you,

How Joint Replacement Has Changed

Kerry Reller 11:16

you maybe you mentioned that joint replacement kinda isn't what it used to be. So if someone's parent or grandparent had a hip or knee replacement like 20, 30 years ago, how is that different than having one today?

Kurtis Biggs 11:27

So 20, 30 years ago is when I was a resident, and I can tell you that those patients minimally stayed for three days, usually five days in the hospital, and then they were going off to a rehab facility for another two or three weeks. Just that part alone has changed to you were there for three to four weeks in some place, and now you're in a surgery center for about five hours. That in itself has changed. The devices, as far as how long they're lasting they're good for 25 to 30 years. It used to be a 10 to 15 year. That's significantly advanced. Our anesthesia has advanced, so not everyone has to undergo a surgery that lasts four hours. Most of them are around an hour and a half, which is a lot less anesthesia. The instruments are better. We're more proficient. The, the surgical techni- technical skills have improved across the board from education and repetition. In this country we do a million joint replacements a year across the US, and that's a lot of joints and the more you do, the better you are at them. And fortunately, we're getting better and better at them. Those things have changed significantly. And then the post-operatively the pain control. It used to be you're having a knee, here's 120 oxycodones, and then I want you to get up and walk all the time and bend that knee, and no pain, no gain." That's changed significantly. We're leaning more towards putting patients on step counts so that they're only walking so much. Cryo support with pressure compression so that we can control their swelling control their pain. Also, we're using blocks that we've never used before, both cryo ablation of the nerve, the genicular nerves around the knee. Also, we're using adductor canal blocks and iliofascial blocks so that we have some good pain relief that can last three or four days after surgery before we turn you over to your oral medication for your support. Those things have made it a much smoother transition from that surgery to the first few days, where it used to be you had surgery and you woke up and you hurt. That's not the case and at this point, we're getting down to where the hips, they may have a pain or 2 or 3 out of 10, knees maybe 3 or 4 out of 10, and that's all the higher that they get. It's just we're finding less is more, and if we can control the swelling, then we'll control the pain and we'll have a better outcome. Those are some of the big things that have changed.

Kerry Reller 13:42

Yeah, plus hospital stay. That's already gonna reduce costs for the whole world too, right? That's

Kurtis Biggs 13:47

Oh, yeah.

Kerry Reller 13:47

rehab and all of

Kurtis Biggs 13:48

Yeah.

Kerry Reller 13:48

So

Kurtis Biggs 13:49

we went from a $55,000 charge at a hospital to now at the surgery center, that'll be a 9,000. So you drop by $60,000 of what the cost is for the f- for the facility for a joint replacement. Nothing to do with the surgical fee. That's just the facility, how much we've saved

Kerry Reller 14:04

Yeah. And some patients do so they're back up and moving, at least with the hip repair, replacement pretty quickly. Why is that one so much, quicker or better tolerated than the knee?

Kurtis Biggs 14:17

There's less peeling. It's really what it comes down to, it's physically less peeling. So when you do a hip replacement, you go between layers. You go between muscle like a curtain, and then you remove that ball. And so then all the work is done within that curtain, and you're not peeling things off. On a knee, you go around the patella, and then you peel the flesh off the inside of the tibia in order to get access to the joint, and that's a much more uncomfortable process recovery-wise. And then with the hip, you're only really pivoting around one point. Where on the knee, you're bending, you're rotating, you're shifting side to side, so it can be a little bit more irritating. So it's a little bit problem, little bit more challenging for the patient.

Kerry Reller 15:00

Okay.

Kurtis Biggs 15:00

I've been down that process myself personally, having had my hip replaced three years ago. So I can commiserate with the patient and knowing what it means to do too much too soon. So I can speak to that as one of those people who follow directions just barely.

Kerry Reller 15:15

Doctors aren't good patients.

Kurtis Biggs 15:17

Terrible patients. Terrible.

Kerry Reller 15:19

Yeah. So you mentioned devices have changed too. So I should We do a lot of allergy at our practice as well, and we get a lot of some, sometime, sometimes consults on, is this patient gonna have a bad reaction to a device implanted in due to metal allergy or something like that, and even with anesthesia too. But can you speak to that at all?

Kurtis Biggs 15:40

Certainly. So the, the, what we're looking at as the, the problem is nickel. Nickel is what usually causes the issue with medi- with orthopedic devices, and so there's a lot of... There's some testing that's done. The Orthopedic Analysis is who we use in our office for patients who are questionable. And I've gotten to the point in my practice where I don't even use a device that has nickel in it. On hips, they're all titanium, ceramic, and plastic, so we don't have any nickel in the titanium. It's a pure alloy. On the knee side, in this country, about 90% of all knees are still chrome cobalt, which have a little bit of nickel. I use a titanium nitride device so that I've e- eliminated any nickel, so I don't even have to worry about it. I used to ask patients and, "Did you ever get bad reaction to earrings, and cheap jewelry make your skin green?" Then we would try to work around it. I just said, "We're gonna avoid it all, and we're just gonna use a nickel-free device, period." So I do believe it's there. It's v- very uncommon, but that can make for a very miserable patient that, that has a sensitivity. And although it happens rarely, you just never want it to be you or your patient because it's a tough recovery process.

Kerry Reller 16:44

Yeah, unfortunately I have had a patient or two, that have actually reversed their replacement because of that.

Kurtis Biggs 16:52

Yeah

Kerry Reller 16:52

that's good you are, screening for these things now, and that the devices and the replacement like have changed the components. I think that's important for

Kurtis Biggs 17:00

And the patients like them 'cause the knees are gold. Know it 'cause it's inside, but you show them this knee that's gold, they're like, "Oh, I have a gold knee?" Yeah, that's the titanium nitride, right? So they, they get

Kerry Reller 17:10

questions based upon that. Can they go in MRIs if

Kurtis Biggs 17:13

Yes

Kerry Reller 17:13

gold knee? Can they go through airport X-rays and things like that?

Kurtis Biggs 17:16

Absolutely. There's no reason that they can't. So we actually, from 25 years ago, we said, "No, you can't go in an MRI. Oh my God, your, their leg'll, it'll hurt you." So now it's, we actually use MRI to help with diagnosis around hip and knee replacements. So we still MRI a knee that's been replaced. It can be helpful for us to go through somebody who's having pain or potential for infection or ligamentous injury. So it's kinda gone full circle to where we don't even think about it now.

What Recovery After Knee Replacement Looks Like

Kerry Reller 17:42

So you mentioned you were a bad patient and did too much too soon. Can you walk me through what a typical recovery would be

Kurtis Biggs 17:49

Certainly.

Kerry Reller 17:50

of...

Kurtis Biggs 17:50

Absolutely. So we'll talk about the knee side because that's the one that's a little more arduous. So for my patients, their surgery itself takes about 45 minutes to an hour, and about an hour and a half after surgery, they've walked and moved, they head home. They have a chatbot that communicates with them. It starts three weeks prior to surgery and it extends for six weeks after. It reminds them of things that they should and should not do about three or four times a day, reminding them to check their Fitbit, which we give them, so that they can monitor their steps. I only want them to take about 1,000 steps a day for the first week, 2,000 for the second, 3,000 for the third. And so that allows them to monitor how many steps and what their activity level is. And then you have to remind them that the steps in your house count. It's not just when you leave the house. It includes walking to the bathroom or to the kitchen. Those are steps. So that's the hardest part for people initially, is to be that bored and sedentary, but I want them to be up with a leg elevated, iced. We use a compressive ice machine, and then we use edema wear, which is a sleeve that they wear that goes from their ankle to their groin to help compress to control the swelling, to help control their pain. I front-load these patients with a medication called Jornavecs, which is relatively new. It's been around since last February. But it acts as a sodium channel blocker in the pain nerve. It does not affect your brain or your stomach, but it does not allow the pain signal to get to your brain, so it doesn't even think that you're hurting. We combine that with anti-inflammatories, initially both with dexamethasone and then transitioning to a traditional anti-inflammatory, such as meloxicam, and then we use Tylenol on a very consistent basis. So in years past, we would give you a narcotic and say, "Take this if you need it." Now I say, "Here's your schedule. Take it right on schedule. Nothing here is as needed. Everything is on pace so that you can control your discomfort." We use additional supplements, a lymphatic supplement that contains diosmin and hesperidin. Those are a supplement that helps your lymphatic system work better and helps drain the fluid so that, again, we're controlling that swelling. I also use CBD products, both topically as well as orally, to help patients with sleeping because it's, it can be very challenging. And education, making sure people understand what it is that they're doing and what they're expected, what's expected of them. A lot of times you have to have the conversation of you cannot go golfing six days after your surgery Because at this point in my practice, if they say they're gonna do that, I say, "You're not," or, "We're... I'm not doing it." Because I, it, that becomes then a problem at two weeks when they're sore and swollen, and they're calling and asking why they're hurting so bad. It's because you didn't listen. We've gotta get through on that part where the patient is responsible for their outcome, and this is an active recovery process, meaning that you have to be engaged and be an, be the participant. Be your own advocate

Kerry Reller 20:43

These unique things that you have developed in your practice? 'Cause I don't

Kurtis Biggs 20:47

Yes.

Kerry Reller 20:48

of these as

Kurtis Biggs 20:49

Y- That's part of the, what we call it here is the Secret Sauce Recovery Pr- Program.

Kerry Reller 20:54

Okay

Kurtis Biggs 20:54

and so it's been a...

Reducing Opioid Use After Joint Replacement

Kurtis Biggs 20:56

We have a great network of orthopods who are trying to eliminate narcotic usage. 80,000 deaths in the US every year from narcotic overdoses. 14% of all narcotics addicts get their first dose from a, a orthopod. So it's a huge thing to get rid of or eliminate. In the state of Florida, the average number of oxycodones for a total knee is 120. So I haven't written for a narcotic since last July. So w- we are making changes, and so there's a program called March to a Million. That's where a group of us across the country, led by Dr. Andrew Wickline in Utica, New York, have documented that we're using less than 10 narcotics per their postoperative recovery process, and we're trying to get a million patients so that we can prove the point to the thousands of other orthopods out there of, you don't need the oxys all the time. You can use other medications for the majority of your patients to keep this pain under control by having a set protocol and not just throwing pills at them. So that's that's unique to my practice here locally, but it's not unique nationally, and there's a large group of us that are moving that direction.

Kerry Reller 22:04

That's amazing. That's so important as everybody, I think, hears on the news and things like

Kurtis Biggs 22:08

Yeah,

Kerry Reller 22:09

we

Kurtis Biggs 22:09

absolutely

Kerry Reller 22:10

trying to move away from that. You mentioned the... I haven't used it personally, but the new pain medicine can you're using it in your practice. Do you find it to be expensive?

Kurtis Biggs 22:19

That's the benefit right now of Vectrex, which is the manufacturer. They're doing a rebate until the end of this year, where they're 30 days for $30. So most people qualify for that. I use a mail-in pharmacy because they handle the rebate for the patient, and they take care of all the, the paperwork. So I send in the script to the pharmacy. That pharmacy contacts the patients, goes through all of their insurance issues, and then they make it so that they can qualify for that rebate. So instead of them paying anywhere from $400 to $700 for that medication, they're paying $30 for their 30 days. So that's a huge benefit, and it is the first of many that are gonna be coming down the pipeline for that drug,

Kerry Reller 23:01

Yeah,

Kurtis Biggs 23:01

they've... It's coming. Yeah

Kerry Reller 23:03

do patients believe you when they say that they aren't gonna need any opioid pain medicines after surgery?

Kurtis Biggs 23:09

The ones who've had surgery previously, they don't. They don't believe it. And so I said, "Look, you can call me and when you're having a problem, and we'll get you a script immediately." And the funny thing is I get a lot that call me and they say, "I can't believe it, but I'm doing okay. It's not that bad." And they're stunned. And and at this point now that I've been doing this since last summer, I have a lot of patients who are coming because of that program. Enough people have talked about it and they're saying I wanna do this." And I'm sharing this information with all my local surgeons that I, that ask. I give them my protocol for the postoperative medication because I think it's that important that we get rid of as much of the narcotics that we can if possible

Kerry Reller 23:50

So you're you're saying this could be helpful for other types of surgery. You're giving it to

Kurtis Biggs 23:53

Absolutely. Any acute pain, it's indicated for it. So our spine surgeon had started using it for his postoperative. The, the key is loading it the night before, and then two pills, one twice a day for big surgeries a month. But for lesser painful surgeries like hips, I only use it for two weeks, and then we're just down to Tylenol after that

Kerry Reller 24:12

That's amazing. is there anything else you wanna share about your post-op protocol? 'Cause it sounds awesome.

Kurtis Biggs 24:18

Yeah, the post-op protocol for me, the, one of the there's a couple different things that I think are, make it a, a difference maker. I got tired of chasing numbers, and that's how it's set up for us in Medicare and how insurance reimbursements are, is that we as physicians the only benefit we have as they continue to cut us is that we need to do more. I'm tired of that. And that's just, you can't chase 1,000 joints a year. You get tired of doing it. It's just not engaging with patients. You don't feel like you're part of their life. You feel like it is... You start to feel like a patient, you're on a conveyor belt, and they're just moving me to the next patient. So this, I have a very personal contact. Patients all have my own personal phone number, so if there's any questions or problems, they deal directly with me. And by, by doing that, they f- they have a lot more confidence, they feel more comfortable, and I end up a few times already I've been at houses, so doing house calls, which takes you back to the old days of but it's you just get more engagement in the program and more buy-in to what they're supposed to be doing. It's that's a huge benefit of the program. But the nutritional support, using the biologics, I do use bone marrow aspiration concentration during surgery. So we'll take a bone marrow aspiration from their pelvis or from their tibia, that gets concentrated down into mesenchymal stem cells and PRP, and then we'll inject the mesenchymal cells around the joint itself in the soft tissue, improve inflammation, reduce healing time. That's also another benefit as far as the, the patients as part of this program. So I'm trying to look at it as a multimodal way to get through it. So using the sodium channel blocker on, for pain medicine, using a dexamethasone for swelling, using Tylenol for the underlying baseline pain, and then using the nutritional support from the collagen peptides, the amino acids, the lymphatic support and then the, the biologics with the bone marrow aspiration, and then the more boutique type use of the CBD, both for sleep with gummies and with and with a topical

Kerry Reller 26:12

Yeah, it's definitely like getting pain from all sorts of I guess methods and ways that we experience pain. You're hitting it from all different angles. It's pretty neat.

Kurtis Biggs 26:22

Yes

Kerry Reller 26:23

absolutely.

Designing a New Hip Implant & the Future of Joint Replacement

Kerry Reller 26:24

You are unique in that you have designed your own hip implant, so tell me about that

Kurtis Biggs 26:31

Yeah, so I've, I, again, I like, I really like what I do. I think it's very cool, and our outcomes are about returning people to activity and making them, their lives better. And so I've been fortunate to be involved in a couple different design projects where, th- they want your thoughts on how do you make this better, what technique, what, what instruments do we do? And I've been through those a few times, and I realized that it was really not what I wanted it to be, because there was too many guys, and then really the company didn't really listen to us very well. They still stuck with the engineer's idea, and an engineer's never put a hip in, they've never put a knee in. And so after those experiences, and they weren't really satisfying, I decided "Why can't I do this myself?" And so I sat down at home with some some printer paper and a pencil, and after doing a few thousand of these now, about 6,000, just this is what works. This is what I want to see different. This is how I want to do this. And then met with an engineer. I said, "Can you put this into a CAD model?" They made it into a CAD model. We 3D printed it, and then from that point, I went on to starting into the patenting process, and then contracted with a manufacturer who then created the device. Then we did cadavers, and so to make sure that things worked properly and where they were supposed to be. Then I turned in my 510application to the FDA to, so that we could start using, manufacturing and using in humans. This all took about four and a half years because it was all, "Okay, this is expensive. I can't do that right now, so we're gonna put this back over here until I can do that." And so it took us about four years to get to that stage, and September 6th of 2024, we were able to put our first implant in. And so we're coming up on two years of follow-up. It's been fantastic. The idea behind the device was to make it easier to put in, to restore the patient's femoral head back to where it's naturally found, so that we created an implant that fit the bone, because typically, we make the bone fit the implant, and that's what tradition is. I rather have an implant that fits the bone. It's, the idea is to make it less painful, to take away less bone and then to be more useful across a, a broader area of patients. So everything at this point is going incredibly well, and I did the first 120 myself, and so we're now expanding into other surgeons utilizing it. So it's it's very exciting to see something that could, make a difference in, in, in our industry plus in patients' lives. So it's been qui-quite unique.

Kerry Reller 28:59

If you must love it that much to do all that. It's like you said, it's expensive, right? Time, effort, and expense to wanna create your own device. And obviously being the expert that, that has done the procedure a thousand, 6,000 times, then I think you're the one to be designing it. That's really cool.

Kurtis Biggs 29:16

It's a definitely a labor of love, but because of the rules and regulations, I'm not allowed to get compensated as the designer for any device that I put in anyone. So there's no renew- I receive no financial gain from putting it in It's all Stark Laws. And so it's... But it's, there's a lot to be said when you put up an X-ray and it's been a year and they're like, "I, this is the greatest thing I've, you know done for my life. I changed it drastically. Thank you." And that's oh, what a feeling

Kerry Reller 29:49

Yeah, I was gonna say maybe you don't get a financial incentive, but I'm sure the first time that you implanted something that you actually created in someone

Kurtis Biggs 29:55

Yeah.

Kerry Reller 29:55

a pretty cool feeling

Kurtis Biggs 29:56

So it's it's a, I guess it's a runner's high, but I've never, I'm not a runner. It's it must be that endorphin

Kerry Reller 30:02

Yeah. Is, is there anything else you'd like to share about the device you created or your practice or the future of joint replacement?

Kurtis Biggs 30:11

Well, the future of joint replacement is very interesting because we're finding that w- the robots that are becoming very popular, our literature is coming out that it's not providing any additional benefit for the patients long-term. But the important thing is that the surgeon who's putting in your device, they need to be using the technique of which they're the most proficient at. So I think of robots as another set of tools, and if that's the toolkit that surgeon uses to get the best outcome, that's what they should use. So trying to educate patients that it really doesn't matter if that surgeon uses a robot, doesn't use a robot, uses goggles, VR, this and that, it's that they use it frequently and that they're very proficient at that, because that's the difference maker. What you don't wanna be is the guy that's trying it for the first time on you. So you wanna make sure that you ask questions. In our literature, it shows that we need... that surgeon needs to be doing at least 100 a year of that procedure to be proficient at it. And that's, those are the things that patients need to be educated. And fortunately, there's a lot of resources for that at this point, for sure.

Kerry Reller 31:15

Yeah. Let's finish with some things patients commonly wanna know. I know I already asked a couple of these questions, but is anybody too young for a joint replacement?

Kurtis Biggs 31:23

Not necessarily. It depends on the problem and the realistic expectation. The youngest patient that I've worked on is a 21-year-old hip, and they had unfortunately suffered avascular necrosis of the ball of their hip, secondary to treatment for cancer. And so this was the n- the knowledge of okay, you do know at 21 that at some point we're gonna have to do this again of some kind, whether it's just replacing the liner and the ball, or if it all has to be done. But their quality of life would've been, just completely decimated. So that's where you have to have that realistic expectation. And both young and old. So the old patients, I've had 102 is my oldest elective hip replacement, and it... She sat there with her family and said, "I don't wanna be alive if I have to live with this pain. I'll take my risk." So we, with anesthesia, she was generally healthy but she still had 102 years of heartbeats. So those things, and she did great, and still doing wonderful at 104. Everything's going along just fine. But the overall health of wh- is what the patients have to understand. The health is what determines whether you're a candidate first. So if you're not healthy, I don't care if you're 65, if you're not healthy, you shouldn't have that surgery. So you have to optimize yourself and have that expectation on your own health, first and foremost

Kerry Reller 32:40

I'm sure this question goes along with the health thing, but how long does it normally last, the hip or joint or knee replacement?

Kurtis Biggs 32:48

of them are around 25 to 30 years, and it's very dependent on the patient's weight and activity level. So if I have the 45-year-old man who's gonna continue to play church league softball, that hip might get him 15 to 20 years before we have to do a poly change. But it's at least they know that up front, and that's the part you have to have that conversation. Now, I'd say most of my patients, if they're 60, I'll tell them that this is a really very high possibility that this will be fine for you for the rest of your life. Because I've seen, already seen patients now that have been out 30, 35, 40 years with old generation implants. As they've gotten older, activity level's gone down, and so their wear has gotten better. So there's there's such a change for the device itself and the plastic quality and the ceramic bearing that have made these a device that's more than just a 10 to 15 year device.

Kerry Reller 33:36

Can you run after a joint replacement?

Kurtis Biggs 33:39

I don't like my patients to run for, on their knees. Knees are really tough on... I let them play, so you play soccer, you can play pickleball, you can play I let people play half court basketball. I have no problem with that. Softball, that's totally fine with me. I don't want them to go running for exercise. "Oh, I'm gonna do three miles three times this week." Not good. Hips, much more lenient about their activity level. I have people that have gone back to running. I've had them, had people go back to running 5Ks. It's all so dependent on their body status. Like, how heavy are you? But most people, at the point that they were at, they weren't looking to go back to that level of activity. It's very rare that we have somebody like, "I wanna have my hip done so I can go back to running marathons." That's a tough conversation because that's unrealistic expectation. So that's why there's a lot of counseling that goes into this preoperatively for joint replacement

Kerry Reller 34:32

You kneel after having a knee replacement?

Kurtis Biggs 34:35

Absolutely. It feels weird.

Kerry Reller 34:37

yeah

Kurtis Biggs 34:37

like kneeling on a water balloon because the, the end of your femur is now metal, the underside of your kneecap is plastic. It feels strange. You're not gonna do any damage. And so some patients just don't like to do it, but they can. And that water balloon reference comes from my mom. I replaced both of her knees, and she says, "Yeah, it's... I can do it. It just feels like I'm kneeling on a water balloon. Just kinda squishy." But it's it's possible

Kerry Reller 35:01

What... So you've done thousands of these replacements. What are... And you mentioned a couple patient stories already. Are there any other transformations that kind of stick with you?

Kurtis Biggs 35:10

Oh, for sure. You know what? I do an anterior approach to my hips, and so what that has done is created an a different surgery that we didn't use to do. We didn't use to do a lot of bilateral hips, where we do a simultaneous or consecutive under the same anesthesia. Those patients just they're so much happier that day of surgery because they're done, they had both hips replaced, and they're up and they're going. Those are some of the most satisfying cases are, even though it's a bigger one, that there's, both sides are done. Those are the people that just, the day after surgery, they have a smile on their face, because they haven't stood up in a while. They haven't been able to touch their shoes to put their socks off and on in years. And all of a sudden they can they just, you can see the light on their face of "Oh, my life is back." That's some of the things that... I've had some patients that got their knees cha- their knee replaced so that they could walk down the aisle at their own wedding, at 65. They're here for their... those are always fun stories.

Kerry Reller 36:04

Yeah. If you have, if someone's listening who's been living with hip or knee pain for years because they're afraid of surgery, what would you want them to know?

Kurtis Biggs 36:13

One is take a good hard look at w- how you're eating, You're exercising, and what your body status is. Get your overall health in check, 'cause that's... For us to inject your knee is not gonna make you stronger. It's not gonna make you fitter. Those are things that you have to check that box first. Now, in order for you to get fit, changing your diet, changing your exercise regime, if you need help to get that direction, then that's that's different. Th- then we can add to that. But the first thing they have to start is taking a look in the mirror and d- determining, what a- how am I? How am I health wise? That's the first and foremost. And then get educated. Get, do your research. There's nothing wrong with getting information, whether it's information that's from the internet, which n- isn't always right, but at least then you're getting something, and then getting in front of a, a provider, whether it's a, a family practice to talk about your knee problems, if they need to r- help with a referral to, for a consultation with an orthopod. It's getting information, and make decisions slowly after you gather information and you feel comfortable

Kerry Reller 37:14

Awesome. Is there anything else you'd like to share with the listeners today?

Kurtis Biggs 37:19

No, stay active and, enjoy where we live here. It's beautiful.

Kerry Reller 37:24

It is. So where can people find you?

Kurtis Biggs 37:26

They can find me in Naples. They can find me on jointinstitutefl.com. That's our website. Also for contact us at the office, it's 239-261-BONE, 2663, 261-BONE. And we're also so we're on Instagram as well as Dr. Curtis Biggs if they wanna check that out,

Kerry Reller 37:45

Awesome. Thank you so much for coming on the podcast today. We'll put all that in the show notes, and I think we've learned so much today, so this has been really awesome. Everybody stay tuned next week for next week's episode, and thank you, Dr. Biggs

Kurtis Biggs 37:57

Thank you