The Joint Replacement Podcast | Episode #66
By Matthew Sloan, MD | Orthopedic Surgeon & Director of Robotics for Orthopedics, Emerson Health
When should you finally consider hip or knee replacement? Can waiting too long make recovery harder? Does anterior hip replacement actually produce better outcomes? And how much does your surgeon’s experience matter?
These are some of the most important questions patients face when considering joint replacement surgery.
In Episode #66 of The Joint Replacement Podcast, I sit down with Dr. Craig Della Valle, Chief of Adult Reconstruction at Rush University Medical Center in Chicago, past president of the American Association of Hip and Knee Surgeons (AAHKS), and current president of the Knee Society.
After performing more than 16,000 hip and knee replacements and contributing to hundreds of scientific publications, Dr. Della Valle has developed a unique perspective on what truly makes joint replacement successful.
Our conversation covers everything from surgical timing and implant selection to the importance of surgeon experience, mental health, and why some commonly marketed surgical techniques may not matter as much as patients think.
1. When Is It Actually Time for Hip or Knee Replacement?
One of the most common questions patients ask is whether their arthritis is bad enough to justify surgery.
Dr. Della Valle emphasizes that the decision is not based on X-rays alone.
Some patients have severe arthritis on imaging but relatively few symptoms. Others have less advanced arthritis yet struggle significantly with everyday activities.
His central message is simple:
When your hip or knee prevents you from doing the things you want or need to do, it’s time to seriously consider joint replacement.
That might mean avoiding family activities, struggling to walk through a parking lot, or constantly planning your day around discomfort.
Joint replacement is an elective procedure, and the decision ultimately belongs to the patient. But waiting until every aspect of your life is affected isn’t necessarily the best strategy.
2. Can You Wait Too Long for Knee Replacement?
One of the most important points from our conversation was that delaying surgery can sometimes compromise the eventual outcome.
Dr. Della Valle explains that preoperative knee range of motion is one of the strongest predictors of postoperative motion.
Patients who develop significant stiffness before surgery may struggle to regain full movement afterward.
In particular, he highlights two concerning findings:
– Loss of knee extension: A flexion contracture of 10–15 degrees can significantly disrupt walking mechanics.
– Loss of knee flexion: When bending decreases toward 90 degrees, everyday activities such as rising from a chair can become increasingly difficult.
Patients who develop severe stiffness may not regain normal motion even after a technically successful knee replacement.
There are also broader consequences of delaying surgery.
Reduced physical activity can contribute to declining cardiovascular fitness, muscle weakness, and decreased independence. Chronic pain and limited mobility can affect relationships, mood, and overall quality of life.
The takeaway: You don’t necessarily need to wait until your arthritis becomes unbearable. The right time depends on your symptoms, function, mobility, and goals.
3. Your Knee Pain Might Actually Be Coming From Your Hip
One of the most surprising parts of our discussion involved patients whose knee pain was actually caused by hip arthritis.
The hip and knee share overlapping nerve pathways, meaning pain originating in the hip can sometimes be perceived around the knee.
Dr. Della Valle describes patients who were evaluated for knee problems—and even patients who had previously undergone knee replacement—when the underlying issue was actually their hip.
In some cases, a diagnostic injection into the hip can provide remarkable clarity.
He describes patients whose knee pain disappeared after their hip was injected with local anesthetic.
The lesson is important:
Just because your knee hurts doesn’t mean your knee is the source of the problem.
A comprehensive examination should consider the hip, knee, and sometimes lumbar spine before major surgical decisions are made.
This is particularly relevant when the symptoms and X-rays of the knee don’t seem to match.
4. Does Anterior Versus Posterior Hip Replacement Really Matter?
This was one of the most revealing conversations of the episode.
Earlier in his career, Dr. Della Valle strongly believed that smaller-incision, minimally invasive hip replacement techniques provided better recovery.
He performed two-incision hip replacements and initially felt that his patients were recovering faster.
But his perspective changed after conducting randomized research and comparing patients managed with similar recovery protocols.
He found that differences he had previously attributed to surgical approach were not nearly as pronounced when other aspects of perioperative care were standardized.
He now believes that several other factors may be equally or more important:
– Anesthesia selection and duration
– Perioperative anti-inflammatory medications
– Multimodal pain management
– Early mobilization
– Patient expectations and education
– The surgeon’s familiarity with their preferred technique
Dr. Della Valle currently favors a posterior approach in his practice.
His experience illustrates an important distinction: A surgical technique that works extremely well in one surgeon’s hands may not necessarily be superior for every surgeon or every patient.
This does not mean surgical approach never affects outcomes. Some studies demonstrate differences in early recovery and approach-specific complications.
Instead, the broader lesson is that surgical approach represents only one component of a successful hip replacement.
5. How Much Does Your Joint Replacement Surgeon Matter?
After more than 16,000 joint replacements, Dr. Della Valle has a clear message for patients selecting a surgeon.
Don’t focus exclusively on advertising, implant brands, or promises about a particular surgical approach.
Instead, look for a surgeon who:
– Has fellowship training in hip and knee reconstruction
– Regularly performs joint replacement surgery
– Works at a facility experienced in these procedures
– Has a consistent, well-established surgical technique
– Communicates clearly and earns your trust
He emphasizes that surgeon and hospital procedure volume can be important factors in surgical outcomes.
Performing the same operations frequently allows surgeons to recognize unusual anatomy, anticipate problems, and refine their techniques.
Another interesting part of our conversation addressed surgeon scorecards and patient-reported outcomes.
Although publishing outcomes may improve transparency, Dr. Della Valle cautions that comparisons can be misleading without accounting for patient complexity.
For example, a surgeon treating patients with multiple medical conditions may appear to have worse outcomes than a surgeon treating only low-risk patients.
Effective transparency requires thoughtful risk adjustment and meaningful measures of patient improvement.
6. Cemented Versus Cementless Knee Replacement: Which Is Better?
Cementless knee replacement has become increasingly popular, particularly as surgeons look for durable biological fixation in younger patients.
However, Dr. Della Valle remains cautious about its widespread adoption.
Earlier in his career, he experimented with cementless femoral components and encountered cases of failed bone ingrowth.
Those experiences influenced his approach.
Today, he primarily uses cemented knee implants and reports an exceptionally low rate of loosening with his preferred implant system.
He argues that when an implant has an excellent track record, changing fixation methods simply because a newer technology is available may not necessarily improve outcomes.
For patients, the central question isn’t whether an implant uses cement.
It’s whether the implant and fixation method are appropriate for their anatomy, bone quality, activity level, and individual circumstances.
Long-term registry data, clinical outcomes, and surgeon experience should guide these decisions.
7. Are We Performing Too Few Partial Knee Replacements?
Another fascinating discussion centered on partial versus total knee replacement.
Dr. Della Valle believes partial knee replacement is underutilized in the United States.
Rather than replacing the entire knee, partial knee replacement resurfaces only the affected compartment while preserving more native bone, ligaments, and anatomy.
In appropriately selected patients, this can offer a more natural-feeling knee and potentially faster early recovery.
Dr. Della Valle explains that approximately 40% of his knee arthroplasty procedures involve some form of partial replacement, including medial, lateral, and patellofemoral arthroplasty.
He also discusses long-term results from his practice demonstrating approximately 90% implant survivorship at a minimum of 15 years in a small cohort of partial knee replacements.
However, partial replacement isn’t appropriate for everyone.
The location of arthritis, ligament integrity, deformity, and overall knee anatomy all influence candidacy.
The takeaway: Patients with arthritis primarily affecting one compartment should consider asking whether a partial knee replacement is an option.
8. Are You Ever Too Young or Too Old for Joint Replacement?
Age alone doesn’t determine whether someone should undergo hip or knee replacement.
Dr. Della Valle shares the extraordinary experience of performing hip replacement on a patient as young as 12 years old.
He describes how the surgery helped a young patient with severe inflammatory arthritis regain function and ultimately pursue a rewarding adult life.
At the other end of the spectrum, he routinely evaluates patients in their 80s and 90s.
For older patients, surgical planning may require particular attention to anesthesia, medications, and the risk of postoperative delirium.
He describes using spinal anesthesia with minimal or no sedation in selected elderly patients to help reduce medications that may contribute to confusion.
The decision depends on overall health, functional limitations, and individualized risk—not simply a patient’s birth year.
9. How Does Mental Health Affect Joint Replacement Recovery?
One of the less frequently discussed factors in surgical success is psychological readiness.
Dr. Della Valle emphasizes that anxiety, stress, emotional distress, and coping ability can influence the recovery experience.
Patients undergoing joint replacement must navigate postoperative pain, temporary loss of independence, rehabilitation, and uncertainty about their progress.
Recognizing psychological distress before surgery provides an opportunity to offer additional support.
This doesn’t mean patients with anxiety or depression cannot have successful joint replacements.
Rather, mental health deserves the same thoughtful consideration as other factors addressed during surgical preparation, including diabetes management, nutrition, and physical conditioning.
Successful joint replacement requires treating the whole patient, not simply replacing the joint.
10. Can Injections Regrow Cartilage or Reverse Arthritis?
With increasing marketing around stem cells, regenerative medicine, and experimental cartilage treatments, patients understandably want to know whether joint replacement can be avoided.
Dr. Della Valle offers an important distinction between treatments that improve symptoms and treatments that reverse established arthritis.
Corticosteroid injections and other nonsurgical interventions may provide temporary symptom relief in appropriately selected patients.
But currently available injections have not demonstrated reliable restoration of advanced arthritic cartilage.
He also emphasizes the value of diagnostic injections in determining whether pain originates from the hip, knee, or another source.
For patients considering surgery, injections may help manage symptoms while they prepare, address other commitments, or decide whether surgery is right for them.
They should not be presented as a proven way to rebuild an advanced arthritic joint.
What I Took Away From This Conversation
After speaking with many leading joint replacement surgeons, one theme continues to emerge:
Great outcomes depend on far more than the implant or surgical approach.
Dr. Della Valle’s experience reinforces the importance of thoughtful patient selection, surgeon expertise, evidence-based perioperative care, and individualized treatment.
Perhaps the most valuable lesson from our conversation was his willingness to change his mind.
Despite decades of experience and thousands of successful operations, he continues to participate in randomized clinical trials because research sometimes challenges assumptions that once seemed obvious.
That willingness to question established beliefs is an essential part of improving surgical care.
For patients, the goal should not be finding the most heavily advertised technique.
It should be finding the right surgeon, understanding the available options, and making a well-informed decision about when and how to proceed.
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Watch or Listen to Episode #66
🎙️ #66 – When Is It Time for Hip or Knee Replacement? Craig Della Valle, MD
In this conversation, we explore how to choose the right time for surgery, the differences between surgical techniques, partial versus total knee replacement, implant fixation, and what decades of clinical experience reveal about successful outcomes.
Watch the full episode: https://www.youtube.com/@thejointreplacementpodcast
Listen on Spotify or your favorite podcast platform.
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About the Host
Matthew Sloan, MD is a board-certified orthopedic surgeon specializing in hip and knee replacement and serves as Director of Robotics for Orthopedics at Emerson Health in Concord, Massachusetts.
He hosts The Joint Replacement Podcast, featuring conversations with leading orthopedic surgeons and healthcare professionals about the science, technology, and patient experience of joint replacement.
Learn more at [www.MatthewSloanMD.com](https://www.matthewSloanMD.com) and [www.thejointreplacementpodcast.com](https://www.thejointreplacementpodcast.com).
Medical Disclaimer: This article and podcast are for educational purposes only and are not a substitute for individualized medical advice. Treatment decisions should be made in consultation with a qualified healthcare professional.