Dr Kevin Stone_Audio_TMFS

Matt Feret: [00:00:00] Hello everyone, this is Matt Ferret, author of Prepare for Medicare and Prepare for Social Security Insiders Guidebooks and Online Course Training Series. Welcome to another episode of the Matt Ferret Show, where I interview insiders and experts to help light a path to successful living in midlife, retirement, and beyond.

Matt Feret: Dr. Stone, welcome to the show. Thank you, good to be here. So tell everybody what you do, how long you've been doing it, and how you help 

Dr. Kevin Stone: people. So Matt, I'm an orthopedic surgeon. I practice at the Stone Clinic in San Francisco. And I'm also chairman of the Stone Research Foundation. And I've been doing that now for about 30 years.

Dr. Kevin Stone: Started in 1988. And I divide my life between clinical practice and then not for profit research. So in clinical practice, we're helping athletes of all ages, focusing on shoulder, knee, and ankle problems. In keeping people active and in research, we're focusing on all the ways of keeping people active, uh, accelerating, healing, treating, preventing and curing [00:01:00] arthritis.

Matt Feret: Thank you. So let's get into, well, you know what I'm going to ask this question first pickleball. Uh, this thing is exploded. Uh, everyone I know over the age of, I don't even, even my son plays it. Uh, everyone seems to be playing it right now. And then I've, I've never done it, but I still see these little articles trickling in that says.

Matt Feret: The injury rate for this particular sport, given especially the demographic that plays it is actually a surprising people. So can, let me, let me get that question out of the way about pickleball first. 

Dr. Kevin Stone: Well, it's the number one referral to our office these days. 

Matt Feret: So those articles are not 

Dr. Kevin Stone: wrong. So if you want to stay out of our office.

Dr. Kevin Stone: Uh, problem is pickleball is just so much fun. Uh, it's so accessible to people of all ages. It's competitive. Uh, you can pick it up pretty quickly. Um, and so what we are reminding people is to see it as any other sport. So all the usual [00:02:00] things, warm up, cool down, stretching, all the things that help you prepare for your sport.

Dr. Kevin Stone: And all the fitness things that help you prepare, strength, conditioning, aerobic capacity, accuracy, balance, proprioception, the whole combination of what we call fitness, you need to think about before you jump on that pickleball court or you'll be in my office. 

Matt Feret: Fair enough. What other sports, I guess, in middle age or older are the ones that are the other referrals to your office?

Dr. Kevin Stone: Yeah, so it really depends on the season. Skiing is a huge referral. We have lots of skiers, uh, of all ages. Uh, I traveled with the U S ski team for a dozen years and. But I also have 70, 80 and now 90 year old skiers as well. And so I'm actually going to my friend's 90th birthday party tonight who lives in Aspen and still skis.

Dr. Kevin Stone: And so it's a fantastic sport. It's so accessible, but the injuries really do hurt. And so if anyone really knew. The actual [00:03:00] injury rate from skiing, they'd probably never do it. So it's just, uh, unfortunately quite high, but it's a fantastic sport and, uh, all the other sports. I see lots of runners and soccer players and basketball players, tennis players, of course, of all ages.

Matt Feret: Um, at what point, um, I guess not what sport, but at what point can we talk a little bit about moving into joint replacement? Um, knees, uh, I know, I think shoulders these days, maybe I'm wrong, but certainly hips have been around. Um, at what point does someone or come to see you or it progresses to a point?

Matt Feret: Is it, is it an acute injury from one of these sports or one of these practices, or is it just over time things break? down. 

Dr. Kevin Stone: So I have an unusual practice. I see people from all over the world, and it's mostly because 80 percent of the patients are people who have been told that they need a total knee replacement don't, and that's not just my data.

Dr. Kevin Stone: That's data from other studies around the world as well. [00:04:00] So um, Okay. You need a total knee replacement, uh, when the entire joint has collapsed down to bone on bone. And so there's no more joint space and there's not an opportunity for me to do other things. And the other things include, number one, starting out with all the great anabolic injections we have these days, which is PRP plus hyaluronic acid, the natural lubricant of the joint.

Dr. Kevin Stone: Or a person could have a biologic joint replacement where I put new meniscus back in their knee or regrow their articular cartilage, and I do that whenever there's still joint space. And then the majority of people who have been told that they need a total joint replacement in the knee joint actually have only worn out one side of their knee, not the entire knee.

Dr. Kevin Stone: And for those patients, we can do a partial replacement using robotics. It's an outpatient procedure, it takes about an hour. We just resurface only the worn out part of the joint. And the reason that's so great is the knee feels much [00:05:00] more normal. They've got better range of motion, quicker rehab. And I just had a patient run across the United States on his bilateral partial knee replacements.

Dr. Kevin Stone: So we can get people back to full sports and about 98 percent of people by the third to fourth month. Say the knee feels like a forgotten knee. And then on the total joint side, when you're really have worn it out so much that you need one, what's changed is that with robotics now we can do a 3d model of someone's knee, put the model on the computer.

Dr. Kevin Stone: Put the implants on the model on the computer, and then when we go to surgery, remove much less bone and not have to use bone cement at all. So it can be an uncemented prosthesis that the body actually grows into. And once your body grows into the implant, the likelihood of you knocking it loose is very low.

Dr. Kevin Stone: And so we let our patients go back to full sports. And so the days of go home and rest your knee and live with pain and wait for your replacement are over. [00:06:00] And the days of go home and protect your joint replacement and don't do too much, or don't play singles tennis, or don't do the things you love and climbing and skiing and running, really, those days are over too now with new technology.

Dr. Kevin Stone: And so we've learned that the more active you are, and this sounds so obvious, but people really didn't pay attention. The more active you are. The longer you're going to enjoy your life, the more you're going to build your bone, the more you're going to build your muscle. And as we age, men and women, women faster than men, as we age, we lose bone naturally.

Dr. Kevin Stone: And the only thing known to build bone density is resistance exercise. And so weightlifting, climbing, hiking, stair climbing, all the things that we encourage people to do. Build their bones, build their muscles, and increase their activities. And so we, we, the goal is to help people drop dead at age 100 playing the sport they love.

Dr. Kevin Stone: And that's our entire focus of our research, of our [00:07:00] activities, of the way we treat people. I wrote a book on this called Play Forever. Which people can find on Amazon talking about all the philosophies and strategies and how to get there. Thank you. 

Matt Feret: Um, I, I, as you're talking, I was having these flashes of 60 minute episodes of, of, you know, people running the Boston Marathon well in their seventies and eighties.

Matt Feret: And that didn't used to happen. I mean, I can think back even to the eighties or, uh, uh, or maybe late seventies. That's probably how far my brain goes back. Um, the advances in orthopedic surgery, uh, and, and technology. How much of an advancement between, say, the 90s or the 80s and today is it? Is it just infinitesimal or is it pretty methodical?

Matt Feret: Are we seeing kind of a hockey stick in terms of technology or a gradual increase in advance in the technology available for people who are aging and then want to continue their sport? 

Dr. Kevin Stone: So it depends on how you look at it. There's two major changes in just the last Uh, decade or two that really have made [00:08:00] a huge difference.

Dr. Kevin Stone: The first is the use of anabolic factors, so growth factors and lubrication. We no longer use cortisone, which often inhibits healing, shuts down cell metabolism, leads to further cartilage injury. We almost always now inject, uh, lubricants, hyaluronic acid. Growth factors called PRP were able to stimulate people's tissues to heal and to be less inflamed and to have less pain rather than inhibiting them.

Dr. Kevin Stone: And so those sets of injections have made an enormous difference in how we treat various problems around the body from tendon injuries to tendonitis to rotator cuff tears to a host of things that we would commonly see in our athletes. The second big change over the last A couple of decades has been the introduction of robotics because it's permitted us to do these partial and total joint replacements and keep people on the tennis court, keep people running, [00:09:00] keep people hiking, place them so much more precisely than I could ever do before.

Dr. Kevin Stone: That's really changed the game quite a bit. 

Matt Feret: Um, when you think about this, I mean, obviously you've got a wonderful reputation and you're world renowned. However, I'm sure all of us have heard horror stories around knee surgeries. I can think of a friend right now who had total knee replacement and it did not go the way it should have gone.

Matt Feret: And this person was in their late forties, early fifties. Uh, and then, and I'm gonna back that into the point that you made earlier and re ask it in another way. I think you said 80 percent of all, uh, all replacements aren't necessary. Is that, did I get that number? Right? 

Dr. Kevin Stone: 80 percent of the people who've been told they need a joint replacement, total knee replacement could have an alternative.

Dr. Kevin Stone: Thank you. So 

Matt Feret: as a consumer, um, how am I supposed to know, uh, or how, what, what should I go about doing to, to [00:10:00] make sure I'm getting, um, um, uh, well, I guess the best advice I can possibly get, do I, you know, do I doctor shop? Do I start with, with you or someone with your, with your creds first? How do I know if I'm getting the right stuff from my doctor?

Dr. Kevin Stone: Yeah, it's hard. It's but with the advent of AI now, first of all, you will never go see your doctor in a year. You will no longer go see your doctor without having an AI voice agent in your pocket or on your phone or on your lapel. And your doctor will no longer listen to you without being augmented With an AI voice agent as well, because why should you go and have to remember every little symptom and everything that happened to you when you can have a good reminder?

Dr. Kevin Stone: And why should you see a doctor who's only going to rely on their own experience or their own knowledge base when they could be empowered by the world's knowledge base now? So AI is going to dramatically change [00:11:00] your knowledge as a consumer. And your ability to get great information. But on top of that, even today, you can do all the usual research.

Dr. Kevin Stone: You can ask your friends at the end of the day, when you sit down with a doctor, you trust, ask them a couple of questions. You don't normally ask, ask them what's their bias, what are they good at? And so if they're biased about, you know, they always do a total knee replacement for everybody with arthritis who comes in well.

Dr. Kevin Stone: You know how they're going to approach your problem if they're biased towards. Oh, I always put cortisone and send the patient away. And, you know, maybe they come back. Maybe they don't. Then, you know, what their bias is about biologics. And so query and find out where is the doctor coming from? Because the doctor's biases.

Dr. Kevin Stone: Influence a lot of the care that you get in, in ways that you don't often realize, and then ask the question to, Hey, what are you good at? What do you like to do? What [00:12:00] are, what are your patients do best with, with this set of treatments? And that's another good way of sort of getting at the biases in a, in a gentle way and finding out what the doctor's good at.

Dr. Kevin Stone: And it's perfectly reasonable to try to find doctors who are good at the things that you think you want and are good for you. We've learned over the years, every patient's a little bit different. I learned so much from my patients who cheat. So my patients who didn't follow my advice early on, who went back to work too quickly, went back to sports quicker than I ever thought they could.

Dr. Kevin Stone: They taught me about how fast healing could occur and maybe I was being too slow and, and holding them back in certain ways. And so. It's a dialogue and enjoy the dialogue. Enjoy the search. Um, have some fun with it. Use all the internet resources that you can. And very soon, I'm sure you will be empowered by an AI voice agent, as will be, as will your doctor.

Dr. Kevin Stone: Uh, 

Matt Feret: thank you. Um, you hit on two things. I want to follow up on in their [00:13:00] recovery time. Um, I don't know. Again, as I'll watch a golfer effect that goes to get knee surgery and their back, it seems like in 24 hours or a professional athlete that, you know, I'll tell you, I had shoulder surgery last year and it's like six months and then it's going to probably be another six months before it feels normal again.

Matt Feret: Uh, and then, you know, you see someone else with Shoulder surgery and baseball in their back and four. And is that just because they have all the time to rehab or their, their, uh, uh, their, their genetically predisposition to outpace everyone else in the world? Or is it because why is that? Why is that difference?

Matt Feret: When I see professional athletes with their teams, is it the doctors? Is it the rehab time? Is it, is the cutting edge technology? Is it, is it there? Is it their genes or is it the combination of all of that? 

Dr. Kevin Stone: So the answer is always all of the above, of course, but your attitude makes a huge difference. So if you can use your injury or your surgery as an [00:14:00] excuse, as an opportunity to come back fitter, faster, and stronger than you've been in years.

Dr. Kevin Stone: Then you're going to do all the things a pro athlete would do. You're going to get your physical therapy done, started the day after surgery as we do with our patients at our clinic. You're going to find a great trainer to work with you and alongside your physical therapist and build your whole fitness program while you might be actively resting the knee that was operated on or the ankle or the shoulder.

Dr. Kevin Stone: You're going to revisit your entire nutrition program and say, okay, how should my nutrition be to help me heal faster and heal better? You're going to revisit your mental attitude. You know, what's my attitude towards being relatively down for a while? Am I creative about Doing other sports or building up my repertoire of sports that I like to do, or am I just so depressed about my injury?

Dr. Kevin Stone: Oh me, oh my, I'm sitting on the couch. I'll never be me again. So that mindset drives so much of what you choose to do. And therefore how you come [00:15:00] back and what time you come back in and whether or not you come back better than you were before. So our goal for people is to come back fitter, faster, stronger than they were before they were injured.

Dr. Kevin Stone: And that's a mantra we use throughout the clinic, and it's what we try to instill in our patients. And then there's one more side of that, too. We try to instill the concept of an athlete for life. So if you come in as a patient and we get the opportunity to fix your knee or shoulder or ankle, we get the opportunity to work with you and with our rehab team and fitness team, the question is, can we bring you back intermittently over the rest of your life and sport test you and see, okay, here's where you're strong.

Dr. Kevin Stone: Here's where you're weak. Here's where you've been favoring. How do we constantly help you to get better and better and better? So our goal is to bond with our patients in a way that makes them feel like You know, that's the best place to go get information, or they'll direct me to the best place where I live and guide you throughout the whole next stage.

Dr. Kevin Stone: Remember, my goal is to have you [00:16:00] dropped dead at age 100 playing the sport you love, and you're not going to get there unless you take these injuries that we all have in life. And use them to build yourself up better than you've ever been. 

Matt Feret: Um, you mentioned the word arthritis in there. Um, and again, I'll be selfish and, and include my, inject my own thing into the show here, which, which is when they were doing my shoulder, it was a torn labrum, a split frayed biceps tendon.

Matt Feret: It had been that way for many years, just got progressively worse. The, um, the surgeon said, Oh, you've got arthritis in your shoulder. In your, in your, in your arm bone, maybe I don't think of myself as my age, uh, but I was like, wow, arthritis, you know, you usually figure your fingers or other joints first, but now I have arthritis in my shoulder, I guess, because it had been exposed.

Matt Feret: Can, can, can arthritis be.

Dr. Kevin Stone: Sure. So there's, there's three basic types of arthritis, the way we think about it. First is inflammatory arthritis, and that's the rheumatoid [00:17:00] gouty arthritis, the things that you, there are now some phenomenal drugs to help treat. That's not the majority of the arthritis that we tend to treat. We treat both what's called osteoarthritis, which may be a genetic disease or possibly some other organism stimulating it.

Dr. Kevin Stone: And we treat mostly post traumatic arthritis. Hey doc, I injured my knee. They tore my meniscus. The doc took out part of it when I was playing high school, college, or football. And now here I am 10, 20 years later and I've got knee arthritis. Isn't there something you can do? And put back in my knee as a shock absorber and buy me some time.

Dr. Kevin Stone: And that's often what we will do. So that post traumatic arthritis is what all of our research is on. We have our research Institute called stone research. org. You can check out the research programs that are going on there. And what we focus on is how do we regrow articular cartilage? How do we replace the meniscus cartilage?

Dr. Kevin Stone: How do we do the right injections for people? To help them delay the time which arthritis progresses or [00:18:00] solve some of the arthritis symptoms. So this is all the research efforts that we have and the clinical practice efforts. So I put lots of meniscus cartilages back in those athletes knees who tore them or lost part of it years ago and are coming in to help buy time.

Dr. Kevin Stone: They've often been told to wait for their knee replacement and we say that's a bad idea. Try to put the cartilage back in. Repair the damage early and you can solve a lot of these problems. So preventing, treating, and then curing arthritis is an important part of the mission of the Research Foundation and of our clinic as well.

Matt Feret: Thank you. Um, is it ever too late? For knee replacement. I mean, does anyone, are your bones too old enough or your body just can't handle the shock or are we seeing people in their eighties, nineties, late seventies going through this? And I mean, by the way, I mean, athletes for this, not just normal people, but is it ever too late for this?

Matt Feret: Or is it just at a point you're like, eh, it's not a good idea. Given your age, 

Dr. Kevin Stone: there are people who are too debilitated or, you know, just [00:19:00] don't have enough of their resources, meaning support around them. The, yeah. The, uh, nutrition around them to undergo a significant surgical procedure and rehab. And for those patients, it's better to inject their knees and to do a rehab program than to subject them to surgery.

Dr. Kevin Stone: Now, let me tell you the other group of patients though. I have a huge number of folks with x rays that look horrible. Bone on bone arthritis, just awful. And they have come in once a year, sometimes twice, I've injected lubrication and growth factors for them, because they say, hey doc, that injection gets me all the way through the ski season, it doesn't bother me much at all, I'm not letting you replace my knee until those injections stop working.

Dr. Kevin Stone: And that turns out to be this unusually great population who just aren't bothered that much by really terrible looking x rays and arthritis. And so there's a wide range of how people respond. And so we've become very biased. [00:20:00] Again, I mentioned to you, you need to know the bias of your doctor. We've become very biased about trying these anabolics, trying the lubrication for many conditions where We might be able to help the patient along without hurting them.

Matt Feret: Yeah, it's almost like, uh, uh, I was, the analogy I was thinking of when you said that it was like, the transmission's old, it's working fine. Just, just, just change the fluid. Don't, don't, don't replace the transmission yet. Don't go in there. A 

Dr. Kevin Stone: little thicker oil sometimes. 

Matt Feret: Yep. Yep. Um, so, uh, going back to a bit of what I talked about earlier in terms of actual procedures or told they need a total joint replacement.

Matt Feret: It sounds like your approach and your recommendation to those folks listening or watching are really in the kind of the step by step process and not only interviewing your doctor or your doctors and asking some questions, which is hard to do. I think for a lot of people is the question, but to do that proactively and then ask for steps, not necessarily bring out the howitzer, uh, but maybe ring out the BB gun first, and then maybe try a [00:21:00] 22 Cal or, uh, you know, and move up that way.

Matt Feret: Is that what I'm hearing? It sounds like it is. 

Dr. Kevin Stone: In general, that is true. The flip side to that though, is if you've damaged tissues in your joint, if you've torn your meniscus, if you've torn the ligaments and joints unstable, it's so much better to repair those early. and save the knee from going down that degenerative pathway than it is to just live with it because then it gets harder and harder.

Dr. Kevin Stone: So, um, yes, I want to do things that help my patients in every way with the least amount of surgery. As I like to say it, I've tried to do the maximum number of things for you and the minimum number of things to you. On the other hand, I want to identify When tissues are torn, that can be replaced or repaired.

Dr. Kevin Stone: So again, our bias, we're very biased towards repairing most meniscus tears. And if the patient's lost the meniscus, very biased towards putting a new one back in because we know that helps save the knee. And we have other biases around the shoulder and the ankle we can talk about, but it's really, you need to [00:22:00] understand how, where your physician's coming from and how they're going to treat that one disease or another.

Matt Feret: Um, most people when they have an issue there, they, you know, they're referred to someone and then we can ask questions. But then normally they'll go to their provider directory and Look up a specialty and, I don't know, pick the, the, the, the top one with the last name. It starts with an aa, uh, and then . So how, and then of course you get on Google and you type in, um, anything in, out spits, you know, Medline, uh, Cleveland Clinic and all these other articles that basically regurgitate similar things where in your experience if people can't access you or your, or that they're not close to you.

Matt Feret: Are there, are there any resources out there specific to what you do in orthopedics that or organizations or foundations that can help people narrow, uh, their selection to people that believe similarly as 

Dr. Kevin Stone: you? So first of all, relative to us, I do a complimentary outside consult for people [00:23:00] who are willing to upload their x rays and MRI to our site.

Dr. Kevin Stone: You go to stoneclinic. com slash consult. And we don't charge for that. I do as many as I have time to do and I try to get a bunch of them done each week. And so. Um, as a service to help people understand where the options are and where our therapies are. And we do that for people all over the world. And then on top of that, there, the resources that are out there are mixed because The institutional ones are so worried about liability that it's tough.

Dr. Kevin Stone: As you said, they all sound the same. The company ones are all a little bit biased towards their company products. So it's kind of hard to read through that. So I think what's happening now is that the AI search engine, so. Most people don't go to Google or many people aren't going to Google anymore.

Dr. Kevin Stone: They're going to Bard on Google, where you can ask an AI a question and the AI will look through all the various websites and data available and give an answer. It's not always the right [00:24:00] answer. Sometimes they make up the answer, but it's a pretty good, uh, filtering of doc, uh, doctor's information, company's information, science information.

Dr. Kevin Stone: That's otherwise been very hard for people to do. So. I think that that tool will help everyone get better information. Not not always perfect, but better. Thank you. 

Matt Feret: Yeah, this has been a really, really good conversation. I've learned a ton and I'm sorry for the elementary questions, but hopefully that serves someone else listening who, who had similar ones.

Matt Feret: What questions about this topic should I have asked that I 

Dr. Kevin Stone: didn't. Well, I think a lot of things we talked about served around the knee. It turns out we're doing a lot of work in ankle cartilage. The ankle is a very unusual joint where it's tiny, your whole body's on it, and yet it very rarely ever gets primary arthritis unless you injure it, fracture it, or have surgery on it.

Dr. Kevin Stone: So the cartilage regeneration techniques in the ankle are accelerating very rapidly and I'm seeing more and more people have been told [00:25:00] to have an ankle fusion or an ankle replacement and who we try to do these cartilage grafting procedures for. With a fair amount of success, surprising amount in the shoulder too.

Dr. Kevin Stone: People always have questions about their rotator cuff injury and their dislocation. Should they have surgery or not? And often the surgery is the right answer, but not always. And so our bias again, here has been to use these anabolic and lubrication injections for many of the injuries that in the past we would always operate on them first.

Dr. Kevin Stone: And I have to tell you, a lot of my patients are not coming back for surgery because. For some reason, a lot of them seem to heal pretty well with these injections. It doesn't cure the problem, but it certainly shuts down the inflammation and the pain and stop some of the scarring and permits them to rehab and strengthen.

Dr. Kevin Stone: So be open minded about looking around the different joints and the different possibilities. The next thing that maybe we didn't talk about enough is identify a great physical therapist and a great trainer near you because many of the [00:26:00] problems that we see, uh, number one, we can avoid surgery with great rehab.

Dr. Kevin Stone: Or number two, we can make adequate surgery look awesome with great rehab. And so it's worth it to have a great therapist and it's worth it to have a great, uh, athletic trainer 

Matt Feret: as well. And, uh, I'm sure you'll give the same advice that I was given that if you can have the best surgeon, uh, possible when, uh, but if you don't do your physical therapy or with a good physical therapist, you're going to get less than, uh, than maximum results, right?

Matt Feret: At the end of the day, it's how much work you put in after that two or three or four hour surgery. It's the two, three, four months worth of work that really makes the difference, right? 

Dr. Kevin Stone: That plus the attitude, become an athlete for life. So use that window of time. To learn all these good techniques, to change all your habits, to optimize them, and become a great athlete for life.

Dr. Kevin Stone: You deserve it. 

Matt Feret: Dr. Stone, thanks so much. My pleasure. The Matt Fairchild Related Content, Publications, and MF Media LLC is in [00:27:00] no way associated, endorsed, or authorized by any governmental agency, including the Social Security Administration, the Department of Health and Human Services, or the Centers for Medicare and Medicaid Services.

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