From left to right: Robert Kollmorgen, Arbi Nazarian, Geoffrey Rohlfing and Raj Amin of University Orthopaedic Associates in Fresno. Photo contributed

Three hip and knee surgeons are using their unique specializations to the Central Valley’s advantage.

Dr. Raj Amin, Dr. Geoffrey Rohlfing and Dr. Amin Nazarian specialize in hip and knee replacement at the Hip and Knee Center at University Orthopaedic Associates in Fresno. The three of them view their expertise as a partnership because each specializes in a particular area to advance the Central Valley’s hip and knee health. 

Rohlfing and Amin both grew up in the Central Valley, and although they underwent medical training outside of the region, they’ve come back to care for patients in their hometown. 

Amin says hip and knee arthritis and musculoskeletal pain is the No. 1 reason people go to their primary care provider’s office. 

Joint replacement surgery rates are scheduled to double by 2030, mainly because of the growing elderly population.

“There’s a huge demand for that surgery in people who are generally 50 and above, although that’s not really a hard age range,” Amin said. 

“As people live longer, they want to continue to remain active, and remaining active will help them with their overall health.  With more and more patients reaching a greater age and nearly one in seven adults suffering from symptomatic osteoarthritis, the need for these surgeries will only continue to increase,” said Rohlfing.

It’s a common surgery as the pain from hip and knee arthritis can be debilitating and disruptive to daily life. The surgery also needs revisiting after wear and tear on patients who received a surgery in the ’80s or ’90s.

“The incidence of us needing to go back in to replace the plastic or tune up the joints, so to speak, is also going up as well,” Amin said. 

Amin said that practicing in the Central Valley is personal ever since his dad, who was also a doctor, passed away from Covid-19. 

“He did a lot of good for his patients in the Central Valley and I kind of want to follow in those footsteps,” he said. “It’s a good opportunity for me to be able to uphold what he was able to do and try to carry that forward.” 

Nazarian went through his training at UCSF Fresno and has stayed in the Valley as well. The three of them each offer a unique approach to their craft, and they share patients depending on the individual’s needs. 

Amin primarily uses robotics to perform surgery – though they are all equipped to do so –  and Nazarian is skilled in complex joint replacement. Rohlfing takes a less invasive approach.

“The robot is a relatively newer technology to us. It’s really been here for about the past 10 years, but in the Central Valley it’s definitely newer just within the past couple of years,” Amin said.

The robot gets accurate down to the millimeter and gives more data in the operating room to get the best-fitting joint replacement for the patient. This gives the most natural feel to the joint, Amin said. Amin used the robot to train during his fellowship at Stanford University.

“It’s especially important for surgeries that we do which are a partial knee replacement. That’s a really fine surgery and has really low tolerances for variation, and so the robot just really helps us keep quite accurate with that,” he said. 

The early part of the pandemic presented a challenge for surgeons in their field.

“The pandemic has been really challenging for us, because hip and knee arthritis is important, but patients need to understand that it’s an elective surgery and they certainly have a choice in it,” Amin said. 

Because of hospital capacity issues, doctors haven’t been able to perform as many surgeries, which often require patients to recover in the hospital for one or two days after. They expect an increase in surgeries, though, as Covid-19 cases are stifled and hospital capacity hopefully takes a dip.

There are many non-surgical preventative measures that can be taken for treatment of the joint pain, like injections or physical therapy. Some patients who go to the practice can even receive hip preservation surgery from Dr. Robert Kollmorgen, also at the Hip and Knee Center, if their hips are aiming for intervention in the future. These cases are typically young sports players with vague hip pain. 

Nazarian says people with these surgeries in past years have had to travel outside of the region. Many people have had to wait over a year to receive this type of surgery.

A complex reconstruction case happens when the patient has had multiple surgeries.

“Every time you do surgery, the soft tissue takes a hit. It becomes more scarred, it becomes harder to separate. Healing suffers and the more bony work you do, the more bone loss happens,” Nazarian said. 

The goal is to make it look like it did before the first operation. In some cases, other companies have to specially make the implants for patients. In those cases, it’s not standard equipment, but rather imaging and more complex thinking. 

“I genuinely feel there is a need for partial knee replacements which are less invasive, have a smaller incision and are a faster recovery than a total knee replacement,” Rohlfing said. “I also really enjoy the Direct Anterior Approach to Total Hip replacement, which has been described as muscle sparing, and  has been shown to have a quicker recovery.”

The biggest challenge right now is having a full, qualified staff. Nazarian said Staff turnover has been a significant factor. But the partnership between all the surgeons at University Orthopaedic Associates gives the practice leverage to offer the care that patients need. 

Rohlfing says another challenge is the need for hip and knee replacements in patients who don’t have the most efficient access to medical care. That is something on which we are currently working, he said. Hip and knee replacements last for upwards of 20 years though, which is a major success to the field, Rohlfing said.

“What drives me most, I would have to say, is listening to the joy of an elated patient speak of how they, once again, have pain free mobility and are back to enjoying golf, gardening, hiking, cycling or playing with their grandchildren,” said Rohlfing.