The Catalyst

Advances in Orthopaedic Care: Dr. Justin Deen

• Season 1 • Episode 12

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Joint replacement surgery has not only become more commonplace, but many patients can return home on the same day with greatly reduced recovery time thanks to new minimally invasive techniques. Join us as we hear from Dr. Justin Deen, Orthopaedic Surgeon with Florida Orthopaedic Institute as he discusses the latest advances in patient-centered orthopaedic care available in Ocala.

Nonprofit Featuring in this Episode: Marion Senior Services

Justin Deen, M.D.
Orthopaedic Surgeon, Florida Orthopaedic Institute 

Dr. Justin Travis Deen is board-certified by the American Board of Orthopaedic Surgery and fellowship trained in lower extremity adult reconstruction. He treats hip and knee conditions with a focus on joint replacement and reconstruction. This includes partial knee, total knee, and total hip replacement, including muscle-sparing direct anterior total hip replacement surgery. He also cares for patients needing complex hip and knee replacement or revision surgery for failed replacements.

Born and raised in Orlando, Florida, he received his undergraduate education from the University of Florida. He then received his medical degree from Florida State University, where he was elected to the Alpha Omega Alpha National Medical Honor Society and Arnold P. Gold Humanism in Medicine Society. He completed his residency in orthopedic surgery and fellowship in adult arthroplasty/reconstructive surgery at the University of Florida.

Dr. Deen is a fellow member of the American Academy of Orthopaedic Surgeons, the American Orthopaedic Association, and the American Association of Hip and Knee Surgeons.

The Catalyst is hosted by the Ocala Metro Chamber & Economic Partnership, sponsored by Douglas Law Firm and recorded live at Wiley Productions podcast studios, located in Ocala, Florida. New episodes, guests, and perspectives of leadership premiere twice a month. Follow us on Apple, Amazon, Spotify, or wherever you enjoy podcasts.

Natalie McComb:

The Catalyst, a CEP podcast on bold leadership in the Ocala Metro, hosted by the Ocala Metro Chamber and economic partnership, sponsored by Douglas law firm and recorded live at Wiley productions podcast studios located in Ocala, Florida. Welcome to the catalyst. I'm your host Natalie McComb, Vice President for the Ocala Metro Chamber and Economic Partnership Foundation. And I'm joined today by Dr. Justin Deen, an orthopedic surgeon with the Florida Orthopaedic Institute. Great to have you on the show, Dr. Deen.

@Justin Deen:

Thank you, Natalie.

Natalie McComb:

So the Florida Orthopedic Institute encompasses a large number of physicians and many practice locations throughout the Greater Tampa Bay region. I understand that you are new to Ocala. So why did the institute decide to expand into our market?

@Justin Deen:

Yeah, as you had mentioned before the Orthopaedic Institute was founded in the Tampa Bay area in Tampa specifically, and it's actually grown quite rapidly, and now has over 150 physicians making it the largest group in Florida and the fifth largest in the United States. So as they began to expand, this was really a natural fit for our group. They have a significant population growth and we really felt that that was outpacing the number of physicians and created an unmet need for musculoskeletal care. Also, when we think about further extensions up into the Panhandle or northeast Florida, the North Central Florida area was really a natural fit to complement the legacy group.

Natalie McComb:

Wonderful and I understand that you were born and raised in Orlando, with degrees from UF and FSU completing your residency in orthopedic surgery at the University of Florida. So you've certainly spent time in a variety of communities. What's your experience been like in Ocala so far?

@Justin Deen:

It's been really nice. I've been here for about three months now, almost four. And I've really been impressed with how engaging and genuine Ocala is. It really is a kind of a traditional community that while growing quickly, I think still has found a way to preserve that sort of small town culture, like many of the surrounding communities, and honestly, the places that I've lived, being really more recently from Gainesville, Florida.

Natalie McComb:

And I understand that the Institute has a lot of partnerships here in the community already. So what hospitals and centers do you currently partner with?

@Justin Deen:

Sure. So I do hip and knee replacement, which I know we'll talk about in a little bit probably, but we operate at the HCA Florida Ocala health system, predominantly at their West Marion campus, but also sometimes at the main hospital in Ocala. And then the surgery center of Ocala located just off state road 200.

Natalie McComb:

And, you know, when you look at the incidences where folks may receive a procedure at the surgery center versus the main hospital, what's kind of some of your determination? Is it that the complexity of the procedure, or is it that it's same day, how do you make that determination?

@Justin Deen:

That's a great question. I think historically most joint replacements were performed in a hospital and I think back to not many years ago, when I was a resident and even early practice, it was not uncommon for patients to stay in the hospital for three or four days. But as our techniques have improved, and our perioperative pain management and early recovery protocols have really started to blossom, the length of stay has shortened quite a bit. And then now most patients really are candidates for sort of same-day or outpatient surgery. So there are still some medical conditions or social determinants that can sort of preclude patients from same-day surgery. But for most, you know, well over three quarters of our patients are candidates for outpatient surgery.

Natalie McComb:

Oh, wow, that is a large a percentage.

@Justin Deen:

It is. it's great for physicians, it's great for patients.

Natalie McComb:

And as an orthopedic surgeon, I know you handle a wide variety of cases, but what areas do you specialize

@Justin Deen:

So I'm board certified and fellowship trained in? in hip and knee arthroplasty which is just a fancy word for replacement. So I spent an entire year really dedicated to studying and performing more complex hip and knee replacements which really gives me the skill set to kind of handle patients who need near hip replacements for non-degenerative conditions. So, you know, arthritis from previous fractures or infections, some people with what's called inflammatory arthritis like rheumatoid arthritis or lupus, as well as redos, which really is probably where sort of my true kind of skill lies I guess is the best way to say it. But redoing failed hip or knee replacements for all sorts of causes.

Natalie McComb:

Do you feel like you're seeing any trends in terms of replacements? Do you feel like you're you're doing more replacements on younger patients? Or is that kind of stayed the same over the years?

@Justin Deen:

Yeah, I would first say that the sheer volume of joint replacements being performed in general for all comers has grown dramatically. So if you look at 2015 data, which seems long ago, but really wasn't, we were doing about 600,000 joints a year. By 2040, that projection is that number, I should say, it's projected to go to 2 million, and then by 2060, 5 million. So it's growing at a fairly rapid rate. And I think this is probably multifactorial. One is the aging population. We know now that this is sort of the the first time in history that the age over 65 will outnumber the age under 65. And I think also we're starting to do joint replacements in younger patients, as you had mentioned. Historically, joints are reserved for elderly patients with just conventional wear and tear, arthritis. But now, what we're seeing is, we're doing joint replacements on younger people due to the obesity epidemic, which we know accelerates degenerative changes. But also the improvement in the materials and the implants afforded us the ability to provide replacements in younger, more active patients without the risk of it sort of wearing out too soon.

Natalie McComb:

And you mentioned wearing out. Typically, how long if you have a total knee replacement? How long is that good for? Is there an expiration date?

@Justin Deen:

Fortunately, no expiration date. But we say that for most people, it's about a 1% rate per year that it would have to be done. So if you take a 50 year old patient by age 75, it means there's a one in four chance that they'd have to have that knee redone. And that's for all causes. So there are many reasons why a knee replacement could fail. So when you lump those all together, it ends up being that roughly 1% per year. So still still very, very likely. And I tell most patients on the by, if the surgery is indicated, and you have no real immediate complications, we would expect that that would be the sort of one operation to last you for the rest of your life for that joint.

Natalie McComb:

And do you utilize any specialized techniques or equipment that helps reduce scarring or helps maybe the patient improve their recovery time?

@Justin Deen:

So I think the terms, you know, muscle sparing, or minimally invasive that they're buzzwords in orthopedics, I think like many, many surgical specialties, and I think it's often synonymous with less pain and improved recovery. But you know, and I'd be remiss to say that I don't use these, because I do think it creates a more gentle operation. But I think it's important, you know, for our listeners, and for patients to understand that while these are really exciting concepts and I think there's a lot of enthusiasm around them, you know, regarding specialized approaches and techniques, I think there's the difference that these make is probably small compared to the value-added from preoperative optimization. So improving a patient's medical condition before surgery, education, and then really an open discussion that frames the treatment plans. I kind of tell patients, I equate it to a runner training for a race. The shoes may make a difference, but that's probably pretty small in comparison to the structured training program and some psychological and emotional preparation.

Natalie McComb:

And also in managing expectations. I'm sure that you know some patients, particularly those who may have prolonged a procedure, they think they're going to be like get up and be running a lot sooner. Right? Then maybe the reality is. How do you partner with, you know, folks providing things like physical therapy and things like that with recovery? What do you do in your practice to help with that recovery?

@Justin Deen:

I think the recovery process actually starts before the surgery ever takes place. So I think many patients benefit from preoperative physical therapy. Some of that is conditioning, but a lot of it is just education so that on the day of surgery, or the days after surgery, they've really already gone through the motions and the steps and it's really just sort of executing the plan that we've laid out for them. We have physical therapy at our clinic. But there are really a lot of great physical therapy centers throughout Ocala that we've really sort of informally partnered with. So we're very fortunate that this area has a fairly high quality, setup or options for our patients.

Natalie McComb:

And what strategies are you utilizing in your practice to help manage pain, but also reduce the risk of addiction after surgery?

@Justin Deen:

So pain has been a pretty important topic when we look across sort of political and social forums. And I'm actually really glad you asked about this because this is something that has really been a passion of mine for the last several years. If we look at prescribing practices, orthopedic surgeons are the third highest prescribers of narcotics, the largest actual surgical specialty. So I think we realized that it's really important for us to take a lot of ownership and in making change. And so for me, in addition to some changes that I had historically made within our practice, I have several publications, and I worked on a committee with the American Association of Hip and Knee Surgeons who did develop a clinical practice guideline for perioperative pain control, specifically for patients undergoing joint replacement. So I think what that really ends up, you know, today for our patients and NFIs, that we have this fairly comprehensive, we call it multidisciplinary pain control strategy. And that means that we utilize several different types of non narcotic medications that allow us to minimize the use of opioid narcotics for pain control. I think, moreover, the patients are then sort of stratified or we sort of put them into four different prescription pathways based on their individual needs, so that we really avoid the under or over-prescribing, which tends to be more problematic like you said, when you when you look at the risk of sort of what's called super therapeutic use or addiction.

Natalie McComb:

And do you feel that, you know, some of the screening and the conversations you have with your patients, you know, does it come into play patients that that may, you know, have had of history, or maybe currently consume a lot of alcohol or other things that are in their system? Does that come into play as well, in terms of that, you know, what they're coming to you with existing?

@Justin Deen:

Absolutely. So it's really, we look at several things, when we decide which of those sort of pathways patients go down. One is the severity of disease. So patients who have had what's called post-traumatic arthritis, or say they develop arthritis from a previous trauma, or they have hardware that needs to be removed, or scar tissue, anything that technically makes the surgery more complicated is at a higher risk for more pain. On the flip side, patients, as you said, who have a history of super therapeutic use, or even patients who are on occasional narcotics are at a slightly higher risk. So we can tailor their narcotic prescriptions based on the surgery and the individual. And as you had said, sometimes the expectation. But that's really, we want to make sure that we're not, we're not tailoring the, we're not doing higher narcotics for patients who expect to have less pain. I think, as you had said, it's really important to understand what a patient's expectation is, and set those as realistic expectations What I do is by and large what's called elective surgery. So patients have a choice. It's really not life or limb-threatening. And so what we're trying to create is some satisfaction, and satisfaction is usually sort of predicated on realistic expectation.

Natalie McComb:

And working in healthcare, you often see patients, you know, kind of in their worst moments. Sometimes whether they're coming to you in pain, or they sustained an injury that has been very concerning, or they're afraid of what their next steps might be in their treatment plan. So how do you approach this as a physician?

@Justin Deen:

Yeah, I think that's a really good question. A nice follow up to the one we just spoke about, because I see patients again, who are oftentimes disabled from these degenerative or post traumatic conditions they have been in, and I think the most important thing to understand though, is that pain and disability are very personal experiences. Patients perceive and project pain in different ways. And while the mechanical symptoms, so the actual bone on bone, or the muscle tearing, or the inflammation, is the most prominent or the most glaring, it's usually the emotional and psychological aspects that are equally if not more important to address. I think unfortunately, orthopedics, orthopedic surgeons, and maybe the medical community in general, often overlooks this in our patients. And this population specifically. So, you know, and patients tend to have very specific functional limitations that bring them in to see a surgeon. Usually, it's one specific thing that they can no longer do is why they came to see me. So I think identifying this really creates sort of early goals that then kind of shapes and inspires them, you know, when they're in recovery.

Natalie McComb:

And recognizing, obviously, you know, that what do they say that a certain percentage of recovery is

@Justin Deen:

That's exactly right. mental, right? It's the physical aspect, but it's mentally that you're willing to put the work in and have a good outlook and know that this too shall pass and, recovery sometimes just doesn't go as planned, right? It may take a little longer, you may have some setbacks, but that doesn't mean you won't get there.

Natalie McComb:

For sure, for sure. So I know that there are many orthopedic groups that are seeing patients now in Ocala. But what sets the Florida orthopaedic Institute apart?

@Justin Deen:

I think one thing that sets us apart from from any any group in this state is that we've really focused on high level expert physicians. So every FOI physician is fellowship trained in their sub specialty. So that means in addition to their residency, typically five years, we've all undergone some additional subspecialty training and the specific types of procedures. I had mentioned earlier that I did one year, you know, exclusively looking at hip and knee replacement surgeries. And I think that's important because orthopedic surgery, it's really grown by leaps and bounds, you know when we look at the sort of the breadth of diagnosis and treatment options. So I think it's important to get care from someone who specializes in your specific diagnosis or procedure. And I think that really improves the outcomes and expertise. Locally, our Ocala group is somewhat uniqu. I think because we were all sort of previously academic or university surgeons. So we were heavily involved in research, education, advancing orthopedics, and training the next generation of surgeons. So I think we're all really excited to bring this sort of high level, high quality, specialized expert care to the members of this community.

Natalie McComb:

And being in education, I'm sure you're always up on kind of the latest techniques and procedures. What's next on the horizon for orthopedic surgery, even, you know, a decade from now, where are things heading? And what kind of has you most excited?

@Justin Deen:

Yeah, so we hit on one earlier, I think outpatient surgery or same-day surgery has really grown rapidly, I think, sort of both organically from the, you know, I said, the surgical techniques and the implants but really also COVID. COVID really accelerated that push because all of a sudden patients didn't need to be in a hospital. But from a tech sort of stand, I think, I think the biggest thing is the introduction and integration of technology, really robotics and navigation, and then what are called patient engagement platforms. So in joint replacement, robotic-assisted technology just involves the use of a robotic arm that assists with the operation with the goal of improving the accuracy and reproducibility. Patient engagement platforms are sort of software-based programs that facilitate two way communication during the recovery process that improves the sort of connectivity and education for patients and surgeons.

Natalie McComb:

Like a text your doc?

@Justin Deen:

Yeah. Or some, a lot of times, they can download or you can upload instructional videos or therapy exercises.

Natalie McComb:

So, what other specialties has your group brought to Ocala?

@Justin Deen:

So we offer a pretty comprehensive musculoskeletal service. We cover major, all of the major, sub specialties in orthopedics, including surgical and non surgical sports medicine, as well as hand. And to be honest, you know, pretty much all comers for any sprains or strains. We see patients as young as two and all the way up to, you know, over 100. So I think if any listeners out there having any issues, give us a call, we'll certainly be able to take care of you.

Natalie McComb:

And now a word from our sponsor.

@Sponsor: Douglas Law Firm:

Hello, I'm Charlie Douglas with the Douglas law firm. We are a full-service law firm with many practice areas to serve your particular needs. The Douglas law firm is located in downtown Ocala at 110 North Magnolia Avenue, give us a call today for a free consultation, or visit us at DHClawyers.com.

Natalie McComb:

So we provide our guests with the opportunity to highlight a nonprofit that they're passionate about. So what organization did you want to highlight today?

@Justin Deen:

I'd highlight the Marion Senior Services. So the senior population is particularly near and dear to my heart. As I said, I mean this, this makes up most of my patient population. So I think our professional goals naturally align and that being to promote the independence and well being of our seniors.

Natalie McComb:

A great organization. And now it's time for our lightning round questions. So okay, you ready?

@Justin Deen:

Sure.

Natalie McComb:

Okay, good. So what trait do you value most are members of your team?

@Justin Deen:

I think the word commitment for some reason stands out in my mind. I want team members who are committed to individual and team excellence, committed to sort of the team above all else, and then committed to our patients.

Natalie McComb:

Top band in your playlist right now.

@Justin Deen:

It's funny. That's a tough one. I I hate to say I listen to everything, but I probably can't speak of one band, but I would say anything sort of 90's country . That is my typical go to. It's nostagic and relaxing.

Natalie McComb:

Nice. Okay. Brings you back to a simpler time.

@Justin Deen:

Not to sound like one of the songs, but yeah, it does.

Natalie McComb:

Make you feel good. So what was your first job? And what did you learn from that experience?

@Justin Deen:

So I started working at 15. I remember very vividly my dad dropping me off every day to work. I was an assistant Greenskeeper at a local golf course. And so it was, you know, as I'm sure many people who golf, you see those folks out there, it was certainly very physically demanding. But I think you know, in addition to this sort of physical and mental discipline and conditioning, it really taught me the importance of careful planning and execution. Whenever you see people mowing a green or mowing or even mowing your own lawn. It's really intriguing to me how people do it different ways. And there's an emphasis on its efficiency and the aesthetics at the end. So that was my introduction to that. And, and a lot of those kinds of principles I think, carry over into my job. And the things that I do are very, I think, technical. They require a lot of planning. And in orthopedics it's kind of nice, I get to see my work fairly immediately, sort of like I did back then. But more importantly, it introduced me to the game of golf, which, which I love so.

Natalie McComb:

And probably now having done that job of fixing others divots, right and all the mess like that, a wayward cart can make in the greens, you're probably a little more conscious of maybe the care that you provide when you're out there on the course, right? Because there's someone doing it, there's someone fixing it. And who is a leader that you admire?

@Justin Deen:

I got my MBA about a year and a half ago. And when I was going through that process, they always talked about a lot of quotes from Warren Buffett as sort of one of the most famous American investors and CEO of one of the largest investment firms really in the world. But he, he's always noted for sort of his, even though he was probably one of the wealthiest men and the most successful investors, he always adhered to a lot of principles of value. And he was very frugal, and he always sort of had these very genuine and insightful quotes that I always have kind of liked those kinds of things. And I just thought a lot of them were really, really cool. You know, I'm actually a father of two young girls, and one of the ones I remember him always saying was giving your children enough so that they can do anything, but not so much that they have to do nothing.

Natalie McComb:

Oh, I like that. Or, you know, someone is sitting in the shade today because someone planted a tree a long time ago. Things, you know, just very good quips. And so I think, you know, when I try to be a leader, I think no matter how successful we are, it's really important to sort of stay humble and that's just something that I've always thought was important. Well, thank you again. Again, we were here with Dr. Justin Dean, Orthopedic surgeon with the Florida Orthopaedic Institute. It was great to have you on the show.

@Justin Deen:

Thank you so much, Natalie, thank you. Thank you to our listeners.

Natalie McComb:

Thank you for joining us for another episode of the catalyst hosted by the Ocala Metro Chamber and economic partnership, sponsored by Douglas law firm and recorded live at Wiley productions podcast studios. New episodes, guests and perspectives on leadership premiere twice a month. Follow us on Apple, Amazon, Spotify or wherever you enjoy your podcasts. Have a suggestion for a future guest email us at thecatalyst@ocalacep.com