Edward Blocker, MD, is a board certified orthopedic surgeon at Novant Health Orthopedic & Sports Medicine - Beaufort. He specializes in hip and knee replacement, lower extremity arthritis, and hand conditions including carpal tunnel syndrome and trigger finger, and serves patients across the Beaufort and Lowcountry region.
What types of hip and knee conditions are you most commonly referred for in the Beaufort and Lowcountry region?
Arthritis is by far the most common condition affecting hips and knees referred to my practice. We will all experience some degree of arthritis in our lifetime, though the severity varies widely from person to person. Cartilage wears down in all of us, but at different rates. Not everyone will need to see an orthopedist. Arthritis is also more common in weight-bearing joints, which is why we see it more frequently in knees and hips than in shoulders and elbows.
When managing patients with moderate-to-severe hip or knee arthritis, what clinical findings suggest it's time to consider referral for joint replacement evaluation?
Symptoms are what matter most. Symptoms should guide the decision to seek evaluation. Clinical findings such as limited range of motion, combined with symptoms like pain and stiffness that interfere with activities of daily living despite conservative measures, prompt consideration of joint replacement.
How do you determine which patients are appropriate candidates for total hip or total knee arthroplasty versus continued conservative management?
If conservative treatment is helping and the patient feels able to do everything they want to do, joint replacement is unlikely indicated, even if their X-rays show severe arthritis. As physicians, we shouldn't be treating the X-rays; we treat the patient. Conversely, if someone has moderate or severe arthritis on imaging and conservative measures are no longer providing relief, and symptoms are interfering with quality of life or daily activities, then joint replacement becomes a real consideration.
Novant Health Coastal Carolina Medical Center has been designated a Center of Excellence in Robotic Surgery. How has robot-assisted technology, such as the Mako system, changed your approach to joint replacement?
The Mako robotic system has added a remarkable level of precision to joint replacement surgery. The robot doesn't perform the surgery, the surgeon does. The robotic arm only moves when the surgeon's hand moves it. The software enables pre-planning of bone cuts so that once the components are in place, the joint is balanced with appropriate ligament tension on each side of the knee. For hip replacements, we can place the socket at a specific, predetermined angle based on each patient's individual anatomy. This level of precision and ligament balancing was not previously achievable.
To make a referral in Bluffton or Beaufort call 843-682-7480.
From a referring provider's perspective, what are the practical benefits of robot-assisted joint replacement for patients in terms of surgical precision, recovery and outcomes?
The Mako system has provided a level of surgical precision we didn't have before. Beyond robotics, nearly every step of the surgical process has evolved, from pre- and postoperative medications, to implant design and sterilization, to intraoperative injections for pain control, to the dressings we use. These advances have meaningfully improved recovery and outcomes.
How do you approach preoperative optimization, including management of comorbidities, to reduce complication risk and improve postoperative recovery?
Preoperative optimization is a key factor in achieving the best possible outcomes from joint replacement. Most of our patients go through our preoperative optimization clinic. Patients complete a standardized panel of labs along with an EKG and chest X-ray to identify anything that needs attention. Sometimes everything is clear to proceed; other times there's a minor issue to address. Occasionally, we discover a previously undetected serious cardiac condition that needs to be managed before surgery can move forward.
For patients who may be hesitant about surgery, how do you structure shared decision-making discussions around risks, benefits and expected functional improvement?
Shared decision-making is central. X-rays matter, but ultimately it comes down to symptoms and whether they're being adequately managed with nonoperative care. Only the patient knows how their hip or knee truly feels, and the surgeon, above all else, must listen.
Beyond hip and knee replacement, you also treat lower extremity arthritis and hand conditions such as carpal tunnel syndrome and trigger finger. When should primary care providers consider referral for these conditions?
Carpal tunnel syndrome and trigger finger are among the most common hand conditions I see in my practice. If symptoms have not improved with time or anti-inflammatory treatment, an orthopedic referral is appropriate.
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What role does imaging play prior to referral, and what studies are most helpful to have available at the time of consultation?
We can efficiently obtain the appropriate X-rays in the office at the time of the appointment, and that's usually the most practical approach. If the patient has already had imaging done, it can typically be transferred on a disc or thumb drive to avoid duplicate studies. For arthritis, plain film X-rays are the most important study. For lower extremity conditions, we obtain weight-bearing X-rays, which show the true degree of cartilage loss. Non-weight-bearing X-rays can underestimate severity. In fact, a weight-bearing X-ray is generally more useful than an MRI for assessing the severity of arthritis.
What should referring providers know about joint replacement care in Beaufort?
At Novant Health Orthopedic & Sports Medicine - Beaufort, care is guided by a patient-centered approach to evaluation and treatment decisions, with access to robot-assisted joint replacement at Novant Health Coastal Carolina Medical Center.
