If you’re over 50 and you’ve had an x-ray, chances are someone has pointed to it and said the words “bone on bone.” But does that picture on the screen actually tell the whole story? Dr. Juan C. Suarez is an orthopedic surgeon specializing in hip and knee joint replacement at Baptist Hospital in Miami — and, as host Dr. Brent Anderson can personally attest, he’s also the surgeon who replaced both of Dr. Brent’s hips with outstanding results.
In this episode, Dr. Brent and Dr. Suarez take you inside the entire joint replacement journey: what actually causes hip degeneration, why x-rays don’t always predict when surgery is needed, and how the threshold for replacement has shifted with better implants and improved techniques. They dive into the difference between anterior and posterior surgical approaches, what robotics actually does (and doesn’t do) in the operating room, and what recovery really looks like in the weeks after surgery. Along the way, they bust some persistent myths — including the eye-opening statistic that 80% of hip arthroscopies performed after age 50 lead to a full hip replacement within two years.
IN THIS EPISODE:
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0:00 Introducing Dr. Juan C. Suarez
Hip and knee replacement specialist at Baptist Hospital Miami, affiliate professor at Florida Atlantic University, and the surgeon who replaced both of Dr. Brent’s hips
2:50 How Dr. Brent Found His Surgeon
The moment Dr. Brent knew Dr. Suarez was the right surgeon — sitting side by side, looking at x-rays, and being asked what he needed to make the decision
5:41 Dr. Suarez’s Background and Philosophy
From Cleveland Clinic to Baptist Hospital Coral Gables — how communication, cultural connection, and patient relationship became the foundation of his practice
8:20 Episode Overview: The Six Million Dollar Hip
Dr. Brent frames the episode’s goals — understanding when replacement is truly indicated, how to prevent degeneration, what to expect from surgery, and a few myth busters
9:09 Shifting Thresholds: When Is It Time?
Why the bar for hip replacement has moved — hips vs. knees, improving materials, longer-lasting implants, and why surgeons are pulling the trigger earlier than before
13:07 Why Does the Hip Degenerate?
The four root causes of hip arthritis — wear and tear, post-traumatic arthritis, autoimmune disease, and anatomic variations like hip dysplasia
15:03 Myth Buster: Do You Need Bone on Bone to Have Surgery?
Why x-rays don’t always tell the whole story — osteonecrosis, the twilight zone of labral tears and mild arthritis, and when the real question is prolonging the life of your natural hip
17:06 The 80% Statistic: Hip Arthroscopy After 50
The data that stopped Dr. Brent in his tracks — why arthroscopy over age 50 leads to full hip replacement within two years in 80% of cases, and what that means for patient decision-making
18:22 Special Populations: Dancers and Hip Deformity
Why ballet dancers with shallow acetabulums and femoral retroversion are at high risk for early joint replacement — and why preventive surgery at 20 is nearly impossible to sell
21:03 Hypermobility and Ehlers-Danlos Syndrome
The instability challenge in hypermobile patients — how surgeons adjust implant selection when there’s no genetic test to confirm collagen disorders
22:00 When Prior Arthroscopy Makes Replacement Harder
What thermal capsular shrinkage does to surgical access — why Dr. Brent’s first hip was significantly harder to replace than the second, untouched one
24:09 Myth Buster: Posterior vs. Anterior Approach
The evolution of surgical approaches from transtrochanteric to posterior to anterior — why over 60% of hip surgeons have now made the switch
26:34 The HANA Table and Surgical Technology
How the specialized positioning table enables the anterior approach — full leg control, traction, rotation, and the emerging era of automated robotic tables
28:41 What Robotics Actually Does in Hip Replacement
Clearing up the misconception — robotics doesn’t make surgery less invasive, it makes implant placement more precise, tracking leg length and offset in real time
30:09 Inside the Operating Room: Step by Step
From spinal anesthesia to capsule closure — a plain-language walkthrough of what happens during an anterior hip replacement and why it now takes under 45 minutes
31:26 Pain Management: Beyond Opioids
Pre-emptive analgesia with Tylenol, Lyrica, and Celebrex — plus Journavx, the first new FDA-approved non-opioid pain medication in 20 years
37:43 Implant Materials: Ceramic, Plastic, and the Metal-on-Metal Mistake
Why metal-on-metal was abandoned, what happened with ceramic-on-ceramic squeaking, and why ceramic head on highly cross-linked polyethylene is the current gold standard
39:11 Hardware Quality, Recalls, and the Consumer Mindset
Why patients should ask about hardware — and why 98%+ of hip replacement patients go on to live full, unrestricted lives
44:29 Recovery: Faster Is Not Always Better
Why Dr. Suarez tells all his anterior approach patients to take it easy for the first three to four weeks — inflammation management, mobility, and avoiding the cycle of pain
46:36 Capsule Preservation and Long-Term Body Awareness
How 75% of capsules are saved during anterior approach surgery, what happens when they’re not, and the question of proprioception and neural feedback after replacement
47:53 Myth Buster: Do X-Rays Always Predict the Need for Surgery?
“I treat people, not x-rays” — how diagnostic injections help confirm whether pain is truly coming from inside the joint
49:13 Osteoporosis and Bone Quality: Cementing the Stem
Why poor bone density changes the surgical plan — cementing the stem instead of press-fitting it dramatically reduces fracture risk in patients with low bone density
50:52 What’s Exciting Dr. Suarez Right Now: Kinematic Alignment
The emerging knee replacement technique that aims to recreate each patient’s individual anatomy — and why it may do for knees what the anterior approach did for hips
51:34 Closing: Live Aligned and Be Kind
Dr. Brent’s sign-off, gratitude for Dr. Suarez, and the promise of a future episode on total knee replacement
MD
Juan C. Suarez, M.D., is an orthopedic surgeon who specializes in adult hip and knee joint replacement surgery, including revision joint replacement and minimally invasive surgical techniques. He has more than 16 years of experience in his specialty.Dr. Suarez has made numerous symposium presentations on the efficacy of surgical methods utilized in hip and knee reconstructive surgery. He also is widely published in such scientific publications as the Journal of Arthroplasty and the American Journal of Orthopedics. He serves as an affiliate assistant professor at Florida Atlantic University Charles E. Schmidt College of Medicine and on the editorial board of Arthroplasty Today. He is a member of the American Academy of Orthopedic Surgeons and the American Association of Hip and Knee Surgeons. He is fluent in English and Spanish. 5/5 star surgeon with over 1000 reviews.
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