¶ Intro / Opening
🎵 Music
Presents are Dr.
This is UK Healthcast. Here's Melanie Cole.
¶ Joint Pain, Diagnosis, and Conservative Treatments
With people living longer than ever, arthritis of the hip and knee is becoming more common, but when that severe pain or joint damage limits your daily activities That's when it might be time to consider seeing a physician to assess your pain. My guest today is Dr. Patrick O'Donnell. He's a hip and knee surgeon that does advanced reconstruction at UK Healthcare. Dr. O'Donnell, what are some of the most common causes of joint pain? What types of conditions cause the hip or the knee to break down?
The most common cause melanin is arthritis. Arthritis can come in a lot of different forms, but I would say that the most common type of arthritis that we see is just degenerative joint disease. Somebody has worn through the cartilage in their knee. And if you think of the cartilage like the tread on the tires of your car, patients are walking around on bald tires. Um that's that's probably the most common thing that we see in our clinic.
So, how do you diagnose when someone comes to you in pain, and maybe they've had pain for a while and they've put off coming to you, how do you diagnose what the cause?
The first thing we do is we we do a thorough history. We want to uh ask the patient about their pain, what causes their pain, where their pain is located is a big thing. Um and then the the real diagnostic tool that we use are some of our our X ray technologies. Um arthritis is diagnosed on an x-ray. A lot of patients will think they need an MRI, um, but the MRI act i isn't actually the the standard of care. You can tell a lot just by a basic x-ray.
So that's where we typically start for hip and knee arthritis, is is a good history, a good physical exam, and then uh an x ray.
Let's talk about first line of defense and conservative management, some non-surgical treatments. Kind of go down in order. What might you try first? And what do you think about modalities that people try at home, such as ice or heat or bracing, activity modification? Tell us what you would recommend.
Yeah, I think you you've stolen a lot of my thunder, Melanie. Um arthritis, you you can break arthritis down into three levels mild, moderate, and severe. Mild arthritis is something that's very uh well treated with over-the-counter pain medicine, sometimes bracing, definitely uh activ activity modification. Um moderate arthritis uh is more treated with injection.
Um injections come in in two varieties, either cortisone injections or what's called visco supplementation, uh that some people may know of as uh a rooster comb injection or a joint lube. And then it's the severe arthritis that we start talking about surgical management. So we we really try to push with our patients um activity modifications, physical therapy and injections before we even start talking or offering uh surgical uh options.
¶ Considering Joint Replacement Surgery and Implants
What does that discussion look like when you're discussing surgery for replacement with your patients and what questions would you like patients to ask a potential surgeon before moving forward with having a joint replacement?
Yeah, good question. Um so joint replacements are an elective surgical procedure. Uh it's not a heart attack, it's not a stroke, it's not a cancer. It's not something that I ever go to a patient and say, You have to have this done. Um a joint replacement is is meant to improve the patient's quality of life. And so when I when I meet a patient who's thinking about a joint replacement, I tend to ask three quality of life questions.
Um does your pain bother you every day? Does your pain keep you from doing things that you want to do in life? And often does your pain keep you from sleeping? And if if your arthritis pain is um affecting those three areas of your life, it's probably start time to to to have a discussion about surgical management.
once the patient has exhausted all of the conservative measures. We think of it like the patient's painted into a corner. They've tried injections, they've tried physical therapy, they've tried braces, but they're still having pain that keeps them from enjoying their life. Um it's only then that we we even begin to talk about surgical
Tell us about some of the types of surgeries that you perform, doctor O'Donnell. People hear partial replacement, total replacement. They're not sure what any of that means.
Yeah. So um the partial versus total replacement is mostly um trying to talk about varieties of knee replacement. So the knee has three compartments. A total knee replacement replaces all three compartments with a knee that's made of metal and plastic. A partial replacement will replace one of those three compartments, and that's typically only used for patients that say have arthritis in one compartment of the knee, but the other two compartments of the knee has have no arthritis.
For hip replacements, we we uh in today's day and age we typically offer total hip replacements. for arthritis. There um there are a lot of different historic techniques for hip arthritis, but in today's day and age everybody sees the total replacement pla replacing both the ball and the socket as the standard of care.
And are you doing hip replacement in the anterior approach? Tell us a little bit about what's changed with hip replacement over the years.
Yeah, so hip replacements is um there are a lot of there are a lot of ways to skin a cat in a hip replacement. Patients will come in and ask for an anterior hip replacement or a posterior hip replacement. Some people will do a direct lateral hip replacement. These are all just different variations in the way that you cut into the hip. But the hip replacement is the same. Um we we cut off the ball of the hip and give you a new ball. We then scrape out the cup and give you a new cup.
The anterior hip replacement is something that we do offer in select indications. Um patients have to be the right size, they have to um have the right bone quality because it is definitely a little bit more of a risky procedure to do it, do the hip replacement anteriorly or through the front.
The gold standard and I would say what we do the majority of our hip replacements today is what's called a posterior hip replacement. That's the way that hip replacements have been done since the nineteen fifties, and it is an awesome sort of Um if if a patient gets a posterior that that does not mean that their um outcome is going to be any different than an anterior. It just changes the rehabilitation by about two to three times.
So in the grand scheme of a twenty to twenty five year hip replacement, two to three weeks probably doesn't make that big of a
Tell us about the implants, doctor O'Donnell. What's new and exciting with them and what's changed over the years?
Yeah, so the the um in orthopedic replacement there are I would say five main manufacturers of orthopedic implants. Um personally I use uh striker implants. Um I think that the the striker triathlon is an excellent knee replacement that has a great track record. Um we have great customer service from our Stryker colleagues. We actually have a member of Stryker in the operating room in real time who during the surgery can answer questions um regarding sizing the patient, regarding
uh motion for the patient that can help me while the patient's asleep in real time uh troubleshoot uh the surgery. Uh for the hip replacements it's the same. I use striker components for the hip replacement. Um and again um uh the striker hip replacement has a great track record. Um other hip replacements and knee replacements like Biomet, Zimmer, um Smith and Nephew, DePew, they're they're all great implants.
Um we just tend to get better results with our striker uh implants and that's why we've stuck with them for about seven years now.
¶ Life After Surgery, Rehab, and Prevention
How long do they last? And and tell us about what life is like after an implant. Can they go through metal detectors in airports? What realistic expectations would you like patients to have?
Yeah, so for a hip replacement, a realistic expectation is what we call a forgotten joint. Um patients will come in in excruciating pain that limits their quality of life. and three, six months after their hip replacement, they forget they've even had a hip replacement. They walk normal, without pain, um
And they they just kinda tend to forget that they've had it. And that's that's in the joint replacement world is considered a slam dunk. Um, having a forgotten joint that the patient doesn't even know that they've had a surgery. Knee replacements I'd say the the forgotten joint isn't the standard. Knee replacements tend to feel a little bit more clunky for patients. Um it feels like a metal and plastic knee. So for our patients that like to hunt or fish or hike
Uneven surfaces can be difficult on a knee replacement. So the goal of the knee replacement is a painless joint. It still doesn't feel like that knee you had when you were twenty years old, but the hope would be it's painless. Um, both hip and knee replacements, we're getting somewhere between twenty to twenty five years out of the implant. And when the implants start to wear, it's not a catastrophic bomb that goes off in the hip or the knee.
But what we see radiographically on the X rays is some thinning of the uh plastic component, the the polyethylene, that suggests it may need to be changed over time. Again, just think of the the tire analogy. The the polyethylene of the plastic is starting to wear like the tires on the car.
And it just needs to be replaced. Sometimes the implants can wiggle loose if the the bone um hasn't accepted them. Um And so the the failure of hip and knee replacements, while it is uh pretty rare, is something that we typically either pick up with pain or on uh an x-ray seeing the plastic getting too thin.
What's the rehabilitation process like after joint replacement? I understand it would be different for knees. and hips, but how soon do you tell people they can kind of get back to physical activity or driving? What is rehab like for
Yeah. So the hip replacement is the the easier one, um, but probably the more risky one. When we do the hip replacement we actually pop the ball out of the socket, do what's called dislocate the hip. Um And so after the hip surgery, patients are at a slight risk for a re-dislocation event, which sometimes can mean more surgery.
So while the recovery is easier for a hip replacement, it's actually a little bit more risky and patients have to abide by the hip precautions that the therapist will show them both before and after the surgery. Um hip replacements tend to take about an hour to do. Uh you get up and walk right away. You're typically in the hospital maybe a night.
Um and then I t I counsel patients that it takes somewhere between eight to twelve weeks, depending on the individual, until you're really back doing everything that you wanted. Um knee replacements are a lot harder. I don't make a whole lot of friends in our patients for about the first, say, four to six weeks after a knee replacement. Because the knee replacement, the hardest part of it, is the recovery.
Again, the knee replacement surgery takes about an hour to do. You can get up and walk right away. Typically again a a short maybe one or two night hospital stay. But the the pain after the knee replacement can be very difficult for patients. And the key with the knee replacement is is while the patient is in pain, you have to do all of your therapy. You have to get your motion back. And so it's it's it's pretty difficult. Patients don't um
they don't feel like themselves. They they tend to have a a tend to really need to focus on their physical therapy, so the recovery is is again in that eight to twelve week mark, but it's much more intense early on. We have great pain medicine we give patients, but it doesn't take away all the pain.
As far as driving, it depends on whether it's a right or a left sided surgery. If you do a right sided knee replacement or hip replacement, you're probably looking at somewhere between six and eight weeks before you can get back to drive. We tend to tell people that when you're getting close to that point to go test yourself in a parking lot prior to actually driving so that they can be safe and morally responsible on the road.
For a left sided hip or knee replacement, patients can tend to drive as soon as they can get into and out of a car and they're off of their narcotic pain.
So much to
Wow, Doctor O'Donnell, you have given us so much great information and so much to think about. Thank you for coming on and really sharing your expertise, explaining everything. So beautifully for us about hip and knee replacement. Give us your best advice now on keeping healthy joints as we wrap up.
Um I'd say keeping healthy joints is ke is staying out of the operating room personally. I'm a surgeon. I love to operate, but I think what what nature gave patients is better than anything that we have as far as a replacement.
The best way for patients to to stay out of the operating room for hip and knee um arthritis is to stay mobile. Motion is lotion. The more you move your joints, the better they'll do. And so really having an active lifestyle walking, um uh exercise bike uh biking, elliptical, doing things where you're really getting some motion in those joints can really help get you a few more miles.
Um when the knees do wear w out or the hips do wear out, we're happy to see ya. But the the hope would be prevention, honestly, Melanie.
It's great advice, doctor O'Donnell. It really is. Thank you again for joining us. This is UK HealthCap. with the University of Kentucky Healthcare. For more information, you can go to uk healthcare dot uky dot edu. That's UK healthcare dot uk y dot ed you. I'm Melanie Cole, thanks for tuning in.