Scott Webb (Host): Hip pain is very common, and there are a variety of causes that my guest today would like to discuss along with the complications of not being treated. I'm joined today by Dr. Nikhil Pandhi. He's a board-certified orthopedic surgeon with Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, it's nice to have you here today. We're going to talk about the common causes of hip pain and complications if it goes untreated. But before we get there, I want to have you just talk about your background, training, experience in orthopedics and sports medicine, and how it helped inform the way you treat your patients today.

Dr. Nikhil Pandhi: Yeah, happy to do so. My background is I'm a board-certified trained orthopedic surgeon. I have sports medicine fellowship training. I did my residency, performed a residency in Detroit, Michigan area through Michigan State University and POH Medical Center. I did that for five years, did training in all sorts of subspecialties and residency like most orthopedic surgeons do, whether that's pediatrics, sports, joint replacements, trauma, you name it.

And so, then, I did a sports medicine fellowship at the Detroit Sports Medicine Program, Detroit Medical Center Sports Medicine Program in Detroit, Michigan. We used to obviously do a lot of surgeries and see a lot of patients and took care of, at that time, three of the four professional sports teams in the area. So, we would do game coverage for Detroit Red Wings for NHL Hockey; Major League Baseball, Detroit Tigers; Detroit Pistons for NBA Basketball. So, we would do the game coverage training rooms. And so, you know, invaluable experience with dealing with, you know, high-level athletes. So, that was a fun time.

Host: Sure. Yeah. Yeah. That's awesome. And when we think about the common causes for hip pain, like I know for me at my age, my ripe old age, in my mid-50s, you know, osteoarthritis is the likely culprit for me. But in general, what are the common causes of hip pain?

Dr. Nikhil Pandhi: Great question. You know, the basic causes, barring some sort of injury such as a muscle strain or a tendon strain, which can happen just, you know, everyday life, sports activity, working out the most common things you see are, osteoarthritis, like you mentioned, losing space in the joint, losing cartilage, which leads to that lack of motion, or pain with motion. You know, that's probably the most common cause as we age. And sometimes that can be predicated upon the fact of injury or just getting older, genetics, carrying more weight on your body. All of these can affect the hip joint.

Other causes can be, you know, like you said, a muscle strain. You could have something that's not involved with the hip joint, such as outside the joint, such as a bursitis, a tendon irritation of the gluteus medius and minimus, which are tendons on the abductors of your hip joint, which also many people consider the rotator cuff of the hip, which you know is in the shoulder. So, those are common causes.

You know, you can have rheumatoid arthritis as well, inflammatory process, a labrum tears, which you see in a kind of a younger population of patients, or in athletes as well, where there's a structure in the hip joint, which helps to not only secure the hip joint, but seal the hip joint. People have tears in that soft tissue cartilage, which can cause pain as well.

Host: Yeah. Yeah. So, lots of, you know, whether it's family history, genetics, injury, arthritis, age, you know, all the above. Are there any specific maybe diseases or just situations that might cause hip pain?

Dr. Nikhil Pandhi: Absolutely. There are situations such as, you know, some people are born with something called a dysplastic hip, where the hip joint has kind of a different look to it on x-ray, a different, you know, mechanical alignment, less coverage of the cup on the ball, so to speak, of the hip. And usually, these are diagnosed at a very young age, at a pediatric population. As we get older, some people do just fine. Some people develop other issues with that hip, such as something called avascular necrosis, AVN for short, which just means the blood supply to the femur bone in the hip is compromised. And it'd be compromised for many different reasons. But this is one reason we're going to be compromised. And that can cause the cartilage and the bone to basically die and disintegrate.

It's like I always equate it to building a house on, you know, a slab of concrete versus building it on sand. It's like you're building a house on sand, so your cartilage collapses over time and increases pain, leading, you know, patients to need other treatments such as hip replacement or other treatments that can maybe be interventional prior to it getting that much more worse.

Host: Yeah. And doctor, it seems like things get worse at night, right? And I know what I tell myself, so if my hip hurts and then it seems worse in the morning, I say, "Well, it's because of the way I was laying and the blood supply or blood flow or whatever." That's why it's great to have an expert here, like why do these things feel like they get worse at night?

Dr. Nikhil Pandhi: Another, you know, great question. It's one of those things I get asked all the time you know, patients ask and they say, "Well, my knee or my hip, it hurts at night. Why is that?" One thing could be, You know, you're up on your feet all day. Depending on what kind of work you do, you're active all day. By the end of the day, most likely you have less space in your hip joint. As the fluid kind of compresses, you lose space in the joint. And also, you've been so active that the lining of the hip joint and, if you had some sort of arthritic process or anything else going on in the hip, by the end of the day, the lining of the hip joints irritated, which causes a pain response. The lining known as the synovium, you know, it can get irritated by the end of the day. So, you basically have this inflammatory process, which is now increasing your hip pain because you've been active. And then, you already had underlying issues with your hip to begin with. So, that's one thing. Just as a weight-bearing joint, you're always on your feet. You know, and jobs, we work with a lot of people that work at the places like the steel mill and there are machinists and they're on their feet all day. And by end of the day, they're worn out. And that's, you know, probably a primary reason of why that occurs.

Host: Yeah. And then, we lay in bed and we potentially lay on that hip. And sure, it's not going to feel great in the morning. So, Doctor, as a sports medicine and joint specialist, I'm sure you use the latest scientific advancements. So, maybe you can discuss how you treat patients when they come in with that chronic hip pain, not the injured type, but that chronic hip pain that's just been going on and they finally have had enough and they come in and see you. So like, what are the latest tools in your tool belt, so to speak?

Dr. Nikhil Pandhi: Yeah. You know, obviously, there's always new tools coming out, right? Every few years, you see something new on the market. So, some of the tools, you know, it's a very basic startup. If somebody comes to see me for the first-time for hip pain, I get a basic x-ray just to see what the anatomy of the hip looks like. I like to get x-rays in, you know, fairly different views, but also with patients standing so I can see how much space in the joint is there when you are standing on your feet to really give a true idea of what your daily joint looks like.

Host: Okay.

Dr. Nikhil Pandhi: So based upon that, I can give, you know, different grades, if it's osteoarthritis, how bad is it? Is it something called femoral acetabular impingement? There's different things we look for. So, that's my first basic assessment. Then, I obviously examine the patient and put the patient through a range of motion, check their strength, their neurovascular status of their hip, and get an idea if what I'm seeing on the x-ray is actually correlating to what I'm seeing on exam. You know, is this a true joint problem or is it outside the hip joint, or is it the back? Because the back affects the hip and the hip affects the back as a common misconception, you know, when people--

Host: Yeah, it's all connected, right? Yeah.

Dr. Nikhil Pandhi: Correct. Yeah, "That's my hip pain." Well, it's really their back, but part of my job is to differentiate between what it is to let patients know. But latest advancements, one thing is, you know, things such as hip arthroscopy for younger patients who maybe have a labral tear. And that's been around for a while, but it's a minimally invasive way to look in the joint, and we fix a labrum tear or something like a missing piece of cartilage in the hip.

The other one is, you know, everybody hears about hip replacements when you have end-stage arthritis. The implants and all the instruments we use in surgery are now made of the latest materials that we hope lasts longer. We hope a hip replacement lasts you 25, 30 years. And, you know, that's another avenue that we use quite a bit because it's very successful. Maybe the most successful surgery in orthopedics in many ways.

And other things that lead to that are robotic-assisted hip replacements, which I specialize in. We also do what's called an anterior approach where there's different ways you can actually do the hip replacements these days. The anterior approach, which has been around a while, is l I'll call it a muscle-sparing approach. Some people want to say minimally invasive, but it's more of a muscle-sparing approach where you don't cut the muscle and the tendon, but merely move it out of the way to do the surgery. So, patients are doing the rehab a little quicker, maybe less pain, moving faster and outpatient joint replacements as well.

Host: Yeah, it's pretty amazing. And as somebody who, you know, as I said, I'm in my mid-50s and may need a new hip or two along the way here, I definitely want it to be, you know, one-time only. So as you say, the lifespan of the hips now can maybe last 25, 30 years, and that might be perfect, right? Get me to the end, so to speak.

Dr. Nikhil Pandhi: Absolutely. I mean with robotic-assisted hip replacements, and now with the advent of AI technology, that's going to be the next it's already kind of happening now as, how we look at hips. And 3D printing was a thing and it's still there. Pre-surgical CT scans where you can map out the anatomy of the hip and see exactly how the hip should look when you're doing the surgery. So, there's a lot of great, nifty gadgets out there to use.

Host: Yeah. It's so cool.

Dr. Nikhil Pandhi: And it's great to have those options. Yeah.

Host: So, Doctor, what about the folks like me who, you know, maybe have osteoarthritis, but just generally, you know, the chronic hip pain, that variety? Like, what are some of the complications, I guess, that might be associated with not treating it, like not coming to see you, not getting that hip replaced, being diagnosed properly. What's the downsides for folks?

Dr. Nikhil Pandhi: Sure. So, I kind of take a global view on this. When you have hip pain, if you're not getting it treated, you know, the real worry is, sure, if your pain threshold is such that you can live with pain and you're getting by and your hip is not really cooperating, you know, what I see the risk is the less active you are, the less you're able to do exercise and stay healthy. You know, you start putting on weight, which also has a negative vicious cycle when it comes to the hip joint, because you're making your hip worse by putting on weight.

So when you can't do the daily activities of life that make you happy and allow you to enjoy your life, whether that's your retirement years, just doing your job, or playing with your kids, whatever it is, I think that's the risk. And that's really has a overall detrimental toll on your health when you can't be active. And I think that's what I talk to patients about all the time, you know, are they at a point where they can't do the things they want do, you know? And you can tell they're miserable and they just realize they can't do the things they want to do, whether it's ride a bike, go swimming, whatever it may be. And that's really a huge part of why we do these procedures when they're needed.

Host: Yeah, well, you just think about, you know, you see people out in public, obviously, and some folks just look like they're in such pain. You know, like it's just agony to walk from the car into a store or walk through Costco or walk out to the mailbox. We're talking about riding bikes and playing golf and maybe doing things like that. But just a simple walking across the room, right? Or walking out to the mailbox. Like hip pain, joint pain in general, but, you know, hip pain as we're talking about today can just really like sort of ruin our lives, right?

Dr. Nikhil Pandhi: Absolutely. It affects, you know, your hip, affects your knee, affects your back, affects your ankles. And the thing is, it is unfortunate because, I think, sometimes people are just scared, right? They don't know what they don't know. That's why, you know, they're worried, they go see a surgeon, it's going to be, "Oh, they're going to say I need a hip replacement. You know, in my eyes, it's more about just getting the initial evaluation, looking at x-rays with your doctor. And it's a very transparent process where the doctor can show you the x-rays and say, "Hey, you know, Ms. Johnson, this is what your hip looks like. This is why you hurt." So, you know, you're not losing your mind that this pain is--

Host: Right. There's something wrong. Yeah.

Dr. Nikhil Pandhi: Yeah, exactly. And that you have options to do better and to live a good life. And function, form, and lack of pain, you know, we do our best to give patients that. And unfortunately, patients, you know, they're scared and I get it. I completely empathize with that.

Host: Yeah, I think some of us picture, because, you know, we're going to go see a surgeon, well, he's going to be sitting there with a scalpel in his hand, you know?

Dr. Nikhil Pandhi: Yeah.

Host: It is kind of a last resort for many folks, right?

Dr. Nikhil Pandhi: I mean, it's a last resort for me as a orthopedic surgeon. You know, if I think there's something else that can make you better, I will definitely give you all those options. There's a lot of talk about doing kind of these different injections on the hip joint and kind of using your own cells to inject back in the hip. And there's good anecdotal evidence and some studies that show that it can help, but you know, it's not always the right thing for everybody. And frankly, a lot of those things Insurance doesn't cover it. So, you know, patients have different price points and you want to make sure you're giving your patient your best efforts to give them something that they can have that's reasonable too.

I'm not snake oil salesman. You know, I hear these horror stories that someone paid thousands of dollars for an injection, which never worked. And I just kind of cringe when I hear that. Because they never went to see the orthopedic specialist who that's what they do. And I hope more people, whether it's through a podcast like this or other informational tools, feel more comfortable doing that and finding the right person to speak to, because it can go a long way.

Host: Yeah. Many of us, we have to start because of our insurance. We have to start with our primary and be referred to someone like yourself. But ultimately, you want to be in the hands of an expert who doesn't have a one-size-fits-all approach and can take things into account, whether that's price point or whatever it might be. I just want to give you a chance here, Doctor, at the end. Final thoughts, takeaways. A lot of folks suffering and you know you can help. How do we get them in the office?

Dr. Nikhil Pandhi: Sure. I mean, you call our office at the Franciscan Orthopedic Department. If someone wants to see me, just ask for Dr. Pandhi. I would be happy to see anybody in our office. You just call and make an appointment. We get you an initial evaluation, x-rays.

And another thing I always mention to patients too is, You know, you may have added x-rays somewhere else, but we have very specific views that we look at. So if you're getting more x-rays, not because we're just getting x-rays, we want to get the correct images so I can treat you in the perfect manner that we can.

Host: Right. That's perfect. Well, I appreciate your time. As I said, there's a lot of folks suffering. The help is available. Some of us suffer in silence. Some of us not so silent. But eventually, hopefully, we end up in the office with you and get out in front of this and help ourselves, whether that's a new hip or injections, whatever it might be. So, thank you so much.

Dr. Nikhil Pandhi: Oh, you're welcome. Happy to see anybody who wants to come by.

Host: And for more information, visit franciscanhealth.org and search orthopedics/sportsmedicine. and if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.