Transcription:

Scott Webb: Many people suffer from knee and hip pain, but the truth is we don't have to. What we need to do is be diagnosed and treated. And the great thing is treatment doesn't always involve surgery. And joining me today to talk about knee and hip pain and our surgical and non-surgical options is Dr. Christopher Jarrett. He's an orthopedic surgeon specializing in hip and knee surgery at New Hanover Regional Medical Center.

This is Healthy Conversations, the podcast from New Hanover Regional Medical Center. I'm Scott Webb. Doctor, thanks so much for your time today. I have both knee and hip pain, so I'm glad to have you on. I want to have you start by telling us about yourself and your specialty.

Dr. Jarrett: My name is Christopher Jarrett. I'm an orthopedic surgeon here and New Hanover county. I do a lot of what we call adult reconstruction, that's hip replacements and knee replacements. We also do a lot of sports medicine for arthroscopic surgery for meniscus tears and ACL surgeries and things that happen to, you know, athletes of all ages.

Scott Webb: Yeah, and it sounds like you're dealing with both chronic and injury, so that's good. And we want to talk about that today. So I like to have you discuss some of the more common causes of hip or knee pain and, in that, you know, definitely talk about chronic versus injury.

Dr. Jarrett: When we're talking about knee pain, the most common thing we see is just, you know, overuse injuries, what we call chondromalacia patella or patellar tendonitis, just people who do a lot of running and jumping and just have chronic overuse injuries. And those can usually be treated with just rest and time off and the anti-inflammatories and a lot of physical therapy to get the weekend warrior, the day-to-day athlete, back at it.

Now, when you talk about acute injuries, those are the ones where you have that classic plant and pivot and pop, sort of the triple P. Those are a little more problematic, because they sometimes indicate something that may need surgery.

Scott Webb: Yeah. And I think we can all identify with that feeling that you just sort of know, you know, the triple P, as you say. And you hear that pop and you're just like, "Uh-oh. Uh, something's not right here, right?"

Dr. Jarrett: Something's not quite right. Yeah, that's exactly right.

Scott Webb: So let's talk about when someone should see a physician about hip or knee joint pain, uh, you know, who should they start with? Take us through this process.

Dr. Jarrett: I think the most important thing is when you have an injury that sort of alters your day to day activity. If you feel unstable or there are things that you can't do that you should be able to do, it's probably time to seek some evaluation. And an orthopedic surgeon is always a great place to start.

Sometimes of course, your insurance may require that you see your primary care doctor first and the primary care doctors are excellent in diagnosing and triaging and figuring out who needs to go where. And so seeing a physician of some sort is always a good idea when your injury or pain interferes with the activities that you want to be able to participate in.

Scott Webb: Yeah, that's probably a good marker or a good threshold, you know, when you can no longer do the things you need to do, you enjoy doing, that's probably a time to reach out. And as you say, insurance is always a factor in there, but your primaries are a good place to start. And then we may escalate and move on to someone like yourself, a surgeon about these things.

So let's talk about whether it's a chronic, acute, what are the types of procedures that you perform to help with joint pain, whether it's knee, hip?

Dr. Jarrett: Even though we're orthopedic surgeons, our first objective is to try not to operate if we can avoid it. Now, we're not always just looking for a simple solution. And most of the stuff we see honestly does not require a surgical solution. So we're looking to see how acute injury is, have you tried rehab or physical therapy?

There are injections. You know, corticosteroid injections are often beneficial in relieving pain acutely. Exercises to strengthen and stabilize the joints, especially for knee pain or hip pain. A lot of the things is stretching and working the range of motion can alleviate that.

Now, once you've been through that, a regimen of injections and rehab and therapy and anti-inflammatories, and you're still not getting better or if you have instability the joints, sometimes we'll get an x-ray or an MRI to better evaluate the situation and figure out what the exact cause of the pain is. And once we have that, we can tailor the surgical treatment based on the findings.

Scott Webb: Yeah, good to know that you're considering the non-surgical options first. I'm sure many patients appreciate that. Let's try a little PT. Let's try some meds. Let's try, you know, some stretching. Let's try not to do the surgery. But when you have to do the surgery, what are those options? I think there's a little bit of confusion maybe when you say joint replacement or knee replacement or hip replacement. What does that mean exactly?

Dr. Jarrett: For cases of advanced arthritis, where the joint is worn out, and when I say worn out, I mean, the cartilage on the ends of the bones meet the end of the femur at your knee or the top of your femur at your hip has worn out. Now you've got what we call bone on bone arthritis where you no longer have that soft pliable tissue that acts as a buffer at the end of your bones when that's gone. Then we sometimes have to replace that. And the option for replacing that, we would be using a combination of usually titanium and a fancy plastic called a cross-linked polyethylene to act as a buffer cap at the end of those bones for you. And that helps relieve the pain.

Scott Webb: Definitely. And I have some family and friends that have had both a knee and hip replacement surgery. And I can recall back 20, 30 years ago, I worked with someone who had a new hip put in and the scar ran, I would say doctor, practically from under his arm all the way down to his knee. I know that's not the case today, right? I mean, it was a pretty gruesome scar. Today, it's pretty minimally invasive. The scarring is pretty minimal, right?

Dr. Jarrett: Oh, yeah, definitely. We've made a lot of progress and I think the progress we've made over the last 15 to 20 years has been really subtle. The procedure is essentially the same, but we've done things to preserve the soft tissue envelope around the bone. Now, the bony procedures are still the same as they were 20 years ago, but by preserving the soft tissue envelope, by putting our incision in slightly different places, by trying our best not to cut muscle when we don't have to, that's made a huge improvement in the rehab.

We've also accelerated the physical therapy and rehabilitation program, so patients were getting back on their feet faster. And we work really well with the anesthesiologists to improve postoperative pain, so that length of stays in the hospital are shorter, you have less postoperative nausea and vomiting than you did. And so as recently as five or 10 years ago, patients would stay in the hospital for three to five days after their hip or knee replacement. And now many patients are going home the same day.

Scott Webb: Yeah, that's so true. And it was definitely true in my mom's case. She was up walking around and went home the same day. The thing that she has not liked about the knee replacement was the rehab. She says that that pretty much feels like torture. So maybe you can put people's fears aside a little bit, you know, that there's a means to an end, there's a light at the end of the tunnel, but it can be a tough road, right?

Dr. Jarrett: It can definitely be a tough road. One of the metrics we use here at New Hanover Regional Medical Center and at orthopedic hospitals, what we call day-of-surgery ambulation. We're actually tracking the percentage of patients we operate on that get up and walk the same day. That's one of our metrics and our goals, is to have that as high as possible, because we found that the patients who get up and get moving, do better.

Now that being said, especially with knee replacements, I usually jokingly tell my patients that the first two weeks after surgery are filled with regret. Patients look back and go, "Oh my gosh. This was a mistake. I should never have done this. This was wrong." I say it laughingly because I think having a good outlook determines a good outcome. And when patients understand that, you know, this is going to be rough, but there is a light at the end of the tunnel, and if you do your physical therapy and work hard, usually by four to six weeks afterwards, you know, things are going really well. And by three months, most patients look back and say, "Hey, I waited too long. I should've had this done sooner."

Scott Webb: That's definitely where my mom is at with this, that, yes, those first couple of weeks, there was a lot of regret. No doubt in her voice, uh, "What did I do?" And then, you know, add in the COVID part of it. And I did just want to briefly ask you about COVID-19 and has it changed the way you're doing anything? Are you doing virtual visits, virtual followups? Uh, has it affected your practice at all?

Dr. Jarrett: Wow. Yeah, I'm a really optimistic person by nature and I always try to look at the silver lining. And what COVID has done has actually given us an opportunity to sort of advance the specialty. We're doing a lot of virtual visits. We're using a lot of technology now that while we had available, we just never really had an opportunity to implement it. So we're seeing patients from the surrounding areas who don't have to drive in to, you know, Wilmington just to be seen. We see them remotely.

Patients are going home faster because the desire or the concern about being admitted to hospitals is definitely real. And we found that the longer you're in the hospital after your hip and knee replacement, the more likely you are to have a complication. So patients are motivated to go home faster, which is what benefits them. And then, we have a lot of pre-op testing and things that, you know, we do a lot of screening before to ensure that not only the patients, but also the staff are safe, as safe as possible, to allow us to continue to operate and to allow us continue to take care of patients.

Scott Webb: Doctor, it's been so great having you on. A lot of great information today, especially for those of us like me suffering from hip and knee pain. Anything else you want to tell people about your approach, how their patients are treated there, non-surgical versus surgical? Anything else? What are the takeaways?

Dr. Jarrett: I think the biggest takeaway is that you don't have to suffer. You know, I think that there are options and things that are available now that weren't available 15 or 20 years ago. The rehabilitation is better and more efficient and patients have things that they want to do. There's a whole world out there they want to see, they want to travel, they want to play with their kids and grandkids and we're here to help, we're here to help facilitate that.

Scott Webb: Yeah. That's good to know. And I think that's a great way to end, you know, that, uh, there are a lot of these things that we all deal with. We all deal with this chronic pain and it does affect our quality of life, but there is help out there both with you and other doctors. So we just need people to reach out. Doctor, thanks so much for your time today. Hope this helps people with knee and hip pain and you stay well.

Dr. Jarrett: Thank you very much. Thanks for having me on.

Scott Webb: for more information about orthopedic surgeries at New Hanover Regional Medical Center, visit NHRMC.org/orthopedics. This is Healthy Conversations, the podcast from New Hanover Regional Medical Center. I'm Scott Webb. Stay well.