Joey Wahler (Host): It can be life changing, including for a Hall of Fame athlete. So we're discussing hip replacement surgery. Our guests from Summit Sports Medicine and Orthopedic Surgery, we're joined by Dr. Denny Carter, an Orthopedic Surgeon, and Karah Brown, a Physician Assistant, plus their patient, baseball Hall of Famer, Jim Kaat, often called Kitty. This is Health Matters from Southeast Georgia Health System. Thanks so much for joining us. I am Joey Wahler. Hi there all. Welcome.

Karah L. Brown, MSPAS, PA-C: Hey Joey.

James "Jim" Kaat: Thank you.

Denny A. Carter, MD: Thank you.

Host: Great to have you all aboard. So first, Dr. Carter, what initially piqued your interest in healthcare and orthopedics?

Denny A. Carter, MD: I sort of gravitated to it when I was probably in high school. I played a lot of sports, including football. Had a couple of injuries. So early contact with athletic trainers as well as an orthopedic surgeon. So, as I continued on through medical school, and I learned more about the field, it drew me right in.

Host: What would you say brought you to the area in the first place?

Denny A. Carter, MD: Well, I grew up in Georgia. So I had a lot of family here. I felt like it was a great place to live. I went to Medical College of Georgia in Augusta, and so when the opportunity arose, I took it. So, been here since 2003.

Host: And Karah, why healthcare and orthopedics specifically for you?

Karah L. Brown, MSPAS, PA-C: Healthcare since I was a little kid. My mom was an EMT and so I was always their mock patient during practicals and that sort of thing, and I just absolutely loved healthcare. So I had wanted to go into medicine really since elementary school. So I thought that going into emergency medicine would be for me. But then I worked in physical therapy briefly during college, and we were across the street from an orthopedic practice. And I just fell in love with orthopedics and so I went to PA school to go into orthopedics. So, here I am.

Host: That's impressive. It must be great to know from such an early age, exactly what you want to do. So many people don't, right?

Karah L. Brown, MSPAS, PA-C: It never changed really. So probably since I was about 12.

Host: Okay, and how do you wind up in the area?

Karah L. Brown, MSPAS, PA-C: So I'm actually from Vermont, but I had a dear friend move to Charleston, South Carolina, and I fell in love with the south. And so then when I decided to go to grad school, I looked at all the schools down here in sort of the southeast and I ended up in PA school in Savannah and then got recruited here after school, and I've been here ever since.

Host: And Jim first of course, congrats on your recent induction to Cooperstown. You were inducted in Baseball's Hall of Fame 42 years after retiring from baseball. So after all your great accomplishments on the mound, what was it like to finally get that call saying you're in.

James "Jim" Kaat: Well, it was, it was more gratification for me than excitement like it was for some of the other younger inductees because, you know, my parents aren't living anymore. My dad was an avid baseball fan, I know how much it would've meant to him. So, at that stage of my life, and after not having pitched for a long time, it was, I'm very gratified and humbled that I was able to get that honor.

Host: Now, Jim, you didn't just pitch. You pitched a lot. You pitched for so long and through so many innings, 25 seasons, more than 4,500 innings. Let's just think about that for a moment, 4,500 innings. I don't recall you being hurt very often during your career, at least seriously, but how much do you think all that gradual wear and tear over the years contributed to you needing hip replacement?

James "Jim" Kaat: Oh, there's no question that it did contribute to it as well as being an avid golfer after my baseball career was over. So, I'm so fortunate that Dr. Carter and Karah, and then I had a hip replaced up here in Vermont as well. That we have those procedures available, at this stage of my life to kind of give me a, a fresh start from having worn down the hips and the elbows and everything else that goes with pitching is such an unnatural exercise that, it takes its toll on a lot of different parts of your body.

Host: And it's ironic, isn't it, because you not only pitched a lot, as we said, but you seem to do so, so effortlessly. Much of the time you used the old school, no windup delivery, it seemed like you were putting as little stress on your body as possible for a major league pitcher, and yet the hip replacement was needed anyway. Eventually.

James "Jim" Kaat: Well, yeah, I think all athletics, you know, you use your arms in pitching, but you really have to have a strong lower base. And I think, people of my era, we were allowed to let our bodies mature and develop, unlike pitchers today, and athletes today that are asked to play travel ball and play too much of one sport for the entire year and their bodies aren't ready to do it.

And, uh, I was fortunate in the minor leagues, even growing up in a cold weather climate like Michigan, where I never overused my arm. You know, I played basketball during basketball season and baseball during baseball season. So, you know, I think I had a good foundation and that probably prevented me from having a lot of the injuries that we see young athletes have today.

Host: So when did the hip pain start and how did it affect you actually?

James "Jim" Kaat: I had my first hip done. I think the way the symptoms are that you think that maybe you've pulled groin muscle or something. Because you feel it on the inside. And then after you go to doctors like Dr. Carter and Karah and the ones I saw up in Vermont, you say, no, that's the symptoms for needing a hip replacement.

So that just gradually began to cause a lot of pain on the upper inside, I guess that would be the adductors. Abductor somewhere in there caused a lot of pain there. And the result was I needed, new hips. I've got two new ones now and I can play golf every day.

Host: Wow. And so how long ago did you need that first one?

James "Jim" Kaat: I had the first one about 10 years ago now. Yeah. Knees first. So I have two new hips and a new knee, fortunately. But yeah, it was about 10 years ago that I noticed, that I started having the pain in one. I was fortunate in that being an athlete, for those that are considering hip surgery or any kind of surgery or replacement part, you have to do the prehab and the rehab.

And so I was accustomed to doing that as an athlete. So yeah, I spent a lot of time on the spin bike. I walked a lot, even though it was painful, I walked a lot. And I think that helped me recover from the surgery much faster than had I not had that history as an athlete.

Host: Understood. So Dr. Carter, how did you determine that Jim needed hip surgery and what's the process when a patient like him in that situation comes to you?

Denny A. Carter, MD: Well, in his case, uh, I think he had a pretty good idea because he been through it before, but not every case is like that. But, first, you know, you just have to talk to patients, get a really good sense of how it's affecting them, take a good history. And then, of course, uh, physical examination.

And then we do diagnostic testing. Usually we start with X-rays and in his particular case, it was pretty obvious from his X-rays, how it was progressing. But we can usually get a good determination from that. And then we make a treatment plan. Sometimes it's physical therapy, sometimes it's anti-inflammatory medications or injections. And then, of course, in some cases when it's advanced, uh, hip replacement.

Host: And Karah, as a physician assistant, how about the role you played in Jim's treatment and his recovery process thereafter?

Karah L. Brown, MSPAS, PA-C: Sure. So at our practice, I've sort of champion the joint replacement program, and so once Dr. Carter posts a patient for surgery, then they come to see me for pre-op and we go over all their medical clearances, their lab work and all the instructions that they'll need to be successful before and after surgery. Jim and I met at his pre-op appointment, and then I assist Dr. Carter in the operating room. And so I was there to help him for Jim's surgery and then rounding on him as an inpatient afterwards at the hospital and seeing him in the clinic from time to time.

Host: And Dr. Carter, Jim alluded to this a moment ago, for patients like him with that athletic background, of course most don't have the kind of athletic background he had to that level, but just having an athletic background of some note, how much does that impact the post-surgery recovery and rehab?

Denny A. Carter, MD: An athletic background like that, certainly patients like that are used to discipline, they're used to hard work. So it does give them a bit of a leg up on their rehab. Like Jim was saying, the prehab, making sure that you're in the best shape that you can be going into a surgery is critical.

And so you prepare for surgery, sort of like you prepare for an athletic competition. You know you want to eat right, you want to get plenty of rest. And maximize your joint function, to the extent possible so that when you get that surgery, when you start your post-op rehabilitation, that you're ready and you're mentally prepared. And I think that really played a role in his ability to have such good outcomes.

Host: Speaking of being ready for it, Jim you touched on it a moment ago briefly, but tell us if you would a little bit more about that recovery process for you. Any surprises about rehab and getting back to your normal activities.

James "Jim" Kaat: Not really. I had a little bit of a glitch in terms of a reaction to the adhesive, and I had a little hematoma that were little hiccups along the way, but they say to athletes when you get an injury, well, it's going to be three weeks. Well, every athlete's different.

And so we're competitive. So like I had buddies that had knee surgery and I said, I want to get back on the course before you did. So, you have that competitive attitude that you want to do the work and you want to recover. And that was true for me. I mean, I got back on the golf course in a reasonable amount of time compared to other friends that I know have had surgeries like that.

And they, they're just not motivated to go through what you have to go through to recover and, you gotta know upfront. If you don't want to do that, you're never going to reach your full potential after getting this kind of a blessing of being able to have a replacement part to live your life the way you'd like to. And if you don't do the work to make that happen, then you're going to continue to suffer.

Host: The fact that you're able to beat your buddies back onto the course. Why am I not surprised by that Jim? So I've gotta ask you, Jim, what was more challenging? Prepping for a big, major league game on the mound, or going through this physical therapy after hip surgery?

James "Jim" Kaat: I don't know about the prepping, you know, the prepping for pitching a major league game. I had a regular routine for many, many years. But I think with prepping for the hip surgery or knee surgery, whatever it might be, it's like, from hearing from friends that had it done before, it was like, let's get this done so I can get back to normal.

So, I knew that the physical part of it was important. But then I think having confidence in like, Denny and Karah and I have a connection because she's from Vermont. I live in Vermont now, so, you know, I had the utmost confidence in both of them that this is what I needed to do and let's do it and get it over with and get it to back to where I wanted.

Host: Absolutely. Dr. Carter, what are the risks associated with hip surgery and how do you mitigate those?

Denny A. Carter, MD: There's definitely risks. It's major surgery. There can be bleeding, there can be blood clot risk and infection risk. But, you mitigate it by, first of all, making sure the patients are educated and understand what those risks are. And if they prep for the surgery, and then we can control what's going on in the operating room.

And then you have a good surgical team as well as all of the people that are involved. The rehab specialists, the nurses on the floor. If you have all of that, you can really minimize, the risks. So you're looking at probably less, you know, 1% risk of, maybe less than 1% risk of infection and blood clots are typically managed with blood thinners and things like that.

So, it's education, it's attention to detail, it's preparation, and the technology also allows us to control for some of that and minimize implant malposition or dislocations and things like that. So it's come a long ways, I'd say in the last couple of decades.

Host: No question about that. And speaking of which, how does the robotic arm assisted hip surgery that you're able to use nowadays differ from what was available 15, 20 years ago?

Denny A. Carter, MD: It's really transformed things. Most hip replacements were done manually, when I first started. With the robotics, it allows you to prepare with CT scans ahead of time. And so you get a three dimensional picture of the joint itself, you can really dial in the position of the implants to within millimeters and, within degrees when you're talking about angles.

You are also able to measure the difference in the leg lengths. So a lot of times within an arthritic hip, the leg may be shorter than the opposite side. Well, with the technology that we use, you get an actual number, say three or four millimeters or maybe nine millimeters or whatever, and then after you put the implants in, you're able to measure that and you can make them equal in almost every case.

So just having that ability to do that has been an amazing benefit. And I think it probably takes dislocation rates to almost zero by following this technology.

Host: Wow. Certainly great numbers indeed. Karah, how has your experience working with patients like Jim shaped your perspective on joint health and recovery, et cetera?

Karah L. Brown, MSPAS, PA-C: Jim's like the poster child for recovery. I mean, he's back on the golf course and living a more pain-free type of life. You know, like he said, his other joints are arthritic too from his baseball career, but really his ability to get back out and enjoy life. And that's what a lot of the patients say is that, you know, I can't wait to have this done so I can get my life back. That's sort of the rewarding part for us is that we get to see the patients doing the things they want to do, whether that's Disney with their grandkids or golfing like Jim.

Host: It's interesting. I think we've talked about as much about Jim's golf game as his baseball career here because of that love of golf Jim. How much of a motivating factor was it for you? You talked about how quickly you wanted to get back out there. Having that carrot of golf, how big a factor was that for you and being motivated and how is the golf game now that you're back out there?

James "Jim" Kaat: The golf game is, I'm 86 and I'm not as strong or flexible, so it's strictly recreation. But I think whether it's golf or any activity, just your lifestyle in general, if people have that pain and they don't realize how much better they'll be after they get it, regardless of whether you play golf or not.

So I think that's the number one motivating factor. You got this pain on the inside of your leg and you want to get rid of it, and fortunately we have the procedures available and the skilled surgeons and assistants that can do that and get you back to normal as quickly as possible.

Host: Couple other things before we let you all go. Dr. Carter, what should our audience remember when it comes to joint health and seeking treatment? What should be the takeaway here?

Denny A. Carter, MD: It's key to live an active lifestyle, to manage your weight, to try to manage your medical problems because a lot of these joint problems are an accumulation of things that occur over years. Now, some of it's genetic. You obviously can't change your genetics, but you can certainly work on that lifestyle and I've found that, that can really, in many cases, delay the need for joint replacement surgery, if you manage that well.

Host: And in summary here, Jim, if you could give one piece of advice to your younger self about taking care of your body, what would it be?

James "Jim" Kaat: Exercise, watch your diet, you can't wait till you're 65 and then all of a sudden say, well, I think I'm going to get in shape. I think I'm going to work out. I, I have a lot of my friends that do that, and I was so fortunate being an athlete that, that was a regular part of my life.

And so if I could give any advice to the younger crowd, even if you're not an athlete, you have to keep yourself active and keep your joints fluid and mobile so that when you do have, if you have to have the surgery, and it's available even now, we've seen a lot of younger people get it, then you're going to be able to recover quickly and get back on your feet.

But if you neglect yourself for 65 years and all of a sudden you think you're going to get in shape in two weeks, it's not going to work.

Joey Wahler (Host): Well, before we wrap up, I just wanted to share a quick story from my childhood as a young boy, growing up in Brooklyn, I was a big Met fan. Still am of course. And during Jim's career when he was in his late thirties, one of the teams you pitched for Jim was the Phillies, and there was a Met Philly game when I was a kid at Shea Stadium on a Friday night where you started. And of course, in typical fashion, you pitched well into the game and then the following day for an afternoon game, second game of the series, my parents took me to Shea to see game two of that series. And after watching game one and seeing you pitch on Friday night as the starter on TV, we go to the game the next day in person, and I'll never forget, it was a bright, sunny Saturday afternoon.

We're walking to our seats. We got there real early after the gates open, the Phillies were on the field taking batting practice. There were a bunch of players in the outfield for Philly shagging fly balls, and I immediately noticed that one of them was Jim Kaat, and I could not believe that the guy that I just saw start and pitch well into the game just the night before in his late thirties was in the outfield shagging flies. Jim, it made such an impression on me, as you can tell, because I've told that story over the years, and it's a great thrill to get to tell it to you. I couldn't get over it.

James "Jim" Kaat: Well, I appreciate that. I think that's one of the things that's lacking in sports today is that you know, we did what we did every day. Nowadays they kind of hot house their athletes. They let them sit and do nothing for two or three days. And quite frankly, I believe that's why we're seeing more and more injuries.

You know, our theory with the pitching arm, it'll rust out before it'll wear out. So we wanted to stay active and do things every day. So that was really what you saw was, part of my routine. Part of it was fielding ground balls with Larry Boer or Ozzy Smith. The other part was chasing down fly balls in the outfield. Just anything to, to stay active.

Host: Well folks, we trust you are now more familiar with hip replacement surgery. Dr. Carter. Karah, Jim, continued good fortune to you all. Thanks so much again.

Karah L. Brown, MSPAS, PA-C: Thank you.

Denny A. Carter, MD: Thank you. Thanks for having us.

Host: For more information, please visit sghs.org/hip-replacement. If you found this podcast helpful, please do share it on your social media. Thanks again for being part of Health Matters from Southeast Georgia Health System.