Bill Klaproth (Host): According to the American Academy of Orthopedic Surgeons, almost 1 million joint replacements are done each year with many more going through some type of hip or knee surgery. My guest today is Dr. Daniel Single. He is an orthopedic surgeon with Tidelands Health. Dr. Single, thank you for being here with us today. What are you seeing as the most common complaints for hips and knees today?

Dr. Daniel Single (Guest): Thanks for having me. With hips, I see a lot of patients, young, active patients and some older patients, that are complaining of hip and groin pain typically are osteoarthritic, which is the most common form of arthritis that we treat. They'll oftentimes present with pain in the front part of their hip near the groin, less commonly in the buttock. It's usually worse with weight-bearing. So, common complaints are "Doc, I've been sitting and I go to get up and those first few steps are kind of stiff and achy," or they may start noticing they're having difficulty putting their shoes and socks on or getting out of chairs and that's usually what prompts them to come visit us. With knees, it's very similar complaints. You know, usually dull, achy pain after periods of inactivity or if they've been on their legs quite a bit during the day, they get off at the end of the day and their knees will be kind of sore and achy. And, typically, when it starts affecting their quality of life, it keeps them from doing things that they like to do or starts affecting their ability to sleep, that's usually when we find that patients are coming in and seeking consultation with us.

Bill: So, when you say “younger”, as far as hip pain goes, how young are you talking about?

Dr. Single: Well, that's an interesting thing. We're starting to see patients now, sometimes even in their 40s, that are presenting with conditions of the hip that sometimes need to be treated surgically, which wasn't as common, I would say, maybe 15 or 20 years ago, but we're starting to get patients that are coming in with arthritis that I tell people sometimes, you know, they have the hips of a 70-year old. But, our target audience tends to be that patient who's between let's say 60-80 years old. I'd say that makes up the bulk of the patients that we're treating with hip and knee replacement surgery. But, again, we're starting to skew a little bit younger for a variety of different reasons, I think.

Bill: Do you think that's because more of inactivity or because people are more active? Jogging and weight training and doing all those things? Why do you think that is?

Dr. Single: I think a couple of reasons. I think that for the younger patient population, I think that there probably is something to overactivity. I think we're starting to see a lot of people that are now entering their 40s and their 50s that were athletes in their younger years and kind of year-round athletes. I tell patients that the injuries that occur when you're in your teens and in your 20s, although we have treatments for them and you may do well in the mid-term or kind of long-term for 20 years but those injuries kind of stay with you and oftentimes will lead to further problems down the road. So, yes, a lot of times when we're dealing with patients that are in their 40s or early 50s, you'll get a history from them that they injured their knee playing football when they were in high school or in college and the knee just got gradually worse over time or the hip got gradually worse over time. And then, I also think that there's, obviously, an obesity epidemic in this country which I think really has more to do with the food supply than it does with the activity level of the population. I think that nowadays with so many foods being processed, a lot of fat, salt, and sugar being in pretty much everything that we eat, it leads to our obesity problem, which again increases what are called joint-reactive forces across the joint which can degrade the cartilage at a quicker pace.

Bill: Carrying that extra weight certainly can make a difference on those joints. So, sticking with the hips, are there things that we can do to protect our hips or exercise our hips so we can stave off any of these problems until much later in life?

Dr. Single: I would say yes and no. I mean, again, a lot of it is I think happenstance. You know, people get injured doing various things but we all have to live our lives. But, in terms of you know, keeping your joints healthy, I'm a big advocate of again, people keeping their weight within reason, low-impact aerobic exercise or non-impact aerobic exercise. I'll kind of steer my patients away from things like running or jumping on a routine basis and try to steer them towards things like cycling or rowing, elliptical or stair-machines which are low-impact or no-impact, swimming is excellent, walking is a very simple and easy and really something that everybody can do. And, sort of the same applies for knees. Again, you're trying to avoid injuries that can occur sometimes with starting and stopping or putting your hip or knee into extremes of motion where sometimes you can tear meniscal cartilage or tear hip labral cartilages which can lead to problems down the road.

Bill: So, paying to attention to less impactful forms of exercise can certainly help with knees and hips. So when it comes to injuries, what is the first line of defense for injuries or arthritic pain?

Dr. Single: Again, there's a variety of things that we talk about in the office. Normally, when people first start having symptoms, we will again, obviously, counsel them on some of things we just talked about--activity modification. We'll ask questions as to what type of exercise they're doing or if they're doing any exercise at all and try to steer them towards the ones that, again, I think are going to be a little bit more joint-friendly. Again, weight loss is important, I think. Trying to keep your body mass index within a reasonable range. Obviously, proper nutrition. You know, you are what you eat? Staying away from some of those foods that we mentioned I think is helpful and sticking more towards, I think a more plant-based diet, lean cuts of meat, and staying away from salt, fat, and sugar to any extent that you can, I think is important. And then, you know, if you're coming in hurting, we'll talk to you about things like Tylenol or acetaminophen, or different non-steroidal anti-inflammatories that can be taken as first line agents to try to decrease pain and inflammation. If those are not successful, sometimes, we'll inject joints with a variety of different agents--usually cortisone is our first-line agent to decrease inflammation over a short period of time, but if that's not successful, sometimes, we'll use joint lubricants in the knee. Currently, they're not FDA-approved for other joints, but some doctors will inject them into other joints, too, to try to help lubricate the joint better and decrease pain. So, those kind of make up the bulk of what we'll usually discuss. There are other things that patients will oftentimes ask about, whether or not they should use ice or heat, and I tell patients that that is sort of dealer's choice. What I find is that for arthritic joints, heat usually is more comforting than ice, but some patients will swear the opposite. Compression sleeves can sometimes give people increased awareness of their joints, so if they have a sore knee, we'll sometimes recommend maybe putting a neoprene sleeve, or some kind of a knee sleeve over it which keeps the joint warm and also gives the brain extra appropriate receptive feedback as to where the joint is in space, which usually helps with stability. Again, if it's a hip and it's somebody's who's maybe trying to avoid surgery, there's an article they make us read when we're training, it's called " Don't Throw Away the Cane," a cane can be very effective, on the opposite side. So, usually if you're dealing with an arthritic left hip, for instance, they would use the cane in the right hand to help offload that joint. And, usually, if it's the knee, it seems to be more helpful on the side of the affected extremity.

Bill: Dr. Single, when do these injuries then require surgical intervention? You were just talking about preventative measures and first line of defense and medication. What about surgery? When does it get to that?

Dr. Single: Yes. Again, I have my thoughts on it. Obviously, when I speak with patients, it's whether or not I think they're surgical candidates, but, really, in most instances, it's when the pain and the symptoms are affecting the patient's quality of life that they think that it's an option for them. I'm a very conservative surgeon, so I will typically try to steer people away from surgery, if at all possible, because it's always your best, last resort. And, again, we can oftentimes treat people successfully non-surgically for sometimes a period of several years. I'm a firm believer in the longer you live with your God-given parts, the better you're going to be because our man-made parts, although they're excellent, they're man-made and they're eventually going to wear out over time and potentially lead to more surgery. So, again, if you're somebody who's been struggling with pain and we've tried some of these non-operative treatments and maybe had some success, or limited success, or no success, then surgery, I think, is an option for you. Again, if your symptoms are obstructing your quality of life to the point where you think it's reasonable.

Bill: Dr. Single, wrap it up for us. Why should someone choose Tidelands Health for their orthopedic needs?

Dr. Single: Oh, you know, Tidelands, I think, and I've practiced at some big institutions, I think Tidelands is an excellent community hospital. I mean, I'm impressed with the quality of the physicians here, the nursing staff at our hospital I think is second to none; they're very attentive. And then little things that patients maybe aren't aware of. The fact that the rooms are private rooms, you know, in most instances, which means, in most instances, you won't have a roommate that's maybe going to keep you up all night, which again, people aren't maybe savvy enough to think about, but it makes a big difference. If you can get some sleep after one of these surgeries and people aren't constantly waking you up, I think that leads to better results. Again, I think it's more the people than the institution itself. It's who's caring for you and, again, the ancillary staff here is excellent. I think we have a good core of people providing care. Again, I don't really hear people complaining at all, as a matter of fact. It's a very rare situation where anybody comes in. Let's say it's a repeat customer, for instance, who maybe we've done a hip or a knee on in the past and are coming in to have the other side done, I'll typically ask them if there's anything they wish would go differently this time in their care and I almost never hear anybody say anything. No, they had a great experience, "Everybody was nice, everything was smooth, and everything was explained to me. I tell my friends to come here." You know, it's just a nice community hospital.

Bill: Well, those are the things you definitely want to hear and, Dr. Single, thank you so much for your time today. For more information about Tidelands Health physicians, services, and facilities, visit www.tidelandshealth.org. That's www.tidelandshealth.org. This is Better Health Radio, I'm Bill Klaproth. Thanks for listening.