264 ‒ Hip, knee, ankle, and foot: common injuries, prevention, and treatment options

[@PeterAttiaMD]

In this episode, we discuss: 0:00:30 - Anatomy of the hip, hip dysplasia in infants, and the development of arthritis 0:09:52 - Diagnosing hip pain in people under 50, stress fractures in the femoral neck, and more 0:18:49 - Common hip injuries, gender differences, and problems that occur when the hip isn’t formed normally 0:25:26 - Advancements in hip replacement surgery 0:28:04 - Common hip problems in people over age 60 0:31:20 - The importance of muscular strength around the hips for injury prevention 0:37:16 - Hip fractures due to osteopenia and osteoporosis 0:42:27 - The utility of biological therapies like stem cells and platelet-rich plasma (PRP) 0:59:27 - Cortisone as a treatment to delay the need for surgical intervention 1:00:34 - Anatomy of the knee 1:04:09 - Are activities like running that amplify forces bad for the knee? 1:08:39 - Risk of future knee issues and arthritis following an ACL tear or other substantial knee injury 1:14:09 - How the ACL injury happens and how it is repaired 1:25:52 - Arthritis of the knee 1:28:22 - Meniscus tears: how they happen and when surgery is appropriate 1:38:16 - Total knee replacement: when it’s appropriate and how the recovery process compares to hip replacement 1:49:41 - Surgical vs. non-surgical approaches to various knee injuries 1:53:42 - Achilles tendon: tendinitis, rupture of the Achilles tendon, and prevention strategies 1:58:50 - Anatomy of the ankle and foot 2:01:32 - Common injuries to the ankle and foot 2:13:17 - Tips for finding a good orthopedic surgeon

[@ericwarner7944]

I have a question. How would an amputee fall into the categories for overuse, or morrality for hip, knee, ankle and foot? Any preventative measure to take?

[@Nicku472]

I have seen some studies that suggest extreme exercise can be detrimental to health. At what point is it overkill?

[@longhealthyjoyfullife]

Great interview. Thank you for a job well done.

[@gabtaraboulsy]

This is an educational MASTERPIECE. Adam Cohen is a supreme teacher. Thank you for putting this together (with models and diagrams and depth)

[@barbarafairbanks4578]

@gabtarabously - I agree...probably one of the best Attia podcasts I've ever seen...if not THE best👍

[@sharonisabelle8029]

Every time Peter Attia mentions the death rate after a broken femur or hip, I think about my 94 year old grandmother breaking her femur. I panicked when my dad told me that as soon as he and my mom left her, after a long visit, she climbed up to change a lightbulb and fell. I was sure it was a disaster. But she recovered really well and did her therapy and ended up back home, on her own, driving and is getting ready to turn 101 in a few weeks! (She is in a retirement/extended care facility as of October!)

[@bobbobson4030]

Awesome to hear :)

[@dr.samierasadoonalhassani2669]

In generalsurgey we learned 33 percent died after hip fractures within a year.not all. some presenters are hyper to sell their opinions and books .Brain is wired to be affected by negative to make us safe and survive.

[@barbarafairbanks4578]

Yes, Dr. Attia mentioned this statistic again in this interview. This time, however, he asked why the injury in the aged seems to skew so highly to death as a result. The answer made sense, to me, in that this surgeon responded with, the D/R is probably so high in this age group because there was already a pre-existing condition or disease present for those who perished...supposedly as a result of the hip fracture so late in life. Sounds like your Grandmother is a very health individual, indeed👍😃

[@elizabethkeough7191]

My aunt has fallen and injured or broken her hip 3x after 70, each time we think it's the end, but she does rehab and goes home again to take care of her disabled son. She is 85 and has no other health issues. I think this rhymes with the advice my doctor gave us when we took our young daughter to the ER when she had sharp stomach pains (5 hours later and apoop, she was fine). If there is one symptom only, you may want to wait it out as they will probably be ok. If there are 2 or more symptoms, there may be a problem. One broken hip in an otherwise healthy Person-regardless of age is probably not going to be their end.

[@jsmith2820]

I appreciate Cohen's thoroughness before he recommends a replacement. Also, towards the end when asked by Peter what to look for when choosing a surgeon he said make sure the Dr is sitting down, looking at you, talking to you, do you feel like you're being rushed. Frankly I'm tired of professionals in general not listening.

[@mfawls9624]

Unfortunately as doctors become more and more forced to become corporate employees this will get worse. Our pedeatrician joined a 'network' (i.e., a more loosely owned corporation). Went in yesterday with our child. They were short staffed because people were out sick. "Oh, something going around?" I asked the nurse we've known for years. Because of HIPAA (of all things after covid opened our eyes on that 'protection') and other new, corporate oversight, she said she wasn't comfortable answering. In the waiting area other other customers were getting more corporate responses and filling out yet more forms required by the new network merger. Unfortunately the ACA healthcare 'debate' chose not to focus at all on for profit drivers of cost increase and instead demonized doctor salaries and other relatively minor issues to shove the legislation through.

[@Rob-me8vp]

It’s not just that, reimbursement for a hip replacement to the physician by some insurance cos is a couple of hundred dollars. This includes follow up bc it is a global fee. When you look at the overhead and malpractice insurance this is exceedingly low. You might say well they still make a good salary but when you also look at the number of yrs of foregone income to become an ortho it’s even worse (4yrs undergrad, 4 yrs med school, 3 yrs residency, 3-4 yrs surgical rotation and no they don’t make a lot of money during those yrs). I am not an ortho, but I have worked in an ortho office. I agree with what the ortho in this video is saying but the pressure on the medical community is tremendous and the only way to make a decent salary is volume.

[@FitnessAndLongevityWithHan]

I am 52 and have been weight training for 39 years. When I turned 50 I began to do the deep squat and other movements to help open up my hips. Two years later, the progress is unbelievable. I have literally literally reversed time out of my body. I feel like a 30 year old. Exercise is the elixir of life

[@dustinkeith8034]

Peter, thank you for sharing. I’m a 37 year old male in the US Marine Corps. I have had a hip labral tear and ACL reconstruction. I successfully rehabbed the labral tear through hip thrusts, squats, deadlifts, and mini band lateral walks. I have also successfully rehabbed the ACL reconstruction with the same exercises with the addition of single leg deadlifts/squats and various speed and agility drills. I wanted to share this with your audience as I believe properly dosed exercise can cure and prevent most physical issues. I hope sharing my experience helps someone out there. Keep sharing the great content!

[@georgegray2712]

Could you do a video on head, shoulders, knees, and toes?

[@blacina9036]

Fascinating!!! Please share with us the link to these exercises that are obviously critical, now that I am seeing this podcast, I need to know!!! Thank you Peter for being such a geek!!! Love it!!

[@thecatebeling]

I just have to comment on the ankle portion of the podcast: As a lifetime athlete, I began having ankle pain and instability. I found one of the top docs in Boulder CO who works with athletes, rugby players, soccer players, etc. The most common injury to the ankle is a sprain and damage/overstretching of the lateral ligament. And the most common surgical procedure done on the ankle (with about a 97% success rate) is the Brostrom procedure. The lateral ligament is shortened and re-anchored. In my case, I also had osteochondrial damage, and I had a procedure done called a Microfracture, where small holes are drilled into the talar dome to stimulate growth of bone callous that works to protect the talar surface. I healed very quickly from this procedure in spite of being 64 years old. I am delighted to have had this done and should have done this earlier--had I known the success rate. If you want to find a good surgeon, ask all the serious athletes you can find for referrals.

[@belalchaudhary736]

and does your surgeon have any UK-based colleagues he could recommend haha?

[@belalchaudhary736]

Amazing, thanks for sharing! I was listening hoping for some more input on treatment strategies for repeated ankle sprains (rolling the ankle outwards) affecting the ATF & lateral ligaments. I will definitely look into this surgery as an option. Do you note any reduced mobility in the ankle after the surgery..?

[@annaatrasfitness]

Loved it. Just as good as a Upper limb one. Waiting impatiently for a vertebral column and spinal injuries episode, please!?

[@AshAndCream]

8 minutes in and I've decided to get an x-ray of my hip. Been having problems. I'll return and edit this comment if something is discovered.

[@danmcarthur8077]

I noticed a little wiggly issue when I was 32, it became worse when I was 34 and my physio friends thought I had a labrum tear went for an X-Ray and was diagnosed with arthritis. I am now 3 months post op from a Total Hip Replacement at 37

[@AshAndCream]

@@danmcarthur8077 ugh you're scaring me lol. I'm at the med center right now waiting for my name to be called.

[@AshAndCream]

@@danmcarthur8077 I am 37 😱

[@danmcarthur8077]

@@AshAndCream Go get it checked out. I am pain free now. Hip replacements have come a tremendously long way. I had my replacement May 12th. On the weekend I did the grouse grind in Vancouver and did a 40km bike ride the following morning and have been golfing and lifting weights.

[@DrAdamHotchkiss]

MOA of Fluoroquinolone induced Achilles rupture: Fluoroquinolones have an affinity for connective tissues. They cause upregulation of tenocytes which leads to collagen fibril degradation.

[@susangleadow5419]

Yes! First connective/soft tissue surgery after taking Levequin. Evil stuff

[@danmcarthur8077]

I just had a total hip replacement at 37 from hip dysplasia. Feels good though better than before that's for sure

[@barbarafairbanks4578]

Kind of a disappointment that the intervuew did not go deeper into treatment for plantar fasciitis. The condition was only mentioned very briefly :( I have several friends with this condition - virtually nothing seems to help them via the usual special orthotic shoes, cortisone shots, and/or physical therapy.

[@rosieod0nald432]

I'll place this episode in my to-watch list but I hope you guys bring up footwear. Especially, modern shoes vs barefoot/barefoot footwear.

[@barbarafairbanks4578]

...and, no they do not. Plantar fasciitis - my main interest - basically went unaddressed, as well (only mentioned v. briefly in passing :(

[@AnTalk_blog]

What I miss from this conversation and would love to know: what can you do after a hip replacement and what you should not. I was diagnosed with arthritis at age 28. Stopped running and doing any impact sports. The next ~20 years I was doing only some swimming and cycling on a stationary bike (at low power). Started running and cycling again around 2 years ago. Yes it hurts but I'm in a very good shape. At 50 I'm fitter as I was in my 30s and 40s. I really enjoy the activities but the punishment comes at night. Last time an orthopedic surgeon saw me he wanted to operate it. He said my hip would not last 2 years. It was 5 years ago. Can I continue running and cycling with a replaced hip? Would it hurt or wear out?

[@greasymarlo2718]

I see this is 4 months old but no one responded. I apologize if you already made a decision or everything I say is old news to you. This is not coming from a medical doctor, but someone who obviously enjoys learning about these subjects from reputable sources. I am, however, a certified personal trainer with a background in biomechanics. Peter Attia uses DNS and a bit of PRI. I am versed in PRI and am familiar with, but have no training in, DNS. Acronyms aside, based on what brief information you shared- it sounds like you potentially have biomechanical issues that led to certain muscles being overactive and certain muscles being underactive, resulting in your joints, and therefore the bones, occupying positions that lead to abnormal force loads, friction points, and the wearing down of the cartilage. My non-medical, stranger-on-the-internet advice: •You basically have three options: continue on the path you are on (see my next point), get the replacement right away and risk it, or try looking into your biomechanics. •The inflammation hitting you at night is a warning sign. The swelling and the fluid have a chance to catch up. I’m surprised by morning you are fine unless you are taking anti-inflammatories or pain killers. •In light of that, I urge you to find someone who is knowledgeable about biomechanics or treat yourself. It seems you are willing to put in the effort to learn yourself. There are a lot of models/schools/perspectives- FRS, DNS, FMS, PRI, the list goes on and on. Conor Harris has a KZbin channel dedicated to biomechanics, understanding (from a mostly PRI, also ISA, perspective) what commonly goes wrong in people’s dynamic Posture, and how to fix it. His channel has a lot of amazing free content. He also has courses on his website. You won’t be sorry if you do his beginner or self-paced course to learn how your skeleton moves in space. I cannot recommend it enough and think it is superior to FRS. •At your age, if you had the hip replacement, cycling might be okay if you fixed the biomechanics (likely extreme adduction/internal rotation/pronation-i.e. extension and force production). Running could be okay if you fix the mechanics, but obviously has higher ground reaction forces on the hip than cycling. Hope this helps, and if it did nothing, I’m sorry. I just feel bad when I see these sorts of comments and people are looking for some sort of lead to go on, no matter how small.

[@nrgnz34]

Lectures like these make me wanna reconsider pursuing emergency medicine instead of ortho😅

[@mayteiglesia-osorio7259]

Getting PT for hip and shoulder in my 40s so this is very helpful. Never thought I would sit through a podcast like this. Pretty cool stuff. Thx!

[@danielevans5864]

I could be a very complex and rare learning opportunity regarding my history of multiple ankle injuries (sprains of ATF, Achilles tears and complete ruptures, medical errors, etc) and my persistent determination to always return to sports. Everything began with surgeries as an infant when I was born bilateral club footed.

[@nobodysfan]

Why ask a hip and knee surgeon foot and ankle questions? You are just giving generic and possibly outdated information. You may want to edit the podcast and video. Update: Dr Cohen is an excellent orthopedic doctor specializing in the shoulder and knee.

[@jsmith2820]

Cohen is an Board Certified Orthopedic Surgeon and Sports Medicine Specialist

[@nobodysfan]

@@jsmith2820 he’s not fellowship trained in foot and ankle. When a foot and ankle fellow is on the show you will get more insightful answers.

[@barbarafairbanks4578]

@@nobodysfan yah...obvious by your YT handle, you'd have a gripe about this interview.🤨

[@barbarafairbanks4578]

Dr. Attia, ' Or, If you're catholic'🤣

[@andreamiller6942]

Great episode, though I had early hip replacements due to dysplasia and I definitely don't feel "amazing"...granted it was 10 years ago, but there are issues with hip replacements though I know it is a far easier surgery than knee replacements. Dr. Cohen definitely sounds far more hands-on and compassionate than my orthopedist...I've found that most don't know the full after-effects of surgery. It's the physical therapists who truly see what happens and how patients feel.

[@davidsnapp3145]

This is a great discussion - had a tibial plateau fracture when I was 30. 55 now and know at some point that I'll need a knee replacement.....good to hear from the experts such as these what I should be considering!

[@nb2028]

Thanks for the wonderful presentation. Would be great Peter, if you could go deeper into sports medicine/orthopedic experts on smaller focussed areas like hand, shoulder, ankle etc.

[@jennyretief4978]

Brilliant podcast, as with your shoulder podcast. Thank you!

[@jp7357]

growing up I was an original computer nurd in the 70's .. never did ANY physical exercise or activities .. I didn't start to get healthy / active until late 50's ... I managed to tear any MCL skiing which recovered in record time .. the surgeon (who promptly had an MI and didn't do the PRP) said that he's rarely seen "older" joints with such little wear and tear .. I think his words were "Ive seen high schoolers with more wear" .. so .. I guess a previously sedentary life style wasn't so bad!. I see friends who were / are "jocks" with hip and knee replacements / arthritis .. all unaware that they were setting themselves up for older pain. Now I wonder if @65yo running 6mi/day/365 is just setting myself up for joint issues when I'm mid 80's //// seems there's no winning .. exercise now and pay later - the piper always get paid.

[@EffectivePickyEatersSolutions]

I am wondering the same if people wear off their knees etc. but my dad was in his late 60s and got knee pain and was not able to walk back home, he didn't need a knee replacement, he did some surgery and shots. So I guess there is an aging component. as far I know my dad had never done any sports when he was at school and was quite sedentary.

[@elclaudiosanchez]

I have an anatomic variance on my hip, my right iliacus muscle is longer, I cant jump with my left leg so running pace its marked by my left leg, also swimming is not straight, you normal people enjoy your normality.

[@LuisRAMIREZ-gz2nx]

There's no evidence to state that repairing an ACL deficiency is going to prevent further damage of meniscus and or cartilage. Likewise saying the non ACL reconstruccion are having less degeneration due to less activity, contradicts your point of healthy cartilage is the one that is not deprived of load.

[@alexbevel6658]

Not much discussion on PRP and/or stem cell, other emerging non-surgical therapies and their outcomes. I'm disappointed.

[@barbarafairbanks4578]

@alexbevel6658 That's an interesting take, on yoyr part. I, OTOH, felt that Dr. Connor delved just enough into the subject of PRP & so-called 'stem cell' therapy to at least give us an eye-opening understanding of the subject... After all, the basis of this interview was not about PRP, but rather hip, knee, ankle injury & health.

[@stoenchu122]

None of 4 horsemen don`t scare me as much as arthritis

[@mattbrown5949]

I wonder if the question about the ankle could be answered by looking at people with fallen arches and/or clubbed feet?

[@toddshampine]

I wish they had covered partial knee replacements. I’m a future candidate, as I have osteoarthritis in one knee isolated on the medial side.

[@monicamolloy5105]

Thank you both. Re: ACL repair: had right compound fx tibia requiring open reduction, and repair of rt ACL in 1987. Told at the time would last “about 11 years.” It’s still ok fine, regained full extension …. However was absolutely faithful about PT, prescribed exercises and hydrotherapy. Now I am 70 yo. …. The rest of my story … I found out at age 32 that I had scoliosis, now kyphosis, have always had “flat feet” w/ over pronation since birth- always wore orthopedic (ugly brown) shoes until high school. Had bilateral bunioneictomies in my forties, also successful. Had three or four hammertoe repairs (all a disaster- they were done by a podiatrist, not an orthopod-- but am certain it was his personality traits and failure to trim the bone of my second toes rather than his discipline or training . Within past 3 years have acquired a cascade of mobility issues as well as chronic pain, callouses and corns. This was one of the most informative video/podcasts i’ve ever watched. Again, i thank you both. R/ monica.

[@firstlast-oy7uk]

It's lying on your side not laying on your side.

[@Livinginpeace1]

I had that and now at 67 I have had a hip replacement I’m like brand new

[@Zoe.TheBody360]

Such a hugely complex area....interesting that having local high inflammatory factors makes not only recovery worse but is a probable involvement in exacerbation of injuries and recovery rates. Maybe there are genetic factors that influence the high inflammatory cytokines making the risk of arthritis higher. Obviously misalignment of the knee is a big factor.

[@jafjdm]

Excellent ortho wish he took my insurance

[@Candleflower42]

I’m one of the 15% unsatisfied - from the folks I know who have had TKR, all extremely satisfied, would not have thought dissatisfaction rate was so high. 16 months out, pain a lot worse than pre op and although can walk around house with no cane etc, use trekking poles to take a mile walk. And I only had it due to problems from a femur break doc thought TKR would help, because it was “a mess” but didn’t hurt for the most part.

[@alexi2460]

The obvious need, yes, you're correct, physical therapy. As a senior, I had developed severe pain in so many areas, I was exhausted often from pain. Bottom line I became serious about doing my old yoga and stretching routine, did my own physical therapy. Problem is the pain comes back. I refused the ortho MD prescribed anti inflammatory meds. Also try acupuncture

[@leahkelly8306]

So it’s illegal if you don’t do it just right, but it’s surprising that physicians aren’t signing up To let the FDA know how well it’s working for their patients? Really? Have we learned nothing During the pandemic?

[@alexi2460]

Lower back pain effecting hip,knee,ankle,foot or or knee problems effecting the lower back, hip, ankle. The slow onset of arthritis, lets say age appropriate is treated disjointly, ie, different specialty departments. UCSF is fairly hit and miss with proper care. Even with good primary care, UC Ortho dept drops the ball.

[@FamiliaritasClinicaMédica]

I enjoyed a lot and leant so much watching this podcast, but I think it´s difficult for people which are not in medical professions. You examplified perfectly, but even like this for exemple the medical abbreviation are dificult to understand. But thank you both, keep going.

[@cam.actual]

Thank you so much, I'm 49 and 2+ years post ACL-Patella tendon replacement, with massive MCL, LCL and meniscus damage also repaired. Due to a fall from a broken ankle (ATFL), 3 surgeries into that leg and I'm now fighting hip and knee damage in my other leg, due to recovery asymmetry. This was very helpful, I now have a better understanding of the leg and I am using the info here to critically look at therapies going forward. Thanks again.

[@Rob-me8vp]

A countering theory of patellofemoral treatment is strengthening the hip external rotators. The hip external rotators eccentrically decelerate the internal rotation of the femur. If you have weak external hip rotators than your femur internally rotates at an excessive rate during foot strike causing torsion between the femur and tibia and what erroneously appears to be lateral tracking of the patella.

[@mTaR36S]

Thankyou Dr. Attia and Dr. Cohen for this video ! I am sincerely so grateful for your time and effort sharing your expertise. There are many people who do not have access to the medical world. I have had hip pain for awhile. It`s been 5 years and it`s not as severe. But I still limp. 3 years ago it was really bad. It felt like my hip was mushy, like I was going to break it or dislocate it. I kept moving. I work fulltime, live in New York City, take public transportation, I`m 68. You must know that you are helping lots of people, with this information, that will not be able to get an X-ray or a cortisone shot or see a doctor. A million times Thankyou ! P.S. When I was young, I would visit my grandmother in Fairview. Last name, MacKay. Small world...:)))

[@n55wood]

So interesting. The visuals are great

[@farhad.noorzay]

As someone who’s recovering from a meniscus tear and surgery, this episode is gold. Thanks you for the in-depth and clear explanations!

[@stoenchu122]

To support your recovery you can try taking boron, MSM, chondroitin sulfate and glucosamine. Wish you well ❤

[@farhad.noorzay]

@@stoenchu122 Thanks. I take a Glugosamine + MSM supplement I got from Costco. Hard to tell if it helps at all.

[@kenbrandy]

So patellafemoral pain if you have been increasing mileage trying to get 3 hours of zone to a week😊 is it the same protocol of increasing quad strength to deal with the pain? And if you know you have bad alignment and structure is it still helpful?

[@RogerL]

You should interview Dr Stuart McGill about lower back injuries and rehab. He is the expert in this topic and his books are great.

[@mattbrown5949]

How does absence of ACL post knee replacement impact post op outcomes? In the model you showed there was no ACL?

[@KR-ei2fw]

I’m suffering from osteoarthritis in hips and joints and as a subscriber I’ve been waiting for you to cover this subject! Thank you.

[@cbacon7813]

@PeterAttiaMD So timely! 41 years old and just got my first broken bone, an ankle fracture last week. Not pleasant with a home and 4 kids to tend to. AirCast doesn't seem to keep it stable. Doc recommends surgery. Scoliosis hardware makes me not want to have any other metal in my body. Ortho hasn't done MRI,just said surgery would be faster recovery.

[@berndklotz9128]

3 years ago my adult son had Lizfranc ligament rupture and 2nd and 3rd metatarsal fracture which was pinned. Curious to know whether anyone has any insight as to whether or not to remove pins. Conflicting information

[@mattbrown5949]

Excellent program. Should probably be required class in high school.

[@jheyfede]

really interesting! As someone who has competed in athletics my whole life and with very high arches...Jones fracture is the bane of my existence.

[@giovannip.791]

Amazing episode! The discussion on PRP / stem cells is super interesting. I wish I had half of the scientific knowledge that these two dudes have. I bet imaging centers will be swamped over the next days.

[@kenbrandy]

If you have a replacement on one side and the alignment is does that screw things up more since the other side is still out of alignment?

[@yrleventhal]

how do I find a Dr. that is in the biologic association registry and a bio registry

[@ElizofAmerica]

I just found out that my left side leg is shorter than the right, now I have frozen shoulder is it related?

[@marciatrakas5543]

I fell and developed bad bruises on my leg Some have developed blisters what do I do?

[@josephacolletti]

Podcast always giving new goods, improvements, thanks!

[@michaelsherman8550]

What is the brand name of the thing clipped on their shirts?

[@sandrawoodworth8391]

Fascinating and carefully explained. !!!

[@tootstoyou1]

I take a rounded tsp of powdered MSM usually once daily, occasionally twice. It definitely helps my pretty stiff (but not seriously painful when walking) knees. The trick is to take more than recommended. Btw, 71 yo F. Healthy weight, walk and ride the ole bike (not elec) daily. Interesting video for sure

[@hopefulforhumanity5625]

Where do you get MSM? How long have you been taking it?

[@christinalombardi5260]

31:43 what do you mean that physical therapy is misconstrued? The role of a physical therapist is sometimes superior to surgery. In addition, one of the concepts I have learned is not always a person falls and breaks his/her hips. Perhaps, due to osteoporosis or other age related issues, the femur is fracture and a person falls…

[@barbarafairbanks4578]

I think - by 'misconstrued'- he meant that the listening audience may misunderstand his meaning...

[@evasz814]

Outstanding presentation! Thank you!

[@skshain]

Great insight to this long term endurance athlete.

[@hisetenespanolbysara6556]

Thanks a million for what you do for us!

[@shelchicago8997]

I like the professional lighting

[@benbakaar2]

Good information

[@perailey]

Thanks, Doc!

[@Palmiik]

If like me you were interested in the discussed non-surgical options for bad hips and knees, here they are: (1) Physical Therapy (PT): PT can help improve strength, flexibility, and stability around the knee and hip joints. It may involve exercises to strengthen specific muscles, such as the quadriceps and gluteus medius. Exercises can also focus on improving biomechanics and movement patterns to alleviate pain and reduce the risk of further injury. (2) Medications and Injections: - Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to reduce pain and inflammation. - Cortisone injections can provide temporary relief from pain and inflammation. However, their repeated use may have potential negative effects on cartilage. - Hyaluronic acid injections, although not FDA-approved for hip use, may be considered off-label for symptomatic relief. (3) Orthobiologics: - Platelet-rich plasma (PRP) and hyaluronic acid injections have shown promise in reducing symptoms and potentially delaying the need for surgery in knee arthritis. - Biologic injections are considered symptom-modifying treatments with a good safety profile. (4) Weight Management: Maintaining a healthy weight or losing excess weight can decrease stress on the knees and hips, potentially relieving pain and slowing down arthritis progression. I got these from the Chat AI at dstill.ai/podcasts/episode/90c70eef-ee78-5382-be63-6b3ec8216b03 see here: screenbud.com/shot/4542261e-5c38-4830-9854-df62355ac131/image.png

[@BrianS-ny9yd]

Was there a power outage? Why was this recorded by candle light? I'm expecting ghost stories or the Jocko podcast. 🙂

[@bellelacroix5938]

Stop listening because Peter couldn't stop interrupting the guy answering questions that he asked that I wanted to know the answers to

[@barbarafairbanks4578]

What the heck! Peter was already asking the pertinent questions that (well, imo) we wanted to know- before we even realized we were wondering the same... the question was being asked AND answered.

[@dosboot1]

Despite being "great content" in some educational sense, this episode is not what I'm hoping to get out of your podcast. Throughout the episode, there was typically little to nothing about injury prevention and stratifying activities by risk (i.e, helping us understand the risk-benefit question for how we live our lives). I don't need to be educated like a surgeon, I need to be educated like a potential patient. In a recent episode Peter talks with Oliver Burkeman about how "there's always more big rocks" we could spend our time on, we "have to have courage turn down opportunities and activities that we do really want to do". Becoming educated about surgical treatment and all these little anatomy locations is fascinating, but it's obviously something that is entertainment and isn't contributing to a meaningful part of my life. I would like to know if the podcast host & podcast producers ever think about the sheer volume of content they are creating that, and how at some point they've created so much content that is interesting and educational, but not actionable or helpful. And if at that point, whether the content they've created becomes one of those "middling priorities" that viewers should say "no" to.

[@barbarafairbanks4578]

@dosboot1 - Well - judging by how many here in the comments' section felt that the data shared in this podcast was extremely helpful to them - I would say, 'speak for yourself' in your critique of this podcast's content. You DO seem to be the outlier here. Just sayin🤔

[@dosboot1]

@@barbarafairbanks4578 Fair enough! Since you cared to reply, do you have any interest in this related topic from the Oliver Burkeman episode? What do you find in your life that you must find genuine courage to say "no" to? Something that you genuinely want to do, and where the only problem is that it isn't a top 5 priority?

[@juukame]

Peter's constant interruptions , especially in the latter half really throw off the flow. I find myself anticipating his interruptions instead of focusing on the guest. Like intellectual edging; right when I start to get especially interested in the words of the speaker, bam! Interruption. Unfortunate because I'm really interested in what the speaker has to say

[@barbarafairbanks4578]

@juukame... hmm, 🤔interesting. On the contrary, I found myself being utterly grateful for Peter's constant questions - he's naturally very curious - which, IMO, is a very good quality to possess for an interviewer. I was simply amazed, throughout this interview that, just as my brain was on the precipice of forming the question, Peter was already asking the question! (The very question that was just beginning to form in my brain.) Amazing - in my opinion - and helped me to understand the material so much better, than if those pertinent questions had gone unasked. Nothing worse, to me, than an interviewer who sits there and nods their head in agreement, and apparently has no curiosity about the material being presented.🙄

[@concisecontenttv]

This guy doesn't know anything about stem cells. All he can say is that it's illegal in the US. But it isn't illegal in Mexico, Costa Rica, Panama etc. But "illegal" is all this guy can say

[@barbarafairbanks4578]

He DID say , Illegal in the U.S. Derp - you expected a map of where it's legal? The interview was about hip,knee, foot injury & repair. NOT about PRP or stem cell therapy.

[@concisecontenttv]

@@barbarafairbanks4578 you might want to listen to the interview so you don't sound so foolish.

[@barbarafairbanks4578]

@concisecontenttv - AND @ Get2ThePt... Feel Entitled much, there dude?😆 I DID watch this full podcast. You, OTOH, apparently let most data go over your head bc you felt so deprived about the lack of stemcell/ PRP data you felt SO entitled to. Again, PRP/stem cell therapy is NOT what this interview was about.

[@concisecontenttv]

@@barbarafairbanks4578 so if they talk about it, it isn't about that? lol. Peter Attia's pinned friggin comment has it time stamped and it still isn't about what HE brought up? congrats on fixing the internet one comment at a time. you are a blessing to the world

[@barbarafairbanks4578]

@concisecontenttv My point...which you keep trying to deny...but here let me spell it out for you one last time.. my point was that this podcast IS about ankle/foot/ hip injury, treatment & injury prevention. Go back and view the thumbnail...maybe it'll finally sink in for you. Further, the interviewee is a surgeon, NOT a PRP/stem cell Clinician. Although Peter does ask about StemCell/PRP, This surgeon indicates that PRP is not in his wheelhouse, but answers Peter with what he does know on the subject. And here you are😫 boo-hooing over the fact that he didn't mention facts about its legality, or not, that YOU ALREADY KNEW anyway! Entitled af! 😢 😭over the fact that, that part of the interview didn't go the way YOU wanted it to. The surgeon didn't mention what you admit you already know. Your attitude is Eff'd up! (My opinion, of course)😉

[@hailynewma9122]

bald men talking joints. interesting

[@whatname4613]

Huh?

[@jellybeanvinkler4878]

CUTE bald men talking joints.❤❤

[@barbarafairbanks4578]

@whatname4613 yah...the op obviously just wanted to gripe about this interview, so made an utterly non-sensical 'point'. Smh (takes all kinds, I guess)🥴

[@evansvillecolorectalsurgery]

Loved this discussion. As a retired surgeon and now full time senior softball player, I will refer questions I get to your channel. Many seniors are now playing with hip and knee replacements…unheard of just a few years ago. I underwent a partial knee replacement ( medial compartment ) at age 69 in early April after a medial meniscal tear 20 years ago. I was able to return to softball full time in 3 months. I would be interested in hearing Dr. Cohen’s thoughts on partial vs total knee in those pts where it is an option. I have certainly found with both my experience and in reading the literature that recovery time and return to sport is much shorter with a partial knee vs total. Thank you again for such an informative conversation.

[@roodog11]

I, too, am very interested in hearing Dr Cohen's thoughts on partial vs total knee replacement. @peterAttiaMD is there a way to follow up w/ Dr Cohen on this? There are a handful of ortho surgeons who are advocates/proponents of partial knee replacement. These surgeons (Dr Redish, Dr Stone, Dr Thompson) are giving compelling rationale for doing partials. I have bone on bone on both knees in the medial compartment so I have a vested interest. A TKR is much more invasive surgery compared to a partial. And the recovery is much longer, keeping a person less active for a longer period of time. I have spoken to three surgeons so far, two said I needed a total knee replacement and the third said a partial knee replacement and that I may never need a total. This third doctor is located in another state from where I live. I am searching for a surgeon in my area who has done many partials with decent outcomes. Thanks Dr Attia for asking the question about tips on finding a good ortho surgeon! I will pose those questions to the next doctor I speak with.