Hip Pain

Osteoarthritis Pain Treatment – Using your own Stem Cells?

April 12th, 2013 By Emory Sports Medicine

hip resurfacing procedureIt is reality now! Physicians at Emory Orthopaedics & Spine are among a select group of physicians around the country to offer a unique procedure using stem cell injections to relieve osteoarthritis (OA) pain. During the procedure, the physician extracts stem cell blood from the bone marrow in a patient’s hip and then injects the stem cells directly into the patient’s damaged joint. The stem cells are from the patient’s own body so the risk of rejection is very low.

Hear first hand from Dr. Mautner and one of our patients how this new treatment option is helping relieve pain from Osteoarthritis:

About Ken Mautner, MD

Ken Mautner, MD is an assistant professor in the Department of Physical Medicine and Rehabilitation and the Department of Orthopedic Surgery. Dr. Mautner started practicing at Emory in 2004 after completing a fellowship in Primary Care Sports Medicine at the American Sports Medicine Institute in Birmingham, Alabama. He is board certified in PM&R with a subspecialty certification in Sports Medicine. Dr. Mautner currently serves as head team physician for Agnes Scott College and St. Pius High School and a team physician for Emory University Athletics. He is also a consulting physician for Georgia Tech Athletics, Neuro Tour, and several local high schools. He has focused his clinical interest on sports concussions, where he is regarded as a local and regional expert in the field. In 2005, he became one of the first doctors in Georgia to use office based neuropsychological testing to help determine return to play recommendations for athletes. He also is an expert in diagnostic and interventional musculoskeletal ultrasound and teaches both regional and national courses on how to perform office based ultrasound. He regularly performs Platelet Rich Plasma (PRP) injections for patients with chronic tendinopathy. Dr. Mautner also specializes in the care of athletes with spine problems as well as hip and groin injuries.

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Take-aways from our Pediatric Orthopaedic Hip and Spine Chat with Dr. Fletcher

February 8th, 2013 By Emory Orthopaedics & Spine Center

On February 5, 2013, Dr. Nicholas Fletcher, Emory Pediatric Orthopaedic Surgeon held a  live web chat to answer questions pertaining to the newest treatment options for pediatric orthopedic hip and spine conditions such as scoliosis, kyphosis, hip dysplasia, leg length differences and femoroacetabular impingement.

One of the most common pediatric orthopedic problems is hip dysplasia. Hip dysplasia occurs when the hip socket does not form correctly, which can lead to hip dislocation as a child grows, stated Dr. Fletcher in the chat. Unfortunately, hip dysplasia cannot be diagnosed in a child before birth, a great question which was asked by one of the chat participants. While hip dysplasia is not particularly common, mild abnormalities of the hip socket are regularly seen at birth, but parents should not be alarmed, as these abnormalities typically get better within a couple of months of a child’s life. One of the pediatric hip dysplasia treatment options Dr. Fletcher mentioned in the chat is called the Ganz Osteotomy, a procedure available at Emory. The procedure is used to realign the hip and settings of hip dysplasia when it is found in teenagers and adults.

Participants were also interested to learn that Emory is one of only a few centers in the southeast that offer hip preservation surgeries. Hip preservation is a surgical approach to hip problems in teens and young adults designed to prevent the need for hip replacement down the road. It usually involves realigning an abnormal hip socket into a more normal position or removing bone spurs in the hip that could lead to early arthritis.

Dr. Fletcher provided some great insights and answered some hard pressing questions from chat participants. If you would like to know more about the causes and treatment options of Pediatric Orthopaedic Hip and Spine conditions be sure to take a look at the live web chat transcript. Also, for more information on Scoliosis and on how to become a patient visit Emory Orthopedic and Spine online today.

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Does Your Child Have Hip or Spine Problems? Chat Live with Dr. Fletcher!

January 10th, 2013 By Emory Orthopaedics & Spine Center

Pediatric Orthopedic ChatDid you know that children can be affected by a wide array of orthopaedic hip and spine issues? Scoliosis, kyphosis, hip dysplasia, leg length differences and femoroacetabular impingement are just a few of the conditions our team sees most commonly from pediatric patients. These conditions can lead to time away from school and chronic pain and disability later in life.

Join Emory Pediatric Orthopaedic surgeon, Dr. Nicholas Fletcher, for a live interactive web chat on Tuesday, February 5 at noon to get all your questions about symptoms, causes and the newest treatment options for pediatric orthopedic hip and spine conditions answered! See you there!

Sign Up for the Chat

About Dr. Fletcher
Dr. Nicholas FletcherDr. Fletcher takes care of all pediatric orthopaedic trauma, neuromuscular disorders, leg length differences, foot conditions, and angular deformities of the lower limbs. In addition, the management of pediatric spinal and hip conditions are particular areas of expertise. Dr. Fletcher also specializes in pediatric and young adult hip conditions including hip dysplasia, femoroacetabular impingement (FAI), perthes disease, avascular necrosis, and slipped capital femoral epiphysis. He is one of only a handful of surgeons in the southeast with expertise in the Ganz or periacetabular osteotomy (PAO) for hip dysplasia and the modified Dunn osteotomy for slipped capital femoral epiphysis. He takes care of children of all ages with hip conditions in addition to young adults with hip dysplasia and impingement.

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Did you know that July is Juvenile Arthritis Awareness Month?

July 20th, 2012 By Emory Orthopaedics & Spine Center

We are all painfully aware that arthritis affects many older adults, but did you know that kids can develop juvenile arthritis?

Approximately 294,000 children age 16 or younger are affected by pediatric arthritis and rheumatologic conditions.
In adults, arthritis typically affects the joints. While juvenile arthritis can cause bone and joint growth problems, it also can affect the eyes, skin, and gastrointestinal tract.

The most common symptoms of juvenile arthritis are joint swelling, pain, and stiffness that won’t go away, particularly in the knees, hands, and feet. Symptoms are generally worse in the morning and after naps. Other signs of juvenile arthritis include:

•    Limping due to a stiff knee

•    Excessive clumsiness

•    High fever and skin rash

•    Swelling in the lymph nodes

The most common type of juvenile arthritis is juvenile idiopathic arthritis. (Idiopathic means “from unknown causes.”) You may have heard this referred to as juvenile rheumatoid arthritis. This type of arthritis is diagnosed when a child has swelling in one or more joints for at least six weeks.

There are several different types of juvenile idiopathic arthritis. The type is usually determined by the number of joints affected as well as by the results of a rheumatoid factor blood test. While children may have a genetic predisposition that makes them more likely to develop the disease, at this point, researchers have not determined a direct cause, and there’s no evidence that toxins, foods, or allergies can cause it. Most children with juvenile arthritis experience remission, when the symptoms get better or go away, and times when symptoms flare, or get worse.

If your child has juvenile arthritis symptoms, the first thing to do is get an accurate diagnosis. Your child’s pediatrician can run tests that will rule out other potential causes, but if the signs point to juvenile arthritis, he or she may suggest you make an appointment with a pediatric rheumatologist.

There is no cure for juvenile arthritis; however, a number of treatments can improve your child’s quality of life, including:

•    Nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and analgesics to help relieve inflammation and control pain

•    Disease-modifying anti-rheumatic drugs (DMARDs) and a biologic response modifiers (biologics), which can alter the course of the disease, put it into remission, and prevent joint damage

•    Splints to help keep joints in the correct position and to relieve pain and orthopedics or shoe inserts to compensate for any difference in leg length or to improve balance

•    Physical therapy to help restore motion and flexibility in joints that have become stiff and occupational therapy to help children learn how to do basic activities without aggravating their arthritis

And, of course, it’s super important for kids with juvenile arthritis to eat healthy foods and get regular moderate exercise, to keep joints strong and flexible.

Does your child have juvenile arthritis? How does your family cope? We welcome your questions and feedback in the comments section below.

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Act Now to Prevent Joint Pain Later

June 26th, 2012 By Emory Orthopaedics & Spine Center

Prevent Joint PainAnyone putting their little toe in the waters of middle age has a glimmer of what joint pain feels like. It’s no fun. But there are things you can do to ease joint pain now and prevent future joint pain. Here are some joint-smart steps you can put into action:

Maintain a health weight. Carrying extra weight can cause significant joint pain over time, particularly in weight-bearing areas like the hips, knees, and ankles. Prevent problems now and down the line by maintaining a healthy weight. Talk with your doctor if you need help starting a weight-loss program.

Get regular exercise. Low-impact activities such as walking or hiking, swimming, and stationary cycling are great options for building bone-supporting muscles, keeping weight down, and improving joint mobility. Just 30 minutes a day can have a real impact on your long-term health and comfort. Exercise has been proved to ease arthritis pain, as well.

Keep your skeletal system strong. Help prevent osteoporosis (more common in women) by getting plenty of calcium, which you’ll find in dairy products and leafy green vegetables or in supplement form. Calcium builds bone density and makes bones less susceptible to arthritis. Consider reducing or eliminating caffeine, as it can weaken your bone structure.

Eat more fish. Fish is high in omega-3 fatty acids, which have been shown to reduce joint pain and stiffness in people suffering from arthritis. If you don’t love fish, take fish oil supplements instead.

Get plenty of vitamin C. Vitamin C may help speed the recovery of damaged muscles by repairing tissues, easing joint pain. These 10 fruits and veggies are rich in vitamin C: oranges, guava, red bell peppers, kiwi, grapefruit, vegetable juice cocktail, oranges, Brussels sprouts, strawberries, and cantaloupe.

Wear sensible shoes. OK. We know that one’s no fun. But joint pain is a high price to pay for fashion. Eschew the high heels and look instead for flexible shoes that provide support. You want the shoe to bend with your foot as you walk. These days, there are plenty of good-looking shoes out there that will be kind to your feet and joints.

Already experiencing joint pain? If you put our suggestions to the test and still feel the pain, make an appointment to see us at the Emory Orthopaedics & Spine Center.

Do you suffer from joint pain? If so, what treatments have worked best for you? We welcome your questions and feedback in the comments section below.

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Minimally Invasive Hip Surgery Gets Patients Active Faster – A Patient Story

June 10th, 2011 By Dr. Bradbury

Thomas Bradbury, MDWhen I first met Mark Putnam, he had chronic pain in his right groin and lower back caused by osteoarthritis of the hip. At 49, Mark felt twice his age. His local orthopedic surgeon was uncomfortable performing surgery because of the extent of the damage to the joint and instead referred Mark to the Emory Orthpaedics & Spine Center.

Mark needed a total hip replacement, and I knew he would be an excellent candidate for anterior total hip arthroplasty, an Emory-pioneered minimally invasive surgery that involved a new approach to the hip joint. Hip arthroplasty traditionally is performed through the posterior, or back, of the hip. This means the surgeon has to remove muscle and ligaments from the bone in order to reach the affected area. Because it takes a while for the tissues to heal after posterior total hip arthroplasty, the range of motion the hip can have for the first couple of months is restricted to prevent dislocation.

Anterior total hip arthroplasty has changed the way we perform hip replacement surgery at Emory. During the procedure, the orthopedic surgeon enters the front of the hip, as opposed to the back, via a single, very short incision to the patient’s leg. Because the surgeon can expose the hip without removing as much muscle and ligament from the bones around the hip joint, the patient retains a better range of motion in the hip and has greater hip stability following surgery.

While anterior total hip arthroplasty takes longer than traditional posterior surgery, the quick recovery time more than makes up for it. After surgery, Mark was pain free for the first time in years.

“It’s been terrific,” he said. “I was out the other day playing catch with my son, and I got down in a catcher’s squat and it didn’t even affect me.”

I encourage you to read up on the details of Mark’s total hip arthroplasty, and watch a video on Mark’s journey. Have you had anterior total hip arthroplasty? We’d like to hear about your experience. Please take a moment to give us feedback in the comments section below.

About Thomas Bradbury, MD

Thomas Bradbury, MD, is an assistant professor of orthopedic surgery. He holds clinic at Emory Orthopaedics & Spine Center at Executive Park and performs surgery at Emory University Orthopaedics & Spine Hospital (EUOSH). Dr. Bradbury’s professional goal is the improvement in quality of life for patients with pain secondary to hip and knee problems. He started practicing at Emory in 2007.

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Got Hip Pain? Get Back in the Game Quickly with Hip Resurfacing

March 10th, 2011 By Dr. Greg Erens

hip resurfacing procedureIn my practice at the Emory Orthopaedics & Spine Center, I see a lot of patients who suffer from hip pain as a result of osteoarthritis, or degenerative joint disease. In the past, when surgery was called for, hip replacement was often the best option—and in many cases, it still is. However, in 2006 the FDA approved the first total hip resurfacing implant in the United States, allowing patients suffering from serious hip pain another highly effective option.

Unlike total hip replacement, in which the diseased head ball of the hip (femoral head) is completely removed, total hip resurfacing preserves the femoral head and removes only the damaged surface of the bone.

Only a small number of surgeons in the Atlanta area have the training and expertise to perform this procedure properly. I have been performing total hip resurfacing procedures at Emory since 2007, with excellent patient outcomes. This specialized operation has a number of potential advantages for the right patient. Total hip resurfacing can:

  1. Preserve bone
  2. Restore the natural anatomy of the hip
  3. Provide the largest possible head size to improve hip stability
  4. Enable restoration of hip function to allow a multitude of activities
  5. Allow for an easier revision (re-do) in the future, if needed

So who’s the perfect hip resurfacing patient? Hip resurfacing is best suited for the young, active male (<55 years of age) with osteoarthritis of the hip and normal hip anatomy. Healthy and active at 45, Mark Gabriel was the ideal candidate. I met Mark last year, after he’d been suffering from pinching and pain in his hip for a year and was referred to me for surgery. Mark, a director for an Atlanta IT solutions and staffing company, was in great shape, save for his hip. His hip pain had resulted in large part from 40 years of playing tennis on hard-surface courts. As he put it, his hip was like a brake pad that had been used too much. Eventually it wore out. Resurfacing his hip was a great way to preserve the hip bone and allow Mark to get back to the active lifestyle he enjoyed.

In July of 2009, I performed Mark’s hip resurfacing surgery at Emory University Orthopedic & Spine Hospital (EUOSH), our state-of-the-art inpatient facility. Mark was put under general anesthesia for the procedure, which went smoothly and took about two hours. Because Mark is young and had stayed active by cycling up to his surgery date, he recovered from the surgery quickly. He stayed in the hospital just two nights and was off pain medication completely three days after surgery. After six days, he was down to one crutch and was back to walking around his neighborhood.

Mark says that he is 100% satisfied with the results of his hip resurfacing. In the year since the procedure, he’s played tennis five days a week, enjoyed golf, and gone skiing. He chooses clay courts over hard surface when he has the option, but Mark is back in the game and loving life after hip surgery.

Have you had hip surgery, or are you considering hip resurfacing? We welcome your questions and feedback in the comments section below.

About Greg Erens, MD:
Greg Erens, MD,  is assistant professor of orthopedic surgery and director of the Emory Adult Reconstruction Fellowship. Board certified in orthopedic surgery, he specializes in both uncomplicated and complex problems of the hip and knee. Dr. Erens started practicing at Emory in 2003.

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Improved Joint Capsule Reconstruction Results in Fewer Dislocated Hips

February 22nd, 2011 By James R. Roberson, MD

James Roberson, MDDislocation of the ball from the joint has always been a possible complication following hip replacement surgery. However, at Emory Orthopaedics, a couple of developments have significantly reduced, if not eliminated, those concerns.

One of these developments is the use of alternative bearing surfaces such as highly cross-linked polyethylene—a super-wear-resistant plastic—which enables surgeons to use larger-diameter balls (femoral heads) in the hip joint. The new, thinner bearing surfaces allow for larger-diameter femoral heads, making the hip intrinsically more stable.

Another development that has significantly increased hip stability is recognition of the importance of reconstructing the ligamentous capsule of the hip joint to its appropriate anatomic position at the completion of the hip replacement. The hip is held in place by the soft tissue around the hip—the capsule, the ligaments, and the tendons. If these are not put back in an anatomic position (i.e., where they came from), the hip will have a greater chance of dislocation.

At Emory Orthopaedics, what these developments mean is that we have become more comfortable allowing our patients to resume natural activities earlier after surgery. Traditionally, patients were told they shouldn’t bend their hip more than 90 degrees, shouldn’t cross their legs, should use an elevated toilet seat, etc. for up to three months following surgery. Patients were apprehensive about dislocating their hip. But with these new materials and improved methods, for most patients we’ve stopped using those restrictions in the early post-op period. Now we feel confident telling patients that they can sit however they’d like to, bend their hips, and so on. They can go straight to enjoying their new and improved hip.

Have you had or are you going to have joint capsule reconstruction surgery? We’d like to hear about your experience. Please take a moment to give us feedback in the comments section below.

About Dr. Roberson

James R. Roberson, MD, chairman of the Department of Orthopaedics and professor of Orthopaedic Surgery, specializes in treating hip and knee arthritis and has performed more than 10,000 hip and knee replacements over the course of his career. Dr. Roberson has practiced at Emory since 1982.

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New Biomaterials Mean Fewer Hip and Knee Replacement Reoperations

January 13th, 2011 By James R. Roberson, MD

James Roberson, MDIn Emory Orthopaedics, we perform hundreds of hip and knee replacement operations every year. Most of these operations are highly successful, but occasionally, a reoperation is necessary. In these cases, it’s usually because the materials originally used in the knee or hip have worn down over time.

At Emory, we’ve been testing new and improved biomaterials for use in hip and knee replacements for more than a decade, and we’ve found that a new generation of biomaterials is making a significant difference in the longevity of these replacements. This means fewer patients will need reoperations down the road.

The failure rate in a knee replacement operation is directly related to how fast the knee wears, which is affected by how well the knee was put in, the patient’s activity level, the patient’s weight, and the wear resistant properties of the materials used. Think of the tires on a car. The stronger the tire material, the longer it lasts. What if, instead of getting 30,000 miles on a set of tires, you could get 100,000 miles? In essence, that order of magnitude difference is similar to the improved wear resistance of new biomaterials used in hip and knee replacement.

I’ve been using alternative bearing surface materials in hip replacements for about 12 years, starting with metal on metal, then ceramic on ceramic, and now highly cross-linked polyethylene. All three materials have dramatically improved wear resistance and have worked very well for several thousand patients, with no measurable wear on any patient visible through x-rays. But while metal on metal and ceramic on ceramic are useful in hip replacements, they aren’t an option in knee replacements. Until recently, this was also true of cross-linked polyethylene. However, the more recent second generation techniques for cross-linking now make this a viable option for knee replacement also.

Polyethylene, simply put, is a plastic formed from long molecular chains made of carbon and hydrogen atoms linked together. Prior to cross-linking manufacturing techniques, these molecular chains consisted of carbon atoms linked to other carbon atoms in single long chains with the remainder of the molecular bonding sites filled with hydrogen atoms. On a molecular level, cross-linking simply means that the single chains now are cross bonded together to, in essence, create a woven structure. This results in a material that looks identical but is actually a more wear-resistant form of plastic.

Over the past three to five years, we’ve performed approximately 1,000 knee replacement surgeries using cross-linked polyethylene. While all three materials—metal, ceramic, and polyethylene—appear to perform fairly evenly in hip replacement surgery, cross-linked polyethylene is less expensive than ceramic on ceramic. Although the individual patient does not experience a cost difference, this is a benefit to the industry as a whole. Our goal is to develop improved materials that will result in better outcomes and be cost-effective.

If you’re having knee or hip surgery, you can trust your doctor to choose the most effective material for you. Regardless of whether it’s metal on metal, ceramic on ceramic, or cross-linked polyethylene, with all of these new biomaterials, we are cautiously optimistic that wear may no longer be a problem.

Have you had or are you going to have hip or knee replacement surgery? Have you had experience with any of the new biomaterials? We’d like to hear from you. Please take a moment to give us feedback in the comments section below.

About James R. Roberson, MD:

James R. Roberson, MD, chairman of the Department of Orthopaedics and professor of Orthopaedic Surgery, specializes in treating hip and knee arthritis and has performed more than 10,000 hip and knee replacements over the course of his career. Dr. Roberson has practiced at Emory since 1982.

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How Do You Know if You Have a Hip Problem?

October 7th, 2010 By Dr. Bradbury

Thomas Bradbury, MDThink you’ve pulled a groin muscle? You may have a hip problem instead. Because hip pain often presents in the groin area, a lot of patients come to me thinking they’ve pulled a muscle, when in fact they have arthritis of the hip or a hip impingement.

Causes of hip pain may include arthritis, hip impingement, and labral tear.

Arthritis is the most common cause of hip pain, usually affecting older adults. Hip impingement, which generally affects younger folks, is caused by abnormalities in the shape of the ball in the socket, and it’s usually congenital, or a condition you’re born with. Impingement can lead to arthritis.

When you have hip impingement, you feel pain when the hip is at the extreme of its range of motion, such as when you’re sitting or walking up stairs. Because impingement pain is positional, it shouldn’t occur when you’re walking on level ground or at night, while you’re sleeping. Hip impingement also may cause a labral tear.  The labrum can be thought of as a cartilage “O-ring” that attaches to the rim of the hip socket. Rarely, trauma can result in a labral tear.

If you have pain in the buttock area, you may have a spine problem rather than a hip problem.

How do you know when to see a physiatrist or an orthopedist?

Pain that doesn’t resolve with several weeks of rest and avoidance of painful activities or with the use of Tylenol or anti-inflammatory drugs needs to be evaluated.  At the Emory Orthpaedics & Spine Center, we use x-rays and MRIs to help diagnose hip problems. Steroid injections into the joint also may help with both diagnosis and to ease the pain.

When hip problems are caused by arthritis, we start treatment with conservative methods, such as use of a cane, modification of activities, and taking Tylenol or anti-inflammatories. If these don’t sufficiently ease hip pain, hip replacement surgery offers the potential for dramatic improvement in pain, function, and quality of life.

When impingement causes hip pain, hip arthroscopy may be beneficial. During hip arthroscopy, your orthopedic surgeon uses a small camera to look inside the joint. If there’s an abnormal shape to the ball or socket, it can be corrected with special instruments. This treatment will often offer improvement in pain. Labral tears can be trimmed or repaired at the time of arthroscopy.

Have you experienced groin pain or hip pain? Have you tried conservative measures and not found relief? Or have you had a hip replacement or arthroscopy? We’d like to hear about your experience. Please take a moment to give us feedback in the comment section below.

About Thomas Bradbury, MD:

Dr. Bradbury is an assistant professor of orthopedic surgery. He holds clinic at Emory Orthopaedics & Spine Center at Executive Park and performs surgery at Emory University Orthopaedics & Spine Hospital (EUOSH). Dr. Bradbury’s professional goal is the improvement in quality of life for patients with pain secondary to hip and knee problems. He began practicing at Emory in 2007.

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