Posts Tagged ‘hip surgery’

Hip Pain: Easing Discomfort with Proven Solutions

Hip pain can severely affect your independence, your lifestyle, your job, and more. With pain reaching unbearable levels, a bum hip can level the toughest among us.

It Might Not Be Your Hip

“One of the major things we immediately try to differentiate between is if it’s actually a hip condition—or is the pain coming from the back?” says Dr. Bryan Whitfield, an orthopedic surgeon at Emory Healthcare.

True hip pain culprits include impingement, labral tear, bursitis, pain coming from the gluteal tendon, and osteoarthritis.

Causes & Symptoms of a Hip Condition

Sometimes the shape of the bones leads to impingement—the socket and ball essentially running into each other and tearing cartilage around the rim. A fall can sprain the hip and tear tendons.

“Most people think their hip is on the back and on the side, what we would call the flank,” states Dr. Whitfield. “It turns out, conditions within the ball and socket are usually felt in the groin, more on the front than the back.” Typically, patients experience discomfort going from a seated position to a standing one. Pain can be triggered by certain activities or accompany every step.

Getting a Diagnosis

If there’s nothing else going on with the body, most normal aches and pains should go away within two weeks. If pain is holding on after two to six weeks, it’s time to get it checked out.

“When diagnosing hip issues, we really take into account an entire view: history, physical, imaging, and response to treatment,” explains Dr. Whitfield. “That helps us determine where exactly the pain is coming from and what condition is most relevant.”

Treatment Options

Some patients just want to be reassured nothing major is to blame and will often do nothing more if the pain is not limiting. However, Dr. Whitfield finds injections in the symptomatic location to be quite helpful.

“The other approach I routinely take is physical therapy. Much of the pain individuals experience is from muscle imbalances,” states Dr. Whitfield. “Physical therapy can help to correct that.”

Anti-inflammatory medications and avoiding activities that exacerbate the pain are also options. If significant pain continues over a long period of time, surgery should be considered.

Hip Surgery

When a patient has arthritis, the only reliable answer is to remove the damaged cartilage in the underlying bone and replace it with different material such as metal and plastic, which is hip replacement.

Pain may also be a result of a tear in the labrum from a sprain or bones impinging, or because of a torn tendon. “If there’s no significant arthritis in the hip, I can go in and remove some of the bone that is impinging and repair the labrum,” explains Dr. Whitfield. “Oftentimes, that’s very effective in taking away the pain.”

Benefits of Total Hip Replacement

In terms of risk versus reward, total hip replacement is considered one of the most successful surgeries and is effective in easing the majority of osteoarthritis pain.

“As techniques have advanced, we’ve changed our approach. A direct anterior procedure is minimally invasive and does not require any muscle detachment,” states Dr. Whitfield. “This allows for a quicker recovery.”

How Long Does a New Hip Last?

“I tell people it’s like a car,” says Dr. Whitfield. “If you’re just driving slowly on Sundays, the tires will never wear out. However, if it’s a sports car and you’re going off the line and around corners quickly, those tires are probably not going to last the life of the car. In my opinion, if a new hip doesn’t last a good 15 to 20 years, I’m disappointed. My hope is that it can last up to 30 years or more.”

For more information about hip pain and treatment, please visit emoryhealthcare.org.

About Bryan Whitfield, MD

Dr. Bryan Whitfield has extensive training and experience in treating all individuals who want to maximize their potential to be active, from high performing athletes to individuals who simply want their joints to keep up with their lifestyle. He believes in a patient-centered approach, tailoring his treatments both operatively and non-operatively to the individual patient’s needs. He earned his BS from Duke University in mathematics and economics before obtaining his medical degree from the George Washington School of Medicine and Health Sciences.

 

**To listen to an interview with Dr. Bryan Whitfield, an orthopedic surgeon at Emory Healthcare, follow this link: http://www.emoryhealthcare.org/podcasts/index.html?segitem=37811

Hip and Knee Replacement Live Chat: December 13, 2016

joint-replacement260x200Are you or someone you know considering hip or knee replacement after living with pain for an extended time? Whether you have just begun exploring treatment options or have decided to undergo hip or knee replacement surgery, we can help answer your questions about the procedure and recovery time.

Join us on Tuesday, December 13 at 12 PM EST for a live chat with orthopedic surgeon Dr. Thomas Bradbury of Emory Orthopaedics & Spine Center. Learn more about new treatment options and whether total joint replacement surgery is right for you. Register here today.

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About Dr. Bradbury

Thomas Bradbury, MDThomas Bradbury, MD, enjoys hip and knee arthroplasty because of the consistency of success in the properly selected patient. Dr. Bradbury’s professional goal is the improvement in quality of life for patients with pain secondary to hip and knee problems.

His research interests center around infections involving hip and knee replacements which are rare, but difficult problems. Dr. Bradbury is researching the success rate of current treatment methods for hip and knee replacement infections caused by resistant bacteria (MRSA). Through his research, he hopes to find better way to both prevent and treat periprosthetic hip and knee infections.

Pediatric & Adult Hip Dysplasia

hip-painHip Dysplasia

The thigh bone’s connected to the hip bone – that’s what the song says. But sometimes that connection doesn’t work so well, which is the result of a hip socket that is too shallow – a condition known as hip dysplasia.

The hip is the largest “ball and socket” joint in the body, held together by ligaments, tendons and a joint capsule. The hip socket is designed to hold the femur tightly to prevent it from coming out of the socket while allowing enough motion to permit a wide variety of activities. Hip dysplasia simply means that the hip is in the wrong shape, most commonly, the hip socket is too shallow and not positioned to fully cover the femoral head.

Most people with hip dysplasia are born with the condition. Many patients never have any symptoms of dysplasia as a child. However, if left untreated, many patients with hip dysplasia will progress to arthritis in their 30’s or 40’s, if not before. Hip arthritis can be a debilitating condition.

Treatment

Treatment for hip dysplasia depends on the age of the affected person and the extent of the hip damage. Infants are usually treated with a soft brace that holds the ball portion of the joint firmly in its socket for several months, helping the socket mold to the shape of the ball.

But some forms of the condition can develop later in life. Older children and adults usually require surgery to correct hip dysplasia. In mild cases, the condition can be treated arthroscopically — using tiny cameras and tools inserted through small incisions. However, if the dysplasia is more severe, the position of the hip socket can also be corrected or cuts can be made in the bone around the socket (an osteotomy) to increase its depth.

In many cases, the condition will lead to tear of the labrum and eventual arthritis because of damage to the cartilage in the socket. Total hip replacement is possible to improve pain and function in this situation.

Our providers have extensive experience in treating patients of all ages with hip dysplasia. The majority of patients with hip dysplasia are treated with surgical procedures including the periacetabular osteotomy (PAO) or “Ganz” osteotomy. This procedure, only performed by a small handful of physicians in Georgia, offers the ability to correct hip dysplasia and potentially avoid the need for a hip replacement. This exciting treatment has offered patients with hip dysplasia a hope for returning to normal activities.

Learn more about Emory’s experienced, board-certified hip specialists who provide the best possible treatment for a wide range of conditions affecting the hip. Pediatric orthopaedic patients should click here to learn more about the variety of pediatric orthopedic conditions we treat.

If you are considering a pediatric orthopaedic procedure at Emory, we encourage you to make an appointment by calling 404-778-3350 or completing our online request form by clicking the banner below.

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About Dr. Bradbury

bradburyThomas Bradbury, MD, enjoys hip and knee arthroplasty because of the consistency of success in the properly selected patient. Dr. Bradbury’s professional goal is the improvement in quality of life for patients with pain secondary to hip and knee problems.

His research interests center around infections involving hip and knee replacements which are rare, but difficult problems. Dr. Bradbury is researching the success rate of current treatment methods for hip and knee replacement infections caused by resistant bacteria (MRSA). Through his research, he hopes to find better way to both prevent and treat periprosthetic hip and knee infections.

How is Arthroscopic Hip Surgery Different?

ArthroscopyArthroscopy (also called Arthroscopic surgery) is a surgical procedure by which the internal structure of a joint is examined for diagnosis (and possibly treated) using an instrument called an arthroscope. Arthroscopy gives doctors a clear view of the inside of a joint, and helps them diagnose and treat joint problems. Hip arthroscopy has been slower to evolve than arthroscopy of other joints such as the knee or shoulder, mostly because the hip joint is much deeper in the body and therefore harder to access, but can be very effective at treating certain hip conditions.

Arthroscopic hip surgery is radically different than traditional open surgery, and may be considered before one opts for a full hip replacement surgery. Non-operative measures should always be considered first — rest, behavior modification, physical therapy and anti-inflammatories may work to alleviate reversible disorders. If non-operative measures aren’t effective and you do elect for surgery, a procedure may be done arthroscopically instead of by traditional surgical techniques, as it usually causes less tissue trauma, may result in less pain, and may promote a quicker recovery.

Hip Surgery: Hip Arthroscopy 101

Hip arthroscopy is a surgical procedure that is performed through small (about 1 centimeter) incisions using an arthroscope (camera used to visualize the inside of the joint) inside of a hip joint. Hip arthroscopy is typically performed in an outpatient setting, so patients can usually go home the day of surgery after a one to two hour recovery in the outpatient recovery area. Although it will take about 6 months to return to sport activity, close to 85-90% of patients will return to their normal activity after they recover from their hip arthroscopy surgery.

Emory Orthopaedics, Sports & Spine has a great team of operative and non-operative physicians who are specialized in treating athletes who need hip arthroscopies. Watch this short video to find out more about our unique program.

Takeaways from Dr. Bradbury’s Hip and Knee Replacements Chat

Thank you for participating in the online chat on Hip and Knee Replacements.  We had a lot of really great questions.  We received a few questions a couple times so we will highlight the answers to those questions here!

What is the longevity of knee replacements?

The lifespan of a knee replacement is related to the body weight and activity level of the individual who receives the replacement.  Individuals who are very active often reduce the longevity of their knee replacement because high activity can put extra stress on the implant leading to loosening of the implants from the bone or “wearing” of the parts used to replace the joint.  Being overweight increases the forces on implant and can also lead to early failure.  In general, 15 year survivorship of modern knee replacement designs used in  good candidate is around 90 percent.

Typically for younger patients,  if x-rays do not show complete loss of cartilage, “bone on bone”, I recommend waiting as long as possible to have the knee replacement surgery.  However, if there is “bone on bone” arthritis, knee replacement is the most effective treatment, but the risks of early failure are increased.

What exercises can I do for a total knee replacement?

Low impact aerobic conditioning 4-5 times per week for 4-6 weeks prior to surgery is best.  Low impact activities include swimming, elliptical, or stationary  bike.

“Prehabilitation” is rehabilitation to get your body ready for the surgery so you can recovery as quickly as possible after surgery.  Instruction during this period should be focused on strengthening the muscles around the joint.  The prehabilitation period should last for several weeks before surgery.

How long is recovery after hip/knee replacement?

It is best to think of how long it takes to reach recovery milestones –

• For hip replacement, pain is typically better than what it was prior to surgery in 2-3 weeks, normal walking typically occurs by 6-8 weeks and full recovery typically occurs within 3-4 months.

• For knee replacement, pain is typically better than what it was prior to surgery by 4-6 weeks, normal walking typically occurs by 8-10 weeks and full recovery typically occurs within 4-5 months.

Thank you again for attending the chat. I hope you found the information useful!  If you have questions or would like to schedule an appointment with an Emory Orthopedic Surgeon about hip or knee replacements please call 404-778-7777.

>>Read the full transcript from the online chat here!<<

About Dr. Bradbury

Dr. Bradbury is an Assistant Professor of Orthopaedic Surgery at Emory. He specializes in hip and knee arthroplasty. He really enjoys this area of orthopaedic surgery because of the consistency of success in the properly selected patient. Dr. Bradbury’s professional goal is the improvement in quality of life for patients with pain secondary to hip and knee problems.

His research interests center around infections involving hip and knee replacements which are rare, but difficult problems. Dr. Bradbury is researching the success rate of current treatment methods for hip and knee replacement infections caused by resistant bacteria (MRSA). Through his research, he hopes to find better way to both prevent and treat periprosthetic hip and knee infections.

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

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.

Improved Joint Capsule Reconstruction Results in Fewer Dislocated Hips

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.