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Does Hip Arthritis Really Warrant A Hip Replacement?

By Colin A. Mudrick, MDColin A. Mudrick, MD, Joint Replacement, Tuckahoe Orthopaedics

A rising number of people are suffering from chronic hip pain and arthritis. In response, hip replacements are becoming increasingly common in the United States. While a hip replacement is an option for pain relief, there may be non-invasive treatment methods worth exploring first.

Here’s a look at the common sources of hip pain and a few ideas for you to discuss with your doctor before considering a hip replacement.

Understanding Hip Arthritis

Hip arthritis is most commonly caused by mechanical wear and tear of the joint surface known as osteoarthritis. This is a physical breakdown of the cartilage that covers the ball and socket joint of your hip.

The first step in understanding hip arthritis is to identify the source of the pain. Pain from an arthritic hip is most often felt in the groin and/or thigh. Pain can also be located in the buttocks or lateral aspect of hip. There are many other causes of pain in the hip region, thus it is important to work with a physician who treats hip problems. He/She can identify the source of the pain through a physical exam and X-ray findings.

Carefully Monitor Your Hip Pain Level

The earlier the diagnosis, the more non-surgical options there are. You’re more likely to reduce pain and increase range of motion without surgery. This is important to note regardless of the level of pain.

Patients typically do not come in until their pain begins to limit daily activity.  This begins with mild discomfort during exercise, but can progress to pain when walking. Eventually the pain is present even without activity and can even make it difficult to sleep.

If you’re experiencing hip pain, we recommend documenting the time of day, severity, and activity causing the pain. That will help us better diagnose your pain and find the best treatment plan for you.

Non-Surgical Treatments for Hip Arthritis

If you’ve been diagnosed with hip arthritis, a hip replacement is not your only option. If you’ve seen a doctor early on, you may be able to address your hip arthritis with treatments such as the following:

Activity Modification:

Repetitive loading of your hip joint, such as with running or tennis, can aggravate hip arthritis. Try activities such as cycling or using the elliptical. They will still give you a great cardiovascular workout while minimizing the stress to your hip.

Weight Loss:

Your hip experiences 2-3 times your body weight while performing normal daily activities. Losing weight can help reduce the wear and tear on your hip joint. Anyone overweight with hip pain can benefit from losing weight. This is especially true for someone who is considering surgery. Recent studies have shown a dramatic increase in infection risk in patient who are over a certain weight.

Pharmaceutical Treatments:

Many patients may have already tried over the counter medications, such as ibuprofen or Tylenol. These medications treat inflammation and therefore reduce pain. There are also prescription anti-inflammatory medications that are used to aid in pain reduction. It’s important however, to be careful about how you medicate.

Many anti-inflammatory medications are processed by your kidneys. Taken chronically, they can increase your risk of cardiovascular disease. It’s important that your doctor follows you closely if you are taking the medications for an extended period of time. This might mean anything longer than 2 to 3 months.

If you can’t tolerate anti-inflammatory medications, there are other pharmaceutical treatment options. These include topical gels and steroid injections directly into the joint. Both can cause significant relief, although likely temporary.

Physical Therapy:

Hip-strengthening exercises can help you regain strength in your hip and leg muscles, reduce pain, and increase range of motion.

Hip Arthroscopy:

Hip arthroscopy is a procedure in which your doctor puts a scope or camera into the hip. This treatment typically treats younger patients predisposed to hip issues.

Many of the above mentioned options will help to alleviate the pain temporarily. At some point these measures begin to lose their efficacy or the arthritis progresses. The more permanent solution becomes a hip replacement.

When to Consider Hip Replacement

An appropriately prescribed hip replacement fixes the mechanical issues you may be experiencing. And it’s the only treatment option that does such.

The hip replacement experience has drastically improved over the past 20-30 years. Many improvements are directly tied to the way in which pain is managed post-operatively. Many surgeons use a “multi-modal” pain regimen that targets different pain receptors in the brain and the site of the surgery. Patients are getting up faster and are leaving the hospital sooner. Thirty years ago, many patients spent up to two weeks in the hospital after surgery.  Today, many people go home within 1-2 days and in some centers in the country are even going home the same day.

If you have tried alternative treatment methods for your hip arthritis, it may be time to discuss the next step.  Your doctor may suggest a hip replacement as the best option for you. If so, contact our doctors at Tuckahoe Orthopaedics today to discuss what’s next for you.

High School Football Injury Prevention Tips From The Sideline

Dr. Shannon M. Wolfe, Tuckahoe Orthopaedics, Arthroscopy & Sports Medicine TeamBy Shannon M. Wolfe, MD

With Fall on the way comes a return to football season, and Tuckahoe Orthopaedics is glad to be heavily involved with local football programs. Many of our patients happen to be football players at various levels within the sport.

Let’s take a look at how we got involved in local football teams and what our roles as doctors are. Then I’ll share some of my experiences and tips for players and their parents.

High School & College Football and Tuckahoe Physicians

Football has always been a passion of mine. I was fortunate enough to be able to play college football during my time at University of Akron. After finishing up my own athletic career and personally experiencing many of the injuries I now treat, it was a natural progression to provide services to other football student-athletes.

Tuckahoe Orthopaedics sponsors a sports medicine Fellowship program through Orthopaedic Research of Virginia.  As part of this program, the practice provides one-year fellowships for those who have completed training at an accredited medical school and wish to experience one more year of in-the-field involvement to hone their skills. A key piece of this fellowship involves working with local football programs, whose season coincides with the start of our fellowship year in July.

The group covers several local high schools and colleges, with physicians and fellows always available to provide service. Our service includes watching games and attending to an athlete who requires assistance before, during, and after the game, which even includes non-game days. Care is coordinated with the school’s athletic trainers, based on the severity of any particular injury. After a player recovers, we are also the ones to clear him to return to practice.

Common Football Injuries

Although those requiring surgery receive the most attention, many football injuries at the high school level are minor ones. Injuries such as ankle sprains are commonplace, and physical therapy can often be used to alleviate symptoms. As physicians, we help monitor a player’s progress and provide guidance as to when the athlete can return to play.

Shoulder dislocations and ACL tears are additional common injuries (the former are often reduced on the sideline while the latter do often require surgical repair). Even though they are not “orthopedic” injuries, per se, concussion symptoms are a common part of the game. Thus, an orthopedic physician or fellow may also be part of the team that helps observe and diagnose those issues for a player.

Injury Prevention Tips for Football Players

One of the best pieces of advice for football players of all ages is to simply listen to your trainer. It’s important to maintain healthy eating, especially on game days. Keep properly hydrated and stay flexible by stretching before taking the field.

The risk of many non-traumatic injuries, such as cramps, is easily reduced with proper care (i.e. hydration).  However, non-traumatic issues can easily lead to more debilitating injuries if not properly addressed. No matter what pains or problems you are experiencing, make sure to immediately report any and all injuries to your trainer.

Tips for Parents

It’s important for parents to know that the physicians and fellows are always available to assist.  If you see your child acting differently and believe the behavior (or injury) hasn’t been reported to a trainer, make sure to let an athletic trainer or medical personnel know of the situation – even if the student-athlete is typically seen by another orthopaedic specialist.

If your child is experiencing pain due to a football injury, we encourage you to schedule an appointment today.

Common Causes of Pinched Nerves

Spine | Tuckahoe Orthopaedics
Walter N. Rabhan, MD | Tuckahoe OrthopaedicsBy Walter N. Rabhan, MD

Many patients, when they have a pinched nerve in the spine or neck, aren’t aware they have a pinched nerve. Instead, they talk about the associated symptoms without knowing the underlying cause. At Tuckahoe Orthopaedics, we use testing and medical knowledge to get to the root of the problem and find the cause of your pain.

Symptoms of Pinched Nerves

Common symptoms of a pinched nerve in the lower back or spine include:

  • Pain, burning, or stinging sensation in one or both buttocks, thighs, or calves
  • Hip pain
  • Pain or burning down to the toes or foot

Symptoms of a pinched nerve in the upper back neck usually include these same sensations, but the symptoms radiate into the upper extremities (arms, shoulders, scapula, hands).

Keep in mind, these are only symptoms, not conditions in and of themselves. A pinched or irritated nerve is really an indication of some other, underlying condition. If you have a pinched nerve, it’s a sign something else is going on in your body.

Causes of Pinched Nerves

Any one of these conditions can result in the symptoms described above.

  • Bulging of the disc.
  • Protrusion of the disc.
  • Ruptured disc
  • Degenerative disc disease (an early form of arthritis)
  • Bone spurs.
  • Fractures.
  • Inflammation of soft tissue from a severe sprain or strain

In rarer instances, pinched nerves may be caused by tumors, fractures, or what is called Piriformis Syndrome (an irritation of the sciatic nerve caused by muscle spasms).

Causes of a pinched nerve often vary by age. From ages 20 to 45, pinched nerves will most often occur as a result of disc or soft tissue problems. From ages fifty to eighty and onward, pinched nerves are most likely a result of degenerative arthritis, spinal stenosis, or other age-related causes.

Diagnosis and Treatment of Pinched Nerves

Diagnosis of a pinched nerve starts with a basic examination and X-ray. A physical exam will tell the doctor at what level of the spine the problem is occurring. Most of the time, barring extraordinary circumstances or significant abnormalities in the examination, the treatment for a pinched nerve is the same.

Routine treatment begins with anti-inflammatory medication, physical therapy, rest, and modified physical activity for three to four weeks. If the symptoms have not abated after this time, then further examination may be necessary, such as an MRI. This will show the doctor the disc, soft tissue, and the nerves to check for stenosis, bulging, protrusions, or other conditions that do not show up on an X-ray.

Beyond the non-invasive treatments are solutions such as cortisone shots and (as a last resort) surgery. However, most patients recover from a pinched nerve before even needing an MRI.

Are you experiencing ongoing neck or back pain that fits the symptoms above? Request an appointment with Tuckahoe Orthopaedics today so we can diagnose your options.

ACL Surgery Recovery: Expectations and Timeline

ACL, Tuckahoe Orthopaedics, orthopedic care

ACL Surgery Recovery: Expectations and Timeline

By Dustin C. Dyer, DO

If you are scheduled to have surgery for your ACL injury, or have recently undergone surgery, you may wonder how long it will take to recover. When can you run or play sports again? What will physical therapy be like?

The most important thing to remember about your recovery is to manage your expectations. For example, NFL athletes who suffer ACL injuries take eight months on average to fully recover. You should not expect a full recovery in just a few weeks. Instead, concentrate on performing every exercise and physical therapy activity correctly. It is also very important to follow all restrictions and recommendations from your surgeon and physical therapist. Do this and you’ll stand a much greater chance of an efficient, stable, and long-lasting recovery.

The Day of Surgery

These days, most ACL surgeries are outpatient, which means no overnight stay in the hospital. Before surgery, the anesthesiologist will administer a nerve block which numbs the nerves that send pain signals to the knee. This will give the patient a head start on the first twenty-four hours of pain control. You can start icing and elevating the knee right away — which will be critical for a proper recovery.

The First Two Weeks

For the first two weeks, you will most likely be using crutches and a hinged knee brace. This brace will initially be locked straight, because the quadriceps muscle tends to get weak after an ACL injury. If not braced, the knee may buckle, risking re-injuring the ACL. The knee can tolerate bearing weight, but must be kept straight when walking until the physical therapist or physician deems otherwise.

These first two weeks will focus on icing the knee (to reduce swelling) and range of motion activities. Heel slides and extension stretching are common activities. Obtaining full extension of the knee is important, because it is associated with a more complete recovery. The more you ice and elevate the knee throughout the first two weeks, the better your knee will feel (thus improving your recovery). A general goal is have range of motion from zero to 100 degrees by two weeks.

The First Three Months

At five to six weeks, the quadriceps muscle is likely recovered enough to support normal walking with your hinged knee brace unlocked. The decision to unlock or remove your brace will be made by your surgeon or physical therapist. From here, a good physical therapy routine and home exercise program are key. A patient that stays motivated and complies with restrictions will excel. Keep in mind that every patient is different, and recovery time and difficulty will vary depending on circumstances.

At this point, the physical therapist will continue to teach closed chain exercises, in which the the foot is planted and the patient works on strengthening the muscles around the knee. Strengthening the quadriceps muscle can help with normal ambulation, while strengthening the hamstring muscle can play a protective role for the healing ACL. Core strengthening, stretching and maintaining excellent range of motion are all vital to the rehab process as well.

Around the three-month mark, you may be able to start running in-line, though you likely will not be performing any cutting or pivoting exercises yet. Sports-specific cutting and pivoting exercises are likely to start five to six months after surgery.

Six to Eight Months

After six months (or longer), the physical therapist may administer a series of functional tests: agility tests, vertical jump tests, hop tests, etc. These tests are designed to determine the level of recovery and see if further physical therapy is necessary. The full recovery may take six months, eight months, or longer. It depends on the patient.

Many patients wonder if they will require an ACL brace after their surgery when they return to their sport or activity. While there is no definitive evidence that all ACL injury sufferers need a brace, there are certain athletes that prefer to wear them. Especially athletes that will be participating in contact sports. The best course of action is to consult with your physician and physical therapist regarding this matter.

If you have questions about ACL injury, surgery, or the recovery process, reach out to Tuckahoe Orthopaedics to request an appointment and get your questions answered.