Chronic Hip Pain

Our knees get all the glory when it comes to replacement surgery. Almost three quarters of a million Americans are getting new knees every year and those numbers are continuing to swell along with the average age of the nation’s population. 

But if you have chronic hip pain, in some ways it can be worse than knee pain. For instance, a good pull-over knee brace may allow you to avoid some of the pain associated with certain movements if your knee is degrading but you’re not quite ready for replacement surgery. But if your hip or hips are causing chronic pain, they will tell you about it when you’re walking and upright (just as your knee will). When you lay down, however, your knee probably quiets down. Not so with your hip. Sleeping can become a challenge, especially if you have damage in both hips. 

Let’s get into some of the causes of your chronic hip pain in this summer blog. 

What is causing my hip pain? 

Dr. Moore sees patients all the time with chronic hip pain. Many of these patients are dealing with serious pain and are reluctant to consider hip replacement, as they’ve heard it is quite difficult. That’s not the case at all. In fact, recovery from hip replacement can be easier than from knee replacement. But that’s for another blog. 

The most common cause of chronic hip pain is arthritis. There are three types of arthritis that impact the hips: 

  •     Osteoarthritis. Life is tough on the hips. If you’ve played sports such as indoor volleyball or tennis; if you’ve been a gymnast or dancer; if you’ve been a runner — all of these activities create a good deal of wear and tear on the hip socket. This all comes due in osteoarthritis, the “wear and tear” form of arthritis, usually after you turn 50. The cartilage on the end of your femur (thighbone) and the cartilage in the hip socket (acetabulum) become torn or worn down to the degree that bone rubs against bone.
  •     Rheumatoid arthritis. The most debilitating type of arthritis, rheumatoid arthritis causes the body to attack its own joints. The chronic inflammation can damage the cartilage, leading to pain and stiffness.
  •     Post-traumatic arthritis. If you’ve seriously injured your hip, the cartilage may become damaged in later years. Post-traumatic arthritis may be triggered by osteonecrosis. When a hip is dislocated (as was Bo Jackson’s during his Raiders’ football days) or fractured, the blood supply to the ball portion of the femur can become restricted. This can lead to the surface of the bone collapsing. Arthritis is sure to follow.
  •     Childhood hip disease. Some children have hip problems where the hips may not grow and develop properly. Even if successfully addressed in youth, this condition will often result in arthritis later in life.

If you have the chronic hip pain described above, there’s no reason to lose sleep and quality of life because of it. Dr. Moore is a board-certified orthopaedic surgeon whose extensive training, experience, and expertise can help you get past the pain with total hip replacement. Call us at (910) 295-0224 to schedule a consultation with Dr. Moore.

When Arthritis Hits Your Kneecap

When you think of arthritis in the knee, you likely think of the cartilage between the bones and ends of the femur and the tibia. But patellofemoral arthritis affects the kneecap, actually the cartilage directly behind it. 

Dr. Moore performs different surgical procedures, if necessary, to address a patient’s patellofemoral arthritis. 

What is involved with patellofemoral arthritis? 

Really, any arthritis involving wear and tear can be lumped under the term “osteoarthritis.” This is the “wear and tear” form of arthritis that affects just about everyone at some point in their life. 

With the kneecap, patellofemoral arthritis affects the cartilage. This cartilage is normally somewhat slippery, enabling the knee to move freely. But when it begins to wear away, the cushioning between bones diminishes. Eventually this will lead to pain. 

Who is at higher risk for developing patellofemoral arthritis? 

  •     Age — This arthritis, as with all areas affected by wear and tear, occurs mainly in people over the age of 40.
  •     Sex — Patellofemoral arthritis is more common in women than men.
  •     Prior injury — Injuries such as a fractured kneecap increase the odds.
  •     Obesity — The increased pressure placed on the knees eventually takes a toll.
  •     Repetitive movement — If a person sustains the same movement for long periods of time, this can lead to patellofemoral arthritis.
  •     Health conditions — Other health conditions, such as gout, rheumatoid arthritis, dysplasia, and Paget’s disease are at higher risk.

What are the symptoms of patellofemoral arthritis? 

Pain is the primary symptom. This pain will usually occur at the front of the kneecap when the person is doing something like climbing stairs. The knee may also crackle when in motion. 

When surgery is necessary? 

Once the damage has been done, there is no way to heal the kneecap and reverse patellofemoral arthritis. Non-surgical treatments, such as wearing a knee brace, having corticosteroid injections, and medications, can reduce the pain during activities. But surgery is often eventually necessary. 

Dr. Moore would have three surgical options in these cases: 

  •     Arthroscopy — This minimally invasive surgery only involves a small incision to gain access. The cartilage is then trimmed and smoothed.
  •     Kneecap alignment — This minor surgical procedure tightens or releases soft tissues around the knee to modify the actual position of the kneecap to reduce pressure and improve comfort.
  •     Knee replacement — In some cases, only the patellofemoral aspect of the knee joint needs to be replaced. However, it’s more likely a total knee replacement is the better option for more severe deterioration.

Do you have chronic knee pain? Call Dr. Moore at Pinehurst Surgical, (910) 295-0224, to schedule an appointment to have him check it out.

Helping You Manage Your Osteoarthritis

Arthritis is a broad term that covers a group of over 100 diseases. The basic definition of arthritis is inflammation of the joints. At Pinehurst Surgical, we deal primarily with a particular type of arthritis, known colloquially as “wear and tear arthritis” — osteoarthritis. This type of arthritis usually affects patients in their older years and can be a result of repetitive use, such as from certain sports, or just from the day in and day out use over the years. Osteoarthritis is the most common form of arthritis. 

What is osteoarthritis? 

Osteoarthritis involves the breakdown of cartilage in the joints. While it can occur in most of the body’s joints, it is most common in the weight-bearing joints: the hips, knees, and spine. Osteoarthritis doesn’t usually affect other joints unless there was a traumatic injury, excessive stress on the joint, or a problem with the cartilage in the joint. Osteoarthritis tends to get worse as wear and tear continues with additional passing years. 

What are the symptoms of osteoarthritis? 

Symptoms develop slowly with time. These are the common symptoms: 

  •     Pain after activity involving the joint
  •     Stiffness following periods of inactivity
  •     Joint swelling
  •     Tenderness
  •     Loss of flexibility
  •     Grating sensation or clicking sound when joint is used

Diagnosing osteoarthritis 

In addition to a thorough physical exam and referencing of the patient’s family history, Dr. Moore will often include these diagnostic tests: 

  •     X-rays
  •     MRIs
  •     Blood tests
  •     Analysis of joint fluids

Treating osteoarthritis 

In these situations, Dr. Moore will try a variety of treatment methods before we even consider any replacement surgery on the knees or hips. The goal of these treatments is to relieve pain, increase mobility, and restore quality of life. Short of surgery, these are the treatments we use: 

  •     Weight loss for obese patients
  •     Exercise to strengthen the muscles surrounding the joints
  •     Medications (anti-inflammatory drugs)
  •     Creams or gels with ingredients such as capsaicin
  •     Joint injections such as cortisone
  •     Assistive devices such as orthotics, canes, or braces

Cortisone is a steroid that when injected directly into the joint can provide effective anti-inflammatory relief, which leads to pain relief. Cortisone’s effects can last from a few weeks up to a few months. 

If the above treatments don’t seem to provide relief, the next step is joint replacement. Dr. Moore is an expert with total knee and hip replacements. 

If you’re suffering with any of the symptoms of osteoarthritis, call the team at Pinehurst Surgical, (910) 295-0224, and let’s get you back to moving without pain.

What expectations can I have with total knee replacement?

Last month we talked about how the prevalence of joint replacement is increasing in the U.S. population. Last year in the U.S. alone, over 700,000 people received new artificial knees.

But when patients meet with Dr. Moore talking about their chronic pain and what they hope to gain with knee replacement, they often don’t know what they can expect from the procedure. What will they be able to do moving forward, for instance?

Let’s get into that in April.

Expectations for your surgery and your new knee

As a patient moves forward toward having knee replacement, Dr. Moore wants his patients to have realistic expectations for these replacements. The human knee is a miracle machine of both function and durability. While today’s artificial replacements are excellent, they still have some limitations.

Over 90 percent of people who have total knee replacement report a dramatic decrease in pain and a significant increase in the ability to perform common activities such as walking. But your artificial knee won’t make your knee superhuman.

With normal use and activity, every knee replacement implant begins to wear in the plastic spacer. Not respecting your new knee speeds up this wear. Placing too much impact or gaining lots of weight can cause the knee replacement to loosen and become painful. That’s why the high-impact sports and activities need to be replaced by low-impact or no impact exercises and activities.

But when patients follow their rehabilitation guidelines and do the necessary work on their part the vast majority of our Pinehurst Surgical Orthopaedic knee replacement patients are quite happy with their new knee.

What kinds of activities can I do after I have a knee replacement?

Our knee replacement patients from across the Carolinas are excited by the feeling of freedom after having this surgery. That’s because their knee pain was causing them to have to miss out on more and more activities such as hiking or even walking around the block.

You’ll be walking at just 1 to 3 weeks, but you’ll use a walker. From there you’ll move to crutches, and then a cane. In 4-8 weeks, you should be walking without support.

Many Carolinians equate “activities” with sports. Here are some dos and don’ts moving forward. Again, Dr. Moore stresses these guidelines toward the goal of the longest duration for your new knee.

  • Swimming, cycling, and golf can resume after the surgical wound is healed.
  • Jogging, basketball, and volleyball are likely out, as they put pressure on your new knee and will cause it to wear out more quickly.
  • Tennis should probably change to doubles only, and at a relaxed pace. Or consider switching to pickleball.
  • Downhill skiing, skating, and sports where there is a risk of falling can be resumed, but the patient should have been proficient prior to their surgery, and you need to understand the risks.

Do you have chronic knee pain that’s impeding your life? Call Dr. Moore at Pinehurst Surgical Orthopaedic & Joint Replacement, (910) 295-0224, to schedule a consultation.

Joint Replacement Becomes More Mainstream

One consequence of a population whose average lifespan has increased 10 to 15 years over the past quarter century is the question if the machinery, particularly the joints, can take the extra decade or two of work. That explains the continuing increase in joint replacement as the U.S. population ages; our joints need a little help keeping up.

At Pinehurst Surgical, Dr. Moore is a board-certified orthopedic surgeon, so you couldn’t be in any better hands for your total hip and total knee replacement surgeries. Of course, replacement surgery is always the last treatment option, but it is a treatment that is becoming more and more common.

Here’s some information on joint replacement trends.

More frequent

Joint replacement has become a common surgery and it comes with low complication rates. In most cases, pain relief and functional improvement are nothing short of night and day. More and more of these surgeries are being performed as outpatient procedures, such as Dr. Moore performs at our Surgery Center. Twenty years ago, many of today’s surgery options didn’t even exist, and if they did recovery was measured in weeks, not days.

Last year in the U.S. roughly 700,000 knee replacement procedures were performed. Add to that another 400,000 total hip replacements. That combination is projected to swell to 3.5 million annual procedures by 2030 as the population ages.

The trend is to move these surgeries and their initial recovery out of the hospital setting and to outpatient centers, such as The Surgery Center of Pinehurst. Pain management protocols must be followed, but almost all patients would rather be in their own bed rather than the hospital. Home health (following our instructions for movement and the like) and physical therapy are both crucial to facilitate successful outcomes.

Joint procedures performed

At Pinehurst Surgical, Dr. Moore specializes in total knee and total hip replacement. They are the two most popular joint replacement procedures. These are the other common joint replacements:

  • Total shoulder replacement
  • Reverse total shoulder replacement
  • Total elbow replacement

If you have continuing joint pain, call us at Pinehurst Surgical Orthopaedic & Joint Replacement Center, (910) 295-0224.

How Osteoarthritis and Rheumatoid Arthritis Affects the Joints

Arthritis is simply the clinical term for joint inflammation. Various types of arthritis are common, and they lead to pain and stiffness in the joints. Two of the most common forms of arthritis are osteoarthritis and rheumatoid arthritis, yet they affect the joints in different ways.

Since we’re all about your joints here at Pinehurst Surgical, let’s spend this blog noting how these forms of arthritis affect your joints.

A joint

A joint is simply the place where two bones meet. The muscles surrounding a joint move the bones. Muscles are joined to the bones with tendons. At the ends of the bones are layers of cartilage that provide cushion and shock absorption between the bones and prevents them from rubbing against each other. The joint is surrounded by a membrane, called the synovium, which produces a thick fluid that lubricates the joint. The synovium is enclosed by the capsule, which holds the joint together with fibrous bands called ligaments.

Osteoarthritis and your joints

Osteoarthritis affects the entire joint, all of the above pieces. This “wear and tear” arthritis breaks down the cartilage, making it flaky and rough. Pieces may come loose and float about in the synovial fluid. This deterioration in the cartilage leaves the bones unprotected.

As the cartilage thins, the bones around it thicken and may develop bone spurs on the ends. Microfractures may occur in the ends of the bones. The joint capsule and ligaments stretch and may thicken in an attempt to stabilize the changing joint. This can cause inflammation throughout the joint to all the soft tissues.

Osteoarthritis commonly affects these joints: knees, hips, neck, lower back, and the hands.

Rheumatoid arthritis and your joints

Whereas osteoarthritis is due to age and wear and tear, rheumatoid arthritis is an autoimmune disease, where your immune system attacks the tissues in the joints, causing inflammation. Rheumatoid arthritis particularly affects the synovial membrane. This creates an overproduction of synovial fluid, which causes the joints to swell and the capsule to stretch. This causes pain and affects mobility in the joint.

This inflammation causes damage to the cartilage and even the bone ends. The inflammation, if left unaddressed, can result in destruction of the joint. Adjoining tendons can also become inflamed and wear down.

Rheumatoid arthritis commonly affects these joints: wrists, hands, fingers, ankles, toes, shoulders, and the knees.

If you have joint pain, you may have one of these forms of arthritis. This isn’t something to “soldier” through. Call Dr. Moore and our team at Pinehurst Surgical, (910) 295-0224, to make your appointment.

Problems with Your Hips

Because the hips feature large bones, many people don’t think of them when it comes to orthopedics. The knees, shoulders, and even the ankles can seem more destined for overuse and damage.

Ah, but your hips will let you know when they’re not happy. At Pinehurst Surgical, Dr. Moore diagnoses the root causes of our patients’ hip pain, and he employs different options for treatment.

What makes up the hips?

The hip is a ball-and-socket joint that joins the ball of the thigh bone (femur) to the socket of your pelvis. Inside the hip joint is a cartilage lining that cushions impacts between the femur and the hip socket. But those impacts can be pretty intense in the hips, and they can be very repetitive. That’s why dancers, gymnasts, and other athletes that participate in sports with impact often have damage to their hip cartilage, not to mention strains, bursitis, and the effects of osteoarthritis.

Common hip conditions

These are some common hip problems that we treat at Pinehurst Surgical:

  • Bursitis of the hip — Bursitis is the painful swelling of the bursae, the fluid-filled sacs that cushion areas where tendons and muscles slide across bone. When a patient has hip bursitis, the bursa at the top of the femur is affected. Because it is involved in so many movements, when this bursa is inflamed it can be very painful.
  • Arthritis in the hip — Osteoarthritis in the hip is gradual loss of cartilage due to daily wear and tear. As the cartilage wears down, or tears, it leads to chronic inflammation that can make it difficult to sleep, let alone perform certain normal activities. Usually, arthritis in the hip is in the form of osteoarthritis, but it can also develop after a traumatic injury.
  • Osteoporosis in the hip — When a person develops osteoporosis, their bone density drops. This leads to the bones weakening and breaking much more easily than is normal. A precursor of osteoporosis is known as osteopenia.
  • Avascular necrosis of the hip — If you’re old enough to know about Bo Jackson (if not, watch the ESPN 30-for-30 show or check out highlights on YouTube), this is the injury that sent him into retirement. A seemingly simple tackle led to dislocation of his hip. This led to avascular necrosis, where the bone tissue begins to die because it isn’t receiving enough blood. This eventually led Mr. Jackson to full hip replacement.

Having pain in your hips? Maybe it’s time to see Dr. Moore and our team at Pinehurst Surgical Orthopaedic & Joint Replacement Center. Give us a call at (910) 295-0224 to schedule an appointment.

How Corticosteroids Help with Inflammation and Pain

At Pinehurst Surgical, Dr. Moore sees patients with joint pain every day. While his expertise and training as a board-certified orthopaedic surgeon make a difference for his patients when they need knee or hip replacement, surgery is typically only pursued after conservative treatments have been exhausted. One of these treatments is the injection of corticosteroids. Often this is the next step when the patient has not responded to other treatments such as physical therapy or oral anti-inflammatory medications.

Here’s some more information about corticosteroids.

What are corticosteroids?

Although often confused with the steroids we hear about from professional athletes or bodybuilders, corticosteroids are different. The steroids for bulking up are anabolic steroids, not corticosteroids. Corticosteroids are synthetic drugs that closely resemble cortisol, a hormone produced by the body. Triamcinolone, cortisone, prednisone, and methylprednisolone are all examples of corticosteroids.

What do corticosteroids do?

For our patients at Pinehurst Surgical, we typically use corticosteroid injections to reduce inflammation. They can also be used to reduce the activity of the immune system, which can cause inflammation as the body is working against its own tissues, such as in rheumatoid arthritis.

Dr. Moore uses corticosteroids to provide relief from pain and stiffness. For instance, we inject them directly into joints and into inflamed bursa. We also inject them around tendons that have been strained due to repetitive movements, such as in patients with tennis elbow.

Why are corticosteroids injected?

Taking steroids orally can produce numerous side effects — everything from high blood pressure to insomnia to muscle weakness. Plus, corticosteroids taken by mouth or through an IV aren’t assured of reaching the problem area. Injections, on the other hand, guarantee the inflamed joint or area is directly targeted.

How are these injections used in treatment?

For our patients who are otherwise healthy, but maybe have joint pain from early osteoarthritis, we may use only corticosteroids for treatment. This may be sufficient to calm the inflammation and end the pain.

In other patients with more involved conditions, we may use corticosteroid injections as part of an overall treatment regimen that includes physical therapy, possible occupational therapy, supportive devices such as braces, and possible other anti-inflammatory pain medications. This, obviously, depends on the unique situation of the patient.

If you have joint pain, call us at Pinehurst Surgical Orthopaedic & Joint Replacement Center, (910) 295-0224, and let’s see how we can help.

Protect Your Joints through the Holidays

The holiday season is fast approaching and while it will look different this year depending on where you are and how serious the pandemic is, there are steps you can take to make sure that your holiday habits don’t impact your joint health.

Holiday Eating

We all indulge a bit over the holidays, and that’s not a problem, as long as you strive for balance. If you just have to have the gravy, be sure to add in an extra walk that week. If you choose to splurge on Grandma’s homemade pumpkin pie (and you should), try to have a smaller slice or increase your strength training. And instead of a nap after your turkey dinner, enlist your family in a game of basketball or touch football and get moving. The biggest risk to your joint health is sodium intake, because that causes you to retain water, puts extra pressure on your joints, and can increase the amount of pain you are experiencing.

Keep Moving

Our routines tend to get disrupted over the holidays, but if there is any way to maintain your exercise routine – even if you’re doing different activities – it can be good for your joints. Alternatively, if you’re supposed to be staying off your feet as part of your therapy, don’t let holidays be the excuse you use to not take care of yourself. All it may take is one more wrong twist and knee replacement surgery will be how you greet the New Year.

Keep Arthritis Pain at Bay

Being mindful about what you eat, striving for balance, and getting some exercise can all be good for managing your arthritis pain, too. In addition, be sure to stay hydrated and don’t go overboard on the alcohol. You can enjoy the holidays and have a little fun without overdoing it to such an extent that you suffer more.

If your arthritis or joint pain is no longer responding to traditional therapies, you should make an appointment to see Dr. Moore. For More information about, contact our Pinehurst, NC office, call us at (910) 295-0224, or check out our orthopaedic surgery blog.

Alternatives to Knee Replacement Surgery

Whether you’re trying to put off your knee replacement surgery until you meet your deductible, or you simply can’t take the time off, are there alternatives to knee replacement surgery? While the damage to your knee may something you can live with for some time, eventually, knee replacement surgery will become necessary to prevent you from losing too much mobility in your leg. Until then, we can help you manage the pain and discomfort until you are ready for surgery.

Preventing Aggravation to Your Knee

One of the best ways to minimize your knee pain is to stay off your knee as much as possible. You’ll need to avoid the activities that stress your knee the most, whether it’s racquetball or biking. You can replace your activity with something more congenial to your knee joints, like swimming, because it is still going to be important that you exercise and maintain your health.

Managing Pain

We can help you manage your pain in a variety of ways. Icing and heating the knee can help reduce swelling and stiffness. NSAIDs like ibuprofen can also help to keep your pain and swelling to a minimum to reduce the level of discomfort you experience. If those therapies don’t work, we can give you a steroid injection. You may also benefit from visco-supplementation (a series of injections to the knee joint). Between treating the pain and preventing aggravation to your knee that further exacerbates the old damage, we can extend the time you have left before you are forced to have knee replacement surgery.

When Is It Time for Knee Replacement Surgery?

For many of our patients, the final determinant of when to have knee replacement surgery is a decision based on how much pain you are in and how much you can tolerate. It also depends on your mobility. When your quality of life is more impacted by not having surgery, it’s time to have the surgery.

For More information about Knee Replacement Surgery with Dr. Moore, contact our Pinehurst, NC office, call us at (910) 295-0224, or check out our orthopaedic surgery blog.