Full length of fitness man running over rocky trail on mountain.

Surgical Options for Runner’s Knee – Patellofemoral Pain Syndrome

If you’re suffering from pain around the front of the knee, patellofemoral syndrome may be the cause. Also commonly known as Runner’s Knee, this pain gradually increases over time and exertion. Teenagers and athletes are prone to patellofemoral pain syndrome in the anterior knee. This arthritic condition results from the wear and tear of fibrous cartilage tissue between kneecap bones being worn away, deteriorated, and inflamed.

Causes of Runner’s Knee

This condition results from repeated abrasion on the surfaces of the patella leading to cartilage damage. Pain and inflammation result from damage to the underside of the patella.

The major causes of this condition:

  • Overuse is repetitive bending and straightening of the knee
  • Misalignment occurs when the patella doesn’t track correctly as the knee is bent and straightened

Symptoms of Runner’s Knee

There are many symptoms of patellofemoral pain syndrome.

Primary symptoms include knee pain when:

  • Sitting with bent knees
  • Jumping
  • Squatting
  • Walking up and downstairs

Accurate Diagnosis of Patellofemoral Pain Syndrome

Before surgery can be successful to correct Runner’s Knee, an accurate diagnosis must be made.

Three important elements make up a correct diagnosis:

  • History of pain plus recent activity, duration, and intensity
  • Physical examination including reproducing knee pain and evaluating patella motion, tenderness, alignment, and muscle strength
  • Imaging through X-ray, MRI, or CT scan to examine damage to tissues surrounding the knee and its overall stability

Surgery Options for Runner’s Knee

After conservative, non-surgical treatment has failed to remedy Runner’s Knee pain, surgery with the goal of relieving chronic pain can be performed arthroscopically. This procedure uses instruments inserted through tiny incisions in the kneecap. These instruments remove damaged kneecap cartilage fragments by trimming and smoothing joint surfaces that have become rough and degraded. The kneecap – patella – is then realigned and secured.

Other Patellofemoral Pain Syndrome surgery options:

  • Kneecap alignment. This minor surgical procedure tightens or releases soft tissue around the knee. The position of the kneecap is adjusted to reduce pressure and relieve pain.
  • Knee replacement. Either the damaged cartilage under the kneecap is replaced – or – the entire kneecap is replaced due to severe joint deterioration.

Don’t Delay Treatment for Runner’s Knee

For best surgical results, reach out to Dr. John R. Moore at Pinehurst Surgical in North Carolina by calling 910-295-0224.

Young man suffering from knee pain at home

Surgically Treatment of Post-Traumatic Arthritis

A traumatic injury to a joint – such as a car accident or fall – has a very high risk of becoming arthritic in your later years. High-impact sporting activities – for example, running, tennis, gymnastics, skiing, rugby – also have a high likelihood of leading to osteoarthritis in your lifetime. This condition is known as post-traumatic arthritis and can be treated with surgery when other non-invasive remedies fail. John R. Moore, IV MD, has been practicing as an orthopedic surgeon since 2001 in Pinehurst, NC, and has the experience to determine if you can benefit from joint surgery.

Post-Traumatic Arthritis Signs and Symptoms

Any substantial injury to your joints can cause post-traumatic arthritis. This condition causes pain and stiffness to the affected joints after an injury or long-term, high-impact sporting activity.

Most common joints affected by post-traumatic arthritis:

  • Elbows
  • Hips
  • Knees
  • Ankles

Any arthritic condition resulting from a post-traumatic injury will adversely affect your ability to comfortably sit, walk, run, play sports, or take part in physical activities you have done in the past.

The debilitating symptoms of post-traumatic arthritis include:

  • Tenderness to touch
  • Stiffness in movement
  • Uncomfortable swelling
  • Chronic pain

Post-Traumatic Arthritis Surgery

There may come a time when you reach an intolerance for your chronic pain and decreased mobility in the affected joint to merit replacement surgery. After opting for and recovering from replacement surgery, you may wonder why you waited for such a long time to finally act. This is because one’s quality of life is greatly enhanced.

If post-traumatic arthritis is limiting your quality of life, surgery may be an option to reclaim function in the affected joint.

Methods of surgery include:

  • This is the removal or cleaning up of damaged tissue or your bones are reshaped to alleviate arthritic symptoms.
  • Joint Fusion. Known as arthrodesis, joint fusion is the insertion of a plate secured by screws to hold the affected joint together, lessening symptoms of arthritis.
  • Joint Replacement. Known as arthroplasty, this is the replacement of your damaged joint with an artificial one made of plastic, ceramic, or metal.

Discover Surgery Options For Post-Traumatic Arthritis

Be proactive and reach out to Dr. John Moore at Pinehurst Surgical in North Carolina to see if you are a candidate for post-traumatic arthritis surgery. Call 910-295-0224 to begin your search for surgical help with your affected joint.

Man waking up in the morning and suffer for back pain


Have you ever heard these old school names for a certain medical condition? Student’s Elbow. Tailor’s Bottom. Housemaid’s Knee. Probably not.

But you’ve heard of bursitis. The definition of bursitis is inflammation of the bursa. That sounds innocuous enough, but bursitis can be quite painful. Dr. Moore often treats bursitis in the hips and knees with corticosteroid injections to calm the inflammation.

What Is a Bursa?

The human body has over 140 bursae. These are small, thin, slippery sacs filled with fluid. The bursae are located near our joints. Their job is to reduce friction between our bones and the surrounding soft tissues (muscles, tendons, ligaments, even skin).

Each bursa is a sac with an outer membrane called the synovial membrane. Inside the sac is synovial fluid, which is a lubricating fluid.

Bursae are usually categorized by the tissue they are next to. If the bursa is between the skin and a bone, it’s the subcutaneous bursa. A subtendinous bursa would be found between a bone and a tendon.


Bursitis is inflammation of the bursae. When this happens from overuse or other causes, the bursa’s lining thickens, and more synovial fluid may be produced. Now the bursa will swell. It can become several times its normal size.

Causes of Inflammation

You can usually point to one of three causes for this inflammation: irritation, friction, or trauma to the bursa.

  • Irritation — Putting pressure on a bursa repeatedly can lead to bursitis. If you’re a desk jockey and you lean on your elbows all day at work, you can develop elbow bursitis.
  • Friction — Repetitive motions, such as bending your knee when running or walking, can lead to excess friction and this causes inflammation.
  • Trauma — With trauma, a bursa may temporarily fill with blood. This creates swelling and irritation of the synovial lining.


Except in cases of trauma, bursitis usually develops gradually. These are the symptoms:

  • Swelling — This happens when the inflamed bursa fills with fluid.
  • Pain — Pain occurs in the bursa and nearby soft tissues.
  • Tenderness — Pressing on the skin above the inflamed bursa is painful.
  • Stiffness — The inflammation can impact movement in a joint.
  • Skin redness and warmth — This can be a sign of bursa inflammation.

If you’re having signs of bursitis in one of your joints, Dr. Moore can help. Give us a call at Pinehurst Surgical, (910) 295-0224, to schedule an appointment.

New Joint and Home the Next Day

It’s funny how quickly people take for granted amazing changes in our lives. Consider technology. You’ve probably been on an airplane and heard someone complaining about the wi-fi connection or speed.

Uh, you’re in a metal tube 30,000 feet in the sky. Your phone is accessing a satellite in nearby orbit, all so you can check your work email. It’s nothing short of mind boggling, but people are so accustomed to it they forget the wonder of it all.

Technology and surgical techniques in the orthopedic world have also come a long way, and joint replacement is evidence of that. Dr. Moore has moved the bar forward at Pinehurst Surgical by providing outpatient joint replacement.

Let’s get into this amazing option for joint replacement.

How is outpatient joint replacement a better option?

Outpatient joint replacement surgery is becoming the first choice for many qualified patients. Studies have shown outpatient surgery to have numerous benefits for patients when compared with traditional joint replacement. These include:

  • Faster recovery
  • Improved outcomes
  • Decrease in infection rates
  • Increased patient satisfaction scores
  • Lower complication rates

Where are outpatient joint replacements performed?

Outpatient is a bit of a misnomer in that the patient isn’t returning home the same day of their surgery. Dr. Moore performs our outpatient joint replacements in The Surgery Center of Pinehurst, located across the street from our practice. It provides much easier access for both patients and families than the typical hospital center.

How is The Surgery Center of Pinehurst better than a hospital setting?

The outpatient joint replacement procedure is the same as in the hospital setting. The key difference is in the concierge experience at The Surgery Center of Pinehurst. Patients of Dr. Moore will stay one night at our outpatient surgical center. While there, two highly qualified and dedicated nurses (2:1 nursing ratio) will be by your side for any needs or concerns.

If you’re interested in joint replacement, there’s no better place than Pinehurst Surgical Orthopaedic & Joint Replacement Center and Dr. Moore. Please call us at (910) 295-0224 to schedule a consultation.

young man sleeping on bed

Sleep Problems after Knee or Hip Replacement

One of the common problems we hear from our Pinehurst Surgical patients after their knee or hip replacement is sleep. They’ve been through the stress of the surgery, but now find a good night’s sleep to be as out of reach as running a 100-meter sprint.

This is an unfortunate common phenomenon after knee and hip replacement. It’s unfortunate not only because everyone hates tossing and turning throughout the night, but that your body needs the sleep time to do its magical nighttime repair work on the tissues around your new knee or hip.

Here’s some more on insomnia after replacement surgery.

You need the sleep

We all need a good night’s sleep; there’s plenty of research out there on the benefits. This is even more true when you’re recovering after knee or hip replacement with Dr. Moore. Here’s why you really need sleep at this time:

  • Sleep helps you physically heal — When we sleep our body can focus on healing, as it doesn’t have anything else to do. It’s an opportunity for our systems to decrease inflammation, clear bruising, decrease swelling, and rebuild affected tissues. When we’re sleeping, our brain triggers the release of hormones that encourage tissue growth.
  • Sleep helps reduce stress and anxiety — Recovery from replacement surgery isn’t a walk in the park. We can feel stressed and anxious about our long-term results. Sleep helps us combat mental fatigue, reduces blood pressure, and helps to mental recharge which is important for setbacks that can occur during recovery.
  • Sleep gives you the energy for rehabilitation — You need energy to work through the physical therapy ahead of you. You want to be able to push as much as necessary to aid your recovery, and you need restful sleep to do so.
  • Sleep boosts overall health — Sleeping 7-8 hours a night is linked to better overall health in all sorts of areas, everything from lower obesity rates to lower blood sugar levels.

Three reasons you’re not sleeping

There are different reasons you may not be sleeping during your initial recovery from knee replacement. These are the three most common:

  • Pain and discomfort — The pain will last for several weeks. After you hit the 2–3-week mark in recovery, your narcotic pain medication is cut back or eliminated. And you’ve increased your activity level to meet the demands of your rehabilitation. This can make pain spike during bedtime.
  • Narcotic pain medication — Pain killers combat pain, of course, but the medication itself can also cause insomnia. Some prescribed pain meds affect your natural REM cycle and disrupt sleep patterns.
  • Depression and anxiety — It’s not uncommon for someone who’s had joint replacement to have some feelings of depression. You can fret about your ongoing recovery time. You can be anxious about your future ability to return to various activities. You can feel isolated because you can’t participate in some of the things you formerly did while you’re recovering.

So, now you know that sleep problems are a common side effect after having knee or hip replacement. The good news? At about the six-week mark you should be experiencing much less pain, be off pain medications, and likely able to sleep in more comfortable positions. That should get you back to your normal sleep patterns.

Do you have chronic hip or knee pain? Give Dr. Moore a call at Pinehurst Surgical, (910) 295-0224, to set up a consultation.

a man touching his knee at pain point

Common Reasons Your Knee Hurts All the Time

Everyone can have occasional knee pain. Maybe you slipped on some wet leaves this past fall and tweaked your knee. Maybe you were playing an awkward lie over at Pinehurst #2 and after you nearly shanked your shot, your knee told you it wasn’t a fan.

Those instances of knee pain are fleeting, maybe lasting a day or two.

Chronic knee pain is a different story. Estimates place from 15-20 percent of men and about 20 percent of women suffering from chronic knee pain. Chronic knee pain trails only chronic back pain in its prevalence in the U.S. population.

If your knee pain begins to preclude you from doing the things you want to do in your life, it’s time to consider treatment. Down that line, the final option is knee replacement with Dr. Moore at Pinehurst Surgical.

In this first blog of a New Year, let’s get into some of the conditions behind that aching knee of yours.

What are some causes of chronic knee pain?

Unlike temporary knee pain that improves, chronic knee pain rarely goes away without treatment. It can’t always be pinned on one cause or incident, but can result from several of these causes or conditions:

  • Osteoarthritis — This “wear and tear” arthritis typically occurs in patients 50 and over. As the cartilage begins to wear away, the cushioning in the joint decreases and pain follows.
  • Tendinitis — Pain in the front of the knee that is made worse when taking stairs or walking up an incline.
  • Bursitis —Inflammation of the knee bursae, usually due to overuse or poor technique when doing things such as running.
  • Chondromalacia patella — This is damage to the cartilage under the kneecap.
  • Rheumatoid arthritis — Your body’s immune system mistakenly attacks your joints, causing swelling and joint degradation.
  • Post-traumatic arthritis — This is another common form of osteoarthritis caused by a previous injury to the knee or another form of trauma.
  • Dislocation — Dislocation of the kneecap. This usually leads to future arthritis.
  • Meniscus tear — A tear in the cartilage that cushions the knee. A torn meniscus does not heal.
  • Torn ligament — Four ligaments help keep the knee in its proper position. The most commonly torn of the four is the anterior cruciate ligament (ACL).

If you’re suffering from chronic knee pain strong enough it is impinging upon your life, it’s time to give Dr. Moore a call at Pinehurst Surgical. Call us at (910) 295-0224 to schedule a consultation.

man doing squats with kettlebell weights at home.

Coming Back from Hip Replacement

Hip replacement may not be as common as knee replacement, but over 300,000 people in the United States have hip replacements done every year. As the median age of the population continues to rise, those numbers will grow.

Dr. Moore is a board-certified orthopaedic surgeon who specializes in knee and hip replacement surgery, and he has performed hundreds of these surgeries.

Patients want to know what to expect, of course. This particularly applies to when they can “get back to normal activities.” Let’s get into that in this final blog of 2021.

Getting back to it

The key, and Dr. Moore stresses this during your consultation and after your surgery, is to not do too much too soon. This is usually what happens when patients have a more difficult time in recovery; they pushed too hard. Here are some guidelines if you are patient:

  • Weight bearing — Dr. Moore will tell you when you’re ready to put your full weight on the leg and hip. This can depend on the type of replacement you have had.
  • Driving — For most patients, they can return to driving when they are no longer taking opioid pain medication and when their strength and reflexes have returned to normal levels.
  • Sexual activity — It will be several weeks before you can resume sexual activity.
  • Sleeping positions — Dr. Moore will want you to avoid certain sleeping positions. He will want you to sleep on your side with a pillow between your legs to elevate your hip for a length of time.
  • Work — Your return to work depends on your job, as you would assume. This means desk jockeys could return in possibly just several days, while strenuous or physical work would need several weeks before returning.
  • Sports and exercise — For sports participants and exercise aficionados, this is the question they want to know. After your course of physical therapy and probably riding a stationary bike, Dr. Moore will clear you for various sports and activities.
    • Walk as much as you like.
    • Swimming can resume as soon as the wound is healed.
    • Low impact sports such as golf, swimming, bowling, pleasure horseback riding, stationary cycling, ballroom dancing, and low-impact aerobics will be fine moving forward.
    • High stress sports, such as hockey, jogging, mogul skiing, soccer, rock climbing, and the like are discouraged. There is too much chance that the artificial joints will wear out, break down, or loosen. These sports will likely shorten the lifespan of your new hip.
    • Mid-level sports such as tennis, moderate snow skiing, recreational cycling, backpacking, and softball are all somewhere in the middle ground. There will be more impact, but it won’t necessarily be enough to hasten the degradation of your artificial hip. If you choose to resume these sports/activities, you need to understand there is a possibility you will shorten the lifespan of your new hip.

Are you dealing with chronic hip pain? If the pain is infringing on your quality of life, it may be time to begin the process of considering hip replacement. Call Dr. Moore at Pinehurst Surgical Orthopaedic & Joint Replacement Center, (910) 295-0224, and let’s talk.

How Long Will My New Knee or Hip Last?

When patients are dealing with the chronic pain and decreasing mobility created by chronic knee or hip pain, the first treatments are always non-surgical. Physical therapy, changes in some activities, and corticosteroid injections all fit into the normal course of treatment. 

But when these don’t help and your osteoarthritis in your knee or hip is beginning to really impact your life, patients start to consider knee or hip replacement surgery with Dr. Moore at Pinehurst Surgical. 

One of the first questions we get during the initial consultation is, “So, how long will my artificial knee/hip last?” 

In this pre-Thanksgiving blog, let’s get into some rough estimates of what you can expect. 


The failure of an artificial replacement can happen early on or over time. While most people wonder about the overall longevity of their prosthesis, they need to manage risk factors to ensure they get the longest duration out of their new knee or hip. Infection is usually the cause of any early failure. Risk factors that can contribute to this are uncontrolled diabetes, obesity, and poor nutrition. 

Long-term failure is most likely to occur because the bond between the bone and the implant loosens over time, or a component of the implant wears down. This will require revision surgery to replace the original implant. Revision surgeries are more involved than the original replacement in many cases, so patients wonder how long they can expect their artificial implant to last. 

The numbers 

Technology and materials continue to improve with modern replacements. But these are still manufactured components and, as with any manufactured item, they have a lifespan. 

It’s generally thought that around 90 percent of modern total knee replacements still function well 10 to 15 years after the placement. For total hip replacement, that number is closer to 20 years. 

But those numbers may be shortchanging the duration of modern implants, as they are evolving quite quickly. The problem is that the data currently available is from implants that, in many cases, aren’t even on the market any longer. For instance, one of the newer technologies is a plastic called “highly cross-linked polyethylene.” It has been showing very low-wear properties, and it is expected that implants made with this plastic will last longer than those made with previous plastics. 

As we’ve discussed in other blogs, how you respect and manage your new knee or hip moving forward also impacts its lifespan. This is especially true of impact activities, such as playing basketball or running. 

When you meet with Dr. Moore, the two of you will discuss trends in the implants he is placing. But it’s expected that 20 years from now the longevity numbers should be even better. 

Are you tired of dealing with chronic knee or hip pain? Give Dr. Moore a call at Pinehurst Surgical, (910) 295-0224, and set up a consultation for possible knee or hip replacement.

Knee Anatomy 101

Knee replacement has become a relatively commonplace procedure — last year in the U.S. over 700,000 people had knee replacement. Those numbers are expected to continue to grow as more and more baby boomers move into their mid to upper 60s and above. Estimates place knee replacements in the U.S. at 3.5 million by 2030. 

That’s a whole lotta titanium and Teflon replacing bone and cartilage. 

Dr. Moore is a board-certified orthopaedic surgeon who has been serving our patients at Pinehurst Surgical for over two decades, and he has helped many people overcome their chronic knee pain caused by osteoarthritis through outpatient and inpatient knee replacement. 

But what do we all really know about our knees anyway? We know they allow us to make all sorts of complex movements, from running in a softball game to springing up to grab a rebound on a basketball court. But what makes up our knees? Let’s get into that in this autumnal blog for Pinehurst Surgical Orthopaedic & Joint Replacement. 

Let’s call it Knee 101. 

The largest joint in the body 

Working like a hinge, our knee is the largest joint in the human body. It’s the junction of the bones of the upper and lower legs. The knee consists of three bones: the femur (thigh bone), the tibia (shin bone), and the patella (the kneecap). 

The ends of the bones are covered with a layer of cartilage, a slick, elastic material that absorbs shock and allows the bones to glide easily against one another as they move. Between the tibia and femur bones are two crescent-shaped pads of cartilage that reduce friction and disperse the weight of the body across the joint. They are the lateral meniscus (situated at the outside of the knee) and the medial meniscus (situated on the inside of the knee). 

The bones of the knee are held together in a joint capsule, which consists of two distinct layers — an outer layer of dense connective tissue and an inner membrane, called the synovium, which secretes a fluid to lubricate the joint. 

The outer layer of the capsule is attached to the ends of the bones and is supported by these ligaments and tendons: 

  •     Quadriceps tendon, which attaches the quadriceps to the patella
  •     Medial collateral ligament (MCL), which gives stability to the inner part of the knee
  •     Lateral collateral ligament (LCL), which stabilizes the outer part of the knee
  •     Anterior cruciate ligament (ACL), which is located in the center of the knee and prevents excessive forward movement of the tibia
  •     Posterior cruciate ligament (PCL), which is located in the center of the knee and prevents excessive backward shifting of the knee

Two groups of muscles support the knee: the hamstrings on the back of the thigh, which run from the hip to just below the knee and work to bend the knee; and the quadriceps, four muscles on the front of the thigh that run from the hip to the knee and straighten the knee from a bent position. 

Now you’re a knee expert. There’ll be a pop quiz later! So how does your knee feel? If it’s causing you chronic pain, it’s time to give us a call at Pinehurst Surgical, (910) 295-0224, and let’s see how Dr. Moore and our entire team can help.

Healthcare worker at home visit.

Diagnostic Imaging

At Pinehurst Surgical, patients can tell us what’s going on with their joints. They can detail their pain, where it seems to come from, and when it occurs. And Dr. Moore can move the joint and examine the surrounding areas to get a good idea of what’s going on. 

But sometimes you just can’t beat the amazing images generated by modern diagnostic imaging. At Pinehurst Surgical, we’re especially proud to work with Alliance Imaging to offer an array of tests, from CT scans to MRIs to Nuclear Bone Scans, all in house. Beyond the obvious convenience, there’s also no need for you to have an individual disk with the imaging or additional paperwork — we load all of the images and readings directly into your patient file. 

Here’s more about our diagnostic imaging at Pinehurst Surgical. 

What is diagnostic imaging? 

Diagnostic imaging uses different technologies to allow us to see inside your body (usually into your joints in our situation) for diagnosis and treatment of disease and other health issues. Although everyone knows the original form of diagnostic imaging — the x-ray — today x-rays have been joined by CT scans, MRIs, PET scans, ultrasound, and other technologies to make a huge impact on diagnostic ability. At Pinehurst, our association with Alliance Imaging, allows us to provide CT scans, MRIs, and Nuclear Bone Scans right here in our facility on First Village Drive. 

What should I expect during my imaging session? 

Everyone has had an x-ray, either at the dentist or doctor’s office. The difference in our x-rays at Pinehurst Surgical is that we often have the patient either stand or squat. This can provide better information on joint inflammation. 

MRIs are the one test that some people have trouble with. This is because the patient must be inside the MRI system for a period of 2-5 minutes for each section being imaged. When inside, you must remain very still to not distort the images being taken. The overall MRI procedure can take from 20 minutes to an hour depending on the area being imaged. 

CT scans are like MRIs in that the patient is on a table and is moved into the imaging machine. The difference is that in a CT scan the table continues to move through the machine, rather than being enclosed inside it. 

What are the risks of diagnostic imaging tests? 

There is a slight risk of radiation exposure with x-rays, but our digital x-ray system uses far less radiation than the previous film x-ray systems. Occasional x-rays for orthopedic injuries really involve no risk with radiation exposure. The average person receives more radiation from normal activities and sun exposure in a year than if they had a number of x-rays. 

MRIs don’t use radiation. Instead, they generate three-dimensional images using a magnetic field. These have no risks. 

CT scans, short for computer tomography, use low dose x-rays combined with computer technology to produce their three-dimensional images. Again, these doses are very low, and most patients may only receive a CT scan once every few years. 

Trust Dr. Moore and our team at Pinehurst Surgical Orthopaedic & Joint Replacement Center to provide the finest in orthopedic care and orthopedic diagnostic imaging. To make an appointment, call (910) 295-0224.