Over the years, I have treated many recreational athletes and tennis pros alike at Methodist Sports Medicine / The Orthopedic Specialists. I had the great pleasure of serving as the orthopedic consultant for the Indy Tennis Championships (formerly the RCA Championships) for 13 years until it recently moved to Atlanta. The professional players sustain injuries that are primarily related to the extreme exertion they sustain over a season that now stretches over the entire year. Recreational players, on the other hand, sustain injuries that are primarily related to poor stroke mechanics, improper equipment, and suboptimal conditioning. Many common injuries can be prevented and that’s why we recently created three educational YouTube videos at the Five Seasons Family Sports Club in Indianapolis. The videos cover proper tennis mechanics, common tennis injuries and the benefits of youth tennis.

The Five Seasons tennis pros demonstrate some of the common mistakes made by recreational players that can lead to injury. They discuss the importance of footwork and balance as essential elements of putting the player into position to hit the ball properly. Additionally they emphasize the importance of the connection of the right and left sides of the body in producing smooth effortless strokes.

In the YouTube video about common tennis injuries, we explain the basic care of acute minor injuries following the R.I.C.E. (Rest, Ice, Compression and Elevation) treatment formula. Injuries which don’t resolve in a few days with the basic care may require the attention of a sports medicine physician.

Youth tennis is another important topic. I encourage parents to teach your children tennis at a young age because it’s one of the safer sports for them to play. In addition, there are long-term health benefits for children who start playing at a young age and continue playing as an adult. We discuss those positives and other benefits in the third YouTube video.

Visit our YouTube channel to watch the videos and tell us what you think in the comments section.

http://www.youtube.com/user/MethodistsSports?feature=watch

Read Dr. Sallay’s “Healthy Tennis” articles in Midwest Tennis Magazine.

http://www.methodistsports.com/physicians/peter_sallay/documents/Dr.SallayTennis_Articles.pdf

The community program will be held at the Indiana Farm Bureau Football Center (Home of the Indianapolis Colts), located at 7001 W. 56th St., Indianapolis, IN.

Dr. Hur will discuss a new hip replacement technique that may speed recovery and decrease postoperative pain for hip replacement procedures. Called the Direct Anterior or “front” approach, this new technique involves making an incision on the front of the hip rather than the side or back as traditionally done.

Reservations are requested as space is limited. Contact Teresa Steffy at 317.208.5103 or tsteffy@methodistsports.com to make a reservation.

During your medical evaluation your doctor will ask you to describe the kind of pain you are experiencing. Hearing about these details can help your doctor determine the cause of your discomfort and the kind of treatment needed. Details such as the location of the pain, the activities that exacerbate the pain or information about previous hip-related injuries is information that should be considered during your medical evaluation.

Following are some common hip pain diagnoses and their corresponding signs and symptoms.

Arthritis: With arthritis-based hip pain, it hurts to move your joints. That includes walking, climbing stairs, and bending down to pick things up. Patients may also experience a limited range of motion, stiffness in the hip and a slight limp when walking. What is interesting about hip arthritis is that symptoms do not always progress steadily with time. Often patients report good months and bad months or symptom changes with weather changes. This is important to understand because comparing the symptoms of hip arthritis on one particular day may not accurately represent the overall progression of the condition.

Snapping hip: A patient might describe this condition as a pop in the hip when they move their leg.
Most patients do not consult a physician when they experience a snapping hip because it rarely causes pain or discomfort. However, when pain does occur a patient’s physician will need to determine the cause of the snapping. To do this a physician will ask a patient to describe the location of the pain, the kind of activities that bring on the snapping, and whether the patient has experienced any trauma to the hip area. The physician also may ask the patient to try to demonstrate the snapping during their medical evaluation.

Stress fracture of the femoral neck: If a patient experiences a dull ache in the groin area that gets progressively worse and does not improve with rest, it may be a stress fracture of the femoral neck. The pain also may feel similar to a pulled muscle but unlike a muscle it will not improve without medical treatment. The two most common causes of a stress fracture to this area include falling or a repetitive stress injury as a result of vigorous exercise.

Trochanteric bursitis: When the bursa, the fluid-filled sack on the side of the hip that overlies the bony portion that you can feel, becomes irritated or inflamed it causes pain in that area. In this situation a patient may experience pain when lying on the affected side, when pressing on the outside of the hip, getting up from a deep chair or getting out of a car, or while walking upstairs.

These are some of the most common hip conditions. However, everyone experiences pain in their own unique way, so it is possible that a patient’s hip pain does not perfectly fit within one of these categories. Orthopedic hip specialists are trained to administer diagnostic tests that can identify each individual’s condition. Once the pain has been diagnosed a physician can identify the proper treatment that works best for that patient’s unique situation.

Traditional management of hip impingement has been with open surgery, although recently arthroscopic techniques are employed to treat FAI. Arthroscopic surgery allows for a less invasive approach and a more rapid recovery than the open approach. In patients with significant arthritic disease, management of impingement is unlikely to provide significant relief of symptoms as irreversible damage has occurred.

By: Shari Rudavsky

Dr. John Hur is an orthopedic surgeon with Methodist Sports Medicine.

Sometimes in medicine it takes new equipment to improve on an old technique. That’s precisely what has happened with hip-replacement surgery.

While surgeons have performed anterior surgeries — accessing the hip joint from the front — since the 1940s, the surgery never caught on widely. Instead, most surgeons preferred to reach the hip from the rear, having patients lie on their abdomens for the procedure.

A new surgical table has led to a resurgence of interest in the anterior approach. Dr. John Hur, an orthopedic surgeon with Methodist Sports Medicine, has done about 20 hip replacements using the new table.

Question: How are most hip replacements currently done?
Answer: Through a posterior approach, where you go through the back of a hip and the buttocks. So you have to cut through some muscle to get there. That adds to the recovery time because that muscle has to heal.

Q: What’s different about the direct anterior approach, in which the surgeon accesses the hip joint from the front?
A: This goes to the front of the hip, where you don’t have to cut any muscle at all. What you’re doing is going through the front of the hip where there’s less fat to dissect. All you have to do is pull the muscle aside and you’re directly into the hip.
You need a special table to make this approach easier. In a total hip replacement, you’re replacing the socket as well as the ball of the hip. The socket is quite easy to get to through this anterior approach, but exposing the top of the thigh bone can be quite difficult.
The table allows you to scissor the legs. The feet are put into ski boots that are attached to two arms that can move around freely, independent of the table. This approach was never popular before because we didn’t know how to get around working around the thigh bone without the new table.

Q: Are there other advantages to this way of doing the surgery?
A: Other approaches require patients to be on their side, which can present problems for the anesthesiologist. On the back, their airways are available.
The other advantage with the patients being on their backs is that you can now bring in an X-ray machine to check how well the implants are placed. One of the risks of hip replacement is that they can dislocate if the implants are not placed correctly. The other way, you get an X-ray in the recovery room when it’s too late.

Q: Will this be the wave of the future for you?
A: Right now we’re doing them on select patients. I think it’s going to become more popular. I don’t think in the next five years it will be the predominant technique yet because it takes buying a special table.

(Anterior-approach) patients don’t have to be so careful after the first six weeks of surgery. Traditionally, we will say you can’t bend over or cross your legs for the first six weeks after surgery. I see this as a good way for younger, active people to recover faster. We’re making a great surgery even better.

Q: What exactly is the Direct Anterior Approach for total hip replacement?
A: The direct anterior approach is a minimally invasive surgical technique that allows a surgeon to access a patient’s hip joint through the front (anterior) of the hip as opposed the side (lateral) or back (posterior).

Q: How is the Direct Anterior Approach different from traditional hip replacement procedures?
A: Traditional hip replacement procedures take either a side or back surgical approach, which can disturb important stabilizing muscles about the hip. The surgical incision is also typically larger with traditional hip replacement procedures though all approaches can be done through a lesser incision length. With all of these factors combined, typically patients that undergo a traditional hip replacement procedure can endure a longer recovery period. Remember though, its not the size of the incision that matters, its what is done on the inside, that counts.

Q: Is it possible to have two hip replacements performed during one surgery, using the Direct Anterior Approach?
A: I typically do not recommend performing two hip replacements at one time. Doing so increases the risk of complications. Generally, if a patient requires having both hips replaced, I will perform the procedure on one hip and then allow for six weeks recovery. Once suitable recovery has been achieved on the first hip, I will perform the procedure on the second hip.

Q: When preparing for hip replacement surgery, is it beneficial to engage in a fitness or weight-lifting program to strengthen muscles in and around the hip area?
A: If done under physician supervision, engaging in a muscle building or strengthening program will assist in a patient’s overall recovery.

Q: Typically, when can a patient return to work after having Direct Anterior Approach hip replacement surgery?
A: A patient’s lifestyle plays a significant role in determining when they can return to work after surgery. If a patient has a job that requires significant manual labor, they could be out of work for up to 12-weeks. Someone with a less physical job may be able to return to work at two to three weeks at the earliest.

Q: Will patients need assistance with everyday tasks immediately after surgery?
A: Tasks that require a patient to bend or lift an object will require some assistance a few days after surgery. I recommend that patients have family or friends stay with them for a few days to help assist them with everyday activities such as cooking and other house chores.

Q: Are Glucosamine supplements effective in slowing the breakdown of cartilage, which ultimately could deter the need for a hip replacement?
A: Glucosamine, which is produced naturally in the body, plays a key role in building cartilage. People have begun to research the use of Glucosamine supplements as a treatment method for osteoarthritis, a condition that overtime causes an individual’s cartilage to breakdown. Unfortunately, recent studies have not shown conclusively that glucosamine helps repair or grow new cartilage, or stops cartilage from being further damaged. Therefore, it’s hard to say if Glucosamine supplements could ultimately deter the need for a hip replacement.

Recently I began using a new method to perform hip replacement surgery, known as the Direct Anterior Approach.

This new approach allows me to reach the hip joint from the front of the hip as opposed to the lateral (side) or the posterior (back) approach. This way, the hip can be replaced without detachment of muscle from the pelvis or femur during surgery. The greatest benefit to this approach is that the most important muscles for hip function, the gluteal muscles that attach to the pelvis and femur, are left undisturbed and, therefore, do not require a healing process to recover from surgical trauma. This decreases the amount of pain a patient experiences and also reduces complications, such as problems with hip dislocation. With less pain and improved function, most patients are able to return to normal activities sooner, if not immediately.

In comparison, conventional hip replacement surgery approaches require splitting and/or detachment of muscles that control motion of the hip and help prevent dislocation. Trauma to these muscles causes pain and swelling that takes time to heal in order to recover function. Typically, this requires six to 10 weeks of rehabilitation and restrictions of not flexing the hip beyond 90 degrees, which affects basic activities like sitting, crossing the legs, putting on shoes and driving an automobile. It is also common for patients that undergo conventional hip replacement surgery to experience dislocation of the hip due to the weakening of the muscles that are detached during surgery.

The Direct Anterior Approach to hip replacement has been around for some time. In fact, it was first performed in Europe in 1947. Since that time, the technique has been continually refined with advancing medical technology. The most significant advancement that was made was with the creation of a special, state-of-the-art surgical table that allows surgeons to perform the procedure with ease. Today, literally thousands of hip replacement patients have benefited from this minimally invasive approach in Europe and America.

Unfortunately, not all patients are a candidate for this type hip replacement surgery. It is particularly difficult to perform on patients that are overweight or who have distorted anatomy. Patients should ask their orthopedic surgeon if they are familiar with the Direct Anterior Approach and if they are an ideal candidate for that type of hip replacement surgery. Only an orthopedic hip replacement specialist can make a proper assessment.

From baseball to soccer to football, everyday millions of children and young adults participate in sports activities. These activities teach children team work and improve their physical fitness, coordination and self-discipline. It also increases their chance of experiencing sports-related injuries such as concussions, sprains, fractures, muscle tears, and back and neck injuries. However, there are measures that can be taken to help prevent these types of injuries, such as:
• Undergoing medical exams prior to the sport’s season, which should include concussion screenings and physical evaluations;
• Using proper protective gear, such as shin guards for soccer and helmets for football and baseball;
• Staying hydrated and always warming up before practice or a game;
• Never playing through pain or an injury.

If an athlete does experience an injury it is important that it is not ignored or taken lightly.
Sports-related injuries in children are of great concern because their bones, muscles, tendons and ligaments are still growing. To avoid long-term damage, young athletes should seek immediate care for any minor or serious injury.

Following are several signs to help determine if immediate care is needed:
• Inability to play following a sudden injury;
• Decreased ability to play due to a chronic or long-term complication following an injury;
• Visible deformity of the athlete’s arms or legs;
• Severe pain from a sudden injury, which may prevent the use of an arm or leg.

Sometimes, sports-related injuries occur after office hours or on the weekends. If and when this happens I recommend that my patients visit the emergency room or an orthopedic walk-in clinic like the one we have at Methodist Sports Medicine / The Orthopedic Specialists. One of our fellowship-trained orthopedic surgeons is available to treat patients with sudden or recent sports or active lifestyle-related injuries. Patients can visit our Avon or Greenwood locations Monday through Friday from 8 a.m. to 10 a.m., or our Carmel location Monday through Saturday from 8 a.m. to 10 a.m. For more information, please visit www.methodistsports.com or call 317-817-1200.

With exceeding expectations for young athletes to perform well, and the fact that their bodies are still growing, injuries are not only common, but can possibly lead to long-term problems. Contact sports such as volleyball, football and hockey put youth at a higher risk of injury. According to the American Academy of Orthopaedic Surgeons, 3.5 million children under the age of 15 have sports-related injuries each year. Specifically, 15 to 30 percent of childhood fractures were a growth plate fracture.
Bone growth is integral to a child’s physical health, and growth plates play an important part in this. Tissue is generated at the growth plate, which is located at the end of each long bone. Since the growth plate is the weakest part of a joint, children often suffer growth plate fractures rather than sprains or ligament injuries.
Here are some tips to prevent and treat young athlete growth plate injuries:

• Develop a diet rich in calcium. Eat foods that are high in calcium, such as milk and cheese. Calcium is proven to increase bone density and makes bones stronger.

• Condition well. Regular strength training and exercise keeps muscles flexible and bodies strong. Also, remember to warm up before starting to play.

• Wear protective gear and padding. This will decrease the risk of injury if a fall or blow to a joint does occur. If you are returning to the sport after incurring growth plate injury and are not fully recovered, extra padding of the previously injured area is recommended.

• Understand proper technique. By abiding by the rules of the sport and following the right technique, injuries are less likely to occur.

• See an orthopedic doctor within five to seven days. Since children heal faster than adults, it is important to see a doctor within five to seven days of injury so that the growth plate and bones don’t heal incorrectly. The doctor will assess the injury and may perform an X-ray and other diagnostic tests to determine the severity of the injury.

• Take it easy while healing. The recovery time for this type of injury can take up to six months or more so don’t overdo exercise or try to get back into a sport until you are fully healed.

Because children are still growing, injuries should not be taken lightly. An injury that persists and is not properly taken care of, can lead to permanent damage or improper physical growth. If there is an inability to play the sport, the pain persists or there is a visible deformity, it is important to see an orthopedic specialist immediately.

When you think of serious health problems, a hip fracture may not be at the top of your list. But according to the American Academy of Orthopaedic Surgeons, 353,000 people are hospitalized for hip fractures each year. A hip fracture is a serious injury, usually caused by a fall or a blow directly to the hip as well as weakened hip bones. The most common breaks occur in the upper quarter of the thigh bone, which result in pain over the outer upper thigh or in the groin. A hip fracture also can cause difficulty walking, inability to stand, leg weakness and/or discomfort to rotate the hip.

You should consider the following common risk factors when it comes to your hips:

• Heredity: Bone size, mass and density can all be attributed to family history and genes. If someone in your family has had a hip fracture, you may be more prone to fractures.

• Health: Hip fractures commonly occur in people with osteoporosis, a condition that causes bones to weaken due to calcium deficiencies. Approximately 1.5 million fractures are related to osteoporosis each year. Taking sufficient calcium and vitamin D as early as possible will help offset this condition. This coupled with weight-bearing exercise and limited smoking and alcohol use will help keep your bones healthy.

• Age and gender: Most people who fracture their hips are older than 50. In fact, 90 percent of those who incur a hip fracture are 65 and older. Interestingly, women are two to three times more likely to have a hip fracture as men because menopause accelerates bone loss.

• Side effects of medications: Some prescription medications can increase your risk of osteoporosis or cause dizziness, intensifying your risk of a hip fracture. Talk to your doctor about the medications you are taking and how they may affect your balance and bone mass.

To reduce your risk of injury, exercise to improve strength and balance and take calcium supplements if needed.

Check with your physician before you make any long-term lifestyle changes and find out what your risk is for a hip fracture.