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. As a result, I can follow the natural spaces between the hip joint’s muscles and tendons, resulting in less damage to these soft tissues.

This new technique often accelerates rehabilitation because the hip is replaced without detachment of muscle from the pelvis or femur. Additionally, because the gluteal muscles and other natural stabilizers are left undisturbed, it is possible for patients to regain mobility more quickly and ultimately go home from the hospital sooner. Following the Anterior Approach, patients may be allowed to bend their hip freely, allowing them to resume their normal daily activities such as sitting or getting into or out of a car without restriction.

If you’d like to learn more about the Direct Anterior Approach to hip replacement surgery, join us on Aug. 23 or 30 at the Learning Center at Clarian North in Carmel, IN. For more information about this seminar or to register, please call 317-962-2533. Hope to see you there!

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.

As stated by Tergesen, hip resurfacing has become an increasingly popular alternative to total hip replacement surgery, especially for younger more active individuals. However, the procedure’s popularity is slowly decreasing as potential problems and challenges begin to surface and new technologies are created.

A misconception among many is that hip resurfacing is less invasive than a total hip replacement.  This is not true.  During hip resurfacing a surgeon replaces the socket and preserves part of the patient’s femoral ball and neck (the part just below the ball), smoothing away the problem areas before placing a cap on the bone.  Typically this procedure can take longer to complete than replacing the hip joint and requires larger incisions. It also requires the surgeon to cut into more muscle and other tissues. The other potential drawback to hip resurfacing is that the neck that was preserved can break (or fracture).  This would require an emergent conversion to a traditional total hip replacement.  This is quite rare, but it is a complication specific to hip resurfacing.

For some patients hip resurfacing is an ideal course of treatment.  A younger more active individual may wear out a hip replacement and be required to undergo a second surgery later on in life.  Hip resurfacing also leaves an orthopedic surgeon with more bone to work with if a second procedure is needed down the road.

In the end, a patient and their doctor should always consider both these procedures on an individual basis.  What’s right for one patient may not be right for another.  That said, I have found the Birmingham Hip Resurfacing (BHR) system to be very successful for many of my patients.   It offers the same metal on metal design as other hip resurfacing devices but has a better and longer track record than other designs.  During a face to face, thorough evaluation, an orthopedic surgeon can customize the right type of replacement for the patient.

Today, there have been many surgical and technical improvements in the area of hip replacements. The improved quality of implants has made hip replacements more durable than in years past.  Advancements in surgical techniques have also allowed for faster rehabilitation and recovery following surgery. As a result of these developments, hip replacements have become a fairly common way for both older adults and active younger people to relieve pain and restore motion.

Even with these improvements, prosthetics have their limits and patients should not have unrealistic expectations about what their new joint can do and how much activity it can withstand. As with any mechanical joint, the ball and socket components move against each other, which can cause a natural wearing down of the joint. The rate of wear is dependent upon on how the hip joint is used.

Being physically active is an essential part of recovery but certain activities should be avoided in order to prevent deterioration of the new joint. Patients participating in strenuous activities and “impact loading” sports such as jogging, basketball, downhill skiing and high-impact aerobics increase the likelihood of wear on the joint’s surfaces.

However, patients should not rule out exercise and sporting activities all together as physical activity is essential to the rehabilitation process. To increase range of motion, muscle strength and most importantly the durability of a hip replacement, patients should consider the following tips and activities post surgery:

• Begin a walking program to slowly increase mobility and endurance.

• Participate in low-impact sports such as swimming, rowing, cycling, hiking and moderate aerobics. This will improve the clinical outcome of the hip replacement and reduce the likelihood of revision surgery.

• Be mindful that any sport placing undue stress on the artificial joint should be avoided. It is better to be a spectator than to participate and run the risk of causing permanent damage or need for revision surgery.

Overall, the longevity of a hip replacement varies from patient to patient, and depends on many factors. These can include a patient’s physical condition, activity level, weight and accuracy of implant placement during surgery. Patients must remember that a prosthetic joint is not as strong or durable as a natural, healthy joint. Limiting physical activity and exercise to activities that put minimal stress on the joint will enable patients to maintain an active lifestyle without increasing the likelihood of revision surgery.

A bone is a living tissue, composed mainly of calcium and protein. Bones with high calcium content are strong. However, as a bone ages it begins to lose calcium and the density and mass of the bone is reduced.  As this occurs it becomes progressively weaker, increasing the risk that it may break. A gradual loss of bone mass generally begins around the age of 35, which is a fact of life for everyone.  After growth is complete, women ultimately lose 30 to 50 percent of their bone density, and men lose 20 to 30 percent. Women lose bone calcium and estrogen at an accelerated pace as they go through menopause, which makes them more prone to hip fractures than men.

Prevention of hip fractures is far better, and far less costly, than treatment after the bone is broken. So, consider utilizing the following ways to prevent a hip fracture:

• Eat a well balanced diet of calcium and vitamin D;

• Engage in weight-bearing exercises, such as walking, jogging, hiking, dancing and weight training;

• Utilize proper treatment and early diagnosis of osteoporosis;

• Take medications to help prevent menopausal bone loss, such as estrogen replacement therapy;

• Eliminate smoking and excessive alcohol use.

If you are diagnosed with a hip fracture you can expect to receive surgery almost immediately to help prevent further complications. There are different types of surgery for hip fractures depending on the location of the break, the position of the bone fragments, and your age.

Surgery for a hip fracture may include one of the following:

• Internal fixation – this involves stabilizing broken bones with surgical screws, rods, or plates.

• Hip replacement surgery – this involves replacing part or the entire joint with artificial parts. The extent of the damage will determine what portion of the hip will need to be replaced.

Typically, surgery is the most effective treatment option for a hip fracture.  Your age, the extent of your injury and your overall health will help your doctor to determine what surgery is right for you.

Choosing fitness and exercise as a New Year’s resolution may seem impossible for joint pain sufferers, but a lack of exercise may actually cause joints to become even more painful and stiff. When you exercise, you strengthen the muscles around the joint, which helps relieve stress and builds flexibility and endurance. However, as with any exercise program, moderation is the key to a safe and successful experience.

The following guidelines and low-impact exercises are ideal for those who wish to help alleviate joint pain:

• To prevent any injuries from occurring in the joints, it is important to maintain strength in the muscles surrounding the joint area and stretch properly before working out. Tight or stiff muscles around a joint will make the area more prone to injury.

• Lower impact exercises, like yoga and dance, which are range-of-motion exercises, are the best form of exercise for people with joint pain. These exercises increase flexibility, relieve stiffness and maintain normal joint movement and should be done daily. Be sure to use gentle, gradual movements, not jerky ones, to minimize the risk of further injuries and/or pain.

•To make sure your exercise routine is beneficial to your joints, put a hot pack on the joints you’ll be working out for approximately 20 minutes before you exercise. This will help to relax your joints and relieve pain before you begin. Once you have completed your workout, apply a cold pack to those same joints for 10-15 minutes to reduce any swelling or pain.

Exercise is very important for individuals with joint pain because it will help keep joints flexible, the muscles around the joints strong and healthy and reduce pain. More importantly, it will improve the overall quality of life for pain sufferers. Soon, getting back into shape will be a way of life and not just a New Year’s resolution.

Snapping hip syndrome occurs when a muscle or tendon moves over a bony structure, or when there is a tear in the cartilage or debris in the hip joint. Athletes, such as ballet dancers and gymnasts, are at special risk for snapping hip syndrome due to their repetitive and physically demanding movements. The condition also frequently occurs in people aged 15-40 years and affects females slightly more often than males.

If you are experiencing the initial stages of snapping hip syndrome, there are a few treatment options you can perform at home. Those include:

• Reducing your activity levels and applying ice to the area

• The use of anti-inflammatory drugs, such as aspirin or ibuprofen, to reduce discomfort

• Modification of your sport or exercise activities to avoid repetitive movement of the hip

If these at home treatments do not work, and pain persists or worsens, you should most certainly seek immediate medical attention. Your orthopedic surgeon and physical therapist will provide you with expert treatment options that can help to reduce your discomfort, such as stretching exercises. If hip bursitis is a cause of inflammation, your physician may recommend an injection of a corticosteroid to reduce the swelling. Finally, in the rare instance that snapping hip does not respond to conservative treatment, arthroscopic surgery may be recommended.