Tackling hip and knee pain
Remaining in the game as we get older is the goal of the baby boomers. How do you go from running, swim-ming, or playing golf and tennis weekly to enjoying the same activities as one nears retirement? Even the idea of walking or simply tying your shoes becomes an obstacle due to normal wear and tear of your joints from arthritis. Pain doesn’t have to be the obstacle it once was.
Remember, the priority is determining the correct diagnosis or cause of your pain. It could be as simple as using the correct shoes, eliminating bad body mechanics, or losing weight. Muscle imbalance and associated pain can be improved by proper exercise or physical therapy. As a board-certified orthopaedic surgeon, who is also fellowship trained in sports medicine and total joint reconstruction, I am capable of providing both the best conservative care or surgical treatment required for a patient’s individual problem.
Establishing a diagnosis with a thorough history and physical exam, along with radiographs, is the primary means of evaluation. Treatment options initially include anti-inflammatory medications, injections, and exercise Physical therapy is often ordered to address a specific problem. When the prescribed treatment fails to address the patient’s complaints, surgical alternatives are often required. My patients frequency tell me when they are ready for surgery, after having failed conservative care, and still experiencing pain that affects their quality of life. Elimination of pain should always be the primary surgical motivation; however, functional limitations with activities or loss of sleep are common motivators.
Surgery of the hip or knee can be a painful procedure, along with a demanding rehabilitation postoperatively. However, advancements in surgical techniques, intraoperative injections, and medication cocktails after surgery can minimize the pain. Probably the two biggest advancements in orthopaedic hip and knee surgery have been the anterior approach for total hips and the use of computer navigated surgery and Robotics for total or partial knee replacements. I utilized these techniques and technology in my practice to provide the best surgical care for my patients. The anterior approach for hips takes advantage of a muscle and tended sparing approach. Recovery has been shown to significantly be faster than other approaches to the hip, along with less pain following the procedure. Dislocation or instability of the hip is rare with this approach.
Robotic surgery with a preoperative CT scan of the knee provides the precise cuts of the bone and aids in intraoperative alignment decisions. Kinematic alignment of the knee, which is best achieved with Robotics, provides for optimal tension of the knee ligaments in flexion and extension. This can create a better balanced knee and one that feels more normal with activities. There may also be less soft tissue damage from surgical cuts due to the use of Robotics. Robotic knee surgery allows the surgeon to personalize the procedure for the patient with both accuracy and precision.
“There may also be less soft tissue damage from surgical cuts due to the use of Robotics.”
I have also promoted the use of preoperative medication cocktails that can include steroids, anti-inflammatory medications, neurogenic pain blockers, and narcotics as a mess means to lessen pain. The surgical procedure is also done under regional anesthesia meaning spinal or epidural, which has hastened recovery with less blood loss and a lower incidence of blood clots. Patients are still sedated, and therefore not awake during the procedure. Periarticular injections are also administered in the hip and knee during the procedures, which allows for significantly reduced pain for the first one or two days. These are often supplemented with peripheral nerve blocks. Finally, patients are discharged with a cocktail of medications, allowing for immediate ambulation and therapy, with the goal being to reduce pain and allow for return to activities, as soon as possible. Conceding that pain is subjective, this comprehensive approach has served my patients well.
Dr. Meyer sees patients at Orthopaedic Specialists of New Orleans, 3434 Prytania St., Suite 310, New Orleans, LA. 70115. For appointments, call 504-897-7877. Surgeries are performed at Touro Infirmary, Ochsner Baptist, and Crescent City Surgical Centre. Additional in- formation is available at drrichardmeyer.com