Hip & Knee
Diagnosis, Treatment & Rehabilitation
Hip pain and knee pain, as well as movement limitations are common, especially with increasing age or following injury. Arthritis is the most frequent cause of hip and knee pain and joint deterioration.
Comprehensive Care for Hip and Knee Pain
Orthopaedic Associates of Central Maryland's orthopaedic specialists include hip and knee experts that perform state-of-the-art surgery and communicate closely with on-site physical therapists for effective pre- and post-surgical rehabilitation. Our goal is to restore pain-free hip, knee, and joint motion to allow our patients to enjoy life to its fullest!
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Click on a condition or treatment to read more about it and view related educational videos.
CONDITIONS
Osteoarthritis is the most common type of arthritis, affecting more than 31 million Americans. The condition tends to develop with age. As weight-bearing structures, the hip and knee joints are most susceptible to osteoarthritis. It occurs as the articular cartilage in the joint breaks down, causing a reaction in the bone. The bones in the joint become thicker and develop growths (osteophytes or spurs), adding to the pain and swelling, while disrupting movement. Synovial fluid, a lubricating fluid in the joint, gets thicker and inflamed.
As osteoarthritis progresses, the hip or knee joint continues to experience changes over several years. Eventually, very little of the articular cartilage remains. Bone-on-bone rubbing causes pain, impairs movement, and makes daily activities difficult.
Hip fractures are most commonly caused by falls. The risk for hip fractures increases with age. Older adults, especially those over the age of 85, are at the highest risk because of changes in bone structure and overall health. Medical complications from hip fractures can be life threatening. Because of the possible serious consequences, you should see your doctor or go to the emergency department of a hospital immediately if you suspect that you fractured your hip.
The prevalence of hip fractures is higher for women than for men. Women may be more susceptible because of differences in their skeletal structure and bone composition. Additionally, women may have higher rates of bone density loss from osteoporosis, a bone-weakening disease. For both women and men, bone density generally decreases after the age of 50.
Hip resurfacing is another option for relieving pain and restoring function for people with advanced arthritis. Instead of removing bones in the joint as in hip replacement surgery, hip resurfacing simply coats the bone with smooth metal.
Your surgeon will make an incision in your thigh, dislocate the femoral head from the socket, trim the bone, remove the damaged cartilage, and cement a metal cap over the head of the femur. The hip socket is prepared in the same manner and fitted with a metal cup. The femoral head is then relocated back into the socket, with a plastic spacer placed between the two to facilitate movement.
Hip resurfacing is a bone-sparing, less invasive procedure than hip replacement. The best candidates for it are those who are younger than 60 and who have larger, stronger bones. About 6 weeks after surgery, you should be able to return to your regular activities free of pain.
ACL
The ACL (Anterior Cruciate Ligament)ligament is one of the bands of tissue that connects the femur to the tibia. An ACL tear can be painful. It can cause the knee to become unstable. An ACL tear usually occurs during athletic activity. The ACL can tear during abrupt movements such as sudden stops, pivots or directional changes. The ACL can also tear when a person jumps and lands awkwardly. In some cases, ACL tears are caused by a traumatic injury such as a vehicular accident or a violent tackle. A common symptom of an ACL tear is a popping sound or sensation in the knee at the moment of injury. The knee may be very painful, and it may swell. It may feel unstable. The person may be unable to continue physical activity.
In some cases, an ACL tear can be treated conservatively in patients who have a low activity level. Nonsurgical options may include crutches, a knee brace, and strengthening and stability exercises. For active patients, surgery and rehabilitation are commonly required.
Meniscus
Within your knee joint are two C-shaped discs of cartilage called menisci (the plural of meniscus). They act as shock absorbers and help your knee joint glide when in motion. Menisci are vulnerable to injury, especially from twisting motions during sports. Older adults can experience a meniscus tear as the result of weakened cartilage and knee degeneration. If you tear a meniscus, you may hear a popping noise. Symptoms include swelling, pain, and tightness that increase over several days. You may not be able to straighten your knee, and it may buckle, catch, or lock in position. It may be difficult for you to put weight on your leg or walk.
Treatment may include ice, rest, and medications to help relieve pain and swelling; physical therapy to help strengthen the muscles that move the knee joint; and arthroscopic surgery to repair larger tears on the outer section of the meniscus or for tears in the inner areas.
PCL
Strong bands of tissue called "ligaments" help stabilize the bones that form the knee joint. One of these ligaments is called the "PCL (Posterior Cruciate Ligament)." It helps connect the femur to the tibia. If you stretch or tear a PCL, your knee may become unstable. The PCL can be injured by a sudden blow to the front of your knee when your knee is bent. That canhappen if you play contact sports. It can happen if you have a road accident. You can also injure the PCL if you misstep and twist your knee. A PCL injury causes pain and swelling. Your knee may feel stiff. You may have trouble walking. And, your knee may feel unstable.
Treatment depends on your needs. Some injuries can heal on their own. You may benefit from options such as rest, a knee brace and physical therapy. If these aren't helpful, you may need surgery to repair the ligament.
If your hip joint hurts, or if it catches or clicks when you move your leg, you may have a torn labrum. That's a rim of tissue that surrounds the hip's socket. It helps to deepen the socket and cushion the joint. A torn labrum can keep the hip joint from working smoothly.
You can tear a labrum during athletic activity. It can happen if you play football, soccer, golf, or hockey. It can also be a problem for ballet dancers. In some people, labral tears are linked to problems with the shape of the hip joint. And, a labral tear can also develop if your hip joint has degenerated because of osteoarthritis. A torn labrum can cause pain in your groin or in the front of your hip. Your hip may hurt when you are active. You may also notice a catching or a clicking sensation in the joint when you move it.
TREATMENTS
Rather than one large incision as in traditional total hip replacement, minimally invasive hip replacement utilizes one or two small incisions (3-6 inches for a single incision and 1-3 inches for each double incision). The surgeon still has to cut through muscles and tendons to access the joint, but to a lesser degree than in the traditional method. He or she will remove the femoral head and damaged bone and cartilage from the hip socket and replace the hip joint with an artificial one.
Benefits of minimally invasive hip replacement include less damage to soft tissues, less pain, shorter hospital stay, and quicker recovery. The surgery is not for everyone though; candidates are typically younger, healthier, active working people or athletes.
Rather than one large incision as in traditional total knee replacement, minimally invasive knee replacement utilizes one small incision approximately 4-6 inches long. This procedure also spares the thigh muscles and other soft tissues surrounding the knee. Instead of cutting through them to access the joint, the surgeon simply moves them aside. He or she will then remove the damaged portions of the knee and replace them with artificial implants.
Benefits of minimally invasive knee replacement include less damage to soft tissues, less pain, a shorter hospital stay, and faster recovery. The surgery is not for everyone though; the best candidates are those who are younger, healthier, and thinner. Rehabilitation is an important part of the recovery process.
The knee joint contains three compartments: the medial (inside) compartment, the lateral (outside) compartment, and the patellofemoral compartment (front of the knee between the kneecap and femur). For some people, osteoarthritis affects only one part of the knee joint instead of all three. If this is the case for you, then you may be a candidate for partial knee replacement.
During this procedure, the orthopaedic surgeon replaces only the part of the knee that is damaged and leaves the rest of the joint intact. Preserving the healthy parts of the knee helps maintain more natural function. Other advantages of a partial knee replacement include a smaller incision, less pain and blood loss, and a faster recovery.
Osteoarthritis, the most common type of arthritis, is the main reason for hip replacement surgery, or hip arthroplasty. During the procedure, your orthopaedic surgeon will remove the damaged portion of your hip and replace it with an artificial joint.
This traditional total hip replacement method involves making a long incision (8-12 inches) on the side of your hip. Your surgeon will cut through the muscle and tendon to access your joint. He or she will remove the damaged bone and cartilage and replace the top part of your femur with a highly polished strong metal ball. Then, the surgeon will attach a plastic socket with an outer metal shell to your pelvis using surgical screws or surgical cement.
There are a variety of artificial joint types, and your surgeon will choose the most appropriate one for you. Your new artificial joint will allow you to move without pain and once again enjoy the things you used to be able to do.
More knee replacements are performed each year than any other type of joint replacement surgery, primarily because the knee is the largest joint in the body and bears the weight of your body every day. If you have advanced osteoarthritis that is affecting your quality of life, it may be time for a knee replacement.
The traditional method for total knee replacement, or knee arthroplasty, involves a large (8-12 inch) incision to access the knee joint. Your surgeon will also have to cut through leg muscles and move the patella (kneecap) aside. Once the damaged bone and cartilage is removed, the joint is replaced with an artificial one.
There are many types of artificial knee joints. Your surgeon will choose the most appropriate one for you, depending on your age, weight, activity level, and overall health. Nearly all of them consist of three components. The new piece for the end of your femur is made of highly polished metal. The tibial component, for the top of your leg, is made of metal and plastic. The patellar part is made of plastic and fits inside of your kneecap. The artificial pieces may or may not be cemented into place.
Our Providers
Scott M. Adams, MD
Orthopaedic Surgeon & Sports Medicine Specialist
Nicholas P. Grosso, MD
Orthopaedic Surgeon & Sports Medicine Specialist-
M. Brian Polsky, MD
Orthopaedic Surgeon & Sports Medicine Specialist
Scott L. Silverstein, MD
Orthopaedic Surgeon, Joint Replacement, and Sports Medicine Specialist
Sam V. Sydney, MD
Orthopaedic Surgeon, Joint Replacement, Revision Surgery
Michael J. Wallace, MD
Orthopaedic Surgeon & Sports Medicine Specialist
Ke Xie, MD
Orthopaedic Surgeon, Joint Replacement: Hip & Knee, Revision Surgery
Ralph T. Zade, MD
Orthopaedic Surgeon & Orthopaedic Sports Medicine
