Relief From Hip Pain – How Arthroscopy Can Alleviate Pain and Restore Function

Hip pain can be debilitating, affecting everything from mobility to sleep to overall quality of life. The hip joint is where the thigh bone (femur) connects to the pelvis and is used constantly when one walks, bends, and supports his/her upper body.

Who is a good candidate for Hip Arthroscopy?

Hip pain has varied causes; in young people the most common cause is a labral tear–damage to the soft tissue lining the inside of the hip socket (acetabulum). A Labral tear can occur from repetitive wear over time, impingement from an underlying problem with the joint structure, or trauma from a sports injury or accident.

For patients who suffer from a labral tear –and who have not found relief from conservative treatments like rest, over-the-counter pain relievers and physical therapy–hip arthroscopy may be the answer. It’s a minimally invasive procedure that can restore hip function and alleviate pain.

Patients with osteoarthritis, cysts, or ankylosis (fusion) of the hip joint are not good candidates for hip arthroscopy.

What is involved in the Hip Arthroscopy procedure?

First, an orthopedic specialist will determine whether hip arthroscopy is appropriate based on a physical exam and x-ray or MRI imaging. Unlike open surgery, arthroscopy only requires a small incision through which a camera (arthroscope) is inserted. This gives the surgeon a clear, magnified view of the interior of the hip joint during the procedure. The surgeon will then repair or remove the damaged labrum, bone impingement, or loose bodies. Performed in an outpatient setting , arthroscopic hip surgery usually leads to less post-operative pain and shorter recovery time than open hip surgery.

Surgical Expertise + State of the Art Technology

Dr. Tyler Welch is a board certified orthopedic surgeon who has performed approximately 300 hip arthroscopy procedures – In addition to his extensive experience, Dr. Welch utilizes state-of-the-art technology, including “HipMap” software that generates a detailed 3D image of the hip structure in advance of the procedure. Used as a planning tool, this advanced imaging enables him to precisely target the surgery and minimize disruption to surrounding tissue.

Another innovative device employed by Dr. Welch is the Guardian, a cutting-edge operating table designed to hold the patient comfortably and securely in place, while providing the surgeon greater range of motion and visibility during the procedure. Traditionally, achieving proper positioning for hip surgery required the use of a post between the patient’s legs, a technique that can cause groin pain . The Guardian table has eliminated post-operative groin pain.

Below, we asked Dr. Welch a few questions about hip arthroscopy.

Where do you perform this procedure?
I perform hip arthroscopy at NECOS and at York Hospital.

Are you still the only practice in the Seacoast that uses the Guardian Table for this procedure?
That’s right, I’m still the only surgeon on the Seacoast that uses the Guardian Table.

Anything else you’d like current or future patients to know about this procedure and how it would benefit them?
What is nice about hip arthroscopy is that it is a relatively straightforward recovery. Crutches are only required for about one week, and most patients make significant gains within 4-6 weeks. It is not too painful, and I have found that most patients only require pain medication for the first 24-48 hours.

Also, surgery is reliable for the right patient. As long as the patient has hip impingement without any sign of arthritis, surgery typically alleviates pain and eliminates most symptoms.

If you suffer from hip pain, don’t ignore it. Atlantic Orthopaedics and Sports Medicine offers treatments–both surgical and non-surgical–that can alleviate hip pain and restore your quality of life. If you think that hip arthroscopy may be right for you, schedule a consultation with Dr. Welch to learn more.

Knee Pain From a Dislocated Kneecap?

Patella Instability Surgery Can Provide Relief!

What Is Patellar Instability?

When the kneecap shifts out of its normal alignment, you may feel pain, trouble walking, a buckling or locking sensation, or a feeling of the knee “giving way.” Patella instability can impact daily life and make it difficult to stay active.

How Does the Patella Instability Procedure Work?

In this procedure, the surgeon carefully realigns the patella within the femoral groove to ensure proper tracking during knee movement. The specific surgical technique can vary based on factors like the patient’s age, and the severity of the injury. In the Medial Patellofemoral Ligament (MPFL) Reconstruction procedure that Dr. Welch describes below, the patient’s ligament was reconstructed to stabilize the patella on the inside of the knee. In cases of severe instability, the surgeon may also reposition the tibial tubercle–the bony bump below the patella–to improve patellar tracking.

What Can I Expect Post-Surgery?

Patients can expect to go home the same day as the procedure. Recovery time varies and patients will need to use crutches and wear a knee brace for a period of time, typically 4-6 weeks. Physical therapy is also an important part of the recovery process.

We sat down for a Q&A with our Orthopedic Surgeon and Sports Medicine Specialist Dr. Welch.

In your own words, how does this procedure benefit your patients?

Patella instability is a condition in which the patella (kneecap) dislocates from the femur (thigh bone). Most patients are young, often teenagers. Fortunately we can fix this condition surgically. This procedure benefits patients because it generally restores one’s confidence and his/her ability to play sports.

Who is a good candidate for the Patella Instability Procedure?

A good candidate for patella instability surgery is anyone who has had at least one patella dislocation or multiple subluxations (partial dislocations).

Where do you perform this procedure?

I perform this procedure at New England Center for Orthopedic Surgery (NECOS) in Portsmouth and at York Hospital in York, Maine.

Do you have a recent patient success story you can share?

Recently, a 15 year old male high school student came to see me with his family. The patient had sustained two dislocations prior to his visit with me. These dislocation events are painful and stressful, and the young man was apprehensive about playing sports ever again unless we fixed his knee. He underwent a procedure–a medial patella femoral ligament (MPFL) reconstruction–to stabilize his patella. Surgery was straightforward and he recovered nicely. He required crutches for 10 days and a brace for four weeks. After six weeks, he had normal motion and no swelling in his knee. I cleared him to return to sports three months after surgery.

Anything else you’d like current or future patients to know about this procedure and how it would benefit them?

There are a few important things to consider regarding patella instability surgery. The procedure is very reliable – dozens of studies have demonstrated success rates in the 90-95% range, and my experience has been similar. The vast majority of these patients are happy because they regain “trust” in their respective knees, and recovery is straightforward. Further, patients usually return to the same level of activity that they had prior to the dislocation(s).

If you have knee pain from dislocation, visit our website to learn more about Arthroscopic Knee Surgery or schedule a consultation with Dr. Welc h.

Torn Meniscus? Eliminate Knee Pain With This Procedure

The meniscus is a C-shaped piece of cartilage in the knee joint that plays a crucial role in function and stability. The two meniscii in each knee function as shock absorbers. They are composed of dense fibrocartilage, which is more flexible than bone but firmer than other types of cartilage. Meniscus pads play an important role in walking, running and jumping, and they aid in weight distribution and alignment. The meniscus also helps keep the knee joint lubricated to reduce friction between the femur (thigh bone) and tibia (shin bone).

A meniscus root tear is a relatively common knee injury that occurs when the meniscus separates from its attachment point on the tibia bone. This type of tear can be caused by the wear and tear that happens with age, or by trauma or injury, such as a sports injury. People who suffer a tear often feel a “popping” sensation in the back of the knee, followed by pain, instability, and a loss of function. Untreated, a meniscus root tear can lead to osteoarthritis and degeneration in the knee. Fortunately, there is a minimally invasive procedure available to fix the issue.

Atlantic Orthopaedics’ surgeon Dr. Welch specializes in meniscus root repair, having performed more than 100 successful procedures to restore function, eliminate pain, and prevent further damage. In this surgery, he makes three small incisions, prepares the torn end of the meniscus for repair, then securely reattaches the meniscus to the root attachment site on the tibia bone through a small tunnel in the tibia.

Following surgery, Dr. Welch places the patient’s knee in a brace to protect the repaired meniscus and allow it to heal. Physical therapy is an important part of the recovery process. Recovery from meniscus root repair takes time and it’s important to follow your surgeon’s instructions regarding weight-bearing and the use of crutches. It may take three months for the knee to fully heal, but the vast majority of patients have excellent outcomes and experience a return to normal knee function.

Below, Dr. Welch answers some questions about Meniscus Root Repair:

Q. In your own words, how does this procedure benefit your patients suffering from knee pain?

A. A meniscus root tear is a specific type of meniscus tear that is more serious than a typical meniscus tear. If the root tears, the meniscus becomes loose and unstable. Surgery involves repairing the meniscus back to the tibia bone. This procedure benefits patients because it restores the function of the meniscus, eliminates pain, and helps restore patient confidence in his/her knee.

Q. Who is a good candidate for a Meniscus Root Repair?

A. A proper candidate for meniscus root repair is a patient who sustains a root tear who does not have significant arthritis in the knee.

Q. Where do you perform Meniscus Root Repairs ?

A. I perform meniscus root repairs at New England Center for Orthopedic Surgery (NECOS) in Portsmouth, NH and at York Hospital in York, ME.

Q. Do you have a recent patient success story you can share?

A. I have dozens of patient success stories. Meniscus root repairs are very reliable; as long as the meniscus heals to the tibia, patients usually return to normal function with no issues. Previous studies have revealed success rates > 90%.

Q. Anything else you’d like patients to know about this procedure?

A. I have many patients (>100) who have had tremendous success after a meniscus root repair. Unfortunately, one issue with this procedure is that each patient must use crutches or a walker for the first 5-6 weeks after surgery. This is inconvenient, but necessary, so that the meniscus has time to heal.

If you’re suffering from knee pain and loss of mobility from a meniscus root tear, you may be a good candidate for this minimally invasive procedure. Schedule an appointment with Dr. Welch for an evaluation: https://www.atlanticorthopaedics.org/providers/tyler-welch-md/

Torn ACL? Get Educated About BEAR

Atlantic Orthopaedics & Sports Medicine now offers patients an alternative to surgical reconstruction – a less invasive procedure called Bridge Enhanced ACL Restoration, or BEAR. Clinically tested and FDA-approved, this promising new procedure has been adopted by our own Dr. Tyler Welch, who performed the first BEAR surgery in the state of Maine! Dr. Welch is an orthopedic surgeon and partner at Atlantic Orthopaedics who specializes in Sports Medicine, with a focus on the knee, shoulder, and hip. His mission is to restore his patient’s function through compassionate, evidence-based care.

Anterior cruciate ligament, or ACL, tears are one of the most common knee injuries, affecting more than 100,000 Americans each year. The ACL is a band of tissue that connects the thigh bone (femur) to the shinbone (tibia) inside the knee joint. It is one of the two cruciate ligaments, along with the medial collateral ligament (MCL), that stabilize the knee joint and prevent the tibia from sliding forward. ACL injuries most often occur when playing sports that involve sudden changes in direction, like:

Basketball
Soccer
Gymnastics
Downhill skiing

Pivoting with your foot firmly planted in place, landing awkwardly from a fall or jump, stopping suddenly, or getting a blow to the knee, along with wearing shoes that don’t fit properly or using ski bindings that aren’t correctly adjusted, can all increase your risk. ACL tears are also more common among women than men. Signs that you’ve torn the ligament, either partially or fully, include severe pain, a popping sensation, rapid swelling, and a feeling of the knee “giving way” when you put weight on it.

If you think you’ve torn your ACL it’s important to be evaluated by an orthopedic doctor as soon as possible. It is possible that the ligament has been stretched or only partially torn, and in those cases the injury may respond to non-surgical treatments like ice, rest, elevation, or physical therapy. Unfortunately, a complete ACL tear can’t heal on its own. This is because the synovial fluid in the knee that keeps the bones from rubbing together also prevents the formation of blood clots needed for healing. Until recently, the only fix for a complete tear has been surgical reconstruction, where a tendon is taken from another part of the patient’s body, or from donor tissue, to reconstruct the torn ligament.

We recently sat down with Dr. Welch to ask him a few questions about the new BEAR procedure.

Q: Tell us Dr. Welch, how does this new procedure benefit your patients?

A: This procedure can benefit patients because it is less invasive than a typical ACL reconstruction. Unlike typical ACL reconstruction, the patient does not need a “graft” to replace the ACL with the BEAR technique. As a result, the procedure may lead to less pain and swelling in the post-surgery period.

What makes BEAR unique is that it doesn’t require patient or donor tissue, instead using an implant made from collagen to bridge the gap between the torn ends of the ACL ligament. The implant is secured via suture, and the patient’s own blood is injected into it during the surgery to form a clot that surrounds the device. This facilitates cell proliferation and enables the body to heal itself. Within about eight weeks of surgery, the implant is absorbed, and replaced by the patient’s own tissue, which will continue to strengthen over time.

Q: Who is a good candidate for a BEAR Procedure?

A: Anyone with an ACL tear is a candidate. Based on recent research, individuals over the age of 20 are the best candidates.

Q: Anything else you’d like patients to know about this new procedure?

A: This is an exciting time in the world of ACL surgery. The BEAR procedure may be a game-changer, but the jury is still out. It is important for patients to know that we do not have any long-term clinical data regarding the BEAR technique. We do not yet know if the re-tear rates (failure rates) are higher in patients who have a BEAR compared to those who have a typical ACL reconstruction over the long term (more than five years). However, current research (two year outcomes) has revealed similar success rates when comparing the BEAR technique to traditional ACL reconstruction. This is encouraging data that suggests that the BEAR technique is reliable.

Candidates for the BEAR procedure must have a complete rupture of the ACL. Eligible patients must also have a stump still attached to the tibia to allow for repair. Dr. Welch currently performs this procedure at York Hospital in York, ME and the BEAR procedure should be available soon at AOSM’s state-of-the-art orthopaedic ambulatory surgery center, NECOS in Portsmouth, NH.

If you think you may be a good fit for the BEAR procedure, schedule an appointment for an evaluation with Dr. Welch. To learn more, click HERE.

NH Magazine Announces 2023 Top Docs

Each year, over 3,000 licensed New Hampshire physicians nominate their peers for the opportunity to receive the honor of ‘Top Doctor.’ Those named Top Doctors received the greatest number of recommendations within 55+ specialties, and the results are in! We think all of our docs are top, but this year, eight of our physicians were voted ‘Top Doctor,’ including:

Glen Crawford, MD – Top Doctor for Orthopaedic Surgery
Robert Eberhart, MD* – Top Doctor for Hand Surgery
Andrew McMahon, DO – Top Doctor for Sports Medicine
Mayo Noerdlinger, MD – Top Doctor for Orthopaedic Surgery
H. Matthew Quitkin, MD – Top Doctor for Hand Surgery
Akhilesh Sastry, MD – Top Doctor for Orthopaedic Surgery
William Sutherland, MD – Top Doctor for Orthopaedic Surgery
Tyler Welch, MD – Top Doctor for Orthopaedic Surgery

Congratulations to all the 2023 Top Doctors!

Learn more about our providers in Portsmouth, NH and York, ME HERE. Or click HERE to make an appointment with our orthopaedic and sports medicine team.

*As of January 1, 2023 Dr. Robert Eberhart officially retired.

Dr. Welch Becomes First Surgeon in Maine to Perform a BEAR Procedure

ACL tears are one of the most common knee injuries, affecting more than 100,000 Americans each year. Until now, the only way to repair the torn ligament was with invasive surgical reconstruction using tendons from other parts of the body or from donor tissue.

We’re excited to announce that there’s now a simpler, less invasive treatment available called Bridge Enhanced ACL Restoration (BEAR), pioneered by our own Dr. Welch, who recently performed the first BEAR procedure in the state of Maine. The surgery uses an implant to ‘bridge’ the torn gaps of the ACL without the need for donor tissue but instead, using patient’s own blood encourages the body rebuild the tissue, typically within 8 weeks.

Congratulations Dr. Welch on this outstanding achievement!

If you’re suffering from knee pain, and would like to discuss your options with one of our knee specialists, please contact us today.

*Other resources on BEAR Procedure can be found here.

Atlantic Orthopaedics’ Dr. Tyler Welch Introduces State-of-the-Art Operating Table “The Guardian” at York Hospital

Dr. Tyler Welch was accepted into the International Society for Hip Arthroscopy, and Atlantic Orthopaedics & Sports Medicine will be introducing the hip arthroscopy procedure at York Hospital with a state-of-the-art operating table called the Guardian.

The Pivot Guardian System is a device produced by one of the nation’s lead medical suppliers, Stryker. The Guardian is specifically designed to mitigate complications, as it limits the amount of force applied to a patient’s hip during surgery. The Guardian also enables the surgeon to obtain better visualization of the hip during surgery compared to other operating tables.

The system’s boots enhance patient comfort and safety during surgery, and the surgeon can make precise range of motion adjustments during hip surgery with the Guardian.

The demand for hip arthroscopy is increasing every year, and surgeons in the US are projected to perform 271,000 hip arthroscopy procedures by the year 2021. This will be a compounded annual growth rate of 18.5%, compared to a 3.9% projected growth in shoulder arthroscopy and 1.6% projected growth in knee arthroscopy by the same year.

Atlantic Orthopaedics & Sports Medicine is a leading practice on the Seacoast for orthopaedics and sports medicine. They have offices in Portsmouth, New Hampshire and York, Maine and physicians have full medical staff privileges at both Portsmouth Regional Hospital and York Hospital.

Dr. Welch Publishes Article in Orthopaedic Journal

Portsmouth, NH – Dr. Tyler Welch, a physician at Atlantic Orthopaedics and Sports Medicine, recently published an article in the Journal of Experimental Orthopaedics. It is titled The Effect of a Dynamic PCL Brace on Patellofemoral Compartment Pressures in PCL-and PCL/PLC-Deficient Knees.

The study examines the PCL, or posterior cruciate ligament, located in the back of the knee. One of four major ligaments of the knee, it connects the femur (thighbone) to the tibia (shinbone). In a controlled laboratory study, Dr. Welch and five colleagues explored a deficiency of the PCL leading to arthritis in the patellofemoral knee joint, and evaluated the hypothesis that dynamic bracing reduces pressure in the knee joint in PCL-deficient knees. Coauthors of the study were Thomas Keller, Ruben Maldonado, Melodie Metzger, Karen Mohr and Ronald Kvitne.

The Journal of Experimental Orthopaedics is an international journal that aims to bridge the gap between orthopaedic basic science and clinical medicine, and publishes works that examine the field of experimental orthopaedics. Each published article goes through peer review and is upheld to the high quality standards of the Journal.

Dr. Welch is a physician at Atlantic Orthopaedics who specializes in cartilage restoration, sports medicine, joint replacement, and arthroscopic surgery of the hip, knee and shoulder. He is the lead doctor of the clinic’s Cartilage Center, a place for patients experiencing joint pain and early arthritis. Dr. Welch is affiliated with the American Orthopaedic Society for Sports Medicine, American Academy of Orthopaedic Surgeons, and the Arthroscopy Association of North America.

Atlantic Orthopaedics & Sports Medicine is a group of Board-Certified physicians who utilize the latest concepts in orthopaedics and sports medicine, coupled with preventive and surgical techniques. For more information, visit www.atlanticorthopaedics.org.

Dr. Welch To Present Lecture on Cartilage Restoration Advances

Dr. Tyler Welch of Atlantic Orthopaedics & Sports Medicine is scheduled to present a lecture on Thursday, January 19^th titled Recent Advances in the Treatment of Cartilage Injuries and Early Arthritis: The Future is Here. Open to the general public, the lecture will take place from 6:30-8PM at the Portsmouth Regional Hospital – Hospital Classroom, located on Borthwick Avenue.

Topics of discussion will include: the role of cartilage in joint function, common symptoms in patients with cartilage injuries, the history of cartilage surgery, and the ways in which treatment options have evolved over the last ten to fifteen years in orthopedic medicine. Dr. Welch will also share various cartilage treatment techniques that he currently practices at the Cartilage Center at Atlantic Orthopaedics & Sports Medicine, as well as how location, size, and extent of a cartilage injury’s damage can dictate the appropriate treatment options for a patient.

Dr. Welch is a Board-Certified physician at Atlantic Orthopaedics who specializes in cartilage restoration, sports medicine, joint replacement, and arthroscopic surgery of the hip, knee and shoulder. He is the lead doctor of the clinic’s new Cartilage Center, a place for patients experiencing joint pain and early arthritis. Using cutting-edge treatments in cartilage restoration, Dr. Welch and his team are able to help patients resolve hip, elbow, knee, shoulder and other joint pain, while avoiding more costly and invasive replacement procedures down the road.

His lecture at Portsmouth Regional Hospital is free and open to the general public. To register, please visit portsmouthregionalhospital.com and find the event under “Classes and Events”.

Tyler Paton Welch, MD Joins Atlantic Orthopaedics & Sports Medicine

Atlantic Orthopaedics & Sports Medicine of Portsmouth is pleased to welcome its newest surgeon and health care provider, Dr. Tyler Paton Welch.

Dr. Welch specializes in a wide range of orthopaedic disciplines, including cartilage restoration, arthroscopic surgery of the hip, knee, shoulder and elbow, and joint replacement. By introducing hip arthroscopy to the Seacoast and utilizing the latest techniques in ligament and tendon repair of the knee and shoulder, Dr. Welch brings a unique skill set to Atlantic Orthopaedics & Sports Medicine.

Dr. Welch received his BA from Colgate University in New York and his MD from the University of Connecticut School of Medicine. He completed his residency at Boston University and sports fellowship at Kerlan Jobe Orthopaedic Clinic in Los Angeles, where he was the assistant team physician for the LA Lakers, LA Dodgers, LA Kings, and USC football. His work has been published in multiple journals, including the Journal of Orthopaedic Research. Dr. Welch has also received several grants, including a research grant from the Orthopedic Research & Education Foundation (OREF) and was awarded a Resident Research Award in Orthopaedic Surgery in 2013.

Outside of the office, Dr. Welch enjoys skiing, golf, traveling, and all that the seacoast has to offer.