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 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.

Exclusive Orthopedic Provider for Phillips Exeter Academy

Our New Partnership with Phillips Exeter Academy

We are proud to be the exclusive orthopedic provider for Phillips Exeter Academy in Exeter, NH!

Learn more about our services at https://www.atlanticorthopaedics.org/

Hear from Dr. Tyler Welch about this exclusive new partnership!

*The following is a transcription of the video.

My name is Tyler Welch from Atlantic Orthopaedics & Sports Medicine. And I’m here to announce that we are now the exclusive orthopedic provider for Phillips Exeter Academy. As part of the new partnership with Phillips Exeter Academy, one of the doctors from AOSM will be on site covering all home football games. During those games, we can help diagnose and treat injuries if necessary.

At Atlantic, we have specialists that focus on every part of the body. This enables us to offer tailored care for each individual athlete here at Phillips Exeter Academy. We’re always trying to get better, we’re always trying to improve, so that we can take the best care of the community possible.

I have experience treating athletes from multiple professional teams, including the Los Angeles Lakers, Los Angeles Dodgers, and the Los Angeles Kings. That experience was very valuable to me. It taught me that you always have to treat each athlete as an individual. All athletes have different goals. They have different needs. They have different injury histories. And you always have to take these variables into account when you’re treating each athlete. This is a mindset that I’m excited to bring to Phillips Exeter Academy.

The one piece of advice I give high school athletes it to listen to your body. You know, if you don’t trust your knee, you don’t trust your shoulder, or you’re lacking confidence, or if you’re having pain that keeps coming back, you want to tell your trainer, tell your doctor. There’s usually an issue that you don’t want to ignore.

Atlantic Orthopedics, Phillips Exeter, game on!

Meet Diana – A MAKO Partial Knee Replacement Story

ACL Tears: Treatment Options for Active Adults

Tyler Welch, MD

What is Hip Arthroscopy?

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.