Knee Minimally Invasive Knee Surgery

What Is Minimally Invasive Knee Surgery

Minimally invasive knee replacement surgery refers to modifications of conventional knee replacement surgery designed to reduce tissue trauma and improve recovery time. Knee replacement surgery is one of the most successful procedures in modern orthopedics. The procedure involves resurfacing the knee joint with biomaterials that substitute for the worn-out bone and cartilage.  Many conditions can lead to the need for knee replacement surgery. The most common causes are:

dr martin examining a knee fracture from xray


  • Osteoarthritis
  • Rheumatoid arthritis
  • Injury
  • Avascular necrosis
  • Knee deformity
  • Gout 

Although modern techniques have allowed conventional knee replacements to last well and improve function, many patients still experience considerable pain and lengthy recovery following surgery. Uncomfortable physical therapy is a particular concern for patients looking to make a quick return to work and activity.  While adults of any age can be considered for knee replacement, most are performed on patients between the ages of 55 and 80. The best results tend to be seen in healthy active patients with few medical problems. 

Surgeons are constantly modifying their technique to improve the results of knee replacement surgery. “Minimally invasive” refers to those techniques that minimize the trauma to the soft tissues and bone around the knee.  Traditionally this meant simply making a smaller skin incision but more recently implant companies have developed specialized instruments that cause less trauma beneath the skin as well. Perhaps the most radical form of “minimally invasive” knee replacement involves modern robotic-assisted procedures where the soft tissues are protected during the cutting of bone by a robotic controlled saw blade.  These modifications to conventional knee replacement surgery are allowing greater numbers of patients to return home within hours of their surgery. 

What Does Conventional or “Traditional“ Knee Replacement Surgery Typically Involve?

  • Large incisions
  • Significant postoperative pain
  • Several day stay in a hospital
  • Postoperative rehabilitation
  • Extensive physical therapy

Patient satisfaction after traditional knee replacement has been described as ranging from 75% to 92%. This means that up to 25% of patients are dissatisfied with their results following surgery.  There are many reasons why patients are dissatisfied after knee replacement surgery but the most common are pain, stiffness, and deformity. The demand for knee replacement is increasing and the average age of patients receiving knee replacement is decreasing.  As people live longer and stay active later in life they put a greater demand on their joints. Modern medicine has responded with technological advances designed to improve the function and longevity of knee replacements.

Another major reason for dissatisfaction after knee replacement is the development of complications associated with the surgery.  Although knee replacement is one of the safest orthopedic procedures performed serious complications can still occur. These can range from skin reactions caused by medications to infection and blood clots.  A person’s overall health should be optimized prior to undergoing surgery to lessen the possibility of complications. Many times a patient’s primary care physician or specialist is consulted to help with this process.  Major advances have been made to our surgical protocols that decrease the risk of complications.  

Benefits Of Minimally Invasive Surgery

One example is outpatient joint replacement.  Healthy patients undergoing “minimally” invasive surgery are usually candidates for returning home the same day as surgery.  This promotes rapid recovery with early walking and decreases the chances of hospital-acquired infection. Many other advances will be discussed in upcoming articles.  

The overall concept of knee replacement surgery is the same for minimally invasive and traditional knee replacement. Biomaterials are used to resurface the worn-out cartilage on the ends of the knee joint.  The most commonly used materials are cobalt chrome, titanium, and polyethylene plastic. The design of the implants is fairly standardized with slight differences between manufacturers. The same implants can be used for either minimally invasive or traditional knee replacement.  It may be best to think of “minimally invasive” and “traditional” knee replacement as different techniques used to perform the same procedure.  

What Should I Expect During Minimally Invasive Knee Surgery?

Knee replacement surgery begins with an incision over the front of the knee. A second lengthwise incision is made beneath the skin going around the kneecap. This allows the surgeon access to the knee joint. In traditional knee replacement surgery, blocks of metal are aligned and fixed to the bone to guide the surgeon as he removes the ends of the bones with a special saw.  Metal implants are then fixed to the ends of the bones with a piece of plastic fixed in between. A plastic button is also sometimes fixed to the underside of the kneecap to complete the joint replacement. The soft tissue incisions are then repaired with suture material and a soft tissue dressing is applied. Patients are encouraged to start walking as soon as possible after surgery.  A physical therapist often helps the patient get out of bed and walk during their stay in the hospital.   dr martin looking at stryker diagram of knee

The major difference between minimally invasive and traditional knee replacement is in the handling of the soft tissues. The same implants still need to be attached to the ends of the bones in the joint but how the soft tissues are handled appears to make a big difference in patient recovery.  Smaller incisions and less soft tissue dissection results in less soft tissue damage which can lead to less inflammation which in turn can lead to less pain and stiffness. However, as with most things there is a trade-off. Sparing soft tissue can lead to better results but it makes the procedure significantly more technically demanding for the surgeon.  A surgeon is typically only as good as what he can see. Making smaller incisions decreases the surgeons ability to see and visualize the joint and increases the potential to make mistakes with implant positioning. Where the implants are fixed on the ends of the bones is probably even more critical to optimal results than minimizing soft tissue damage.

Decreased visualization and the technically demanding nature of minimally invasive surgery are the two biggest disadvantages. The next generation of knee replacement surgery utilizing robotic-assistance promises to minimize or eliminate these drawbacks.  This next generation of minimally invasive knee replacement utilizes software that allows the surgeon to visualize a patient’s joint without physically “seeing” it and helps the surgeon determine the optimal position for the implants. After this is done a robotically controlled sawblade protects the soft tissue surrounding the bones of the knee during cutting.  The precise cutting with the robotic arm ensures accurate placement of the implants. These advances improve results with many patients experiencing less pain and better range of motion following surgery than with traditional knee replacement.

Hip Replacement

What To Expect After Anterior Hip Replacement

What Is An “Anterior” Total Hip Replacement 

An anterior total hip replacement is also known as a total hip arthroplasty and is a surgical procedure that replaces a damaged hip joint to allow patients to function without hip pain. Anterior refers to where Dr. Martin places his incision, which is on the front of the thigh/ groin area. Both anterior and posterior hip (ie traditional hips) have excellent outcomes however the anterior approach allows patients to bounce back quicker. The surgery is often performed in an outpatient setting with patients up and walking within 1-2 hours of surgery. Improved patient recovery with the anterior approach stems from several different factors including: 

  • The muscle-sparing technique 
  • A quicker return to a full range of motion 
  • A decreased risk of dislocation 
  • The decreased pain after surgery
  • Return to walking and moving quickly 

What To Expect After Anterior Hip Replacement 

After having an anterior total hip replacement you can expect the following:

  • Procedure and Post Procedure 
    • Outpatient robotic hip surgery ranges from 60-90 minutes and once patients are stable they can go home
  • Going Home 
    • Patients will go home with a walker for balance and are up walking within a few hours of surgery 
    • Patients can shower the same day as surgery 
  • Physical Therapy 
    • Patients often do not require formal physical therapy after an anterior hip replacement 
    • Walking after your hip replacement is the best therapy for patients, which is why they begin walking within an hour of surgery 

Anterior Hip Replacement Recovery Timeline 

Day Of Surgery 

  • The procedure itself ranges from 60 to 90 minutes 
  • Each patient is unique and anesthesia depends on a patient’s health status but Dr. Martin prefers to use spinal anesthesia for his patients 
  • Spinal anesthesia allows a patient’s lungs and upper body to keep working during surgery, lower blood pressure, and reduces post-operative pain. 
  • Dr. Martin also utilizes an analgesic medication inside of the surgical incision to control post-op pain. 
  • After the surgery is complete patients are awoken in the post-operative recovery area where it can take 30-60 minutes to fully wake from the medications 
  • After the anesthesia has worn off, they are allowed to get up and walk with the aid of a walker for balance purposes 
  • The incision is closed with absorbable sutures and skin glue. There is no dressing to care for 
  • After patients have walked well with the walker, used the restroom, and feel confident moving they are discharged home 
  • Patients are provided a hand out with exercises to begin and movements/motions to avoid called anterior hip precautions. 
  • There are no diet restrictions after surgery, but we do recommend starting with a small meal and plenty of liquids 
  • All medications patients need in the postoperative period will be sent directly to the pharmacy for pick up. 
  • Pain management medication varies from patient to patient and will be discussed with Dr. Martin 
  • For blood thinning after the surgery, Dr. Martin prescribes 81mg aspirin taken twice a day for 4 weeks. 
  • The facility will provide a walker to patients who do not have one at home 
  • Having the path from your door to the bedroom or couch is ideal prior to returning home 
  • Make sure pets and other tripping hazards are kept out of the way of the walker ( including cords and rugs) 
  • Patients may shower the same day as surgery if they desire 
  • After the surgery patients find it comfortable to sleep on their backs or on the non-surgical side, with a pillow between the knees. We do not recommend sleeping on the stomach. 

1-2 Days After 

  • The first 1-2 days after surgery the medication Dr. Martin placed in the incision is still helping control pain. Patients typically feel very good. 
  • Patients are up walking (with the walker for balance) and starting to resume activities of daily living, such as showering, getting the mail, and walking through the house. 
  • A list of basic exercises to start will be in the discharge paperwork, patients typically start 1-2 days after surgery. 
  • Often patients are feeling very good and we advise during this time frame to not be too aggressive with activities. 
  • Pain medications may or may not be needed during this time frame and is wholly patient dependent. 
  • Patients may continue showering regularly but cannot soak in a bathtub, hot tub, or pool until evaluated in the office. 
  • The incisions should be monitored for any bleeding or drainage, but no other care is required. DO NOT SCRUB THE INCISIONS. 
  • There may be swelling, bruising, warmth, redness, tingling or numbness around the incision. 

3 Days After 

  • On day 3 typically all of the pain-alleviating effects of the local medications have worn off. Patients may require pain medication this day/evening to rest comfortably. Use as prescribed. 
  • Swelling, redness, warmth, and tingling/numbness may still be felt around the incision site. 
  • Thigh stiffness and mild knee pain may be present. 
  • Patients continue their home exercises, daily walking, and medication regime. 
  • The use of the walker in the house is dependant on stability, but Dr. Martin recommends continued use of the walker in public until follow up. 

5-7 Days After 

  • Patients will follow up in the office with Dr. Martin and his staff at around 5-7 days out of surgery. 
  • At this visit, Dr. Martin will address your medication management, incision healing, driving, work status and asses your gait and strength. This will determine whether or not he recommends formal physical therapy. 
  • At this time patients can start using a recumbent exercise bicycle or elliptical to begin building strength and stamina. 
  • Weaning off of the walker in public is common at this time, but is patient dependent. 
  • At the week mark patients may begin walking in the water ( pool or hot tub) 
  • Patients often begin weaning off of any narcotic pain medications at this time, but it is normal to require it for sleep for an extended period of time. 
  • Some patients resume driving at this time but it is largely determined by which hip was operated on. 

10-14 Days 

  • Patients return to the office for a 2 week follow up where Dr. Martin evaluates the patient’s scar, gait, and overall progress from the surgery. 
  • The skin glue at this time is typically in the process of falling off on its own but can require some light washing with a clean washrag. 
  • Patients begin to advance their activity levels and have weaned off of the walker in public at this time. 
  • Resuming non-impact activities such as chipping and putting can be expected. 

4-6 Weeks 

  • Anterior hip precautions fall away 
  • Patients begin to resume more heavy impact activities with guidance from Dr. Martin 
  • Patients notice the swelling and stiffness associated with the surgery begin to dissipate. 

10-12 Weeks 

  • Patients are back to work and normal activities. 
  • Dr. Martin recommends maintaining a home exercise program to continue strengthening the joint. 
  • Patients are discharged from the office and only follow up on an as-needed basis. 

Common Anterior Hip Replacement Recovery Questions 

When Can I Use The Stairs 

  • As soon as you feel comfortable and stable 

When Can I Drive Again 

  • Driving depends on which hip had surgery and your individual use of pain medications but often patients start driving after 1-2 weeks 

When Can I Resume Sexual Activity 

  • Sexual activity can be resumed at your comfort so long as anterior hip precautions are abided by ( no deep lunging or extreme hip extension) 

When Can I Return To Work 

  • It all depends on what you do for work, patients with sedentary jobs can return as early as 1 week, others with high impact jobs may require 4-6 weeks. 

When Can I Start Exercising 

  • Walking starts day 1 
  • Non-impact exercises like the exercise bike, swimming, and elliptical can be started within 1 week of surgery 
  • Heavy impact exercises like tennis and weight lifting can be resumed after 6 weeks 

When Can I Travel On An Airplane? 

  • 2-4 weeks after a hip replacement with restrictions. Please speak to the office about air travel recommendations as it can vary from patient to patient 

Will I require antibiotics for dental cleanings or dental work? 

  • Dental work poses a risk for infection close to surgery so it is recommended you wait 4 weeks after surgery prior to any dental work. Additionally, for 3 months from the date of surgery, Dr. Martin recommends an antibiotic for any dental work. After this time period, the dentists or treating specialist will decide. 

Top Tips for Avoiding Joint Pain this Winter

When winter weather rolls into town people often feel that it not only brings tidings of holidays, shopping, and family but also joint pain. For some, they feel it so keenly that they seem to be able to predict the weather changes based on the status of their joints. Although science provides no clear explanation of this phenomenon several studies have documented the correlation between weather fluctuations and joint pain. 

The Correlation Between Weather And Joint Pain

There are some theories that can explain the correlation including the changes in barometric pressure with the shift in season. A decrease in temperature may also thicken the fluid that lines the joints, causing more stiffness and sensitivity to pain. Winter also leads to inactivity and changes in the activity which can lead to painful joints. Cold weather may even affect us at the genetic level as a 2015 study noted that genes that promote inflammation are more active in the winter while anti-inflammatory genes are suppressed. 

In addition to all of this, the incidence of illness increases in the winter, leading to more pain and inflammation for those who fall sick. 

Tips To Prevent Joint Pain in the Winter

As for patients who experience this influx of pain with the season change, they certainly agree there is a link and often look for a way to relieve the joint pain. If cold weather has been causing joint pain for you or your loved ones the following conservative treatments may offer some relief: 

  • Warm-up with activity: When the temperature drops doing a few stretches, using a recumbent bike, or finding a local exercise class can increase mobility and reduce pain. Be sure not to overdo it and listen to your body. 
  • Help reduce inflammation: Diet plays a large role in the body’s overall inflammation. Highly processed foods, sugary foods and foods high in saturated fat can increase inflammation and therefore pain. Avoiding these can help reduce pain and help patients lose extra weight which will also reduce stress on your painful joints. 
  • Stay warm with layers and heat: wearing the proper clothing, especially here in Arizona, will be helpful. If you are used to wearing shorts year-round it may be time to get some long pants to wade through the winter months. Moreover, we are hesitant to use heat here, but it can be helpful to prevent joint pain. An electric blanket or heating pads are also wonderful. 
  • Taking OTC (over the counter) painkillers with care: medication like Advil (ibuprofen/Motrin), Aleve (naproxen/Naprosyn) and acetaminophen (Tylenol) can help get you through painful periods. These medicines are not without side effects, however, and if you plan to use them you should consult with your doctor before using them. Follow the instructions they give you regarding dosing, type and frequency because these medications can cause new problems or worsen existing ones. 
  • Try OTC rubs and creams: Patients often find relief with OTC ointments and creams including Blue Emu, Salonpas Icy Hot, Bio Freeze, Arnicare, and Aspercreme. In a recent study, Capzasin was the top-recommended product, but each person’s experience is different. Find what works best for you. 
  • Try an herbal remedy: Turmeric (curcumin), arnica, ginger, aloe vera, and other medications have been shown to help reduce pain and inflammation. As with any medications these can have side effects and you should contact your doctor prior to trying them. 
  • Alternate between using ice and heat: Ice and heat can both be effective during flare-ups, and alternating between the two throughout a painful spell can be beneficial. Do no use either for longer than 10-20 minutes and do not sleep with heating pads or ice machines on. This can cause serious skin damage. 
  • Keep swelling to a minimum: keeping your joints from swelling can help prevent pain. You can use well-fitting gloves, compression garments, and compressive knee braces to help reduce swelling and improve functionality. Make sure any tight item whether it be a piece of clothing, glove, or brace does not squeeze too tight so as to prevent blood flow. If you feel a limb become cold or tingly remove the items immediately. 
  • Lastly, remember the weather will change: Looking ahead to warmer days can help prevent the psychological effect that the cold, dark, and damp weather may have on your body. Studies have found that patients can experience a lower threshold of pain during the winter months due to a lack of sunlight. To prevent this find ways to occupy your mind with things you enjoy, try to get enough sleep and maintain a good diet (even during the holidays). Learning how to improve your mood plays a big role when managing chronic joint pain, but if you feel your mood is slipping out of your control follow up with your doctor. 

Common Running Injuries And How To Prevent Them

Running is a physically demanding activity that works your entire body but impacts your lower body with every footstrike. When you run your weight-bearing joints, specifically the knees and hips experience pressure around 3 times your body weight when walking and approximately 5 times your weight when running. Although reported running injuries range in each study a broad review of the literature notes that the average runner experiences from 2.5 to 12.1 injuries per 1000 hours of running.  It’s not surprising then that hip and knee pain is a common trend among runners. Although sometimes debilitating, these pains can often be managed with conservative treatments like RICE ( rest, ice, elevation, compression), stretching, strengthening exercises and modifying the frequency and intensity of your runs. 

Common Running Injuries Runners Face

Knee Injuries

The knees are the major shock absorbers for the body while running and they also play an important role in locomotion or propelling you forward as you run. Because of this function, the kees are often injured or irritated by running. 

1. Patellofemoral Pain Syndrome (PFPS) 

Also known as runner’s knee is the most common knee injury. Runner’s Knee affects the point between your patella (kneecap) and the femur (thigh bone), more specifically the cartilage behind the kneecap. Symptoms of runner’s knee include Mild swelling, pain or soreness when you complete any activity that puts pressure on the knee, such as running, stairs, kneeling and squatting. Your knee may pop and crack (known as crepitus) a lot more when you bend and straighten the knee. 

 How To Treat Runner’s Knee:
  • Take a break from running
  • Reduce mileage
  • Cross-train with activities that don’t aggravate your knee
  • Apply ice for 15 minutes five times a day
  • Compress the knee with an ACE wrap or compression sleeve 
  • Take an anti-inflammatory like Aleve 
  • Quad and hamstring stretching 
  • If the pain persists or worsens, follow up with a doctor
How To Prevent Runner’s Knee:
  • Keep the muscles around your knee and hip strong with strength training 
  • Stretch and roll daily
  • Shortening your stride can take the pressure off your knees. Aim for 170-180 foot strikes per minute

2. Patellar Tendonopathy 

Or patellar tendonitis is a common soft tissue pain from running.  It is typically called Jumper’s Knee because it affects people who do a lot of sports that require excessive jumping or landing on the knee – such as with running. The patellar tendon connects your kneecap to your tibia( lower leg bone). When the attachment is stressed repetitively it becomes inflamed and irritated. Symptoms for patellar tendonitis include a stiff or swollen knee. The tendon may look thicker and swollen along the front of your knee. To be sure, compare it to the unaffected side. You may have pain in your knee while walking or running along with pinching or burning sensation on the bottom of the kneecap. 

How To Treat Patellar Tendonitis: 
  • Stop running until you can do so pain-free; cross-train instead
  • Apply ice for 15 minutes five times a day
  • Using a Chopat strap AKA  patellar tendon strap can reduce pain

If the pain persists or worsens, follow up with a doctor.

How To Prevent Patellar Tendonitis: 
  • Strength training to balance muscle tension in your hamstrings and quadriceps 
  • Stretch your quads and hamstrings 
  • Foam roll daily

3. Illiotibial Band Syndrome (ITBS) 

Another common knee injury from running is Iliotibial Band Syndrome (ITBS) and is in line to overtake PFPS as the most common knee pain from running. This injury affects the outer hip to the knee which is where your iliotibial band (ITB) runs from your ilium of the hip to the tibia or your lower leg bone.  Your knee extends and flexes when you run, which causes the IT band (outer hip to knee area) to run against the femur, leading to friction and pain in the outer knee joint. Symptoms of ITBS include swelling and inflammation with lateral knee pain that comes when you are using the knee and goes away when you stop using it.

How To Treat ITBS:
  • You can run unless pain forces a change in your form; Reduce your mileage and cross-train
  • Foam roll your ITB on the soft part of your outer thigh
  • Do ITB stretches 
  • If you overpronate when you run/walk, wear motion-control shoes 
  • See a doctor if it persists
How To Prevent ITBS:
  • Strengthen your glute and core (abdominal) muscles 
  • Foam roll or stretch your ITB daily
  • A shorter, quicker stride can help. Aim for 170-180 foot strikes per minute

4. Osteoarthritis ( OA)

OA is a form of wear and tear arthritis. Running increases the wear on the hyaline cartilage which protects the ends of your bones. Once this cartilage begins to degrade your bones will rub on each other and cause pain. OA will also present with stiffness, warmth and swelling after impact activity like running. 

How To Treat OA:
  • Continued movement helps preserve the knees
  • Take an anti-inflammatory or Tylenol 
  • Run on soft surfaces 
  • Add in non-impact activities such as swimming or biking 
  • Follow up with a specialist for other conservative options 
How To Prevent OA:
  • Weight loss
  • Reduce impact activity 
  • Strength training

5. Other Soft Tissue and Bone Injuries 

Running can elicit a variety of injuries to the knee including meniscal pathology, subchondral fractures, chondral lesions, among others. The key for knee pain is that if it fails to respond to conservative treatments like RICE and over the counter (OTC) medications then you should stop running or the activity that causes the pain and follow up with a specialist. 

Common Hip Injuries In Runners

The hip is our largest ball and socket joint in the body and is surrounded by large ligaments and muscles. Running can not only stress the ball and socket joint itself but also the hips support structures. Hip pain is common in runners because it is easy for hips to become tight. This can leave them less flexible under the pressure and impact of running, leading to stress and strain. Eventually, this can lead to pain and injury.

1. Muscle Strain and Tendonitis

Muscle strain and tendonitis occur when muscles in the hips are overused. You may feel aches, pains, and stiffness in your hips, especially when you flex your hip or climb the stairs.

How To Treat Muscle/Tendon Strain:
  • Stretch before and after your run, focusing on the muscles around the hip joint 
  • Foam roll
  • Take a break from running and cross-train with non-impact exercise 
  • If you overpronate when you run/walk, wear motion-control shoes 
  • Ice the affected area for 20 mins, 3-4 times a day
  • Over the counter (OTC) non-steroidal anti-inflammatory medications (NSAIDs) like ibuprofen if allowed can be helpful 
  • See a doctor if it persists
How To Prevent Muscle/Tendon Strain:
  • Strengthen your glute and core (abdominal) muscles 
  • Stretch your hip and gluteal muscles regularly, especially the hip flexors (think runners lunge) 
  • A shorter, quicker stride can help. Aim for 170-180 foot strikes per minute

2. Bursitis 

Bursae are fluid-filled sacs that cushion the bones, tendons, and muscles protecting each other from shear forces. Repetitive motions, such as running, put pressure on your bursa, causing them to become painful and inflamed. This leads to bursitis, which is characterized by swelling, redness, and irritation.

How To Treat Bursitis:
  • Stretch before and after your run, focusing on the muscles around the hip joint 
  • Foam roll
  • Take a break from running and cross-train with non-impact exercise 
  • If you overpronate when you run/walk, wear motion-control shoes 
  • Ice the affected area for 20 mins, 3-4 times a day
  • Over the counter (OTC) non-steroidal anti-inflammatory medications (NSAIDs) like ibuprofen if allowed can be helpful 
  • Physical therapy 
  • See a doctor if it persists
How To Prevent Bursitis: 
  • Strengthen your glute and core (abdominal) muscles 
  • Stretch your hip and gluteal muscles regularly, especially the hip flexors  runners lunge) and IT band ( figure 4 stretch) 
  • A shorter, quicker stride can help. Aim for 170-180 foot strikes per minute
  • Running on a softer surface like a track 

3. Iliotibial Band Syndrome (ITBS) 

Iliotibial Band Syndrome (ITBS) is the same IT band that can give you knee pain. This injury affects the outer hip to the knee which is where your iliotibial band (ITB) runs from your ilium of the hip to the tibia or your lower leg bone. You may feel or hear a clicking or popping noise when you move. Symptoms of ITBS include swelling and inflammation with lateral hip pain that comes when you are using the hip and goes away when you stop using it.

How To Treat ITBS:
  • You can run unless pain forces a change in your form; Reduce your mileage and cross-train
  • Foam roll your ITB on the soft part of your outer thigh
  • Do ITB stretches 
  • If you overpronate when you run/walk, wear motion-control shoes 
  • Rest, Ice 
  • OTC medications like Ibuprofen as discussed above 
  • See a doctor if it persists
How To Prevent ITBS:
  • Strengthen your glute and core (abdominal) muscles 
  • Foam roll or stretch your ITB daily
  • Stretch the other large muscles around the hip to avoid imbalance 
  • A shorter, quicker stride can help. Aim for 170-180 foot strikes per minute

4. Labral Cartilage Tears

  • Your labrum is the ring of cartilage in the socket portion of the hip that helps cushion and stabilizes the ball. Tears in the labrum can occur from repetitive motions like running or jogging. Often times these tears present with a clicking, catching or locking when you move. You may feel and hear it. You may experience stiffness and limited mobility. 
How To Treat a Labral Tear: 
  • If you suspect you have a labral tear, make an appointment with a doctor 
  • Stop running and ice the joint
  • Use OTC medications like Tylenol or ibuprofen if allowed 
How To Prevent a Labral Tear: 
  • Maintain a healthy weight 
  • Stretch regularly
  • Cross-train and allow your hip to rest 

5. Other Soft Tissue and Bone Injuries 

Running can elicit a variety of irritations in the hip including but not limited to iliopsoas (hip flexor muscle) tightness and snapping, avascular necrosis, subchondral fractures, chondral lesions, among others. The key for hip pain elicited by running is that if it fails to respond to conservative treatments like RICE and over the counter (OTC) medications then you should stop running or the activity that causes the pain and follow up with a specialist. 

Ankle Injuries

Runners are extremely susceptible to ankle injuries because the ankles are important in all 3 axis of rotation in addition to shock absorption.  Ankle strain, tendonitis, and stress fractures are the most common injuries that runners sustain in the ankle joint. Injuries to the ankle often require a hiatus from running while the injury heals and you rehab the joint.  If your ankle pain fails to improve with RICE and other conservative treatments it is important to follow up with a medical professional. 

Exercises to Prevent Running Injuries

To prevent injuries from running, always start slow.  Take small bites when approaching a new training program, whether it be running itself or a strength and conditioning program to help manage your endurance. 

Here are some exercises that can help prevent injuries 

Single-Leg Squat (helps improve pelvic stability, gluteal strength, overall balance)

  • Stand on one foot. Bending at the knee, sit your hips back as if you are going to sit in a chair behind you. Aim for your upper leg to be parallel or lower to the ground. Do not let your knee pass your foot. 
  • Return to a standing position. Repeat 12 reps before switching to the other leg.

Standing Calf Raises/ Calf Stretch

  • Start on your tiptoes on the edge of a step (make sure you are well balanced), gradually lower one heel below the step.
  • Using the other leg, raise yourself back to the starting position.
  • Do three sets of 15 reps of each exercise twice a day.

Gluteal and Hip External Rotator Strengthening

  • Kneel on the floor with your hands on the ground, knees below your hips and hands beneath shoulders.
  • Lift one knee off the floor and way out to the side
  • Hold for 1-2 seconds and lower as slowly as you can. 
  • Perform 10  times, then repeat on the other leg.

Side Leg Raises (for gluteal strength) 

  • Lay on your right side with your legs extended out and stacked on each other.  Head can be supported with hand or on a pad/pillow.
  • Engage your left glute muscles and slowly lift up your leg keeping your foot in a neutral position.
  • Lower leg to starting position. Do 12 reps. Repeat on the other side. May use a resistance band for higher intensity.

Plank (core building)

  • Begin in push up position and lower down to your forearms, making sure shoulders are over elbows and palms are flat on the floor.
  • Make a straight line from your head to your heels, hold this position for 20-60 seconds.
  • Do not drop your hips, make sure to squeeze your glutes to protect your low spine. 

Side Plank (core building)

  • Put one elbow on the ground with your side on the ground.
  • Extend both legs out so that your body is in one straight line, balancing on the outside edge of your bottom foot.
  • Keep your waist up and lifted, and don’t sink into your bottom shoulder. Reach your upper hand to the ceiling.
  • Hold for 20-60 seconds before repeating on the opposite side.

Runners Lunge 

  • Place one leg forward, knee bent at 90 degrees. Do not let your knee pass your foot. 
  • Place the other leg behind you, toe to the ground, heal in the air. 
  • Hold a static stretch for 15- 30 seconds. Do not bounce
  • Repeat on the other side, repeat as many times on each side as feels good.

Forward Stretch

  • While protecting your low back, keep your knees straight and lean forward
  • Hold for 15-39 seconds
  • Stand up slowly, one vertebra at a time. 
  • Repeat one more time for a full stretch

8 Things To Know About Makoplasty Joint Replacement

Robotic surgery is at the cutting edge of medicine and is often an important discussion point for patients undergoing elective surgery. Makoplasty offers valuable insight into precision methods that allow surgeons to work more efficiently, and for patients to recover much sooner than with traditional surgical methods.

1. What Is Robotic Surgery? 

Robotic surgery, in general, is a type of surgical procedure that allows surgeons to perform complex surgical procedures while circumventing limitations of traditional and minimally-invasive surgery. Robotics enhance the surgeon’s skills with advanced control, flexibility and precision. Robotic surgery or robotic-arm -assisted surgery for MAKOplasty, allows Dr. Martin to perform a total hip replacement, total knee replacement, and partial knee replacement with these benefits. 

2. What Is The Makoplasty Robotic System? 

It is a state of the art remedy for patients suffering from painful joints and arthritis of the hip or knee. The system utilizes a 3D virtual model of your unique anatomy and a robotic arm, called Mako which helps Dr. Martin plan and perform your joint replacement surgery with increased accuracy and efficiency. 

3. What Does The MAKOplasty treat? 

The Makoplasty robotic-arm assisted surgery is indicated for patients with degenerative or traumatic damage in the hip and knee joints. 

The current Mako System offers Partial Knee, Total Hip and Total Knee applications.

4. Who Is A Candidate For A Mako Procedure? 

Any patient who is a candidate for a traditional hip or knee joint replacement procedure is a candidate for a robotic arm assisted procedure. 

Typically, robotic joint replacement patients share the following characteristics:

  • Knee or hip pain with activity
  • Start-up pain or stiffness when activities are initiated from a sitting position
  • Failure to respond to non-surgical treatments including injections, physical therapy, activity modification and nonsteroidal anti-inflammatory medication

Patients suffering from diseases including osteoarthritis, rheumatoid arthritis, avascular necrosis, and traumatic arthritis can find their way back to activities and a better lifestyle with robotic replacement surgery. 

5. How Does MAKOplasty Work? 

The MAKO robotic arm interactive orthopedic system creates a three-dimensional pre-surgical plan from your personal CT scan. Dr. Martin uses this pre-surgical plan to template the appropriate implants for your needs. 

During surgery, the system provides him with real-time visual, tactile and auditory feedback to facilitate optimal joint resurfacing and implant positioning. 

It is this precise placement that can result in more natural knee or hip motion following surgery.

The precision of the robotic arm also lessens post-op soft tissue irritation. 

6. What Can I Expect If I Have A Robotic-Arm Assisted Surgery? 

MAKOplasty robotic surgery can be performed as either an inpatient procedure or on an outpatient basis depending on what Dr. Martin determines is right for you. 

The majority of Dr. Martin’s MAKOplasty surgery is performed in an outpatient setting and patients return home the same day.

Patients are permitted to walk directly after surgery, drive a car within two weeks and return to normal daily activities shortly thereafter. 

7. Is Mako Covered By Insurance?

MAKOplasty is typically covered by most Medicare-approved and private health insurers.

8. What Is The Lifespan Of A Makoplasty Implant?

All implants have a life expectancy that depends on several factors including the patient’s weight, activity level, quality of bone stock and compliance with Dr. Martin’s recommendations.

Proper implant alignment and precise positioning during surgery are also very important factors that can improve the life expectancy of an implant.

Through the use of the robotic arm system, your implants are optimally aligned and positioned to ensure the longest benefit.

Individual results may vary. There are risks associated with any joint replacement surgical procedure, including MAKOplasty®. Dr. Martin can explain these risks and help determine if a MAKOplasty® procedure is right for you. For more information on the MAKOplasty robotic-arm assisted surgery please click here.

Injury Prevention Sports Injuries

How to Prevent Common Golf Injuries and Protect Your Joints

Golf, despite its quite reputation, is a very physical sport. While Golf’s inherent dangers aren’t obvious, players are often injured or in pain. Most professionals exercise to remain conditioned for golf but even still the aggressive nature of a golf swing may place hefty stress on their body causing a majority of professional golfers to experience some sort of nagging injury. Here in the valley of the sun, we have prime golf weather and the courses are filled with all levels of experience. But you don’t have to be a professional to experience some of the most common golf injuries.  Recreational golfers experience the same injuries as professionals. 

Most injuries stem from some part of the swing which entails balancing a powerful forward motion, extreme muscle contractions, and the “long lever arm effect” created by the force of the golf club. Other injuries come can be a result of the repetitive nature of golf or from improper form. 

Some Common Golf Injuries Include: 

1. Golf Knee Injuries

Knee pain, especially in the lead knee, can occur from the strain placed on a weak knee to stabilize the rotation of the hip axis at the beginning of the swing. Extreme force placed on the knee can result in strained or torn ligaments and muscles. This stress can also cause existing arthritis to become increasingly painful due to the shearing force between the bones. 

Treatment of knee pain largely depends on the underlying condition. Most conditions are inflammatory and acutely respond to rest, ice, compression, and elevation ( RICE) along with over the counter anti-inflammatory medications like ibuprofen. If the knee pain is recurrent or fails to improve a visit to the doctor is recommended.  Knee pain and injury can be prevented by stretching prior to playing, bracing, and proper form. Over the counter compression sleeves and hinged knee braces can be beneficial to help support the knee during 

2. Golf Hip Injuries

Although hip pain is a less common complaint, it can halt the power and fluidity of a swing. The hip is the body’s bridge to the legs making it integral in the stance, posture, weight shift, and creating torque. Pain in the hip can keep golfers from the course. Typically hip pain and injury arise from the repetition of golf where swinging puts excessive pressure on the hip and its supporting muscles especially if the players form is compromised. Chronic pain in the hip can arise from bursitis, tendonitis, muscle strain, and arthritis. More serious acute injuries include stress fractures, labral tear, hip impingement and loose body (bone or cartilage in the joint).  Like any golf injury playing with pain does not lead to positive outcomes. Evaluation by a professional is important along with rest and rehabilitation. These steps lead back to the course. 

3. Golf Wrist Injuries

The most common golf-related wrist injury is tendinitis or inflammation of the tendons responsible for wrist movement.  Golfers often injure their lead wrist because due to weakness or poor position. This leads to overload which causes pain and tenderness on the top of the wrist. Typically the wrist is painful at the top of the backswing and at impact. Adjusting your wrist angle can help prevent this. To prevent wrist tendinitis condition and strengthen your wrists and forearm. 

4. Golf Back Injuries

Golfers are at high risk for a back injury due to the rotational stress of the swing. It can place extensive pressure on the spine and muscles. This rotational irritation is compounded by the repetitive bending, often totaling 4-5 hours, per round. This scenario causes strained muscles, tendons, and discs which can lead to more serious conditions. In order to prevent back injuries in golf add in exercises that stretch and strengthen your back, including core workouts. 

5. Golf Shoulder Injuries

Swinging with a sore shoulder is not only detrimental to the game it can also cause significant injury.  Like with other injuries shoulder pain can come from a variety of sources including muscle, bone, cartilage, and most commonly tendon. The rotator cuff tendons often bear the brunt of an explosive golf swing. Treatment will depend on the type of underlying injury but as other injuries acute shoulder pain often responds to rest, ice, and anti-inflammatory medications. 

How To Prevent Golf Injuries

To prevent injuries, professional golfers follow structured conditioning programs as most professional athletes do. Although most recreational golfers cannot dedicate as much time as the professionals maintaining fitness is a keystone of a healthy and competitive golf game. Although most injury prevention focuses on the improvement of the swing there are other means to improve the game and avoid painful situations.

1. Warm-Up

Before hitting the course take a moderately paced 10-minute walk or find another means to increase heart rate and warm the muscles. After getting warm, stretch out your arms, wrists, hands, shoulders, spine, and pelvis. Also, swing the club a few times starting slowly and increasing your range of motion.  

2. Pace Yourself 

Although common, hitting the range to warm up though might not be the best option. If the body is not conditioned for the strain of repetitive swings the range may do more harm than good. Start slowly and work your way towards your goal. 

3. Build Muscle Strength and Endurance 

Strong muscles can help increase club speed and reduce injury rates while Regular aerobic activity can give you staying power on the course. Try walking, bicycling or swimming.

Creating a low maintenance year-round strength and aerobic training program is the best way to approach this goal. 

4. Regular Stretching

Focusing on flexibility and range of motion can lead to a more fluid golf swing and prevent high-velocity injuries. 

Safety on the Golf Course

  • Golfers who carry their own bags have a high rate of back and shoulder injuries, so be sure to use proper lifting technique by keeping your back straight and using your legs to lift the weight.  
  • Wear proper footwear that provides comfort and protection. Golf shoes with short cleats are recommended. 
  • Try to avoid striking the ground; elbow and wrist injuries are often a result of hitting the ground or the rough. 
  •  Limit sun exposure, especially in Arizona. Use sunscreen, wear sunglasses with UVA and UVB protection, and wear a hat or visor to shade your face. 
  • Drink plenty of water and watch for signs of dehydration and heatstroke. 
  • Keep your feet inside the cart to avoid broken ankles
  • Watch for storms 

Beyond basic fitness and precautions, players should work with a golf professional to learn proper swing techniques. Proper form reduces stress on the joints and spine while helping improve agility and flexibility whereas a poor swing increases the risk of injury.  Before taking the first swing, though a golfer should stretch and warm-up including walking prior to playing, walking the first fairway, and focused stretching prior to each round.