Penn Orthopaedics

Penn Orthopaedics

Monday, October 12, 2015

Three Myths about Severe Hip Pain and Hip Replacement Surgery

Think of your favorite activity. You’ve done it for years either recreationally or professionally, but lately the nagging pain in your hip is making it difficult. You switch to something less intense—from singles tennis to doubles or from full-court basketball to half-court.

Atul Kamath, MD
Atul Kamath, MD
Soon, the pain grows so bad that you give up your activity and take up swimming or walking to ease strain on your joints. You dread seeing an orthopedic specialist because you are concerned they will say you need a hip replacement. And that will take you out of the game completely, right?

Not really.

Atul Kamath, MD, Director of the Penn Medicine Center for Hip Preservation, addresses three myths about severe hip pain.

Myth #1: Joint replacement is the only treatment option for hip pain.

Part of this myth is rooted in history. “In the ’90s and even into the early 2000s, young patients with hip pain would be told by doctors, ‘Well, we’re only seeing mild degenerative changes on X-ray, so you’ll have to deal with the pain and get a hip replacement later on if the arthritis worsens,’” recalls Dr. Kamath.

Now, instead of joint replacement, non-surgical and minimally invasive procedures can be done to preserve the hip joint.

Non-surgical options include things like physical therapy, acupuncture, and manual massage. “These are all good adjunctive therapies that help recover, but in isolation may not help relieve pain and improve function on a long-term basis,” he advises.

Surgical procedures to address the root cause of the hip pain include:
  • Hip arthroscopy: A minimally invasive surgery to repair damage, such as cartilage injury, deep inside the hip joint.
  • Core decompression: A minimally invasive technique to decompress dead bone tissue in the hip socket. Pelvic bone stem cells can be re-injected to stimulate the growth of new, healthy bone tissue.
  • Osteotomy: An open surgery to form a more normal or stable hip socket, particularly for patients with dysplasia.
  • Surgical hip dislocation: An open surgery that dislocates the hip joint from the socket—without reducing blood supply—to correct severe deformities and cartilage damage.

Myth #2: Treatment for hip pain only applies to older people.

Sure, age can be a factor, but the health of your cartilage is really the key.

Dr. Kamath sees young patients who have had childhood diseases like Perthes disease or dysplasia. They may have had treatments as a young child, and now they’re experiencing hip pain or dysfunction related to abnormal bone structure.

Dr. Kamath also sees other patients like 20- and 30-year-old elite athletes or performers who routinely twist their hips into extreme positions, causing hip injury. Then, there’s the 30- to 50-year-olds who are very active, but now have some wear and tear at the hip joint.

These groups aren’t eligible for hip replacement, but they may be candidates for hip preservation because of their healthy cartilage.

Hip replacement is reserved for patients with poor cartilage, arthritis and joint damage that is too far gone to save.

Myth #3: Hip pain always feels like hip pain.

Not necessarily. Sometimes, it can feel more like you pulled a muscle in your groin, which makes it harder to identify.

“With groin pain, it may be vague and often deep-seated in the joint,” Dr. Kamath explains. “And there’s a whole confluence of muscles, nerves and other tissues right around the hip, as well as, pain that may come from the low back or pelvis.”

hip pain
“With true hip joint pain, you can’t often literally put your finger on the pain, so it can be challenging for the patient,” he adds.

This is because most people think their hip joint sits at the side of the upper thigh. “The hip joint is actually more in the groin,” Dr. Kamath explains. “If you put one finger in front of the groin and one finger in back and meet them in the middle, that’s actually where the hip joint is located.”

Surprisingly, hip pain can also feel like back pain, especially when there is a component of buttock pain or pain that wraps around the side or front of the hip. A skilled clinician can tease out these subtleties.

Whatever type of hip pain you’re experiencing, you do have options.

“In orthopaedics, the beauty is that most things are elective,” Dr. Kamath adds. “Just reaching a correct diagnosis, getting some information, and understanding the treatment options goes a long way in helping decide—even if surgery isn’t an option.”

Don’t put off addressing your hip pain.

Schedule an appointment with a specialist at the Penn Musculoskeletal Center today.

Not ready to see a doctor? Download our free guide Managing Your Hip Pain.

Wednesday, October 7, 2015

When Shoulder Pain Disrupts Sleep

Peaceful, undisturbed sleep.

Andrew F. Kuntz, MD
Isn’t that what we’re all looking for?

Unfortunately for many, shoulder pain and the nagging discomfort that accompanies it have led to countless sleepless nights.

Sleep is a critical component to good health. Tossing and turning throughout the night can cause you to be less active and mentally exhausted during the day. It can even reduce the time it takes your body to recovery from injuries.

One of the most common shoulder injuries, a torn rotator cuff is often the source of intense pain and restlessness. The rotator cuff is a group of tendons and muscles that connect the upper arm to the shoulder blade. You may have gotten this from wear and tear over time or from some type of quick motion that led to a tear.

It’s Time to Get Your Zzz’s

The good news is that there are things you can do on your own and with your doctor to break the cycle. With changes to your lifestyle – and possibly medication – you should be able to get back to enjoying a good night’s rest.

trouble sleeping"Depending on the type of injury, adjustments in sleeping posture, anti-inflammatory medication, heating pads and ice packs can all help to relax a painful shoulder," said Andrew F. Kuntz, MD, shoulder surgeon at Penn Orthopaedics. "However, if those non-operative treatments are unsuccessful, it’s time to seek medical atten

If you have shoulder problems, the Penn Shoulder Service provides comprehensive care and surgery. Surgery is typically recommended if:

Symptoms last more than six to 12 months
  • Your tendon tear is bigger than three centimeters
  • You experience significant weakness/ loss of function
  • Your tendon tear was caused by a traumatic injury 
The team will work with you to customize a treatment plan to help you feel better and sleep better.

"If you're tired of the pain and wakefulness, the specialists at Penn Medicine can help,” said Dr. Kuntz. "Our nationally and internationally recognized orthopaedic specialists create and use the latest advances in shoulder diagnosis, treatment, surgery and rehabilitation to get you back to living pain-free."

The Region’s First Musculoskeletal Center

The Penn Musculoskeletal Center is a team of doctors, nurses and physical therapists who take a whole-body approach to diagnosing and treating joint pain. These experts work together as a seamless unit to provide a wide range of treatments, not just surgery, and help you return to an active, pain-free lifestyle.

Wednesday, September 23, 2015

Seven Foods to Help You Fight Arthritis

It’s true.

Certain foods can actually help to ease arthritis symptoms and improve your overall joint health.

Along with the use of medications, a proper diet can curb the inflammatory responses from the body that cause pain. Eating the right foods also helps you maintain a healthy weight, which is incredibly important since your hips and knees support most, if not all, of your body weight.

To ease your arthritis pain, try these five types of food:

Fatty Fish

Salmon, mackerel and tuna have high levels of Omega-3 fatty acids and vitamin D. Both of these have been found to help reduce inflammation. We recommend a healthy diet that includes fish a couple of times a week. For non-fish eaters, consider fish oil supplements as an alternative.

Dark Leafy Greens

Spinach, kale, broccoli and collard greens are great sources for vitamins E and C. Vitamin E works to protect the body against pro-inflammatory molecules. Vitamin C helps the body make collagen, which is a major component of cartilage that aids in joint flexibility.


Almonds, hazelnuts, peanuts, pecans, pistachios and walnuts contain high amounts of fiber, calcium, magnesium, zinc, Vitamin E and Omega-3 fats which all have anti-inflammatory effects. Nuts are also heart-healthy, which is particularly important for people with rheumatoid arthritis (RA) since they have twice the risk of heart disease as healthy adults.

Olive Oil

Extra virgin olive oil is loaded with heart-healthy fats, as well as oleocanthal, which has properties similar to non-steroidal, anti-inflammatory drugs. Olive oil, combined with vitamin D, has also been shown to protect against bone loss.


Berries pack a double dose of anti-inflammatory properties. All fruits are high in antioxidants, which can help fight inflammation. Additionally, foods like blueberries, raspberries, strawberries and blackberries contain anthocyanins, which reduce inflammation.

Garlic and Onions

Believe it or not, but these pungent vegetables contain anti-inflammatory chemicals that have shown to relieve some forms of arthritic pain. As an added bonus, they are also known for their immunity-boosting properties.

Green Tea

This mild-mannered drink contains a natural antioxidant called epigallocatechin-3-gallate (EGCG). This ingredient has been shown to stop the production of certain inflammatory chemicals in the body, including those involved in arthritis. Recent studies also suggest that EGCG may prevent cartilage from breaking down, helping to preserve joints longer.

While it’s important to incorporate as many of the items listed above into your diet, there are foods you should try to avoid. Those high in saturated and trans fats – such as red meat, fried food and packaged baked goods – are unhealthy in general and can lead to weight gain, which can make symptoms worse.

To speak with a physician for more helpful tips on how to manage your joint pain, schedule an appointment today.

Not ready to speak with a physician? Check out our "Pain Guide" for more helpful information to manage your pain.

Thursday, September 10, 2015

Advances in Throwing: Latest on Injury Treatment and Performance Optimization

Join us for a dynamic, one-day conference to learn about the latest tools and techniques for treating throwing athletes. Specialists from Penn Medicine and beyond will share their expertise in a series of panels, presentations, and debates designed to advance injury treatment and optimize performance for throwing athletes, focusing on:
  • Proper biomechanical principles to evaluate the kinetic chain
  • Sound treatment for common injuries
  • Optimizing training for peak performance
  • Updates on the latest surgical techniques — including Tommy John surgery

Event Details

Date: Saturday, January 23, 2016
Time: 8:00 a.m. - 5:00 p.m
Location: Biomedical Research Building Auditorium
               University of Pennsylvania
               421 Curie Boulevard
               Philadelphia, PA 19104

Keynote Speakers

W. Ben Kibler, MD, FACSM

W. Ben Kibler, MD, FACSM, Lexington Clinic Orthopedics – Lexington, KY
Dr. Kibler is the medical director at the Lexington Clinic and a former vice president of the American College of Sports Medicine.

Phillip Donley, PT, ATC, MS

Phillip Donley, PT, ATC, MS, Optimum Physical Therapy Associates, PC – Swarthmore, PA
Mr. Donley has practiced physical therapy in the Philadelphia region since 1957, authored numerous papers, and has consulted with the Phillies and the Eagles.

Craig D. Morgan, MD

Craig D. Morgan, MD, Morgan Kalman Clinic – Wilmington, DE
Dr. Morgan has cared for Major League Baseball pitchers, Olympic-level athletes and golfers on the LPGA.

*Additionally Event and RSVP Information Coming Soon

Who Should Attend?

This program is intended for athletic trainers, coaches, physical therapists and physicians. Attendees are eligible for eight (8) Continuing Education Units for athletic training.

Wednesday, September 2, 2015

Penn Orthopaedics Welcomes Dr. Gray

Benjamin L. Gray, MD, joins the department of orthopaedic surgery as an assistant professor of orthopaedic surgery. Dr. Gray specializes in the treatment of a wide range of injuries and conditions affecting the hand and wrist. 

Benjamin L. Gray, MD
Benjamin L. Gray, MD

Welcome to Philadelphia, Dr. Gray. Can you tell us more about your decision to join the team of surgeons at Penn Orthopaedics?

Penn Orthopaedics offers the perfect fit for me. Not only am I able to practice what I love, but I am able to continue to teach residents and further my research endeavors. I feel privileged to join the world-class surgeons at Penn Orthopaedics. All of the departments are extremely well-rounded, and I hope to fill out the need in the hand department at Pennsylvania Hospital. I know that my training in hand surgery, as well as microvascular surgery, will complement the department well.

What types of patients will you see? Where will you see them?

My primary focus is the hand, wrist and forearm. I will see adolescent and adult patients with common problems such as carpal tunnel, trigger fingers, arthritis of the hand and Dupuytren’s disease. I will also see any patient that has suffered an injury to their hand or forearm, whether it is a break of the bone, an injury to a nerve, or a tear of a ligament. These injuries could be from anything ranging from a sports injury to a car accident. A portion of my time will also be spent doing microvascular surgery, which are surgeries that involve the small blood vessels and nerves in the hand. This will include being part of the hand transplant team.

I will have two offices – one at Pennsylvania Hospital in Center City and a second at Penn Medicine Radnor.

What is your philosophy on patient care?

I believe doctors should educate patients about their problem so that they can make informed decisions regarding their own care. I try not to tell patients what to do. I want to help them make the best choice by offering what I believe are the best options for their problem. There is not always a single best treatment, and thus I focus my attention on the care of each individual patient.

What kind of research will you be doing as part of Penn Orthopaedics? Can you give us a brief overview of the studies that you will be involved with or look forward to being a part of?

I am currently pursuing a Masters of Science in Clinical Epidemiology to help develop better research projects that focus on outcomes-based research and to strengthen my statistical background. This coursework will span three years. During this time, I will primarily study various treatments for small joint arthritis, as well as Dupuytren’s disease. I will also study the best pain control for patients after surgery.

What do you enjoy doing outside of practicing medicine?

Outside of medicine and my masters program, my main passion is my family. I have a son who was born during my fellowship and has certainly kept me busy. It’s been extremely rewarding to help him reach each milestone and see him develop into a little man. I also have a loving wife who is in her training to be an ophthalmologist and is incredibly supportive. Beyond that, I enjoy running, cycling, playing piano and cooking.

What are you looking forward to the most with your transition to Philadelphia?

My wife and I are looking forward to the amazing food in Philadelphia as we both love to cook and explore new restaurants. There is such an incredible restaurant scene here. Having lived in landlocked cities my entire life, I am excited to be on the coast and hoping for some fresh seafood. We’ve also tried a few Philly cheesesteaks, but have yet to decide on a winner.

It’s football season and Philadelphians love their Eagles. Being from St. Louis, you’ve had an opportunity to see Sam Bradford firsthand. What can you tell the people of Philadelphia about him?

I've actually had the opportunity to see Sam Bradford in practices and watch him develop over the years in St. Louis. During my orthopaedic training at Washington University in St. Louis, I helped cover the team as a team physician during my sports medicine rotations. I think Philadelphia will be a great fit for Bradford and, with the addition of his college teammate/roommate DeMarco Murray, it will give him that extra boost of confidence. I expect it to open up the passing game because defenses will have to keep an eye on Murray.

Is there anything else you would like your patients to know about you?

My passion is helping improve the lives of my patients. I hope patients find me to be approachable, knowledgeable and compassionate.

To schedule an appointment with Dr. Gray, visit

Thursday, July 30, 2015

GPS for Better Knee Replacements

David G. Nazarian, MD
David. G Nazarian, MD
For many with chronic knee pain, knee replacement is the best option to get them back on their feet. But not all knee replacements are the same. Each procedure is tailored to patient preference and the type of pain.

Advancements in minimally-invasive procedures and medical technology have given patients more options than ever. Since the first knee replacement surgery was performed in 1968, there are now 700,000 people who undergo this procedure each year, according to the Centers for Disease Control. David G. Nazarian, MD, an orthopaedic surgeon at the Penn Musculoskeletal Center, uses cutting edge sensor technology to help his patients get the best possible outcomes.

In order to properly balance the joint during knee replacement surgery, Dr. Nazarian utilizes a sensor, which provides real-time data related to balance and alignment. This allows for the best possible positioning of the replacement, thus reducing the likelihood of the implant failing.

The Penn Musculoskeletal Center

The Penn Musculoskeletal Center is a team of doctors, nurses and physical therapists who take a whole-body approach to diagnosing and treating joint pain. These experts work together as a seamless unit to provide a wide range of treatments, not just surgery, and help you return to an active, pain-free lifestyle.

Wednesday, July 29, 2015

World's First Pediatric Double-Hand Transplant Performed in Philadelphia

L. Scott Levin, MD, FACS
Thanks to Penn Medicine surgeons from the departments of Orthopaedics, Transplant, and Plastic Surgery, Zion Harvey, 8, is the first child to receive a bilateral hand transplant. The procedure, which lasted 10 hours, took nearly two years to plan.

"The planning took approximately 18 months," said team leader L. Scott Levin, MD, FACS, chair of the Department of Orthopaedic Surgery at Penn Medicine and the director of Penn and CHOP’s Hand Transplant Program. "For those of you who are familiar with the book about Apollo 13, Failure Is Not an Option, that's how our team approached this transplant."

Zion suffered a life-threatening infection at age two that forced doctors to amputate both his hands and feet. Harvey says the new hands are a dream come true. "I just want to say this, never give up on your dreams. It will come true."

More Links:

8-year-old becomes 1st child to get double hand transplant
For the first time ever, doctors have transplanted donor hands and forearms onto a child. Eight-year-old Zion Harvey lost his hands and feet at the age of 2 due to a serious infection that also led to a kidney transplant.

8-Year-Old Boy Gets Double Hand Transplant in Surgical First
In a surgical first, Philadelphia doctors have transplanted donor hands and forearms onto an 8-year-old boy whose own hands were amputated when he was a toddler.

First Pediatric Bilateral Hand Transplant Performed
Led by Dr. Levin, a team of forty surgeons, anesthesiologists, nurses, and other clinicians at Children's Hospital of Philadelphia (CHOP) operated for 10 hours on an 8-year-old-boy earlier this month to achieve the world's first pediatric bilateral hand transplant.