John R. Moore, IV, MD

As healthcare is ever changing we are seeing a trend towards outpatient procedures. Outpatient joint replacement surgery is a safe option that reduce the time you need to spend in the surgical center. In the past outpatient joint surgeries have been performed in a hospital setting, but the national trend has been towards ambulatory surgery centers like the practice of Dr. John Moore. If you are interested in an outpatient joint replacement, contact our Pinehurst, NC office today. How is outpatient joint replacement surgery different from normal joint replacement? Outpatient joint replacement surgery is nationally trending as the first choice for many qualified patients. Studies have shown that outpatient joint surgery has numerous benefits for the patients over tradition joint replacements. These include: Faster recovery Improved outcomes Decrease in infection rates Increased patient satisfaction scores Lower complication rates CANDIDATES FOR OUTPATIENT JOINT REPLACEMENT Candidates for outpatient joint replacement surgery are restricted to privately insured, healthy patients. Due to Medicare restriction, medicare patients are not eligible for outpatient joint replacement. As always patients that are physically healthy and socially supported are the best candidates for the outpatient experience. Dr. Moore has successfully completed over 100 outpatient joint replacements in the past four years with ZERO hospital re-admissions after outpatient surgery. WHERE ARE OUTPATIENT JOINT REPLACEMENTS PERFORMED? The Surgery Center of Pinehurst is the home to our outpatient joint replacement surgeries. This facility is located across the street from our practice and provides easy access to the facility for patients and their families. Dr. Moore’s team has created a structured guideline and protocol for impeccable preoperative and post-operative care to all of our patients. HOW IS AN OUTPATIENT SURGICAL CENTER BETTER THAN A HOSPITAL? The outpatient joint replacement procedure is the same as a hospital setting. The key difference is in the concierge experience. Patients of Dr. Moore will stay one night at our outpatient surgical center, The Surgery Center of Pinehurst. While there, two highly qualified and dedicated nurses (2:1 nursing ratio) will be by your side for any needs or concerns. THE JOINT REPLACEMENT PROCEDURE Prior to your procedure, an anesthesiologist will sedate you and perform a femoral nerve block on you. You will likely not remember the introduction of the procedure. Our anesthesiologist will also As a part of your spinal anesthetic. This type of block causes numbness in the anterior portion of the thigh, and is beneficial in reducing pain after your surgery. From here, your surgery with Dr. Moore will differ depending on what surgery you are reciving. To learn more about a specific surgery, please look at the following pages: Total Knee Replacement Total Hip Replacement Surgury typically requires approximately one hour of time. You will be in the recovery room for one to three hours until the effect of the spinal anesthesia is worn off. Once that occurs and your vital signs are stable, you will be taken to your surgery center hospital room. WILL I NEED PHYSICAL THERAPY AFTER JOINT REPLACEMENT SURGERY? Yes, you will still need physical therapy after an outpatient joint replacement. Your therapy will be tailored to the type of operation that you received. Only a few hours after surgery, the nurses will have you up walking and you will recieve formal physical therapy the morning after surgery. Prior to your discharge home from Surgery Center of Pinehurst, our physical therapists will have you walking and stair climbing. initially be using a walker but you can advance to the use of crutches if you can master the technique. It is your personal preference whether you go home on a walker or on crutches. The physical therapist will also be certain that you understand your discharge exercise program and have all the assistive devices that will help you cope in the immediate postoperative period.

The decision to have a knee replacement is rarely spontaneous. It comes after months and years of steadily increasing knee pain and stiffness. Maybe it started long ago, and now it just seems unbearable. Well, you don’t need to continue to live with the knee pain. Orthopaedic surgeon Dr. John R. Moore and his staff offer relief from the pain with total knee replacement surgery at their surgical center in Pinehurst, NC. This surgery can help you live an active life without constant pain. If you are interested in a knee replacement to reduce your joint pain or improve its function, call our office in Pinehurst, NC at (910) 295-0224. We proudly provide knee replacement surgeries to patients from Fayettevile, Laurinburg, Pinehurst, Sanford, and beyond. What is Knee Replacement Surgery? Knee replacement surgery is a procedure to reduce pain caused by arthritis or other conditions in the knee joint. As we age, cartilage in the knee can be worn away, resulting in inflammation. The process is usually gradual and may take months or even years for it to progress from a mild to a severe level. In a knee replacement at our Pinehurst, NC surgical center, Dr. John Moore replaces the hinged joint of the knee with a metal-on-plastic artificial knee joint. He performs both total Knee replacement and revision knee replacements. CONDITIONS THAT CAUSE KNEE PAIN Knee pain can stem from several conditions. Below are some of the most common causes of severe knee pain: • Osteoarthritis of the Knee Osteoarthritis of the knee joint is a degenerative type of arthritis that most often occurs in patients 50 years or older. It occurs when the cartilage of the knee begins to wear away gradually joint space between the bones of the knee joint decreases. As this occurs, X-Rays will reveal bone on bone in the knee joint. Osteoarthritis develops at a slow pace with increasing pain over time. Avascular Necrosis Avascular Necrosis is a condition that occurs when bone loses blood supply. Blood is required as our bones are living tissues, when the supply of blood is interrupted, the bone begins to die. If the blood loss is not stopped or treated, the bone will collapse. • Post-Traumatic Arthritis Post-traumatic arthritis is another common form of osteoarthritis caused by a previous injury or another form of trauma. This type of arthritis can occur in any joint such as hip, knees, shoulder, and elbow. Over time the arthritic process will increase in severity and patients will have increasing pain and decreasing function which is no longer managed by conservative measures. At this point, it is time to consider a total knee replacement seriously. The decision to perform the surgery is usually based entirely on the patient’s complaints. DO I HAVE ALTERNATIVE TREATMENT OPTIONS TO KNEE SURGERY? In the early stages of the knee disease, the pain and loss of function may be improved by conservative treatment options. These options may include nonsteroidal anti-inflammatory agents, intra-articular injections of steroids, or visco-supplementation (a series of injections to the knee joint). In the end, the decision for surgery comes down to the patient’s tolerance for pain. WHAT IS THE PROCESS FOR KNEE REPLACEMENT SURGERY? The knee is a hinged joint that connects the lower end of the femur or thigh bone and the upper end of the tibia or shin bone. Articular cartilage covers the surfaces of each of the bones. The hinged joint has an additional component in that the knee cap or patella rubs on the anterior end of the femur. This serves as a fulcrum for the quadriceps muscle which straightens the knee. In a total knee replacement, the end cap of the femur is removed and replaced by a metal shell made of either titanium or a combination of chromium and cobalt. In a total knee replacement, the end cap of the femur is removed and replaced by a metal shell made of either titanium or a combination of chromium and cobalt. The upper-end cap of the tibia is replaced by a surface made of high-density polyethylene or plastic that is attached to the bone by a metal plate. This process creates a metal-on-plastic artificial knee. Dr. Moore also replaces the portion of the patella that slides on the femur with a high-grade polyethylene surface. Revision Knee Replacement A previous knee replacement that has failed may also need an additional surgery called a Revision knee replacement. The most common reason for a revision knee replacement the loosening of the components from the bone or wear of the polyethylene liner. In this procedure, Dr. Moore replaces failed components from the original replacement with more modern implants.

Hip pain can grow slowly over months, and sometimes years. You try to live with it, but the pain continues to grow, it becomes unbearable, and you struggle to do the activities you once loved. This doesn’t mean you need to accept the pain. Orthopaedic surgeon Dr. John R. Moore and his staff offer relief from the hip pain with total hip replacement surgery at their surgical center in Pinehurst, NC. This surgery can help you live an active life without constant pain. If you are interested in a hip replacement to reduce your joint pain or improve its function, call our office in Pinehurst, NC at (910) 295-0224. WHAT IS A HIP REPLACEMENT? A hip replacement is a surgical procedure that replaces the abnormal or worn surfaces of the hip joint. The surgery is typically performed to reduce hip pain from arthritis or to repair a fractured hip. In this procedure, Dr. Moore will create an artificial hip joint using a plastic-in-metal socket made of high-density polyethylene. CONDITIONS THAT LEAD TO HIP REPLACEMENT SURGERY: Osteoarthritis of the Hip Osteoarthritis is a degenerative type of arthritis that most often occurs in patients 50 years and older. When the cartilage of the hip begins to wear away gradually, this is Osteoarthritis of the hip joint. As the cartilage wears away by becoming rough, this decreases the joint space between the bones of the hip joint. As this occurs, X-Rays will reveal bone on bone in the joint of the hip with joint space narrowing. Osteoarthritis typically develops at a slow pace with pain increasing over time. Avascular Necrosis Avascular Necrosis is a condition that occurs when bone loses blood supply. Blood is required as our bones are living tissues, when the supply of blood is interrupted, the bone begins to die. If the blood loss is not stopped or treated, the bone will collapse. Post-Traumatic Arthritis Avascular Necrosis is a condition that occurs when bone loses blood supply. Blood is required as our bones are living tissues, when the supply of blood is interrupted, the bone begins to die. If the blood loss is not stopped or treated, the bone will collapse. Hip Fractures A common cause for a total hip replacement is in the case of a fracture of the hip. Many hip fractures are managed by pin or screw fixation. However, some severe circumstances require a hip replacement because the bone itself will not heal. WHEN DO I NEED A HIP REPLACEMENT? The decision to have a hip replacement is often one based on the patient’s complaints and pain tolerance. In the early stages of hip disease, the pain and loss of function may be improved by conservative treatment. This option can include non-steroidal anti-inflammatory agents and intra-articular injections of steroids. At some point, however, if the arthritic process increases in severity, patients will have increasing pain and decreasing function. At this stage, it is time to consider a total hip replacement seriously. The decision to perform the surgery is usually based entirely on the patient’s complaints. WHAT SHOULD I EXPECT WITH A HIP REPLACEMENT? A hip replacement replaces the abnormal or worn surfaces of the hip joint. The specifics of the procedure depend on what type of hip replacement you need. TOTAL HIP REPLACEMENT A total hip replacement begins with your surgeon removing the head of the femur and replacing it with a metallic head. Next, they will remove the acetabulum and replaced it with a plastic-in-metal socket made of high-density polyethylene. A new capsule or lining forms around the joint to maintain the ball inside the socket. Dr. Moore will typically use a newer type of fixation which involves the patient’s bone growing into the roughened or porous surface of the hip implants. He believes that this kind of fixation is superior in most patients, providing a better long term longevity.

Osteoarthritis is the clinical name for a condition that affects approximately 27 million Americans. You may know it as degenerative joint disease or degenerative arthritis. Osteoarthritis is the most common chronic condition of the joints, occurring most often in the knees, hips, lower back, and neck. At Pinehurst Surgical, osteoarthritis is often the determining factor behind the majority of our hip and knee replacement procedures. The goal is to relieve the chronic pain and decreasing mobility that osteoarthritis can cause. WHAT IS OSTEOARTHRITIS? Colloquially known as “wear and tear” arthritis, osteoarthritis involves the breakdown of the cartilage in the joints. It can occur in most of the joints of the body but is most common in the weight-bearing joints: the hips, knees, and spine. In other joints, osteoarthritis usually only occurs if there was a previous injury to the joint or a problem with the cartilage in the joint. At Pinehurst Surgical Orthopaedic & Joint Replacement Center, we have vast experience with osteoarthritis in the hips and knees. In healthy joints, cartilage is the firm, rubbery material that covers the ends of the bones. Cartilage acts as a shock absorber, reducing the impact and friction in the joints. When a person has osteoarthritis, the cartilage breaks down, becomes stiff, and loses its elasticity. As it becomes less malleable, the cartilage is more prone to damage and wear. Now its shock absorbing benefits decrease, and the tendons and ligaments stretch, causing pain. As the deterioration progresses, patients can begin to have bone on bone contact in the joint. Where are the most common joints for osteoarthritis? The weight-bearing joints are the usual locations of osteoarthritis: the knees, hips, and spine. This is simply due to the daily stress of the joints handling typical movements such as walking, bending, running, or jumping. Over time, everyone’s joints deteriorate, the degree of deterioration and the accompanying pain and loss of mobility are the signs of osteoarthritis. Who is at risk for osteoarthritis? Most people over 60 have some degree of osteoarthritis, although they may simply consider it to be a “ stiff hip or knee.” It is more common in women than men. Younger people can get osteoarthritis, but it’s usually a result of a joint injury (say from football or other sports) or repetitive stress from overuse (dancers and runners). One in two adults will develop symptoms of knee osteoarthritis during their lives. One in four adults will develop symptoms of hip osteoarthritis by age 85. One in 12 people 60 and over has osteoarthritis in his or her hands. WHAT CAUSES OSTEOARTHRITIS? Although the daily use of our knees and hips is really what leads to osteoarthritis, there are certain factors that can contribute to developing the condition. Genetics— Some people inherit a rare defect in the body’s production of collagen, the protein that makes up cartilage. This can lead to osteoarthritis in people as young as age 20. Also, defects in the joints and the way the bones fit together can accelerate degeneration of the joints. Obesity— Simple physics says that adding weight to a joint increases pressure and wear. Overweight people put much greater loads on their joints, causing the cushioning cartilage to break down faster and earlier than in people at or near their ideal weight. Joint overuse— Overuse of certain joints leads to osteoarthritis. For instance, if a person has to continually bend his or her knees for their job, the knee joints will wear more quickly. Injury— A past injury in a joint has a higher risk for that joint becoming arthritic. Also, heavy impact sports such as gymnastics lead to a far higher incidence of osteoarthritis in later years. Other diseases— People with rheumatoid arthritis (the second most common form of arthritis) are more likely to develop osteoarthritis. Certain other diseases can also increase the odds of developing osteoarthritis. If you are living with osteoarthritis, Dr. John Moore and his team of professionals at Pinehurst Surgical Orthopaedic & Joint Replacement Center can help relieve your symptoms. To request a consultation, please call us at 910-295-0224. Our practice looks forward to serving you!

Patellofemoral arthritis is an arthritic condition that affects the kneecap. Behind the kneecap, just along the femoral groove, is articular cartilage. This substance is normally somewhat slippery. In cases of patellofemoral arthritis, this cartilage has begun to deteriorate and become inflamed. The wearing away of fibrous cartilage tissue can eventually eliminate the cushion between bones, leading to pain. PATELLOFEMORAL ARTHRITIS VS. OSTEOARTHRITIS? This is kind of a game of semantics really. Any wear and tear over time that causes the cartilage in our joints to degenerate is known as osteoarthritis. This is true of every joint in the body as patients pass their 40th birthday. So, when wear and tear due to the aging process and simple long-term use of your knee (which is the main cause of patellofemoral arthritis) is behind your condition you could call it osteoarthritis. People can confuse osteoarthritis with the other forms of arthritis, such as rheumatoid arthritis. They are completely different, however. Osteoarthritis is simply due to wear and tear on a joint over time. Rheumatoid arthritis is an autoimmune disorder where your body’s immune system mistakenly begins to attack your joints. WHAT ARE THE RISK FACTORS FOR DEVELOPING ARTHRITIS IN THE KNEE There are several risk factors for patellofemoral arthritis. Having a risk factor does not mean you will develop kneecap arthritis. Also, there are cases in which patellofemoral arthritis has developed in the absence of risk factors. It is essential to obtain a full medical evaluation if uncomfortable symptoms occur. Age is a common factor in arthritic conditions, including patellofemoral arthritis. Most diagnoses occur in patients over the age of 40. Statistics indicate that women are affected more commonly than men. A knee injury such as a fractured kneecap can increase the risk of post-traumatic kneecap arthritis. Obesity may cause joint degeneration, which could lead to arthritis of the knee and kneecap. Certain repetitive movements sustained for long periods can wear down the knee joint, leading to osteoarthritis of the kneecap. Health conditions such as gout, rheumatoid arthritis, dysplasia, and Paget’s disease are risk factors for kneecap arthritis. WHAT ARE THE CAUSES OF PATELLOFEMORAL ARTHRITIS? There are several factors that may contribute to the development of patellofemoral arthritis. Ultimately, any inflammatory condition or mechanical abnormality of the knee can cause the arthritic condition. Inflammatory diseases such as rheumatoid arthritis may affect the entire knee. A mechanical defect may result from injury to the kneecap, such as dislocation. Damage to the posterior cruciate ligament can also make the knee joint unstable, exerting pressure on the patellofemoral joint. WHAT ARE THE SYMPTOMS OF PATELLOFEMORAL ARTHRITIS? Pain is the primary symptom of patellofemoral arthritis. Usually, this pain occurs at the front of the kneecap after being triggered by activity such as climbing stairs. However, some people feel kneecap pain for no known reason and even during times of rest. The knee joint may also “crackle” when in motion. What Is The Recovery Time After Surgical Treatment? As for healing times after surgery with Dr. Moore, these vary widely depending upon the procedure. With arthroscopy, patients can be fully recovered in around 12 weeks. There can be some residual pain, but this will fully clear by 6 months in most cases. Knee realignment that involves only the tightening or release of soft tissues does not involve a long recovery. Within a couple months, patients have usually regained full function. After knee replacement, most patients can resume normal daily activities within 6 weeks. It may take from 4-6 months to fully recover and realize the full benefits of the replacement surgery. SEE WHAT OUR PATIENTS ARE SAYING: “Dr. Moore is a talented and excellent physician with incredible bed side manner. He takes time to really listen to his patients and give them all of their options. He also has wonderful staff that are always so friendly and helpful.” -Heather W. PREVENTION OF PATELLOFEMORAL ARTHRITIS The best way to reduce the risk of patellofemoral arthritis is to protect the knee joint as a whole. Protective measures include: Maintaining a healthy body weight to avoid exerting excessive pressure on the knee joint. Maintaining a healthy body weight to avoid exerting excessive pressure on the knee joint. Wearing protective gear during sports activities where there is a potential for direct contact or other injuries. Stretching can decrease inflammation and prevent stiffness of the knee joint.

The bursae are critical for helping our joints move smoothly. They act as cushions for the bones, tendons, and ligaments in our joints. Overuse these small fluid-filled sacs at your own peril — they’ll tell you by becoming irritated and swollen. If this is the case, you have bursitis. Bursitis is common in the shoulders, elbows, and hips. In the hips, there are two bursae that become irritated and inflamed. At Pinehurst Surgical Orthopaedic & Joint Replacement Center, we’ll help you get past the pain of hip bursitis. WHAT IS HIP BURSITIS? In the hip, there are two major bursae. One bursa covers the bony point of the hip, This is the greater trochanteric bursa. Inflammation of this bursa is called trochanteric bursitis. It is the more common bursitis of the hip. The other bursa is located on the inside of the hip toward the groin. It is called the iliopsoas bursa. Bursitis in the iliopsoas bursa is far less common than trochanteric bursitis. Both of these inflammations are known as hip bursitis. IS BURSITIS A FORM OF ARTHRITIS? Bursitis is not a form of arthritis. Arthritis is joint inflammation. In the hips, this is usually associated with osteoarthritis (wear and tear arthritis). Bursitis is inflammation of the bursa, the small, jelly-like sacs that are positioned between bones and soft tissues. HOW IS HIP BURSITIS DIAGNOSED? Hip bursitis can be mistaken for symptoms of other conditions. That’s where Dr. Moore’s extensive experience as a board-certified orthopaedic surgeon comes into play. When diagnosing hip bursitis, he first must rule out other potential causes, such as hip osteoarthritis, tendonitis, iliotibial band syndrome, and conditions affecting the lower back. To rule out conditions such as osteoarthritis, Dr. Moore may order imaging tests, such as x-rays, bone scans, or magnetic resonance imaging. Blood tests may be used to rule out or confirm certain systemic inflammatory conditions, such as rheumatoid arthritis, psoriatic arthritis, and gout. Dr. Moore will conduct a physical exam and discuss your symptom history, along with your medical history. We’re looking for a pattern of pain and other symptoms. WHAT ARE THE SYMPTOMS OF HIP BURSITIS? The main symptom of any bursitis is pain. With trochanteric bursitis that pain is at the point of the hip, and it usually extends to the outside of the thighs. Initially, the pain is acute, sharp and intense. As the pain endures, it becomes more of an ache and spreads across a larger area. The pain can be worse after long walks, climbing many stairs, or any time squatting. The pain typically worsens at night, when lying on the affected hip, and when getting up from a chair after being seated for a period of time. RISK FACTORS FOR HIP BURSITIS Hip bursitis is more common in women, and in middle-aged and elderly people. There are certain risk factors that are associated with a person developing hip bursitis. Hip Injury – This can be a fall onto your hip, a bump with your hip, or even when you lie on one side of your body for an extended period of time. Repetitive stress or overuse – When you’re a runner, cyclist, run stairs, or have a job that keeps you on your feet for long periods, you’re more likely to develop bursitis. Unequal leg lengths – When one leg is significantly shorter than the other, the stress when walking can lead to irritation of the bursa. Rheumatoid arthritis – This increases the likelihood that your bursa will become inflamed. Spine disease – Scoliosis, osteoarthritis in the lumbar spine, and other diseases inflame the hip bursae. Previous surgery – Hip replacement or surgery in the area can lead to bursitis. Bone spurs – These can develop within the tendons that attach muscles to the trochanter. CAN BURSITIS SPREAD TO OTHER JOINTS? The bursa are individual sacs that provide cushioning between bones and adjacent soft tissues. They don’t work together and are not susceptible to inflammation spreading from one bursa to another. What can happen is not spreading, per se, but evolving inflammation. If the activities you’re doing are irritating and inflaming bursa in one area, it would be logical that if you don’t cease the activity you could begin to irritate adjacent bursa. In the hips, the bursa that covers the bony point of the hip bone called the greater trochanter is prone to inflammation. This is trochanteric bursitis. Another bursa, the iliopsoas bursa, is located on the inside of the hip. If you have a hip injury or are overusing the hips such as when running, you could cause both bursae to become inflamed.