Hip Preservation: An Emerging Approach to Hip Pain

Hip Preservation is a new approach to hip pain.  If you are experiencing persistent or chronic hip pain, the emerging field of Hip Preservation may be able to provide answers – and get you back to your activities.

Michael Merz, MD, pursued a fellowship in this new field at Boston Children’s Hospital, affiliated with Harvard Medical School.  He had comprehensive training with leaders in the field in hip conditions for patients from birth through middle age that included both arthroscopy and osteotomies of the pelvis and femur.  Like all of our Orthopaedic Surgeons, Dr. Merz is trained in General Orthopaedics, and can see patients for all Orthopaedic issues.  His dual fellowship training is in Hip Preservation and Joint Replacement.  Specific conditions that he treats include: hip dysplasia (DDH), femoroacetabular impingement (FAI) or hip impingement, hip labral tears, Perthes disease, avascular necrosis (AVN) of the hip, femoral anteversion, and congenital hip dislocation.  Call (919) 220-5255 to schedule an appointment with Dr. Merz.


Is Outpatient Joint Replacement An Option For You?




If you are healthy enough, outpatient joint replacement (where you have surgery and go home on the same day) may be an option for you at EmergeOrtho.  In comparison to inpatient joint replacements, much of the process remains the same but there are a few differences.  Special consideration of the medical status of the patient is the biggest factor.  Anesthesia techniques (to make you more comfortable) are modified for outpatient replacement patients.  Physical therapy at home is begun the day after surgery.  Since you won’t be at the hospital where the surgical team can check on you, an earlier follow-up appointment is scheduled.  Lastly, you’ll need a caregiver or team of caregivers present with you to assist with walking, medications, and meals.

Some of the advantages to outpatient joint replacement include:

1) cost

2) convenience/comfort

3) fewer complications

Outpatient joint replacements often offer substantial cost savings since there is no hospital stay.  Also, they can be done at “surgery centers” which typically charge significantly lower fees than typical hospitals might.  Many patients are more comfortable being at home in a familiar environment while they recover.  Patients may be more likely to avoid complications since they are likely to move around the home more than they might at the hospital.  Lastly, the chance of picking up an infection from something or someone at the hospital is lessened the shorter the amount of time spent there.

Sometimes patients scheduled for outpatient surgery may end up having to stay at the hospital (or may be sent to a hospital from a surgery center) if unforeseen complications occur.  To lessen this risk, the patient’s health is carefully screened prior to surgery.   The bottom line is your safety is our top concern.


The main differences between inpatient and outpatient joint replacements at the surgery center involve the type of anesthesia used.  Outpatient patients often get a shorter-acting “block” or injection to allow them to move their legs sooner.  A long-acting “local anesthetic” to numb the tissue around the incision is frequently used to help provide comfort.  Special combinations of pain and nerve medications may be prescribed.  Generally, urinary catheters are not used for patients undergoing outpatient joint replacement.

Rather than being transferred to a hospital bed (also called “the floor”) after surgery, you will have physical therapy (PT) when recovered enough in the post-anesthesia care unit (PACU). When you have proven you can walk appropriately with PT and are felt to be safe to be sent home, you will be discharged. Patients undergoing outpatient joint replacements may stay in the PACU longer than inpatient replacement patients since they need to be fully recovered before being released.



  • Take your medications as directed in your discharge paperwork
  • Your leg muscles may be weak for the first day or so – make sure to wear any braces sent home with you and use your walker or crutches when you move around
    • Do not stop using braces until you are advised to do so by your therapist or surgical team
    • Try to drink plenty of fluids and eat a healthy diet – you need energy to heal
    • Follow the instructions for your dressings and showering given to you at the time of discharge


To learn about whether outpatient joint replacement surgery would be a good fit for you, visit www.triangleortho.com or call (919) 220-5255 to schedule an appointment with one of our surgeons.


Article By: William Silver, MD, Orthopaedic Surgeon, Medical Director, EmergeOrtho Triangle Division

New App for Joint Replacement Surgeries!



Are you or a loved one planning to have a shoulder, hip, or knee replacement? Download our free App and be ready for the entire process from beginning to end!  Know what to expect from the first appointment through recovery after surgery, all in a user-friendly design from BeeWell.  We’ve created brand new video content so you can do your physical therapy practices with confidence.  Educate, Prepare, and Engage!

Available on Google Play and the App Store!

Google Play:














Join us in Welcoming Our Newest Orthopaedic Surgeon



Please join us in welcoming Dr. Douglas Freels,MD, to our orthopaedic team!  He will be seeing patients at Wilson Ortho, a division of Triangle Orthopaedics.

Dr. Freels has extensive experience in orthopedic surgery and joint replacement patients having been in practice for over 18 years. This includes both primary hip, knee, and shoulder replacement patients including minimally-invasive joint replacement surgeries such as the “Oxford” partial knee replacement and the direct anterior approach for hip replacement surgery. He also has experience in the more complex joint replacement patients including infections, peri-prosthetic fractures, and revision joint replacement surgery.

To see Dr. Douglas Freels,MD, please contact us at 252-243-9629.



Pros and Cons of a Hip Arthrodesis

Considering Hip Arthrodesis

For some patients with severe arthritis or a hip injury, an artificial hip may become worn out over time from hard labor after surgery.   As a result, your Triangle Orthopaedics surgeon may recommend a hip arthrodesis.  A hip arthrodesis is the fusion of the thighbone to the pelvis.  Metal screws and metal plates are used for the fusion to lock the hip in the correct position.

The main goal of a hip arthrodesis is to alleviate pain for the patient.  Post-surgery, the patient will walk with a limp as the joint is removed during the hip arthrodesis surgery.

During a consultation with our Triangle Orthopaedics specialists, you will learn more about the hip arthrodesis procedure and find out if the surgery could be a good solution for your hip pain.  Typically, this surgery is only recommended for patients who have explored all other pain management options, including:

  • Pain medications
  • Splints
  • Normally-indicated treatments
  • Hip replacement surgery

A hip arthrodesis is not the best solution for every patient. To learn more about your own hip condition and if a hip arthrodesis is the best fit for your individual needs, please contact Triangle Orthopaedics today.

Learn More about Triangle Orthopaedics

To learn more about the Triangle Orthopaedic difference, please do not hesitate to contact our North Carolina clinics.  We will schedule you for a consultation with one of our physicians that can best address your individual needs.

Considering a hip arthrodesis is a major decision, but with our Triangle Orthopaedics team, you are not alone with all of the surgery’s considerations.  Call Triangle Orthopaedics today at 800-359-3053 to learn more about the hip arthrodesis and other hip procedures we offer at our North Carolina clinics.



Considering MAKOplasty

Considering MAKOplasty at Triangle Orthopaedics

At Triangle Orthopaedics, we are always looking for the best ways to help our patients return to the activities that they enjoy quickly and with less pain. With the MAKOplasty treatment option, patients can experience partial knee resurfacing and total hip arthroplasty with added precision, allowing for restored mobility and the ability to return to active lifestyles.

Through this Triangle Orthopaedic blog, you will learn more about the benefits to considering MAKOplasty, and how to schedule a consultation with one of our specialists.  Keep reading to learn more about this state-of-the-art technology and technique available at Triangle Orthopaedics.

What Are the Benefits to MAKOplasty?

MAKOplasty is currently used at Triangle Orthopaedics for partial knee resurfacing and for total hip arthroplasty.  MAKOplasty procedures are performed with an extremely advanced, surgeon-controlled robotic arm.  Typically, this procedure is conducted to help individuals with non-inflammatory or inflammatory joint disease.

For patients with early to midstage OA in the medial, patellofemoral, or in both compartments of the knee, MAKOplasty can serve as an effective treatment method.  With MAKOplasty Partial Knee Resurfacing, patients may observe the following benefits:

  • Optimal implant positioning, which allows for a more natural feeling post-surgery.
  • Faster recovery and decreased length of hospital stay when compared to traditional knee replacement surgery.
  • Can be an outpatient procedure.
  • Quicker pain relief and return to normal activities.

A MAKOplasty hip procedure provides numerous benefits to a patient including:

  • Stable biomechanical reconstruction with matched leg length restoration.
  • Real-time data for surgeons to most optimally align and position implants.
  • Decreased recovery and pain associated with surgery.
  • Ability to return to normal activities sooner than with traditional hip replacement.

During a consultation, your physician will discuss your individual MAKOplasty options with you, and evaluate if the procedure is a good solution for you.  To learn more about MAKOplasty, please contact our North Carolina Triangle Orthopaedic centers today.

Learn More about MAKOplasty

If you would like to learn more information about MAKOplasty, please do not hesitate to contact our team of experts at Triangle Orthopaedics.  We will answer all of your questions related to the procedures, and help you to further understand the specific risks that may be associated with each procedure.

At Triangle Orthopaedics, your health and wellness are of the utmost importance to us.  With MAKOplasty and our team of orthopaedic physicians, you can return to the activities that you love, with less recovery time than ever before.  Learn more today by contacting our North Carolina Triangle Orthopaedic clinics at 800-359-3053.


Physical Therapy

Physical Therapy and Triangle Orthopaedics

When an injury becomes painful or disabling, many individuals wonder if they will ever be able to regain strength or if the area will ever be pain free again.  This is where the Triangle Orthopaedic team of rehabilitation medicine physicians can help.  Our team is able to treat any disability ranging from various diseases to sports injury, all without surgery. (more…)

Direct Anterior Total Hip Replacement Recovery

At Triangle Orthopaedics, we are always searching for the most cutting edge surgeries, procedures, and techniques to keep our patients healthy and moving forward. Our physicians learn ways to help patients decrease suffering and increase the amount of times patients can spend doing the activities that they love the most. (more…)