Is Anterior Hip Replacement the Right Approach?


Over the past 5 years a major advance in the surgical approach to performing a hip replacement has been developed. In addition to remaining minimally invasive, this approach avoids cutting any major muscle groups. The incision is placed over the front of the upper thigh and avoids lateral hip pain when sleeping on one’s side.

This anterior approach to the hip has been quite successful, offering excellent results, and is appropriate for nearly every primary total hip. With more than 200,000 hip replacements performed in the U.S. each year, this approach will dramatically change the future of this great operation.

The Main advantages of the Anterior Supine Hip Approach are:

  • No muscle cutting, allowing improved hip strength after surgery
  • Lowest dislocation rate compared to all previous approaches (0.5%
  • Improved leg lengths – allows more accurate equalization of leg lengths
  • No restrictions after surgery – sitting, crawling, stooping are all
    allowed with no postoperative limitations
  • No restriction on weight bearing or exercises
  • Reduction in postoperative pain
  • Decreased hospital stay and quicker recovery

James R. Ramser, MD is one of a few orthopaedic surgeons in Virginia that routinely performs anterior supine intermuscular hip replacement surgery. This unique procedure uses the most advanced surgical techniques to replace an entire hip joint through a small 4-5 inch incision.

The incision is made in front of the hip and does not cut through any muscles or tendons. This technique results in less pain, minimal dislocation risk, and quicker recovery. Most importantly, since the hip is immediately stable, it does not require any lifestyle modifications such as not being able to bend over to tie your shoes or not sitting in low seats. Traditional approaches restrict bending past your waist or sitting in very low chairs for varying periods of time (sometimes permanently). In most cases, you will be back on the golf course in 6-8 weeks.

This surgery is appropriate for anyone that needs a primary hip replacement. The approach is also used to replace certain types of hip fractures and usually results in much quicker recovery in the elderly population. Hospital stays are usually 2-3 days.

The Anterior Supine Hip Approach – Younger Patients

“Many of my younger patients are now staying only 2 days in the hospital and do not require physical therapy” says Dr. Jim Ramser. “The anterior approach is now my primary procedure for all total hip replacement patients, including those with hip fractures. Surgery time is about 1 hour avoiding lengthy anesthesia time. I am amazed how quickly people walk independently, giving up their crutches and canes after only 3 weeks.”

Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. For your convenience, both of our Warrenton and Gainesville offices are equipped with in-office radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at (540-347-9220) or our Gainesville office at (703-743-2814). Or visit to make an appointment

Texters Beware!

Take note texters, your spine is suffering

You’re 18, ready to start college, play sports, make it big and prepare for spinal surgery. Wait, what? Spinal surgery? But I don’t have back pain or injury you say. Go ahead and blame that sometimes 60 degree angle of your neck is at while you are texting friends and family. Our bodies aren’t designed to keep that kind of stress on the neck and will eventually lead to degeneration.

“Your spine is at its happiest when your ears fall on the same plane as your shoulders, and your shoulder blades are retracted. Without these adjustments, you put added stress on your spine, Dr. Kenneth K. Hansraj, spinal & orthopaedic surgeon.

When you are texting, you are actually doing damage to yourself. Okay, once in a while isn’t going to hurt you, unless you’re driving at the same time, but consistent posture like this will do damage. It’s like carrying 60 pounds of extra weight on your spine. That’s a second grader on your back all the time! Nobody wants that. Normal usage would be about 700 – 1,400 hours of pressure and the worst offenders are looking at about 6,000 hours of that intense pressure on their spine per year. Here’s an idea of the pressure you put on yourself when you text and hold that position for a while.

Image Courtesy of

Image Courtesy of

Your resting pressure when you hold your head up straight is about the weight of your head, or 11 pounds. At 15 degrees tilted, it’s about 27 pounds, 30 degrees is about 40 pounds and by the time you hit a 45 degree angle, you are looking at 60 pounds of pressure on the spine.

That is a lot of pressure to be putting on your spine. However, it’s almost impossible to avoid today’s technologies so what do you do to help combat it?

Make an effort to limit the tilt. Okay, that can be easier said than done so here comes the Mom card. Do as your mom always told you and stand up straight. Good posture is so important on so many levels, don’t let it fall aside for a text. Keep your phone, or electronic device, away from waist level when looking at it to ease of off the pressure. “Look down with your eyes, no need to bend your head.” advises Hansraj

Here at Blue Ridge Orthopaedic & Spine Center, we offer complete comprehensive care for the whole family, including Physical Therapy, which is an invaluable resource to getting you back to your daily activities after an injury or surgery and will work with you to reverse the detrimental effects of repetitive daily activities like this.



Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office  radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

It’s NEVER a stupid question. Always ask.


40 Questions to Ask Your Surgeon Before Back Surgery Stephanie Burke

Before you decide to have the surgery

1. What type of surgery are you recommending? Why?
2. What is the source of the pain that is being addressed? How do you know this?
Exploratory surgery is never done on the back.
3. Please explain the procedure in great detail.
The amount of information depends on your personal preferences. Some patients want to know everything, some not so much!
4. What are my non-surgical options?
5. What is the natural course of my condition if it is not surgically addressed?
6. What would you recommend if I was your friend, wife, sister, or daughter?
7. How long will the surgery take?
8. What are the side effects, potential risks, and potential complications?
9. Please explain the risks and how they relate to me personally.
For example, different risk factors like smoking, being overweight or having grade 3 spondylolisthesis, etc, will affect surgical outcomes.
10. What if, during my surgery, you encounter a different spine issue than you expected?
11. Do I need to donate my own blood? If yes, why?
For most types of back surgery, blood does not need to be donated ahead of time.
12. Do you perform the whole procedure? Will any students and/or other surgeons be doing any parts of the operation? If yes, who are they and what are their qualifications?
13. Who else will assist you in the operation? What are their background and qualifications?
14. What are the long-term consequences of the proposed procedure?
For example, will the operation ever need to be re-done? If it is a fusion, will it lead to degeneration at other levels of the spine? Questions about the surgeon
15. How many times have you done this procedure?
Generally, when it comes to surgery, “practice makes perfect,” so more experience is better. However, if the doctor is recommending something that is not often done, such as multi-level fusions, more experience would not necessarily be better.
16. Are you board eligible or board certified?
You can usually look on the wall and see a certificate.
17. Are you fellowship trained in spine surgery?
This is more important if the surgery is a fusion, artificial disc replacement, or other more extensive procedure.
18. If I want to get a second opinion, who would you recommend?
The recommendation should be someone not in the same practice.
19. Statistically, what is the success rate for this type of surgery? What is your personal success rate, and how many of this type of surgery have you done?
20. Can I talk to other patients who have had a similar procedure?
The patient will have to sign a HIPAA release form, but typically, happy patients want to share their success stories.

Any defensiveness on the part of the surgeon when you ask these types of questions may be a red flag. A surgeon with good results and appropriate qualifications will not be threatened by these types of questions and will respect your attention to these matters.

Questions about what to expect after the surgery

21. What kind of pain should I expect after the surgery and for how long?
22. How long is the hospital stay?
23. May a family member spend the night with me in the hospital?
24. How do you manage the pain in the hospital?
25. Which pain medications will I be sent home with? What are possible side effects of these prescriptions (e.g. constipation, drowsiness, etc.)?
26. Will you know before the surgery if I will need a back brace afterwards? If so, will I be fitted for one before the surgery?
27. Will I need any other medical equipment (like a walker) when I go home?
28. Who can I call if I have questions after the surgery? What is the process for communication?
29. How often will I see you after my surgery?
30. What symptoms would warrant a call to your office?
31. What symptoms would warrant immediate medical attention?
32. What limitations will I have after surgery and for how long?
33. How long should I wait to bathe?
34. How long will I be out of work? School?
35. What kind of help will I need when I return home?
36. When can I drive again?
37. When can I resume normal (light) household chores?
38. What expectations do you have for my recovery?
39. When is it safe to resume sexual relations?
40. How soon after the surgery can I start physical therapy?

One thing we pride ourselves on here at Blue Ridge Orthopaedic & Spine Center is our willingness to listen to you and answer all the questions you may have about a procedure. Back surgery is scary stuff and it’s not taken lightly, often it’s the last resort when treating the injury. Please do not hesitate to bring these, or any other questions to the table if
you are looking at having spine surgery. We welcome it.



Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office  radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

Is Minimally Invasive Spine Surgery ever an Option?

Is Minimally Invasive Spine Surgery ever an Option?

Article written by: Allison Walsh –

After months of conservative therapy, some spine patients may opt for spine surgery if their pain is uncontrolled or if they are unable to do their daily tasks, and if a surgeon can identify a spine lesion that is responsible for the pain.

Conservative vs Surgical Care for Lower Back Pain

spinal cord

Some surgical candidates worry that they will need a spine fusion, which is an invasive surgery requiring months of recuperation.

The good news is that some spine conditions can be treated with a minimally invasive surgery, like a discectomy.

Reasons you may need a spinal fusion

First, let’s take a look at the types of conditions that may need to be treated with a fusion.

A fusion surgery is designed to stop joint motions in the spine that are generating pain. This may happen as a result of:


For many patients, spinal fusion helps them get back on the road to leading a normal, pain-free life. But as stated above, the surgery is considered invasive and the recovery time can be up to a year long.

Spine Fusion Risks and Complications

Many patients who need spine surgery will find relief from less invasive surgical procedures known as microdiscectomy or a microdecompression.


Reasons you may need a microdiscectomy or microdecompression surgery

Sometimes nerves in the spine are compressed by a narrowing of the spinal canal, causing referred pain to radiate down the arms or legs. This pain is called radiculopathy. The narrowing of the spinal canal may be caused by a bone spur or by a herniated disc.


See herniated discs and bone spurs


A microdiscectomy or microdecompression spine surgery, considered a minimally invasive surgery, removes the small portion of the offending bone or disc, allowing the nerve to heal.

See also Microdiscectomy (Microdecompression) Spine Surgery

The majority of patients with only radiculopathy pain (in the absence of one of the conditions mentioned above as a reason for spine fusion) improve without fusion surgery.

Microdiscectomy is often done on an outpatient basis. Typically, the patient will have no restrictions on their activity immediately following the surgery, and the success rate is 90-95%.

Most back patients will never need surgery. If you do need spine surgery, it doesn’t necessarily mean you will need a spine fusion.


BRO-Logo-colorBlue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office
radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

Exercise benefits more than just the waistline


In this article published by Stephen H. Hochschuler, MD on, the importance of exercise and fitness on your back is discussed. Keeping strong and active, keeps the muscle from becoming stiff, which can lead to more pain. However, make sure before you do ANY activity, especially after surgery or an injury, be sure to consult with your doctor to make sure it’s safe.

Exercise and Fitness to Help Your Back

A common (and harmful) misconception is that exercise should be avoided when a patient is experiencing back pain. Understandably, many patients are reluctant to exercise out of the fear that any exercises or stretching will aggravate their existing back pain. This may make them rely too heavily on medical treatments and underemphasize the importance of exercise for healing and long term back pain relief.

For most back problems, exercise and movement are the natural stimuli for the healing process. Controlled, gradual and progressive exercise, rather than inactivity and bed rest, most often provides the best long-term solution for reducing back pain and preventing (or lessening) future episodes of pain.

Most experts recommend no more than one or two days rest at the onset of most episodes of back pain. Prolonged inactivity can actually increase back pain as the back becomes stiff, weak, and deconditioned. As the pain increases, many patients reduce their activity and exercise levels, resulting in even more back pain and aggravating the cycle of inactivity and back pain recurrence.

Exercise plays the dual role of both treating back pain and helping prevent future episodes of pain.

  • By nourishing and repairing spinal structures, exercise helps alleviate existing back problems.
  • Movement and exercise keep the anatomy of the back healthy, flexible and strong in order to reduce the chances of further injury and back pain.

It is always advisable for patients to first consult with a health professional before beginning any exercise or fitness program. Working with a physician or experienced spine specialist will ensure that patients’ activities are safe for their back and for their overall health. With back pain, it’s particularly important to get an accurate diagnosis for the cause of the patient’s pain from a physician or chiropractor in order to rule out possible types of back pain that may be aggravated by exercise (such as spinal instability).

How Exercise Helps the Back
Engaging in exercise and fitness activities helps keep the back healthy by allowing discs to exchange fluids which is how the disc receives its nutrition. A healthy disc will swell with water and squeeze it out, similar to the action of a sponge. This sponge action distributes nutrients to the disc.

In addition, fluid exchange helps to reduce the swelling in the other soft tissues that naturally occurs surrounding injured discs. When there is a lack of exercise, swelling increases and discs become malnourished and degenerated.

Exercising the back reduces stiffness by keeping the connective fibers of ligaments and tendons flexible. Improved mobility through back exercise helps to prevent the connective fibers from tearing under stress, which in turn prevents injury and back pain.

Another important effect of exercise is that it stretches, strengthens, and repairs muscles that help to support the back. The back and abdominal muscles act as an internal corset supporting the vertebrae discs, facet joints, and ligaments. When back and abdominal muscles are weak they cannot support the back properly. Back strengthening exercises help to strengthen these supporting muscles in order to prevent straining soft tissues (e.g. muscles, ligaments, and tendons) and provide sufficient support for the structures in the spine.

Additionally, stretching is good for the back. For example, stretching hamstring muscles helps to relieve stress on the low back. Another benefit of back exercise is that the motion helps lubricate the facet joints, which are synovial joints that require appropriate motion.

Integrating Exercise with Medical Treatment

Exercise and fitness are necessary for healing existing back problems, recovering from back surgery, and especially for keeping the back healthy to help prevent (or at least lessen) future episodes of back pain.

Ideally, an exercise and fitness program should be integrated during most phases of treatment for pain relief and to improve the overall health of patients. If the pain is severe, however, patients may first need to be treated for the pain prior to starting a back exercise program.

Specific Exercise Strategies

The following guidelines and insights are designed to help patients plan and follow through with a safe and effective exercise program to condition the back. The key goals of engaging in exercise and fitness activities are to aid the healing process for an injured back and alleviate existing back pain while helping to prevent (or at least minimize) future problems.

  • Find the right type of professional to help with the exercise and fitness program. Patients should always consult with a physician prior to beginning any exercise or fitness program. A healthcare professional can assist with the development of an appropriate list ofback exercises and activities in which to engage or avoid. Health professionals such as physical therapists, chiropractors, and physical medicine and rehabilitation physicians (physiatrists) often have specific training and expertise with exercise and fitness programs for pain relief. It’s particularly important to see a health professional with expertise in spinal conditions and back pain, as different back conditions often require very different exercise programs.

See How a Physical Therapist Can Help with Exercise

  • Expect some initial discomfort when beginning a new exercise and fitness program. However, start slowly, because the results of back exercise, such as soreness, may not be felt for 24 to 48 hours after the exercise session. Beginning an exercise program after an episode of back pain will likely cause some increase in pain in the beginning. However, the back pain experienced during exercise should be “good pain.” This pain is to be expected as a natural part of increasing activity and stretching tissues that have become stiff and deconditioned.
  • Set a careful pace when starting to exercise. When returning to activity after an episode of pain or following surgery, ease into back exercise and physical activity. Be careful not to overwork or strain muscles that may have become deconditioned after a period of inactivity. Taking into account that there may be some initial discomfort, a cautious approach to back exercise can help keep back pain under control and prevent a flare-up.

Include a combination of stretching, strengthening, and low-impact aerobic conditioning exercise. Utilizing these three components of exercise will help heal existing problems, avoid injury and prevent future problems. Muscles will become strengthened and more flexible, repairing strained muscles that cause back pain. Low-impact aerobic conditioning helps to stretch and strengthen the back as well as the abdominals and hamstrings, two muscles that help to support the back.

Engage in gentle forms of exercise, such as water therapy or walking. For patients experiencing higher levels of back pain, exercise may be more comfortable in the water than on land. Water therapy provides the therapeutic effect of relieving pain and also can help prepare the body for more extensive exercise. Another form of gentle physical activity is exercise walking, a good option for patients in less pain who are ready to move onto more intensive exercises on land.

Consider alternative forms of exercise, such as Pilates, yoga, or Tai Chi. Pilates, yoga, and Tai Chi provide gentle strengthening and stretching exercise that can help alleviate present back pain. They help improve overall fitness and posture, which in turn prevents future episodes of back pain. Other benefits of alternative therapies like Pilates, yoga, and Tai Chi are stress relief and relaxation, which can also assist with back pain relief.

  • Know when to reassess the exercise and fitness program. If back pain during exercise becomes severe, it is important to redesign the back exercise program with the help of a professional. The individual patient is the best judge of whether the pain during exercise is normal discomfort or if the level of pain is signaling that the patient should discontinue the specific exercise.
  • Build a motivating support system during the course of the exercise program. Friends and family may often encourage patients to rest and avoid physical activity because of the common misconception that exercise causes back pain. However, the opposite is true when patients perform the appropriate back exercises. The patient may need to educate others about the importance of back exercise and fitness for back pain relief. Telling friends and family about plans to increase start exercising and asking for their encouragement may help the program’s success.
  • Keep a written record of progress made during the exercise and fitness program. Tracking progress is useful for the patient as well as for health professionals who are helping with the exercise program. Records could include a list of the specific back exercises performed, number of sets and repetitions, duration of exercise, and pain and sensations experienced during exercise. This helps both the patient and the exercise professional track progress toward fitness goals and ensures that information is accurately communicated among different professionals and to the patient. Monitoring progress may also help keep the patient motivated to continue with the exercise and fitness program.
  • Many people will experience some kind of lower back pain at some point in their lives. An ounce of prevention by doing a few simple exercises daily to keep the back nice and healthy will go a long way to alleviate lower back pain problems. Learn why exercise is so important for a pain-free, healthy back in this video.

 Article courtesy of and Stephen H. Hochschuler, MD


BRO-Logo-colorBlue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. For your convenience, both of our offices are equipped with in-office radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton  office at 540.347.9220 or our Gainesville office at 703.743.2814. Or Click here to make an appointment.