York, ME (207) 363 3490 | Portsmouth, NH (603) 431 1121

20Hip Care
10Hip-Conditions and Injuries
Cartilage Injury
Femoroacetabular Impingement (FAI)
Gluteal Tears
Hamstring Tears
Hip Instability
Deep Gluteal Space Syndrome
Labral Tears
Psoas Impingement (Internal Snapping Hip)
Trochanteric Bursitis
10Hip-Treatment and Surgeries
Gluteal Repair
Labral Debridement
Labral Reconstruction
Labral Repair
Psoas Release
Trochanteric Bursa Debridement
33Knee Care
13Knee Conditions and Injuries
ACL Tear
Cartilage Injury
Discoid Meniscus
Lateral Meniscus Tear
LCL Injury
MCL Injury
Medial Meniscus Tear
Osteochondritis Dessicans
Patellar Instability
Patellofemoral Chondromalacia
Posterolateral Corner Injury
Trochlear Dysplasia
20Knee Treatment and Surgeries
Anterior Cruciate Ligament (ACL) Reconstruction
Cartilage Restoration Surgery – Autologous Chondrocyte Implantation (ACI-Carticel)
Cartilage Restoration Surgery – Donor Graft
Collagen Meniscal Implant (CMI)
Lateral Collateral Ligament (LCL) Reconstruction
Medial Collateral Ligament (MCL) Reconstruction
Meniscus Repair
Meniscus Root Repair
Meniscal Transplant
Medial Patellofemoral Ligament (MPFL) Reconstruction
Osteochondral Allograft Transfer
Osteochondral Autograft Transfer (OATS)
Partial Knee Replacement (MAKO)
Partial Meniscectomy
Posterior Cruciate Ligament (PCL) Reconstruction
Posterolateral Corner (PLC) Surgery
Tibial Tubercle Osteotomy
Total Knee Replacement (MAKO)
20Shoulder Care
10Shoulder-Conditions and Injuries
AC Joint Injuries
Biceps Tendon Injuries
Calcific Tendinitis
Clavicle Fractures
Frozen Shoulder
Labral and SLAP Tears
Rotator Cuff Injuries
Shoulder Dislocation/Instability
Subacromial Impingement/Busitis
10Shoulder-Treatment and Surgeries
A-C Joint Stabilization
Biceps Tenodesis
Clavicle Fracture Fixation
Pectoralis Major Repair
Rotator Cuff Repair
Shoulder Instability Surgery – Bankart Repair
Shoulder Instability Surgery – Latarjet Procedure
Subacromial Decompression and Acromioplasty
Superior Capsular Reconstruction
Total Shoulder Replacement


Articular cartilage lines all three bones in the knee (the femur, tibia, and patella). Cartilage protects the ends of bone. It can withstand a significant amount of impact and is significantly smoother than ice. Patients who have arthritis have developed advanced wear of the cartilage that lines the bones in the knee. As the smooth cartilage lining over bone breaks down, patients with arthritis feel pain, stiffness, and other symptoms. Arthritis can occur due to many different factors; there is a genetic component as arthritis is more common in those patients who have a family history. Arthritis may also develop due to many other factors, including previous meniscus injury, previous cartilage injury, previous surgery, inflammatory conditions (such as gout), or obesity.


  • Swelling of the knee at the end of the day
  • Stiffness after sitting in one place for a long period of time
  • Catching in the knee
  • Pain after walking or running for an extended period of time

Diagnosis And Treatment

Dr. Welch considers each patient’s symptoms, as well as a detailed physical examination, x-rays, and sometimes and MRI of the knee to make the diagnosis. Dr. Welch recommends non-surgical management for most patients with arthritis. Low impact exercise, weight loss, and a dedicated physical therapy program may help alleviate some symptoms. Physical therapy focuses on range of motion in the knee and strengthening of the core muscles, hip muscles, and quadriceps. Other non-surgical options for treatment include unloader braces, which are designed to take pressure off of the side of the knee with the most cartilage damage. Other options include oral anti-inflammatory medications (such as Motrin or Aleve) and injections, including steroid injections, visco-supplementation, and platelet-rich plasma (PRP). In those patients who do not improve with non-surgical management, Dr. Welch may recommend surgical intervention.

In those patients who fail non-surgical management and have advanced damage in one “compartment” of the knee, the best surgical option is usually partial knee replacement. In those patients with advanced cartilage damage (“arthritis”) in multiple compartments in the knee, the best surgical option is total knee replacement.

Recently, a few companies have developed robotic-assisted knee replacement surgery. One company, MAKO, was recently acquired by Stryker. Dr. Welch had extensive training using the MAKO system as a fellow at the Kerlan Jobe Orthopaedic Clinic in Los Angeles. The benefit of MAKO robotic-assisted surgery is that it helps eliminate human error during surgery and enables surgeons to position the implants very accurately. Dr. Welch prefers and strongly endorses robotic-assisted partial knee replacement or total knee replacement for patients with arthritis who have failed non-operative treatment.

For more information please click here.