Subscribe to our newsletter
" It’s quality of life "
› Request an appointment

Council bluffs : 712-323-5333

Omaha : 402-991-9958

Team physicians for Iowa Western Reivers
Fri, 05 Nov 2021

What is hip impingement or femoroacetabular impingement (FAI)?

Dr. Blake M. Bodendorfer

Femoroacetabular impingement (FAI) is a condition where there is too much friction in the hip joint from bony irregularities causing pain and decreased range of hip motion. The femoral head and acetabulum rub against each other creating damage and pain to the hip joint. The damage can occur to the articular cartilage (the smooth white surface of the ball or socket) or the labral tissue (the lining of the edge of the socket) during normal movement of the hip. The articular cartilage or labral tissue can fray or tear after repeated friction. Over time, more cartilage and labrum are lost until eventually the femur bone and acetabulum bone impact on one other. Bone on bone friction is commonly referred to as osteoarthritis.

FAI impingement generally occurs as two forms: cam and pincer.

Cam impingement: The cam form of impingement is when the femoral head and neck are not perfectly round, most commonly due to excess bone that has formed. This lack of roundness and excess bone causes abnormal contact between the surfaces.

Pincer impingement: The pincer form of impingement is when the socket or acetabulum rim has overgrown and is too deep. It covers too much of the femoral head resulting in the labral cartilage being pinched. The pincer form of impingement may also be caused when the hip socket is abnormally angled backwards causing abnormal impact between the femoral head and the rim of the acetabulum.

types of femoroacetabular impingement

(Source: https://orthoinfo.aaos.org/en/diseases–conditions/femoroacetabular-impingement/)

Most diagnoses of FAI include a combination of the cam and pincer forms.

Symptoms of FAI

Symptoms of femoroacetabular impingement can include the following:

  • Groin pain associated with hip activity
  • Complaints of pain in the front, side or back of the hip
  • Pain may be described as a dull ache or sharp pain
  • Patients may complain of a locking, clicking, or catching sensation in the hip
  • Pain often occurs to the inner hip or groin area after prolonged sitting or walking
  • Difficulty walking uphill
  • Restricted hip movement
  • Low back pain
  • Pain in the buttocks or outer thigh area

Risk Factors

A risk factor is something that is likely to increase a person’s chance of developing a disease or condition. Risk factors for developing femoroacetabular impingement may include the following:

  • Athletes such as football players, weightlifters, and hockey players
  • Heavy laborers
  • Repetitive hip flexion
  • Congenital hip dislocation
  • Anatomical abnormalities of the femoral head or angle of the hip
  • Legg-Calves-Perthes disease: a form of arthritis in children where blood supply to bone is impaired causing bone breakdown.
  • Trauma to the hip
  • Inflammatory arthritis


Hip conditions should be evaluated by an orthopaedic hip surgeon for proper diagnosis and treatment.

  • Medical history
  • Physical examination
  • Diagnostic studies including X-rays, MRI scans and CT scan

Treatment Options

Conservative treatment options refer to management of the problem without surgery. Nonsurgical management of FAI will probably not change the underlying abnormal biomechanics of the hip causing the FAI but may offer pain relief and improved mobility.

Conservative Treatment Measures

  • Rest
  • Activity modification and limitations
  • Anti-inflammatory medications (NSAIDs: Motrin/ibuprofen, Aleve/naproxen, etc.)
  • Physical therapy
  • Injection of steroid and analgesic into the hip joint

Surgical Treatment

Hip arthroscopy to repair femoroacetabular impingement is indicated when conservative treatment measures fail to provide relief to the patient.


Call to make an appointment with Dr. Bodendorfer today! 

For more information, you can also visit his website at www.omahasportsdoc.com

Follow him on Instagram, Twitter and Facebook: @omahasportsdoc. 

Thu, 29 Apr 2021

Patient Success Story: One Happy Camper

Outpatient Hip Replacement Surgery by Miller Orthopedic Specialists

Condition: Osteoarthritis of the left and right hip

Treatment: Same-Day Outpatient Total Left and Right Hip Replacements

Results: Improved mobility, pain relief, and quality of life regained

Tammie Stoneking of Grant, Iowa came to Dr. Boese at Miller Orthopedic Specialists for hip pain in both her left and right hip, requiring a total hip replacement on both. Tammie says, “I’m so glad I had a hip replacement done! I couldn’t be more pleased with my results. I was able to camp this past summer and climbed the steps repeatedly in and out of my camper, which I couldn’t do before surgery.”

Dr. Boese explains, “Tammie is a pretty typical patient coming in for a consultation because she was in pain. That first step is the most important in order to determine and make a plan for treatment. We did x-rays and a complete exam, which led to her diagnosis of severe osteoarthritis. I knew right away that I could help her and provided my recommendation for total hip replacement.”  

MOS: What prompted you to make an appointment with Dr. Boese initially?

Tammie: “I knew it was time to discuss surgery when the pain began to interfere with my daily activities. I couldn’t go camping, which I love to do! It was too painful to climb the stairs in and out of my camper. I chose Dr. Boese based on his reputation and he also replaced my father’s hips.”

MOS: Did you have any concerns before your surgery? 

Tammie: “I’ll admit I was a little scared before my first hip replacement surgery. I didn’t know what to expect but I felt secure being in Dr. Boese’s capable hands.”

MOS: What advice would you give others who may be considering a same-day outpatient hip replacement?

Tammie: “If you are having a lot of hip pain and are unable to comfortably go about daily activities like I was, don’t put it off! I have absolutely no regrets. If it’s at all possible to have your surgery on an outpatient basis — that’s the way to go. I didn’t have to spend a single moment in the hospital and that was awesome.

One important thing that I learned is you should definitely follow the instructions you’re given for your recovery. I didn’t listen well with my first hip replacement surgery, as I thought I’m only 57 and I don’t need to take it easy like an ‘old’ person. I thought I was invincible but I was wrong. For my second hip replacement surgery, I followed the rules to the letter which resulted in a much more comfortable recovery.”

Tammie is just over two years post-op on her left hip and over a year on her right hip. Dr. Boese shares on Tammie’s recovery, “Tammie recovered as expected and received great results with her surgery that relieved her pain. In just three months post-surgery, Tammie was released to doing full activities without any restrictions. Her new hips are expected to last her for another 20-30 years!”   

For more information, visit our Same-Day Outpatient Total Joint Replacement page.
Dr. Boese is a highly regarded surgeon, fellowship-trained at John Hopkins University, and is a recognized leader specializing in total joint replacements. Schedule your appointment to learn if you are an eligible candidate for outpatient total hip replacement by calling Miller Orthopedic Specialists at 712-323-5333 or online.

Tue, 26 Jan 2021

Should I have my hip or knee surgery during COVID-19?

A couple go on a hike through a park. Their joints are not experiencing much stress.

This is a question and concern for many patients right now. First and foremost, your safety and well-being is our primary concern. Deciding to have surgery is a big decision in itself, but when you are in pain and missing out on your quality of life, it’s not necessary to delay it because of COVID-19.

It is still the perfect time to move forward with your joint replacement. If you delay, there is the possibility of increasing your symptoms and pain and perhaps further deterioration of the joints or weakened muscles that surround them. One of the ways to move forward more safely is with an outpatient joint replacement. Dr. Boese explains, “Staying out of the hospital is now more important than ever. Protect yourself and have your surgery in a facility where you don’t have to worry about COVID-19 or infections.”

Outpatient Total Joint Replacement Surgery

Outpatient total joint replacement surgery is now more common and is often preferred for a minimally invasive alternative. At Miller Orthopedic Specialists, our physicians provide same-day total joint replacement surgeries at the Advanced Surgery Center. This facility does not treat those sick with COVID-19, and every precaution is taken to prevent the spread of the virus and ensure the facility remains a safe environment for patients and staff. Click here to read more about their specific safety measures.

What are the advantages of outpatient total joint replacements?
  • Avoid patients sick with Covid-19
  • Recovery is quicker
  • You can go home the day of your procedure
  • You can recover comfortably and safely in your own home
  • You’ll save money
  • Your risk of infection is reduced

Outpatient Same-Day Total Joint Replacement is what we do, and we’ve been successfully leading the way for several years in the Omaha and Council Bluffs area. Dr. Boese is a highly regarded surgeon, fellowship-trained at John Hopkins University, and is a recognized leader specializing in total joint replacements, specifically outpatient and minimally invasive hip and knee surgeries.

Schedule your appointment at one of our clinic locations to see if you are a candidate for outpatient total hip replacement surgery or total knee replacement surgery.

Mon, 26 Oct 2020

The Benefits of a Partial Knee Replacement

Partial Orthopedic Knee Replacement Surger by Miller Orthopedic Specialists

Arthritis in the knee can cause pain and make everyday activities more difficult. There are a range of treatment options, but if the arthritis is limited to just one area of the knee, a partial knee replacement is a minimally invasive option to consider. Partial knee replacement is also called a unicompartmental knee replacement and essentially means that only a portion of the knee is replaced or resurfaced.

Partial knee replacement is a surgery that replaces only one of the parts of the knee. Your knee is divided into three major compartments:

  • Medial (the inside part)
  • Lateral (the outside part)
  • Patellofemoral (the front of the knee)

This procedure uses smaller incisions to remove the damaged tissue and bone in the knee joint. The areas are replaced with a prosthetic or resurfaced, which leaves healthy parts of the joint preserved. Because only the damaged compartment is replaced, the healthy cartilage and bone in the rest of the knee are left alone. This means that a patient will usually spend less time recovering and return to normal activities sooner than with a total knee replacement.

If your knee pain continues after taking anti-inflammatories, maintaining a healthy weight, and trying other non-surgical treatments, you may want to consider a partial knee replacement. What are some of the benefits of a partial knee replacement over total knee replacement?

  • Recovering more quickly
  • Less pain during recovery
  • Can feel more natural than a total knee replacement
  • Less blood and bone loss
  • Smaller scar

A few of the important considerations for whether you may be a good candidate include having an intact ACL, a sufficient range of knee motion, damage to only one compartment, and a stable knee. The minimally invasive partial knee replacement is ideal for patients with severe arthritis of the knee that have not found relief with standard non-surgical treatments. A thorough evaluation with an orthopedic surgeon will ultimately determine whether you are a good candidate for a partial knee replacement.

Recovery from a partial knee replacement takes approximately six weeks, including rehabilitation exercises to help maintain your range of motion and restore your strength. You will begin putting weight on your knee immediately after surgery and may need a walker, cane, or crutches until you become comfortable enough to walk. During this time, you will also continue to see your orthopedic surgeon for follow-up visits.

If you have joint pain or arthritis and want to return to your active lifestyle, we are here to help. Our specialists work with you to diagnose, treat, and answer your questions and get you back to doing the things you love. It’s quality of life! Request an appointment online with Miller Ortho or call us at 712-323-5333.

Fri, 22 May 2020

Outpatient Knee Replacement Surgery and the Benefits

Knee Replacement Surgery | Miller Orthopedic Surgeons

Outpatient knee replacement is a great way to get a patient in and out of the hospital on the same day. Not everyone qualifies or prefers this method, but many do. Outpatient total knee replacement is becoming more and more common. Many, however, do not know what to expect with an outpatient procedure and therefore just stick to inpatient. Outpatient procedures do have their benefits, so it is important to be informed. A good orthopedic surgeon, such as total joint specialist Kent Boese, MD, can help you decide the best option for your knee replacement.

Total knee replacements (also called total knee arthroplasty), both inpatient and outpatient, are very similar. The biggest difference is in where post-op recovery is spent and the length of a hospital stay. The process of a total knee replacement is the removal of damaged bone or cartilage and the insertion of a prosthesis. The healthy bone and cartilage are resurfaced to help with the support of the implant. So, after the removal of the damaged bone and cartilage, the new joint is fused into place. This procedure is intended to reduce pain and increase the mobility of the patient. The goal is an improved quality of life.

Some Benefits to outpatient total knee replacement:

  • Lower infection rates
  • Recover in the comfort of own home
  • More Convenient
  • Cheaper

Outpatient surgery is an option because of less invasive surgical techniques, less blood loss, better pain control, and better anesthesia practices than were previously available. This allows people to be up and walking shortly after surgery. This is not a procedure that is appropriate for everyone, but through careful discussion with a fellowship-trained, Board Certified Surgeon, such as Dr. Kent Boese, a proper diagnosis and treatment plan can be decided.

 Many people will ask the same question about newer procedures, is it Safe?

Many different studies have found that in the proper candidate, outpatient is just as safe as inpatient knee replacement surgery. A lot of it comes down to ensuring the surgeon is a skilled, trained surgeon. Overall, most studies do not find a major increase of risk from inpatient to outpatient. It is important to address any concerns or complications before or after the surgery with the surgeon or nurse navigators to ensure a better outcome and recovery for the patient.

One important thing to note about outpatient procedures is they can turn into an inpatient procedure if needed. This means that after surgery if something is questionable in the post-op evaluation, the surgeon can request the patient to stay overnight to be monitored. This helps resolve unforeseen complications that may have arisen. The patient will have a careful evaluation to be cleared for discharge to be sent home, but even once they get home, it is extra important that the patient have someone around to help monitor them in the case of complications. Communication is very important throughout the entire process.

A nurse navigator is there to help both in and outpatient knee replacement patients. The nurse is there to guide the patient through any problems or questions that might arise before or after surgery. The nurse is there to help put the patient’s mind at ease while helping monitor their recovery status for all knee replacements.

One important thing to note when choosing outpatient surgery is that it is extra important for the home to be prepared prior to the surgery. Because there is less immediate supervision following the surgery, the patient needs to be sure to eliminate potential causes of slips, trips and falls in the home.

There are risks involved with all knee replacements, but there are also so many benefits to people being able to walk around and be more mobile than they have been in years. Outpatient knee replacements have patients up and walking by that afternoon and on their way to recovery. Choose a surgeon that can help prepare you, educate you, and get you back out doing the things you love.

If knee pain is keeping you from doing the hobbies you love then it’s time to schedule an appointment. Miller Orthopedic is here to help you, give us a call at 712-323-5333 (Council Bluffs) or 402-991-9958 (Omaha) or click here to request an appointment.

Tue, 18 Feb 2020

Jumper’s Knee

free sports injury clinic

Jumper’s knee is a condition that involves an inflamed patellar tendon. That’s why it is also called patellar tendonitis. The patellar tendon is the tendon that connects the kneecap to the shin bone. This is a condition that gradually weakens the tendon and can eventually lead to muscle tears if left untreated.

Jumper’s knee arises from overuse in the joint. This is often from sports that require a lot of jumping on hard surfaces. The constant jumping and force of the leg hitting the ground can cause strains and stress to the tendon. If left untreated, the condition usually worsens.

If you think that you have jumper’s knee, then it’s important to go see a specialist. They can help diagnose and come up with a treatment plan to prevent the condition from worsening. Some symptoms include:

  • Pain under the knee cap
  • Swelling
  • Bruising or redness
  • Leg or calf weakness
  • Pain when bending
  • Stiffness when squatting, kneeling, or jumping

Once someone with this condition comes in and is diagnosed with “jumper’s knee” there are a few ways it is often treated. The biggest thing doctors typically say is to take a break from the sports or activities that caused the injury.

Tips on treatments for the condition:

  • Rest
  • Ice
  • Compression (taping, wraps or straps just under the knee cap)
  • Ibuprofen or other pain relieving, swelling reducing medicine
  • Physical Therapy (this can be at home or with a physical therapist to start to know the best exercises and strategies for each individual)

It is important to note that sometimes, when the condition is not treated or the person does not rest the knee to allow it to heal, it can worsen. In some situations, surgery can be required. This is another reason why it is crucial to come in and see a doctor when you start exhibiting symptoms. It is also always a good idea to see a physical therapist upon diagnosis to help provide some guidance on the best way to get you back in the game more quickly.

Miller Orthopedic Specialists offers a free, walk-in sports injury clinic in Council Bluffs from 10–11 a.m. and by appointment in Omaha. The initial consultation is free, but extra will be charged for x-rays, supplies, or follow-up visits if needed. This is a great opportunity to come in and see a specialist to get peace of mind without having to pay a hefty doctor bill. Your specialist can also provide input on what activities you are able (or unable) to participate in. Getting a general timeline and advice on what to do while recovering can make the recovery go more smoothly.

Contact us today for more information or to schedule your FREE* consultation. 

Mon, 23 Dec 2019

Hip Pain May Not Be Because of a Hip Problem

 If you are experiencing hip pain there could be a variety of things impacting it. Sometimes, the hip pain is due to something wrong in the hip, other times it is a deeper, different problem altogether. The following injuries could be causing your hip pain. 

A graphic with the title of "What Causes Hip Pain?" It includes reasons such as osteoarthritis, snapping hip syndrome, inflammatory arthritis, and Iliopsoas bursitis.


Many times, hip pain is due to a hip injury, such as a fracture. Fractures of the hip are more common as people get older. Often, hip fractures happen in conjunction with falling. The risk of falling is increased in the icy winter, so it is always important to be careful and to remember to walk like a penguin on the ice.


Arthritis is another big factor in causing hip pain. When arthritis hits in the hip, physical therapy is often ordered to help strengthen the muscles around the joint. A joint replacement is often needed once the more conservative treatment options have failed.


One other common cause of hip pain is bursitis, which stems from an inflammation of fluid-filled sac or the bursa. These sacs help cushion tendons, muscles and ligaments. Thus, when they swell it can cause a lot of tenderness and pain. Not all hip pain stems from an issue within the hip, sometimes it is something different.


Another reason one might be experiencing hip pain is sciatica, the inflammation of nerve roots from the spinal cord. Often times, this causes hip pain and pain that shoots down the leg. Sciatica can occur because of a variety of reasons such as spinal stenosis, which is often from osteoarthritis, spasms in the lower back, or bulging or ruptured disks. This pain, despite often occurring in the hip, is actually from an issue in the spine.

Peripheral Neuropathy

The sciatic nerve is not the only nerve that can become inflamed and pose as a hip problem. Peripheral nerves are another set that, when inflamed, can cause hip pain. This is often caused in pregnancy, but there are other triggers for it as well, including diabetes and too tight of clothing.

Receive a Proper Diagnosis Today

A proper diagnosis is crucial when trying to take care of hip pain. For instance, if someone were to get a cortisone shot in their hip, but the issue is a ruptured disk in their back, then the injection is not going to do a ton of good. Proper diagnosis is important to know the proper treatment plan. It can help people know what exercises might help or hurt their condition. It is also important for the patient to know if there is a deeper underlying condition that could be more serious of an issue than they originally anticipated.

If you are experiencing hip pain, come in and see one of our total joint doctors or come see our spine specialist if the pain is running through your back or leg as well. They can help provide a proper diagnosis and determine the root cause of the condition. This will help them work with you to come up with an individualized treatment plan to best address your pain. 

Contact Miller Orthopedic Specialists today for your individualized treatment plan for your hip pain today!


Tue, 28 May 2019

Larose marks 30 years at Miller Orthopedic Specialists

orthopedic sports medicine, Doctor Daniel Larose
Dr. Daniel J. Larose, an orthopedic sport medicine doctor was the first partner under Dr. Ronald Miller, who started with Miller Orthopedic in 1972. Photo and article by Susan Payne

This year, Miller Orthopedic celebrates the 30-year anniversary of Dr. Daniel Larose, one of the first recruited associates under Dr. Ronald Miller in 1988, founder of the practice.

While Miller Orthopedic welcomes the newest physician to the team, Larose is one of the longest standing physicians with 30 years in the field and no plans for retirement.

“We came here in 1988 and it was a nice, easy-going place. My wife liked it a lot too, to raise our kids. She felt like she could be here and not worry about heavy traffic or feeling unsafe,” Larose said.

Larose is one of 12 orthopedic specialists on the Miller Orthopedic team, partnering with the University of Nebraska at Omaha Mavericks, Iowa Western Reivers and more recently, College of Saint Mary Flames in sports medicine.

“We don’t formally teach medical students, but we are starting a program with the College of Saint Mary that they will do clinic rotations,” he said. “We cover southwest Iowa clinics and I’ve been going to smaller communities, we have about 10 satellite clinics.”

In the last 30 years, Larose said he’s proud of the growth he has seen first hand.

“I’ve seen a lot of patients and now I’m starting to see the children of the patients I’ve seen. We have grown and Council Bluffs has grown quite a bit, as well,” Larose said.

To read the original story from the Daily Non-pareil, click here

Tue, 07 May 2019

Getting a hip replacement can improve your mobility

hip replacement surgery for back pain

The anterior approach to total hip replacement surgery is an alternative to traditional hip replacement surgery. The surgeon approaches the hip from the front instead of the side or behind and works between the patient’s muscle and tendon rather than cutting through it, sparing the tissue from trauma. This approach allows for less pain, faster recovery and improved mobility.

This approach is different than the traditional approach because it uses a smaller incision than most. It is important to note that having a good surgeon is going to be one of the key factors in the size of the incision with any replacement, but this approach helps ensure a smaller one than most surgeons would have with a traditional replacement. Smaller incisions usually mean less overall pain and shorter recovery for the patient.

Most hip replacements are traditionally done from the back or side rather than the front like this one is. This approach helps reduce muscle trauma and pain. Thus, hopefully helping the patient get up and move more quickly and with less downtime.

The goal of the hip replacement surgery whether it is the anterior approach or a more traditional approach is to replace the top of the thigh bone and the socket of the pelvis with an implant and decrease daily pain. An advantage of the anterior approach total hip replacement is a patient can begin rehabilitation faster because there are fewer muscles that need to recover from the surgery.

Other potential benefits of the anterior approach total hip replacement surgery may be minimal soft tissue trauma, reduced post-surgery pain, less scarring, earlier mobilization, and less post-operative restrictions.

This approach cannot be done on all patients and it is important to consult with an orthopedic specialist to discuss all of your options and let them help you determine if this would be an appropriate option for you.

Fri, 08 Mar 2019

Stem Cell-Meniscus Treatments

knee replacement surgery

The meniscus is a piece of cartilage that provides a cushion between your femur (thighbone) and tibia (shinbone). There are two menisci in each knee joint.  They can be damaged or torn during activities that put pressure on or rotate the knee joint. Taking a hard tackle on the football field or a sudden pivot on the basketball court can result in a meniscus tear.  However, you don’t have to be an athlete to get a meniscus tear.   Simply getting up too quickly from a squatting position, a sudden pivot or turn, deep squatting, or heavy lifting can lead to a meniscus injury.   The meniscus weakens with age and tears become more common in people over the age of 30.  

Many athletes are at risk for a meniscus tear.   The meniscus can be torn during activities that cause direct contact or pressure from a forced twist or rotation. Sports that require sudden turns and stops may put you at higher risk for meniscus tears. Some of these sports include:

  • Football
  • Basketball
  • Soccer
  • Tennis

If someone has osteoarthritis, they are at higher risk of injuring their knee or tearing their meniscus. Osteoarthritis is a common joint disorder involving pain and stiffness in joints caused by aging and wear and tear.  When an older person experiences a meniscus tear, it’s more likely to be related to degeneration. This is when the cartilage in the knee becomes weaker and thinner.    

When a meniscus tear occurs, you may hear a popping sound around the knee joint. Afterward, you may experience:

  • Pain, especially when the area is touched
  • Swelling
  • Difficulty moving your knee or inability to move it in a full range of motion
  • The feeling of your knee locking or catching
  • The feeling that your knee is giving way or unable to support you

You may also experience a slipping or popping sensation, which is usually an indication that a piece of cartilage has become loose and is blocking the knee joint.

Contact your doctor if you experience any of these symptoms and they persist for more than a few days or occur after your knee has been injured. Call your doctor immediately if your knee locks and you’re unable to bend your knee after straightening it.

Treatment Plans

After you discuss your symptoms with your doctor, they will examine your knee, test your range of motion, and look closely at the spot where the meniscus is along the joint.   Initially, they may treat the knee injury with conservative techniques that include rest, ice, compression, and elevation.  If this approach does not provide relief and surgery is not an option, a new procedure utilizing MOS Regenerative Medicine Solutions and Platelet Rich Plasma may be the optimal way to treat the injury.

 PRP (Platelet Rich Plasma) is a concentration of platelets and growth factors created from a small amount of the patients own blood.  It focuses on concentrating the healing factors to increase the speed of recovery.  

The platelets are concentrated down to a cellular level.  Outside of the bloodstream these platelets become activated and release important proteins to help increase growth levels and improve the signaling of recruitment / regenerative cells to the injured area.

A similar treatment can be executed for reoccurring sprains as well.

Do not live in pain; schedule a consultation with an orthopedic specialist at Miller Orthopedic today to receive a customized treatment plan.


Request an Appointment

Please fill out the form below to request an appointment with one of our specialists.

* Indicates a required field