Dr. Adam M. Almaguer is a fellowship trained orthopedic surgeon with special training in joint reconstruction and hip preservation. He treats a variety of patients with musculoskeletal issues resulting from developmental hip dysplasia, arthritis, injury, and overuse.
Dr. Almaguer is a native of Florida and completed his undergraduate education at Florida State University. He earned his medical degree from the University of Central Florida and completed his residency in Orthopedic Surgery at the University of Alabama at Birmingham. Following residency, he completed an Adult Reconstruction and Hip Preservation fellowship at Orthopedic Centers of Colorado.
Under the guidance of Dr. Presley Swann, he obtained extensive training in the treatment of hip dysplasia performing periacetabular osteotomies. This allows him to care for the young adult population in preventing the early onset of hip arthritis associated with hip dysplasia.
Dr. Almaguer’s expertise also includes performing total hip and knee replacements in the outpatient surgical setting. He performs hip replacements through a variety of approaches tailored to each patient’s needs. This includes the minimally invasive, muscle sparing direct anterior approach and bikini incision. He performs total and partial knee replacements using kinematic alignment. This advanced technique involves the use of robotics or patient specific 3-D printed models and guides allowing for a customized joint replacement that is specific to each patient’s unique anatomy.
Outside of orthopedics, Dr. Almaguer enjoys spending time outdoors with his wife, Lexi, and their two children, Luke and Brooklyn. Some of their favorite activities include freediving, spearfishing, hiking, biking, and snowboarding. He and his family are avid Nole fans.
Hip Preservation
Hip dysplasia occurs when the femoral head (ball) is improperly seated in a shallow acetabulum (hip socket). Over time this misalignment causes pain, labrum tears, and cartilage wear. While most cases of hip dysplasia are caught during infancy, mild cases of dysplasia often are not diagnosed until young adulthood.
The field of orthopedics has come a long way in the treatment of hip dysplasia. The subspecialty of hip preservation has been created to help treat these patients by restoring their function and preventing the development of early onset arthritis.
Prior to advances with hip preservation, the primary treatment method for many patients with hip dysplasia was a hip replacement. Parts of the joint were removed and replaced with a prosthesis. The problem with this treatment option is that young adults, who are often very active, ware down the prosthesis over time and a repeat hip replacement is often required later in life. The field of hip preservation has overcome these limitations and with advanced surgical techniques, including periacetabular osteotomy, we now are able to correct the malalignment and preserve the natural hip joint.
Periacetabular Osteotomy (PAO)
Periacetabular osteotomy (PAO) is a surgical procedure that reorients the patients acetabulum (hip socket) into the correct position. Cuts are made to the bone and screws are placed to properly align the acetabulum. This correction reduces pain and wear and tear of the hip joint which prolongs the need for a hip replacement.
Historically, the procedure releases all the muscles around the hip which results in a more invasive procedure and a longer recovery. Dr. Adam Almaguer has completed extensive training in hip preservation and has adopted innovative surgical techniques to decrease surgical time, blood loss, and reduce the number of post-op days in the hospital.
Knee Replacement
Total knee replacement, also called a total knee arthroplasty, is a surgical procedure in which the damaged or worn out surfaces of the knee joint are removed and replaced with an implant. Arthritis, injury, or other diseases can damage the protective layer of cartilage and cause extreme pain and difficulty performing even basic daily activities. Surgery may be recommended if all non-surgical treatment options fail.
Your doctor may advise a total knee replacement if you have:
- Severe pain that limits your activities of daily living (walking, climbing stairs, getting up from a chair)
- Moderate to severe pain that occurs during rest or awakens you at night
- Failure to obtain relief from medications, injections, therapy, and other conservative methods
- A bow-legged or knock-kneed deformity
Your doctor will also look at medical history, physical exam, and X-ray to determine if a knee replacement surgery is right for you.
Kinematic Alignment for Knee Replacement
Total knee replacements are implanted using either mechanical alignment (MA) or kinematic alignment (KA). Historically, most knee replacements are done using the mechanical approach. Using this method, every patient has their knee cut at the same angle which effectively makes every patients knee perfectly straight. We know that not every patient naturally has perfectly straight knees. Many patients are slightly bow-legged or knock-kneed. The ligaments, soft tissues, and patella are used to functioning in these preexisting angles. We now know that cutting every patients knees perfectly straight can cause some to be left with continued pain and swelling after replacement.
After decades of research, numerous studies have now demonstrated the clear benefit of kinematically aligned knee replacements. The prosthesis is custom inserted in the exact position that matches the position of the native knee before the patient developed arthritis. A CT scan is done prior to surgery and custom 3-D printed models and guides are made to complete the operation. This method is extremely accurate and measurements are taken down to the millimeter to ensure accuracy. This alignment makes for a more custom and comfortable knee replacement.
Dr. Almaguer uses this patient specific approach so that each patient gets a truly customizable knee replacement that matches their individual anatomy.
Hip Replacement
The hip is made up of two main parts: the head of the femur (ball) and the acetabulum (socket). These bones are covered in a protective cartilage and typically move together smoothly without friction or pain. However, in an injured or arthritic hip, the cartilage is worn down and these bones rub together causing pain and limited range of motion.
There are many non-surgical treatment options for managing hip pain, but when conservative treatment methods fail, a hip replacement may be recommended.
Your doctor may advise a hip replacement if you have:
- Severe pain that limits your activities of daily living (getting dressed, climbing stairs)
- Moderate to severe pain that occurs during rest or awakens you at night
- Inability to participate in activities you enjoy
- Failure to respond to conservative/ non-surgical treatment options
Hip replacement, also called a hip arthroplasty, is a surgical procedure that replaces parts of the hip joint with an implant. A total hip replacement involves replacing both the head of the femur (ball) and the socket of the acetabulum.
Direct Anterior Approach (Minimally Invasive)
Traditional hip replacements have been performed through the posterior (back) or the lateral (side) of the hip. Both techniques involve detaching muscles and tendons to access and replace the hip joint. Detaching these muscles and tendons can lead to longer recovery time, increased pain after surgery, and higher risk for dislocation.
The minimally invasive direct anterior approach is a technique that involves an incision through the front of the hip and does not cut any major muscles or tendons. A small 3-4 inch incision is made and the muscles and tendons are moved aside for the hip to be replaced. As a result, the hip is more stable post operatively and hip precautions are minimized. This surgery is typically performed in under an hour and most patients are discharged from the hospital or surgery center the same day. Dr. Almaguer uses this minimally invasive approach to help restore patients hip function and get them back to doing the activities they enjoy.
Rehab Protocol for PAO
Patient Guide to Scope PAO
