Using MIRE for knee arthritis

My physical therapist wants to try monochromatic infrared photo energy, MIRE, for my knee arthritis. Is it worth doing?

There are no clinical studies comparing MIRE with other treatments. According to a recent review, individual case studies appear to be favorable, decreasing pain and improving function without any side effects.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Monitoring Perthes disease

When I was a child, I had a hip problem called Perthes disease. As an adult, sometimes I have hip pain but not always. Should I do anything special to keep this from getting worse?

The natural history and long-term results of Perthes (also known as Legg-Calve-Perthes) disease are still largely unknown. Some studies following children with this condition into their later years have been done. Our current treatment for this condition is based on the results of those studies.

We know that the duration of the disease from start to complete healing depends on the extent and severity of the condition. As you might expect, the children with the greatest amount of damage to the growth plate have the worst results.

Age makes a difference, too. Younger children (less than six years old) with Perthes tend to have milder deformity compared with older children (10 years old or older).

One study from the University of Iowa showed that patients treated with range of motion programs had better motion and function at age 45. But 10 years later, there was significant deterioration of the hip. By the time these patients were 55 years old, 40 per cent of the group had a total hip replacement. And another 10 per cent had enough pain and arthritis to need a joint replacement, too.

Individuals who receive physical therapy do show improvement in hip motion and strength. Whether or not lifelong exercise makes a difference has not been studied.

It might be a good idea to see an orthopedic surgeon. An X-ray can show the current condition of your hip. A physical therapy exam can establish your levels of motion and strength. Any other loss of function or disability can be addressed with a specific rehab program.

Regular follow-up visits with both the surgeon and the therapist may help identify any developing problems and nip them in the bud.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Does re-injury of repaired ACL require additional surgery?

I had my left ACL repaired two years ago. I just re-injured it playing baseball again. Should I have a second surgery to repair the first surgery? Or should I wait and see what rehab can accomplish?

Many surgeons advise a three-to-six month trial of rehab before undergoing a revision operation. For those who are older or less active, this may be a good choice. But for younger athletes or older, very active adults, early re-operation is advised.

Studies show that an unstable or deficient knee will cause increased damage to the meniscus and joint cartilage. The result is early osteoarthritis. It may be best to have the revision surgery within three months of the re-injury. This will prevent further cartilage damage during the subacute stage.

The condition of the cartilage really dictates the final results. Any defects in the joint cartilage will inhibit twisting and turning activities. Strenuous sports activities are also limited.

Whenever possible, the surgeon will save the meniscus. This helps promote joint stability and possibly prevent degenerative changes. Technically correct surgical stabilization of the knee is the key to a good, functional outcome.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Pain, limp and unstable hip likely if post-revision surgery instructions are not followed

My father just had surgery to revise a total hip he had done last year. The doctor has given him strict warnings not to put any weight on that leg just yet. He’s also been told not to abduct his operated leg. Dad’s pretty cantankerous. He’s likely to do it anyway. What can happen if he doesn’t follow orders?

It sounds like your father has been given instructions called trochanteric precautions. These precautions include no active hip abduction and no weight on the affected leg for six weeks.

Such precautions are advised when a patient has had a trochanteric osteotomy as part of the revision operation. In this procedure, the outside edge of the femur (thigh bone) is removed. A large knob of bone at the top called the trochanter is part of the bone that is cut off.

The surgeon performs this type of osteotomy to gain better access to the hip joint. It is reattached with wires or cables. The instructions given are to help prevent nonunion and/or migration (movement) of the bone fragment during the healing process.

Hip muscles that attach to the trochanter can exert a tremendous pull on the bone. Until it has healed and re-united with the main part of the bone, compressive, shear, and load forces can cause problems.

Your father must be given as much information as possible to insure compliance with these instructions. The successful outcome of surgery may depend on it. Early breakage of the fixation system with migration can cause chronic hip pain, a limp, and an unstable hip.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Getting range of motion back after total knee replacement surgery

I had a total knee replacement about three months ago. I’ve had a devil of a time getting my motion back. I’m still having trouble getting up and down stairs or getting up out of a chair. Will I eventually get these back?

Knee range of motion has clearly been recognized as a very important part of function. Without it, walking, stair-climbing, and everyday activities can be difficult. Being unable to complete these tasks alone or even with some help can be very disabling.

For most patients, getting enough motion back to accomplish the type of tasks you mention is possible. It may take persistence on your part. A daily exercise program of range of motion and strength training is definitely needed. You’ll need at least 90 degree of knee flexion to do stairs and another three to five degrees to rise from a chair.

For some people, deformity or misalignment at the knee may be holding back restoration of greater motion. A flexion contracture (unable to straighten fully) causes a loss of full extension needed for normal gait (walking). And without full flexion, going up and down stairs can be very difficult.

It’s probably about time for you to check back with your surgeon for a follow-up visit. Ask about your limitations. You may need some additional surgery to correct a problem. Or perhaps another round of rehab is appropriate. The benefit you will get from obtaining additional motion is well worth the time and effort.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Hip bone movement after revision hip replacement

My wife had a very complicated hip surgery to revise the first hip replacement she got last year. They had to cut off part of her hip bone and then reattach it with wires. X-rays show that the wire didn’t hold the bone in place and it has slid up. We’re trying to decide what to do. Can she avoid another surgery?

The operation to remove a portion of the femur is called a trochanteric osteotomy. This is done to help give the surgeon better access to the hip joint. It’s a procedure used most often in complex cases requiring revision surgery of a total hip replacement already in place.

The trochanteric bone removed is reattached using a wire or cable system of fixation. Sometimes the device breaks or it isn’t tightened enough and the bone migrates (moves).

Trochanteric migration can be a major complication. It causes the hip muscles to lose their mechanical advantage. Walking without pain and/or a limp may become impossible.

The surgeon will use X-rays to measure how much the fragment has moved. Migration less than two centimeters can be watched and monitored carefully. If functional changes are already present, then surgery to stabilize the fixation is usually advised.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

The importance of exercise after total knee replacement

I had a total knee replacement six months ago. I’ve been doing my home program of exercises for my knee ever since. I think I may have maxed out because I’m not getting any more motion. Can I stop now?

If you have had a knee replacement, it’s likely that you are an older adult with arthritis or at least some type of joint degeneration. An exercise program to maintain motion, strength, and balance is still very important for you.

You may be able to drop back from a daily program of specific exercises for your knee and leg to one that’s done three or four times each week. But you should keep up with other activities such as walking, biking, golfing, tennis, or other recreational sports that you enjoy.

If you are having any trouble with walking, stair climbing, or other daily functional activities, then it may be time to have your exercise program re-evaluated. Your physical therapist can do this quickly and easily and help you get on a better track for what you need and/or want to do.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Is age a factor in hip replacement surgery?

My doctor said that he wants me to wait before having a hip replacement because I am only 45 years old. But, I’m in a lot of pain, which he doesn’t seem to understand. Why does he want me to wait?

Whether people should wait for replacements because of their age is debatable. Some doctors feel that if you put in a hip into a young patient, you are increasing the chances of the patient needing a second hip replacement when he or she gets older. However, there is also the quality-of-life issue that needs to be discussed. If someone is in tremendous pain and can’t function because of a sore hip, then a replacement might be called for.

Speak with your doctor and make sure that he understands completely how this is affecting your life.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

How do Cirque du Soleil performers do that?

I went to see Cirque du Soleil in Las Vegas. I’m just amazed by the kind of body contortions these people can do. Do they take some kind of drug to loosen up their joints?

Many of the movements you see in the Cirque du Soleil performers are just the result of natural flexibility and dedicated training. Some have natural flexibility we refer to as joint laxity. Most have been involved in gymnastics and/or dance from a very young age, which has helped mold and shape the joints to accommodate extreme movements.

You may also notice that many of the performers are Asian women. Young, females of black and Asian origin appear to have natural hypermobility (loose ligaments in the joints). This also contributes to their ability to look like body contortionists.

People with generalized joint laxity may be born with some differences in the connective tissue that account for this degree of looseness. There are at least 18 different types of collagen fibers making up the various soft tissue structures in the body. It may be that joint laxity is the result of changes within the collagen structure, a different type of collagen fiber in the joints, or a combination of both.

Scientists are studying these differences in hopes of helping to prevent joint injuries in young athletes as well as prevent joint stiffness as we age.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

What causes clicking of hip implant?

My mother has an artificial hip and sometimes she hears “clicking” when she walks. What does that mean?

Clicking of an artificial joint can have a few causes and most are benign or don’t cause any problems. After a joint is replaced, some clicking or popping may happen as the joint moves. Unless this is causing pain, there shouldn’t be any problem with it.

However, sometimes the clicking is a sign that the joint has moved or dislocated. For this reason, if your mother is having any pain, is unable to bear weight on the hip, or is otherwise uncomfortable, she should see her doctor and have the hip x-rayed to be sure about the cause.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.