What is hip osteoarthritis?

August 31st — admin

My doctor thinks I have the start of hip osteoarthritis. What is this disease anyway?

Osteoarthritis (OA) is more of a condition than a disease. It occurs slowly over time as the loss of cartilage begins. The layer of bone just under the cartilage starts to harden, a process called sclerosis. Bone spurs start to form around the edges of the joint.

Patients affected by OA report pain, loss of motion, and loss of function. Hip OA can cause pain in the groin, thigh, and upper outer part of the leg. Pain can go from the hip down to the knee. Morning stiffness is common. Patients often have trouble putting weight on the affected leg.

Early identification and treatment may help patients stay active and avoid surgery for years. Exercise has been shown to reduce pain and disability. The use of manual physical therapy combined with exercise seems to give patients greater return of function that lasts longer.

If you haven’t already, talk with your doctor about the various treatment options. Find out what is recommended for you.

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 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.

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Options for hang glider who crashed, tearing rotator cuff

August 30th — admin

I’m a certified hang gliding instructor with 20 years of experience. Even so I hit an updraft and crashed, tearing three of the tendons in my shoulder. I’ve had two surgeries to try and repair this massive tear. They didn’t work. Are there any other options left to me?

Repair of massive tears of the rotator cuff can be problematic. In some cases they are considered irreparable. Studies have been done trying different surgical methods of treatment for this problem. So far there hasn’t been a single type of surgery that works best.

For the most part the best approach seems to be cleaning up the damaged tendons. This is called debridement. Then the bone across the top of the shoulder (acromion) is removed. This is called an acromioplasty. If just the underside of the acromion is shaved, it’s called a subacromial decompression.

When any part of the rotator cuff is torn and can’t be repaired, an imbalance occurs at the shoulder. That’s why the rest of the rotator cuff can get impinged. Reducing or removing the acromion leaves room for the remaining tendons of the rotator cuff to slide and glide without getting pinched.

Other surgeries used to reconstruct massive rotator cuff tears include tendon transfers, fusion, and tendon grafting. No one method seems to have better results than the others.

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 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.

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Will total knee replacement stop senior marathon runner?

August 27th — admin

I’ve been a marathon runner all my adult life. At age 66 I’m going to have my right knee replaced. What are my chances of being able to run again?

There’s much interest and debate around this topic. The materials used in a total knee replacement (TKR) are designed to give the implant movement like a normal joint. The implant is usually made of sturdy materials such as stainless steel, alloys of cobalt and chrome, and titanium. Plastic liners may be part of the implant. These are durable and wear resistant.

Orthopedic surgeons, engineers, and other scientists are working together to improve the surgery and implant materials. Right now these materials are not made to withstand the stresses of running, heavy physical work, or contact sports. Engaging in these types of activities after TKR may lead to damage or early wear of the implant. The estimated lifespan of a knee implant is 10 to 15 years.

Impact sports like running are not usually advised. No-impact or low-impact sports are acceptable. Be sure to tell your doctor your interests in activities. Sometimes the type of implant used can make a difference. Find out what to expect. Your implant last the longest if you follow your doctor’s advice.

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 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.

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Partial hip replacement may result in fracture

August 26th — admin

My mother just had a partial hip replacement. I guess it was like having a tooth capped. Just the top of his femur was replaced. She ended up with a hip fracture afterward. Is this common?

It sounds like your mother had an operation called joint resurfacing. This type of operation has been around since the 1930s. It has come and gone based on problems afterward and materials available. Most recently, new metals have made it possible to resurface the head of the femur (thigh bone) with good results.

Fracture (usually of the femoral neck) is the most likely complication of hip joint resurfacing. It happens in up to four per cent of the cases. Studies show fracture occurs most often in the first 100 cases done by a surgeon. Fracture rates go down as the surgeon becomes more familiar with this technique.

Causes of fracture are both patient and technique-related. Obesity, decreased bone mass, and arthritis make a difference on the patient side. Anyone with a femoral neck cyst should get a total hip replacement instead of resurfacing. Putting the implant in with too much of a tilt or twist can also result in fracture.

Women seem to have a higher risk of fracture after hip joint resurfacing. The reason for this remains unknown at this time. Short-term results of hip joint resurfacing are good to excellent. Long-term studies aren’t available yet. Total hip replacement may be needed by patient who have a fracture after resurfacing.

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 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.

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Rodeo rider may want shoulder replacement, not fusion

August 25th — admin

I’m a professional rodeo rider and had a bad calf roping accident. My right shoulder was dislocated severely and the muscles around the joint ruptured. After three surgeries already I’m going to have it fused. How do they do this operation? What can I expect during recovery?

Shoulder fusion is not used as commonly as it once was. Shoulder replacement has replaced fusion in many cases. If you haven’t already talked to your surgeon about a total shoulder replacement, you may want to ask about this as an option before shoulder fusion.

Shoulder fusion or arthrodesis is called a salvage procedure. The arm is saved from amputation but full shoulder motion isn’t preserved. You may not have enough motion to swing a rope over your head or enough strength to wrestle a calf to the ground.

The fusion is done using metal plates and screws. The reconstruction plate is actually one normally used in the hip or pelvic area. It goes up along the outside of the upper arm and over the top of the shoulder along the bony ridge of the shoulder blade. Screws help compress the bones together to fuse the area. Sometimes bone grafts are used to fill in any spaces left open.

Your arm will be immobilized for at least eight to 10 weeks. Some doctors use a special abduction pillow. Others put the arm in a full cast from wrist to shoulder. Once there is evidence of fusion on X-ray, rehab exercises can begin.

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 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.

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NASA pressure chamber could help speed rehab

August 24th — admin

I’ve heard there’s a pressure chamber designed for NASA that might be used in the future for rehab after knee and hip injuries. What can you tell me about this?

Astronauts are subject to many possible problems due to travel in a gravity free environment. Muscles start to waste away. Bones get brittle and the heart and lungs start to get deconditioned.

Exercise in space has not been able to help staff keep muscle strength and mass. Treadmills with bungee cords have been tried but the harness is uncomfortable. A lower body negative pressure chamber has been devised to help with this problem.

The chamber is a rectangle-shaped box that forms a vacuum around the lower body. It’s sealed at the waist. A special saddle helps the legs stay relaxed while supported. Pressure can be lowered to reduce the force on the joints equal to 20 percent of the person’s body weight.

Using this idea might be helpful with patients who need to get up and moving but can’t put weight on their leg. This could apply to patients with hip and knee surgeries, amputations, and even strokes. It’s not available for commercial use yet. It’s still being tested for patient use.

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 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.

Posted in Hips, Knees. Tags: , , , . No Comments »

Is a total hip replacement necessary for just one part?

August 23rd — admin

I just got the results of my hip X-rays. One hip has arthritis but just at the top of the thigh bone. The round ball in the socket is all broken down. It’s not really round anymore. Do I have to have a whole hip replacement just for one part?

Maybe not! You may have a couple choices. The first is called a hemiarthroplasty. The surgeon removes the round top of the femur (thighbone) and drills out some of the bone down inside the shaft. Then a replacement top and stem are inserted down into the bone.

Or if you are younger than 60 and have good bone stock, you may be able to have a hip resurfacing arthroplasty (HRA). In this operation, just the top or cap of the femoral head is removed and replaced. It’s a lot like having a tooth capped by the dentist.

Your surgeon will be able to tell you both what is possible and what he or she can do. Not all surgeons perform all types of joint implants. Experience is important so it’s a good idea to go with what your surgeon is skilled at doing. If you are a good candidate for a HRA, then you may want to go to a center where this operation is done routinely.

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 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.

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Dislocated collarbone does not always require surgery

August 20th — admin

My son is a freshman away from home at college. He fell from a ladder and dislocated his collarbone. He tells me he had a ‘closed reduction’ and he’s okay. What does this mean?

Reducing a dislocation of any joint means the joint is put back in place or ‘relocated.’ A closed reduction suggests the medical person who treated him was able to get it back in place without surgery.

Sometimes it’s just a matter of putting the patient in just the right position and the bone will slip back in place. For example, one way to relocate the collarbone (clavicle) to the sternum is to lie down on the back with the dislocated side on the edge of a table. A sandbag is put between the shoulders. The arm is brought out to the side and pulled out gently. The sound of a “pop” occurs when the clavicle goes back into place.

There are several other ways to relocate this joint. If that doesn’t work then surgery or open reduction may be needed. The clavicle is lifted up and put back in place. If it stays there without slipping down the incision is closed and the patient is immobilized in a special sling to hold it in place.

If the clavicle keeps slipping out of place then more extensive surgery may be needed. Your son should be advised not to do any lifting for the next six weeks until the joint is fully healed. Strenuous upper body exercises such as push-ups or pull-ups should also be avoided.

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 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.

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Unicompartmental knee arthroplasty not always the answer

August 19th — admin

I had a unicompartmental knee joint replacement last year. That means they only replaced the inside half of my left knee. I thought it was going to be the answer to all my problems. Instead I ended up with more problems. Would it have been better to have a total knee replacement?

Many studies support the use of the unicompartmental knee arthroplasty (UKA). It’s been shown to have a faster rehab time, give better function, and cost less than a total knee replacement.

Failure in a small number of cases does occur. There are several reasons why this can happen. Sometimes the arthritis continues to get worse. The bone around the implant wears away and the implant loosens.

In other patients the hip, knee, and ankle don’t line up as well as they used to. Finally, overcorrecting a deformity at the time of surgery can cause too much load on the knee joint. The wear and tear on bone and ligaments can lead to failure of the implant.

It may still be possible to salvage your “new” knee. Sometimes surgery to revise the implant is the answer. In other cases, replacing the unicompartmental implant with a total knee replacement is the next step. Be sure and ask your doctor what are your options. Perhaps get a second opinion from another surgeon.

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 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.

Posted in Knees. Tags: , , , , . No Comments »

Will Mom outlive her hip implant?

August 18th — admin

My mother is thinking about having a total hip replacement. She’s 72-years old. The doctor says the new implants last about 15 to 20 years. Does anyone have an implant that lasts longer than that? As she gets older, a second hip replacement may not work so well. We’d like to avoid that if possible.

Long-term studies over 15, 20, and even 25 years are being reported more and more. The revision rate of the earlier implants may turn out to be higher than rates for implants used today. The materials, design, and even the surgery are much improved over even 10 years ago.

One study from the University of Iowa Hospitals and Clinics reported on 357 cases of total hip replacement (THR) done by one surgeon. All patients got the same kind of implant called the Charnley THR. This type of implant was put in using hand-packed cement. Today many implants are cementless or cemented in place with a cement gun for a better fit.

All of the patients still living had the implant at least 25 years. Many of the patients who had died still had the original Charnley implant at the time of their death. About 10 per cent of the patients had to have an implant revision because of infection, dislocation, or implant loosening.

At age 72, your mother’s implant has a good chance of outliving her. Revision or replacement of the first THR may not be needed. The new implant methods reduce pain, increase function, and improve quality of life for most patients.

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 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.

Posted in Hips. Tags: , , , , , , , . No Comments »
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