Will tailored business suit still fit after knee replacement surgery?

January 31st — admin

My husband is a business executive and wears expensive, tailored suits to work. He’s going to have a total knee replacement in two weeks. Will his suit pants still fit?

The straightforward answer to your question is ‘Yes’ but with a few ifs, ands, or buts. First of all it’s not likely he will be wearing his suits right after surgery when swelling may make a difference.

Most patients enter a rehab program for a short time and find gym clothes or sweat pants much easier to get on and off. Loose fitting or pants that stretch will be helpful duringthis time.

By the time your husband re-enters the work world his regular suits should fit him once again. Total body weight gain/loss may occur anytime someone is off work or has had major surgery. This weight change will not be related to the size and weight of the joint implant.

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.

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Why bone may need to be removed during a rotator cuff surgery.

January 28th — admin

After my rotator cuff repair, the surgeon showed me on the X-ray how much bone had to be removed. I wasn’t really understanding why the bone was taken out. I thought it was just the muscle that was torn. Can you explain this?

Rotator cuff tears occur most often in young athletes and sports participants. The force of a stress greater than the strength of the muscle/tendon unit results in a tear of the tissues where the tendon joins the muscle.

The most common site of injury is the myotendinous junction. This is a region of highly folded tissue between the end of the muscle fiber and the tendon. These folds increase the surface area for force to be transmitted through the soft tissues. The junction of tendon to muscle is especially vulnerable to injury where the inflexible tendon meets the stretchy muscle.

In older adults, changes in the surrounding structures may contribute to rotator cuff tears. For example, bone spurs often form. Jagged edges rub against the tendon and cause the tissue to tear or rupture. In such cases, it’s not enough to repair the torn tissue. It is necessary to remove the bone spur(s) to keep it from happening again.

In other cases, the tissue gets stuck or impinged between two moveable parts of the shoulder complex. Sometimes the surgeon has to shave the bone down or even remove the end of the bone to keep this from happening.

When you see your surgeon again, don’t hesitate to ask him or her to explain again what happened in your case. The more you can understand about your own injury and recovery, the better. Preventing rerupture or other injuries from happening is an important part of patient education.

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.

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Adult protection from childhood hip problems.

January 27th — admin

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 disease (also known as Legg-Calvé-Perthes) 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.

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The torn meniscus has been repaired, should I bother with a second surgery for the damaged anterior cruciate ligament?

January 26th — admin

I have a torn meniscus and a damaged anterior cruciate ligament in my left knee. The meniscus was repaired with arthroscopic surgery. The surgeon couldn’t repair the ligament at the same time. I’ll need a second surgery for that. Right now my knee is much better. Should I even bother having the ligament fixed?

One of the jobs of the anterior cruciate ligament (ACL) is to keep the lower leg bone (tibia) from sliding too far forward on the upper leg bone (femur). A weak, lax, or insufficient ACL means higher stress on the knee cartilage.

The medial meniscus is affected the most. This is the C-shaped piece of cartilage on the inner (medial) side of the knee joint. Repairing the ACL will unload the medial meniscus and make it less prone to further damage or degeneration.

Your surgeon will be able to guide you in making this decision based on your symptoms, the result of tests, and the peek he or she had inside the joint during the meniscal repair. The results of many studies suggest a better long-term result if the ligament is repaired either at the same time as the meniscal tear or soon after.

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.

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Shoulder dislocations after corrective surgery.

January 25th — admin

My hotshot basketball playing son tore his rotator cuff and the labrum of his shoulder. After a very expensive surgery, he continued to dislocate his shoulder. Now we are faced with another surgery. How do we know this next surgery will be any better?

You should really talk with the surgeon about your questions and concerns. There may be reasons why the first surgery failed that can be avoided the second time. For example, it’s very important that the patient follow the surgeon’s instructions after the procedure.

Immobilization in a sling is usually advised for four to six weeks. The patient must keep the arm next to the body at all times except when bathing under the armpit. The sling is removed once or twice a day to keep the elbow from getting stiff. But it’s very important to avoid moving the shoulder until the surgeon approves.

Sometimes the type of surgery makes a difference for this problem. Arthroscopic repairs are less invasive but have a higher risk of failure. Using this approach, it can be difficult to place sutures far enough down on the tear. Sometimes there aren’t enough sutures used. Combining any of these risk factors together can have poor results.

A recent study from California reported on 30 cases of revised Bankart repairs. All patients were athletes involved in overhead sports. After an arthroscopic repair they all had a traumatic event causing the shoulder to dislocate again. A second operation was needed.

This time they had an open revision surgery. The results were good for most of the patients. Many were able to return to their previous level of sports activity. Follow-up over the next four years showed continued good results. All patients in the study rated their satisfaction as good or excellent.

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.

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Successful hip replacement surgery requires following doctor’s orders.

January 24th — admin

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 cantakerous. 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.

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What is a resurfaced patella?

January 21st — admin

What is a resurfaced patella? I see it in the surgeon’s report on my new total knee replacement. I don’t remember ever hearing about that.

When the knee joint is replaced the surgeon has two choices about the kneecap (patella). He or she can leave the patient’s patella in place or remove it and replace it with an implant. Unresurfaced or nonresurfaced means the patient’s patella is cleaned up but left alone. Any bits of uneven bone are usually smoothed over. Pits and dings in the cartilage are also evened out.

If the patella is removed and replaced, then a plastic-backed implant is used most often. Early patella replacements were made of metal but bits of metal kept breaking off causing problems.

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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Brachial Neuritis (neck/shoulder and arm pains), the cause and cure.

January 20th — admin

I’m a 44-year old male and recently diagnosed with brachial neuritis. The doctor doesn’t know what caused it but thinks I was overtraining for an iron man competition. Will I recover enough to still compete? The event is about a month away.

Brachial neuritis is a fairly uncommon disorder that affects the shoulder and/or one or both arms. Brachial refers to the group of nerves in the neck and arm called the brachial plexus. Neuritis means an inflammation of the nerve.

Patients notice a sudden start to their symptoms. Some report a burning or sharp pain. Others report a throbbing sensation. The pain starts in the neck and moves down one or both arms. The pain may last a couple hours but often persists for several weeks.

For some people there’s no known cause of this condition. Others link it to a viral infection, heavy exercise, surgery, or immunization (vaccination). About half the people affected have no idea what might have triggered the neuritis.

Your pain should gradually get less and less. As the pain goes away, muscle weakness becomes more obvious. Over time, the weakness may be accompanied by muscle atrophy (muscle wasting). Recovery is a very slow process, often taking a year or more. Some patients still notice mild weakness or sensory loss.

Most doctors advise their patients with brachial neuritis to limit their activity until strength is fully (or nearly completely) recovered. A rehab program can help you regain motion and strength. Depending on what your doctor tells you, it may be more realistic to shoot for next year’s iron man competition.

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.

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Is another surgery necessary after revision surgery didn’t fix a total hip replacement?

January 19th — admin

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.

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Should kneecap be removed during total knee replacement?

January 18th — admin

I hear there’s a big debate over whether to leave the kneecap in or take it out during a total knee replacement. Why can’t they figure this out? It seems like a simple ‘yes’ or ‘no’ question to me.

This has been an unresolved issue ever since the total knee replacement (TKR) was first done in 1968. Today 365,000 TKRs are done each year in the United States. At first the kneecap (patella) was replaced. Early problems with fracture, loosening, and rupture of the tendon around the patella caused surgeons to rethink this decision.

Some studies were done of patients who all had a resurfaced (replaced) patella. Others reported findings on studies with patients keeping their own patellae (nonresurfaced). A single answer to which was better couldn’t be reached.

It seems there are too many factors to compare. There are many different kinds of implants to choose from. Different surgeons come to the (operating) table, so-to-speak with a wide range of experience and surgical methods.

Even the patient’s diagnosis can make a difference. Some patients have one knee replaced while others have both knees replaced. It’s not always possible to tell if the results vary because of one of these factors or because the patella was or wasn’t replaced.

There remains a need for high quality studies to be done in this area of orthopedics.

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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