I considering have a hip joint resurfacing operation. What kind of problems are likely?

March 31st — admin

I’m thinking about having an operation called hip joint resurfacing. But I’ve heard the metal used can cause problems. What kind of problems are likely?

Early attempt to use hip resurfacing were done with titanium alloy, cobalt chrome, alumina or ceramic components. Over time, new developments have led to the use of metal components made from cobalt chromium.

As you’ve discovered, there were some concerns about heat build-up between the bone and the metal. If the temperature of this interface gets too high, bone necrosis (death) can occur. But surgeons have overcome this problem with modified techniques to dissipate the heat.

There were also some questions about maintaining an adequate blood supply from the shaft of the femur (thigh bone) up into the femoral head. But studies using nuclear imaging show that an even mount of blood flow is preserved.

Metal-on-metal hip resurfacing (MOMHR) has not been approved for use in woman of childbearing age. There is concern that debris from the metal can cross the placenta and affect the growing fetus. Cobalt and chromium ions have been found in umbilical cord blood to prove this can happen.

So far, there’s been no negative effect seen in children who have been exposed to ion particles. But we don’t know if long-term studies would show the same benign effect. More study is needed before MOMHR will be approved for this group of women.

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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My mother has knee pain that’s being called an insufficiency fracture. What is it?

March 30th — admin

What is an insufficiency fracture? My mother was told that’s what’s causing her new knee pain.

Insufficiency fracture is a small subset of a larger group of fractures called stress fractures. Insufficiency fractures are caused by the effect of normal stress on weakened bone. Osteoporosis is the most common cause of bone loss leading to insufficiency fractures.

Loss of bone density from osteoporosis decreases the bone’s ability to “give” slightlyand resist everyday loads. The loss of this “elasticity” seems to affect the spine, tibiaand fibular (lower leg bones) and calcaneus (heel) most often.

These fractures seem to be on the rise in older adults, especially postmenopausal women.

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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I dislocated my right shoulder and require surgery. How long will it take to get my strength back?

March 29th — admin

I am a volleyball player at the collegiate level. I can’t tell you how many times I’ve dislocated my right shoulder while playing. Now that we are in the off-season, I’m going to have surgery to repair it. How long will it take to get my strength back?

Your rehab and recovery may depend on the type of surgery you have. Some surgical procedures are more involved than others and require a longer period of immobilization before rehab can begin.

The operation can be done by one of two main methods: open versus closed. The open incision method is done arthroscopically and may cause weakness in the internal rotator muscle strength. The tendon of this muscle (the subscapularis muscle) is cut or dissected during an open repair. Scarring and shortening of the tendon after surgery can delay recovery.

Some studies show that open surgery to stabilize the shoulder can also lead to atrophy and fatty infiltration of the subscapularis muscle. The result can be muscle insufficiency and weakness.

A recent study comparing muscle strength after both open and closed operations showed that the long-term results aren’t any different. By the end of 12 months, patients in both groups had full return of shoulder motion and strength.

But patients who had the closed (arthroscopic) repair had a faster and better recovery in the short-term. By the end of six weeks, the arthroscopic group had 80 per cent of normal strength. By the end of three months, more than 90 per cent of normal strength had returned.

Not only that, but an aggressive rehab program can be started sooner for patients who have arthroscopic surgery. This may put you closer to your goal of returning to sports play sooner than later. You can expect at least a three- to four-month rehab period after surgery.

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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I’m having a mini-hip replacement. How much time will it take for rehab, etc.

March 28th — admin

I’m going to have one of those new fangled mini-hip replacements. I’m supposed to be in and out on the same day. What should I figure on for recovery time with rehab and all?

An interesting discovery has been made about the post-operative results of the mini-incision technique for hip replacement. At first, surgeons thought the smaller incision was the reason patients had a faster recovery.

But more and more studies have been done now comparing the various types of incisions (large and small). It looks like early weight-bearing and quick recovery are possible with all types of incisions. This is true for the anterior, posterior, single, and double incision of all sizes.

A second look at this result points to the importance of the rehab program. It looks like a more comprehensive rehab program may be what’s making a difference.

For one thing, patients are given more education before the operation. They are told what to expect and shown how to do the exercises and walking regimen before even having the surgery. This helps speed up recovery because the information isn’t new to them.

Better intra-operative technique has also proven beneficial. Pain medication is started while in the operating room, rather than after the patient wakes up.

New drugs have been developed to reduce side effects such as nausea from the anesthesia. And regional anesthesia makes it possible to numb the area without exposing patients to systemic effects of anesthesia.

Patients who get good education and follow-up care before and after surgery go home sooner, recover faster, and use less pain medication. Every surgeon or surgical center has their own way of coaching patients through the experience.

Ask your surgeon what his or her plan is for rehab for you. Try to follow the suggestions as closely as possible to avoid adding any extra problems or complications.

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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Having gotten off a bus for 10 years, my mother’s hurt knee was diagnosed as an insufficiency fracture. Why was this time different?

March 25th — admin

My mother was getting off the bus when she had severe, sharp knee pain. The MRI showed a stress fracture. The doctors are calling it an insufficiency fracture. She’s gotten off that bus everyday for the last 10 years. Why was yesterday any different?

You didn’t say your mother’s age but age may be a factor. Older women are at increased risk for this problem. There’s an increased number of these fractures in women who are postmenopausal. Osteoporosis (decreased bone density) in this age group is another important factor.

Without its normal resiliency, the simplest, everyday stress can cause damage to the bone. Anyone who has arthritis is also at increased risk. Often, the osteoporosis added to any slight knee deformity can be enough to cause this problem.

Other factors include alcohol use, Crohn’s (intestinal) disease, and the use of steroids for arthritis. Low calcium absorption, vitamin D deficiency, and hormonal changes are also factors.

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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I’m told I can have an open or closed Bankart repair for my shoulder. Which one should I choose?

March 24th — admin

Okay so please help me out here. I’ve been told there are two ways to have my dislocating shoulder repaired. The operation is called a Bankart repair. They can do it open or closed. Which is better? How do I know which one to choose? Do I get a choice?

You’ll want to discuss this decision with your surgeon. He or she may have a preference based on training and experience and/or based on specific factors that only apply to you.

The Bankart repair is for a shoulder injury of the labrum. The labrum is a dense ring of fibrous cartilage that is attached to the acetabulum (socket) of the shoulder joint. It gives the socket a little more depth and stabilizes the head of the humerus (upper arm bone) in the joint.

Repeated shoulder dislocations in the forward direction cause the labrum to tear away from the acetabulum. Surgery is needed to shave any loose fragments and reattach the labrum. The operation can be done with an open incision, which involves cutting through the subscapularis tendon.

Open repair gives the surgeon a better view of the area but has the downside of causing damage to the soft tissues. Fibrosis and scarring can occur during the healing process. These factors can delay recovery.

The closed or arthroscopic method involves the insertion of a long, thin needle into the joint. A tiny TV camera on the end of the scope gives the surgeon a view inside the joint without opening it up.

There is a minimal scar (puncture size) and less risk of complications. Arthroscopic surgery is also shorter with less postoperative pain. And according to a recent study, muscle strength returns to normal sooner with arthroscopic surgery. So if you are an athlete or sports participant, this feature may be of some particular interest to 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 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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I have heard of range-of-motion exercises, but what are they? Do they make a joint stronger?

March 23rd — admin

I have heard of range-of-motion exercises, but what are they? Do they make a joint stronger?

Range-of-motion exercises are exercises given to a patient following an injury, surgery, or procedure on a joint that may affect how well the joint can move.

The way you can move your shoulder, for example, provides you with and example of a range of motion. If you can move your arm in all the ways it is intended, you have a good range of motion. However, someone who has pain may not be able to move the arm as well. This is a restricted range of motion.

Physiotherapists provide ROM exercises to help enlarge that target range or to keep the current range from getting smaller.

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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I’ve heard a lot about ACL tears in the knee. Are PCL tears just as bad?

March 22nd — admin

I’ve heard a lot about ACL tears in the knee. Are PCL tears just as bad?

There are two major ligaments in the knee joint: the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). By far, the ACL is injured or damaged more often than the PCL. Not as much is known about what happens when the PCL is torn. A recent study in Germany tracked 181 patients with PCL tears who did not have surgery to repair the injury. They found that damage to the joint cartilage after a PCL tear is common. In fact, more than half of all patients with a PCL tear develop cartilage damage and arthritis after that.After a PCL tear, there is a change in where the knee joint comes together during movement. A weak PCL causes more pressure on the inside edge of the knee. Higher loads and greater force act on the cartilage. The cartilage gets worn down and damaged.

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 causes a frozen shoulder?

March 21st — admin

What causes a frozen shoulder?

Frozen shoulder is also known as adhesive capsulitis. It is a loss of shoulder motion due to tight soft tissues around the shoulder. A restricted joint capsule is also part of the problem. Pain and limited motion usually result in loss of function as well. Muscle weakness and atrophy then develop from disuse.

The actual cause and underlying pathology behind a frozen shoulder are still unknown. People with diabetes, heart disease, and rheumatoid arthritis are at increased risk for frozen shoulder syndrome. Trauma to the shoulder can also lead to adhesive capsulitis.

There are several theories to help explain this condition. Anything that changes the way the shoulder moves and results in impaired shoulder movements can lead to shoulder capsule adhesions.

Adhesions are little areas of scar tissue that bind two areas of tissue together. When there are adhesions, the joint capsule doesn’t move smoothly. Then the soft tissues around the joint start to contract and tighten up.

A cycle of pain-spasm-loss of motion-pain can develop. This keeps the individual from regaining lost motion. In addition, there is an area of extra capsular material called the capsular redundancy or axillary recess that gets stuck.

This part of the capsule is at the bottom of the shoulder joint. As the arm moves up overhead, the capsule unfolds to allow smooth gliding action. When adhesions develop within this fold, the capsule can no longer unfold and motion stops.

Again, no one is sure which comes first: loss of capsular motion and unfolding or impaired shoulder motion. Treatment for the frozen shoulder syndrome focuses on restoring both.

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 it possible that a doctor would want to do a partial replacement on one hip and a total replacement on the other?

March 18th — admin

Is it possible that a doctor would want to do a partial replacement on one hip and a total replacement on the other?

The type of replacement a doctor chooses to do depends on the damage, the patient’s health and condition, and the state of the femur, or thigh bone. It is possible that a doctor would prefer to do a partial replacement on both hips but one is not a good candidate for it – that could be one reason. This is the type of question that a patient should ask the surgeon beforehand.
 
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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