I’m just starting to research the idea of a metal hip joint resurfacing procedure. What can you tell me about this treatment?

April 29th — admin

I’m just starting to research the idea of a metal hip joint resurfacing procedure. What can you tell me about this treatment?

Hip resurfacing arthroplasty is a type of hip replacement that replaces the arthritic surface of the joint but removes far less bone than the traditional total hip replacement.

Because the hip resurfacing removes less bone, it may be used for younger patients. Hip joint resurfacing is a good idea for those who are expecting to need a second, or revision, hip replacement surgery. The need for a revision operation increases as they grow older and wear out the original artificial hip replacement.

During the procedure, the femoral head is dislocated out of the socket. Special powered instruments are used to shape the bone of the femoral head so that a new metal surface will fit snugly like a cap on top of the bone. The cap is held in place with a small peg that fits down into the bone. The hip socket may stay the same, but more often it is replaced with a thin metal cup.

The patient must have enough healthy bone to support the cap. The metal materials hold up well under the increased activity of a younger adult group of patients. There is a lower risk of hip dislocation after joint resurfacing compared with a total hip replacement. This may be because the fit is so much closer and better for hip resurfacing.

There have been some problems with metal-on-metal hip joint resurfacing. For example, tiny pieces of metal can fleck off the implant with prolonged wear and tear. Those metal ions can create irritating debris in the joint contributing to increased wear and tear.

Long-term reports of metal-on-metal hip resurfacing are fairly limited in number. Future research efforts are needed to observe the natural history after hip joint resurfacing and report on long-term results.

One study after 12-months reported a 75 per cent satisfaction rate. But this means that one-quarter of the patients were not happy with the results. Factors contributing to suboptimal recovery are unknown. It could be a lack of rehabilitation after the operation. It could be a different type of rehab is needed for hip joint 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 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 read that blood clots are very common after knee joint replacements. How often does this happen and what causes it?

April 28th — admin

I read that blood clots are very common after knee joint replacements. How often does this happen and what causes it?

Actually, doctors report the chances of a blood clot after a total knee replacement (TKR) are very high. The medical term for this is deep venous thrombosis (DVT). One study reported DVT occurs in at least 50 per cent of all patients.There’s a lot of trauma that occurs to the blood vessels of the leg during this operation. The doctor must cut through soft tissue and blood vessels to get down to the bone and joint. A tourniquet is used above the knee and this adds to the problem.Taking the old joint out and putting a new joint in requires a lot of force. The leg is twisted and turned, pushed and pounded. Since the risk of DVT is so high, prevention is started before the operation even begins.

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 had a steroid injection into my shoulder last week. My pain got much worse. What went wrong?

April 27th — admin

I had a steroid injection into my shoulder last week. My pain got much worse and I broke out in a skin rash. I’m not going to do that again. What went wrong?

You may have had what experts refer to as a corticosteroid flare. In a small number of patients, the body reacts negatively to the injection. Local irritation in the form of pain and/or a skin rash occurs.

This response occurs within the first eight to 24 hours after injection. The benefits of the injection (pain relief and reduced inflammation) are usually still experienced.

No one is sure just why this reaction occurs. It may be an immune reaction to the preservative in the product. Or it may be a response to the corticosteroid. Some experts have suggested needle penetration into nerve endings may be the cause. Others say that if this were the cause, then more patients would have the flare reaction.

When corticosteroid flare occurs, ice can be applied to the injection site. Your doctor may prescribe anti-inflammatory medications and analgesics (pain relievers). Analgesics used for this problem may include narcotic medications.

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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Does it make a difference in recovery for patients based on the type of hip fracture they have?

April 26th — admin

Does it make a difference in recovery for patients based on the type of hip fracture they have? My aging aunt has what’s called an intertrochanteric hip fracture. I got the impression from the hospital staff that this is the worst kind. Why is that?

There are many different types of fractures classified by location and specific type. For example, in the hip, the most common fractures in older adults affect the femur (thigh bone). These fractures include: ty

  • femoral neck
  • femoral head
  • subtrochanteric
  • intertrochantericFemoral neck fracture is a fracture in the femur (thighbone). The break is between the (long part of the femur) and the round round head at the top of the femur. This is where the femoral neck attaches the shaft to the head. These fractures often damage the blood supply to the femoral head. Loss of blood to the top of the bone can lead to death of the bone cells. This condition is called avascular necrosis.

    Femoral head fracture is a break in the femoral head. This is usually the result of high-energy trauma. Dislocation of the hip joint often occurs with this fracture. Subtrochanteric fracture involves the shaft. The break is right below the lesser trochanter (bony knob on the femur). Subtrochanteric fractures may also go down the shaft of the femur.

    When the break is between the greater and lesser trochanter, it’s considered an intertrochanteric fracture. This is the most common type of hip fracture. The prognosis for bony healing is usually pretty positive if the patient is in good health.

    But older age, poor nutrition, and poor health (especially combined together) puts a patient at risk for a poor prognosis. Immobilization after a hip fracture increases the risk of infections that can be life-threatening. A simple urinary tract infection or pneumonia can compromise the health of an older adult hospitalized with hip fracture. Deep vein thrombosis (blood clot) is also a risk in these cases.

    Many people beat the odds. So just having the risk factors doesn’t guarantee that your aunt will have a poor outcome. There may be other health issues or concerns that caused the hospital staff to react this way. You may need more information before coming to any firm conclusions.

    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 had an ACL-repair about a month ago. I’m getting my motion back nicely but I still can’t do all the things I expected by now. Is this normal?

    April 25th — admin

    I had an ACL-repair about a month ago. I’m getting my motion back nicely but I still can’t do all the things I expected by now. Is this normal?

    Getting knee motion back after surgery is called mechanical recovery. Being able to perform your daily activities or get back to sports is referred to as functional recovery. What you are noticing is the lag between mechanical and functional recovery.

    Such a difference is fairly common. There are many possible reasons for this. Regaining motion is just one part of recovery. There’s also muscle strength and joint position sense (proprioception) to consider. Your rehab program will include exercises to help with motion, strength, and proprioception.

    Your doctor and your therapist should be able to give you some idea of what to expect over the next weeks to months. They will likely base their predictions on your age, condition before surgery, and compliance with rehab. They also have the advantage of seeing the results of many patients who have come and gone before 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 had my shoulder joint resurfaced and also had a second surgery, but apparently the first implant wasn’t even loose. What could have been causing me pain?

    April 22nd — admin

    I had my shoulder joint resurfaced in an effort to avoid a total shoulder replacement. It didn’t work and I ended up with a second surgery. But it turns out the first implant wasn’t even loose. What could have been causing all my painful symptoms?

    One of the main advantages to humeral resurfacing arthroplasty is the fact that bone is saved and a total shoulder replacement (TSR) is still possible later, if needed.

    Shoulder resurfacing smooths the diseased bone and covers it with a metal cap. The head of the humerus (upper arm bone), surface of the acetabulum (shoulder socket), or both may be involved with a resurfacing procedure.

    But if this procedure fails for any reason, then the patient can have a revision surgery to remove the bone and replace it with a TSR. Infection leading to loosening of the implant is the most common reason to remove and replace the joint 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 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 didn’t fall or hurt myself that I can remember. How can I find out what’s causing my pain?

    April 21st — admin

    How can I find out what’s causing my hip pain? I don’t notice it so much during the day but at night it aches like a son of a gun. I didn’t fall or hurt myself that I can remember. It just started bothering me all of a sudden.

    There are many possible causes of hip pain. Often what patients call hip pain isn’t coming from the hip at all. Pain along the outside or back of the hip may not indicate a problem with the hip. True hip pain tends to cause pain along the inside of the leg near the groin.

    There are many structures in and around the hip that can be causing painful symptoms. These include the joint itself, the rim of cartilage around the joint (called the labrum), the bursa, ligaments, muscles, and tendons.

    Sometimes pain coming from the sacroiliac joint or low back can be referred to the hip. Most of the time, pain in the general region of the hip is caused by the soft tissue structures around the hip. There may be tightness, laxity, impingement, weakness, or poor alignment resulting in hip pain. Less often, fracture, infection, or tumor may be the source of symptoms.

    A medical examination may be needed to find out exactly what’s causing your symptoms. Your doctor will take a history, perform some standard tests, and possibly order lab work to look for inflammation or infection.

    Based on the results of these tests, further work-up may be advised. A set of standard X-rays may be needed. MRIs or CT scans are reserved for cases where further detail is required to make the diagnosis.

    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.

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

    My kneecap is causing me pain. If I have a release of fibers alongside the kneecap, will I get lasting results?

    April 20th — admin

    The kneecap on my left side is rubbing the wrong way causing pain. My pain might get better if I have a release of the fibers alongside the kneecap. Is this a short-term improvement or will I get lasting results?

    Many studies have been done following the results of a lateral retinacular release (LRR). In this operation the fibrous tissue called the retinaculum is cut alongside the kneecap. Sometimes the surgeon will also cut the capsule surrounding the joint and the attached synovial tissue.

    The results may vary depending on the cause of the problem. Results are best in patients with a tight retinaculum but a stable knee. Long-term results remain the same in this group. Patients with a dislocating patella may end up dislocating again years later.

    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.

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

    What is the proper treatment for a shoulder blade fracture?

    April 19th — admin

    What is the proper treatment for a shoulder blade fracture?

    Making the proper diagnosis is key. They are frequently overlooked. Ninety percent of the time, conservative treatment rather than surgery is adequate. Conservative treatment includes ice initially, then the use of heat. Immobilization for three to four weeks is usually necessary. Physical therapy for strengthening of the muscles around the shoulder blade is often prescribed. Repeat imaging such as computed tomography is used to monitor the healing progress of the fracture.

    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.

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

    My husband broke his hip. The surgeon explained that there are two options: repair or replace the hip. Which is best?

    April 18th — admin

    My husband is quite a bit older than me and needs surgery to repair a displaced, broken hip. The surgeon has explained the two options: repair or hip replacement. It does make sense to try and repair it first. If it doesn’t work, then we can still go with the hip replacement. Is there a downside to this approach?

    The treatment of some types of hip fractures remains a hotly debated topic among surgeons. Displaced femoral neck fractures can be especially complicated. Displaced refers to the fact that the broken bones have shifted away from each other. They no longer line up so good healing is not likely without surgery to repair or replace the bones.

    Studies show that all in all, it makes more sense and costs less for the older adult to have a hip replacement. Reduction and internal fixation (the repair option) has a higher rate of complications. If the bone fails to heal, then a second surgery (hip replacement) is needed.

    A total hip replacement (THR) after failed fixation does not give the same results as if the THR was done in the first place. Quality of life is less and cost is more when two surgeries are done instead of just one. There is also a chance that function will be further reduced by the second operation.

    The repair option is advised if the patient is a good candidate for this management approach. This is usually the young, active adult who is in good health both mentally and physically. With good bone quality, there is an excellent chance for successful healing with no complications.

    For the older adult who has decreased bone density, diminished mental capacity, or who had poor function before the fracture, THR is 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.

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