Thigh muscle won’t contract after total knee replacement surgery

June 30th — admin

A month ago, I had a total knee replacement. I’m working very hard with my exercises, but the thigh muscle just doesn’t seem to contract when I try to straighten or lift my leg. Why is this?

Scientists refer to this as “inhibition.” The muscle along the front of your thigh is the quadriceps. The surgery disrupts this muscle and keeps it from contracting with full force. In other words, the voluntary contraction is inhibited. Pain and swelling in the joint probably add to the problem. A new study supports the use of electrical stimulation and biofeedback to get back the full power of the muscle. You may need a more complete rehab program with a physical therapist to regain this muscle function. It will prolong the life of your implant and reduce your risk of falls.

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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What’s the difference between shoulder replacement and resurfacing?

June 29th — admin

What’s the difference between shoulder replacement and resurfacing?

Shoulder replacement is the removal of the shoulder socket and head of the humerus (upper arm bone). These parts are replaced with an artificial implant.

On the shoulder socket side, a cup-shaped metal or ceramic implant is pressed or cemented into the bone. On the humeral side, an implant shaped like the head of a humerus with a long stem is inserted down into the shaft of the humerus. New bone from the humerus grows into and around the implants.

With joint resurfacing, the surgeon removes any bone spurs and smooths the joint surface. Then the joint surface is covered with tissue from some other part of the body. This could be a piece of tendon, flap of muscle, or rim of meniscus. The tissue usually comes from a donor bank.

Biologic resurfacing is also known as interpositional arthroplasty. It has been around in one form or another since the mid-1800s. It is one alternative to a total joint replacement for young, active adults. Less bone is removed. This makes it possible to convert to a total shoulder replacement later, if needed.

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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Pros and cons of hip joint resurfacing

June 28th — admin

My father had a hip joint resurfacing surgery. He’s fairly active and thought this would help save the hip in case he needed a hip replacement later. Unfortunately, exactly four months later, his hip broke and he ended up with a total hip anyway. Is this a common problem? We don’t know what to think about it.

Hip joint resurfacing has the main advantage of preserving bone in the neck of the femur (thigh bone). The main disadvantage is the risk of overloading the femoral neck causing fracture or loosening of the implant. Patients are chosen carefully for this procedure to avoid these problems. But sometimes unexpected complications occur anyway.

Joint resurfacing is fairly new, so we don’t know all the risk factors or variables that might lead to implant failure. One new area of study has been to look at the amount of load placed on the femoral neck before and after implantation. It’s possible that too much load on the hip too early after the surgery could lead to fractures. How much load the hip can take isn’t known yet. This could vary from patient to patient depending on their bone density, anatomical angles of the hip, and body weight.

Studies are also being done to examine the effect of slight variations in the placement of the implant. Even a 10-degree rotation of the implant can make a difference. More study is needed to look at patient risk factors and surgical techniques that might lead to hip fracture. Reducing these risk factors will help decrease the number of fractures and other complications of 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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Will surgery fix trick knee?

June 27th — admin

I have a trick knee that goes out on my every now and then. It’s from a torn ACL from an old football injury. If I have it repaired surgically will that stop it from giving way?

It should but there are no guarantees. It may depend on the condition of the rest of your knee joint. Are the other ligaments okay? What about the cartilage? Are there any signs of advancing arthritis? How much strength do you have in the muscles around the knee joint? These are all important factors.

There are two popular ways to repair a torn anterior cruciate ligament (ACL). One of these methods called the bone-patellar tendon-bone graft has been shown to be 22 percent more stable. In other words, it’s less likely to give way because of joint laxity. The increased graft strength may come from the small piece of bone plug that’s used along with the tendon tissue to make the repair.

The choice of graft material must be made on a case-by-case basis. It’s an educated decision based on the condition of your joint, your activity level, your goals, and the surgeon’s level of expertise.

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 Arthritis, Knees. Tags: , , , , , . No Comments »

How many patients who have surgery for shoulder dislocation develop arthritis?

June 24th — admin

About five years ago, I dislocated my shoulder repeatedly. Eventually I had surgery to clean out the joint and tighten it up. I’m starting to notice some crackling noise in that joint when I move my arm overhead. Does this mean something has come loose? Do I need to do something for this before it becomes a problem?

You may be noticing some early signs of joint degeneration. Arthritic changes aren’t uncommon after shoulder surgery for recurrent shoulder dislocations. In fact, some studies show up to 20 per cent of patients who have surgery for shoulder instability develop postoperative arthritis.

Sometimes early arthritic changes are already present in the shoulder before the surgery. This has been observed in about nine per cent of patients with chronic shoulder instability. Loss of shoulder motion and function seem to be linked with deficiencies leading to arthritis.

A follow-up visit with your orthopedic surgeon may be in order. At the very least, an X-ray of the joint will be done to rule out fracture or loose fragments in the joint. The X-ray can also confirm the presence of arthritic changes.

Early diagnosis of orthopedic problems is always recommended. Taking care of a minor problem can help prevent major problems 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 Arthritis, Shoulders. Tags: , , , , . No Comments »

Hip joint resurfacing vs. hip joint replacement

June 23rd — admin

I thought I was going to be spared having a total hip replacement by going for joint resurfacing. But I ended up with a hip fracture and a second surgery to replace the hip anyway. No one seems to know what caused the problem. What are some possible reasons for this happening to me?

Hip joint resurfacing instead of a total hip joint replacement is fairly new. Resurfacing replaces the arthritic surface of the joint but removes far less bone than the traditional total hip replacement. It saves bone in the femoral neck but can put strain on the femoral neck leading to fractures.

There are two main groups of risk factors for fracture after joint resurfacing. The first has to do with the patient. Bone quality is important. Decreased bone-mineral density and cystic bone changes can contribute to weakened bone. The bone has a decreased ability to withstand forces leading to fracture. Any changes in natural alignment of the hip can result in mechanical abnormalities. The most common of these malalignments are coxa varus (angled inward) and coxa breva (short femoral neck).

The second group of risk factors is related to the surgical procedure. Placement of the component is important. If the implant is tilted or angled too far in any direction, loading patterns change. The risk of fracture increases. The surgeon also uses a special technique called notching as part of the procedure. Studies show that notching reduces the bone’s resistance to fracture.

Sometimes it isn’t clear what went wrong. Efforts are being made to identify patients who are good candidates for joint resurfacing. Bone quality, general health, and past medical history are important features to consider. At the same time, surgeons are looking for ways to improve the implant and surgical techniques used.

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 Arthritis, Hips. Tags: , , , , . No Comments »

Knee creaks after ACL repair. Is this normal?

June 22nd — admin

I had an ACL repair done about 18 months ago. The knee works fine but it creaks and cracks a lot when I move it. Is this normal?

You may be describing what’s called crepitus. This sound or feeling occurs when the back of the kneecap grates against the bone. This finding is more common before the ACL repair is done rather than afterwards.

Any snaps, clicks, crepitus, or joint sounds should be reported to the surgeon. The same goes for locking or giving way of the knee joint. Crepitus or similar sounds could occur when the extensor mechanism of the quadriceps muscle isn’t working quite right. This can occur when scar tissue forms or if the tendon has been shortened too much.

The doctor will be able to tell the difference between sounds caused by scar tissue and those caused by cartilage rubbing against bone. There may be some treatment that can help you. It’s not a normal sound and should be taken care of before it gets worse.

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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When can patient play tennis again after arthoscopic shoulder surgery?

June 21st — admin

I’m going to have an arthroscopic surgical procedure for a problem with a chronic left shoulder dislocation. I’d like to get back on the tennis court in time for the adult summer league. What kind of rehab program should I expect?

Rehab programs after a shoulder stabilization procedure may be the same whether it was an open versus closed procedure. Sometimes this depends on the surgeon’s preferences. Type of sutures used, amount of damage to the soft tissues, and condition of the joint capsule are only three of the important considerations.

Most often, the protocol used during the early phase of rehab is one that can be modified for each patient. Your therapist will advance you along as quickly as possible. The rehab protocol is really just a guideline.

Most likely you will be put in a shoulder immobilizer (sling) in the operating room. This is worn for two to four weeks. Exercises are started at two weeks. Passive and active-assisted partial range of motion is allowed. Full, active range of motion is permitted at six weeks.

The therapist will progress you to and through a series of strengthening exercises. The speed at which you will be able to advance may depend on your level of pain, degree of stiffness, and strength. You will be able to start training for tennis participation between eight and 12 weeks. If there are no complications or problems, you may expect to return to your sport about four months 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.

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

90-year old tennis player breaks hip – will he walk unaided?

June 20th — admin

My husband fell playing tennis at age 90 and broke his hip. He was always so proud he could still play. Despite his good mobility before the fracture, they are saying he probably won’t walk alone again. What do they base these absurd predictions on? How do they know what he will or won’t do?

Studies show that advanced age is a predictor of poor function after hip fracture. Although it is entirely possible that your husband will regain independent mobility, only two per cent of the population aged 90 and older are able to return to their prefracture level of independence. Many older adults end up using a walker but are able to gradually progress in their rehab program to use two canes. Eventually, it may be possible to eliminate one cane and just walk with one assistive aid (or none at all).

The fact that your husband was still playing tennis suggests good health and good mobility. Both of these factors are in his favor in terms of recovery and rehab. If all goes well, he may very well be among the two per cent who regains his previous level of independence and function.

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 »

Knee replacement patients do less after surgery?

June 17th — admin

I can’t help but notice my family and friends who’ve had a knee replacement do less and less after their surgery. I thought replacing the joint would free them up to do more. Is this a common pattern?

Research data shows patients get relief from pain after a total knee replacement (TKR). But residual disability is common as you’ve noticed. Most patients get enough motion and strength back to do their daily tasks.

Recovery to pre-TKR levels just doesn’t happen for the average person. A year after the operation, most patients go up and down stairs at half the speed of healthy adults the same age. Squatting, gardening, and heavy housework often go by the wayside. Patients with TKRs walk slower and shorter distances than before the surgery.

Physical therapists are studying this problem. They hope to find ways to prevent or overcome these problems. A recent study from the University of Delaware suggests strengthening the quadriceps (thigh) muscle may be a key factor.

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 »
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