Why not replace hips before they break?

August 31st — admin

I know that this sounds way off, but why not just replace hips before they get broken? So many old people break them anyway.

That’s an interesting idea but not all that practical. First of all, not all seniors do break their hip, so it would become difficult to have to decide who would get a replacement and who wouldn’t. But, setting that all aside, this type of question shows that there is a misconception about the risks of surgery. Any type of surgery has its risks. Not everyone is healthy enough to have a major surgery like a hip replacement. Illnesses such as heart disease, asthma, and diabetes, can cause problems post-surgery. Hip replacement surgery requires that a patient go under a general anesthetic (risky on its own) and be subject to many of the potential surgical complications, such as infections, blood loss, and malfunction of the implant, to name a few. Then after the surgery, the patient has to be confined to bed and chair for a while and then undergo physiotherapy to regain the strength in the leg and hip. For some people, this is easy, for others, this is much more difficult. So, while the idea is certainly an interesting one, it’s not a practical one.

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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Which leg should donor tissue come from?

August 30th — admin

Should I have my ACL repair done using donor tissue from the same leg or the other leg? Which is better?

If the tendon graft is taken from the same leg, then only one leg is affected. The patient can shift the weight off that leg during the early days after the surgery.

Repairing the knee with donor tissue from the other leg means both sides are affected. There have been a few cases reported of problems developing from overload of the donor side.

This is more likely during the first 24-hours when the patient is still under the influence of anesthesia and drugs to limit pain. Without complete sensation, the patient can put too much load on the donor leg. The result can be an avulsion fracture. The remaining (weakened) patellar tendon pulls away from the bone.

On the plus side, taking donor tissue from the other leg leaves less trauma to the reconstructed knee. Rehab can progress along much faster.

Most surgeons use donor tissue from the same side. Talk to your surgeon about his or her preferences and reasons for choosing one over the other.

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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Rotator cuff injury is two years old, too late for surgery?

August 29th — admin

I injured my rotator cuff about two years ago. At that time, I didn’t have insurance to pay for the surgery. Now with a new job, I want to get this taken care of. But I’m wondering if I waited too long. Do the results depend on the timing of the surgery?

Outcomes of surgery for a rotator cuff tear depend on a wide range of factors. Patient age, duration of symptoms, and time from injury to surgery can make a difference. Even more important is the type and severity of injury.

Most rotator cuff tears affect the supraspinatus tendon. If the force of the injury is enough, the tear can extend posteriorly (backwards) to include the supraspinatus tendon. Less often, the subscapularis tendon is injured. If the force is great enough, the tear extends anteriorly. The long head of the biceps can be damaged. This causes a condition called biceps tendon disorder.

Early surgical repair is advised for tears that extend through half (or more) of the tendon. With no delays in treatment, there is less muscle atrophy, less fatty infiltration of the tendon/muscle unit, and less scarring in the area. After three to six months from the time of the injury, pain and loss of motion are signs that surgery is still needed. More than six months after the injury, the surgeon will want to re-evaluate the shoulder and see if the tear can be repaired. Sometimes severe tears cannot be repaired. Instead, shoulder rehab is needed to regain as much motion and function as possible.

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 revision surgery for a total hip replacement?

August 26th — admin

What does it mean to have revision surgery for a total hip replacement? My twin sister is having this operation next week. I’m wondering if she needs me to come help take care of her.

Revision tells us that your sister had a primary or index (first) hip replacement procedure already. Revision suggests the need to remove and/or replace one or all of the implant parts. The most common reason for implant revision is loosening of the stem on the femoral (thigh bone) or acetabular (cup or socket) side. This can occur with or without infection. The surgeon removes the old implant and replaces it with a new one. In the case of implants with a polyethylene (plastic) liner, excessive wear can cause tiny flecks of the liner to slough off and enter into the joint. Sometimes the bone around the liner starts to disintegrate.

If the whole implant is removed and exchanged or replaced, it’s like having the surgery all over again. Your sister will have to go through a shortened version of the original rehab program. Having had the surgery already one time, she will be more prepared for the postoperative recovery than she was the first time. She will be able to tell you if she needs extra help for a day or two. There’s always the chance that complications will occur, which could mean a longer recovery time and the need for more help.

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 are closed-kinetic chain exercises?

August 25th — admin

Since I hurt my ACL, I’ve been reading a lot about doing closed-kinetic chain exercises after knee injury. What kind of exercises are these anyway?

Closed-kinetic chain exercises are done with the foot or feet planted firmly on the ground or some other surface. This type of exercise is preferred because it helps reproduce normal, everyday movements.

Squatting, stepping, and stair climbing are examples of closed-kinetic chain activities. The exercises are functional but also reduce the strain and shear force on the ACL. In fact, they also decrease the compressive force on the patella (kneecap), too.

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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Robbery results in rotator cuff tear

August 24th — admin

I was robbed while standing at the ATM machine last night. The robber pulled my arm back, grabbed the money, and ran. The shoulder didn’t dislocate but I felt something pop. Today I can hardly move it. It especially hurts if I try to reach into my back pocket for my comb or my wallet. What do you think got hurt?

You’ll need a medical examination to find out what soft tissue structures might have been injured. With the mechanism of injury you describe, it sounds like a possible rotator cuff injury. The rotator cuff is a group of four tendons and the muscles that envelope the shoulder and hold it in place.

Along with stabilizing the shoulder joint in the socket, each one of the tendons has a specific job. Placing your hand behind your back requires medial (internal) rotation of the shoulder. The primary muscle for that movement is the subscapularis. Subscapularis injuries occur when the shoulder is suddenly laterally (externally) rotated or hyperextended with force. The arm is next to the body at the time of the injury. With an injury to the subscapularis, there is weakness in internal rotation and excessive shoulder external rotation.

An orthopedic surgeon will test each muscle of the rotator cuff to determine what might be wrong. Usually the history and clinical tests are enough to make a diagnosis. X-rays can rule out fractures. An MRI or a CT scan may be ordered, especially if the surgeon is considering surgery as a possible treatment option.

Studies show that early diagnosis and treatment yield the best results. Don’t wait too long before you have someone look at this and at least give you a diagnosis. It’s possible with time and a rehab program, healing and recovery will occur without surgical intervention. But getting started while the body is in a reparative stage is important.

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 treat osteoporosis after hip is already broken?

August 23rd — admin

I fell and broke my hip two weeks ago. I finally made it out of the hospital and home again. Now my doctor is after me to take drugs for osteoporosis. I don’t see what’s all the fuss. I already broke the hip. How is taking some medication going to change anything?

There is a mistaken belief that by the time a fracture has occurred, it’s too late to do anything about the underlying osteoporosis. Nothing could be further from the truth. Study after study has confirmed the benefit of a three-arm approach to the prevention and treatment of osteoporosis (which includes preventing a second fracture).

The first is calcium supplementation with Vitamin D. The second is exercise. Weight-bearing exercises on land (not a swimming or aquatic program) helps bone formation. When the muscles contract and their tendons pull on the bone, it has the effect of stimulating bone formation. And third is the use of anti-osteoporotic medications called bisphosphonates.

Bisphosphonates such as alendronate (Fosamax), ibandronate (Boniva), or risedronate (Actonel) help slow down how fast the bone is resorbed (destroyed). Everyday new bone cells are formed and old bone cells are resorbed or destroyed. During childhood, new bone cells are formed faster than old ones are destroyed. In the aging adult, resorption exceeds formation. Despite the number of older adults with osteoporosis and even a history of hip fracture, not very many people are taking these medications. And for those patients who do have a prescription, taking it on a regular basis is not consistent. But they have been proven effective in reducing hip fractures and the death rate associated with hip fractures in patients with osteoporosis. And since your risk of a second fracture goes up dramatically after the first one, your doctor is right in strongly urging you to take this medication. It’s important to take it as prescribed over a long period of time. Follow your doctor and pharmacist’s directions when taking this (or any) medication. Report any side effects. The drug dosage or specific drug can be changed or altered. The goal is to give you the maximum benefit with the least amount of adverse effects.

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 »

Questions to ask about bilateral knee replacement

August 22nd — admin

I have severe osteoarthritis and need both knees replaced. How soon after the first one can I have the second one done?

This is entirely up to you and your surgeon. Some people have both knees replaced at the same time. Others wait anywhere from three weeks to three years or longer.Your decision may be based on some personal factors. For example if you have both knees done at the same time, is there someone who can help you at home for a few weeks after the operation? This is very important. How is your overall health? Can you withstand two replacements at the same time or two major operations in the same month? Same year? Is one knee much worse than the other or are they pretty much the same in terms of pain, stiffness, and loss of motion?

Some patients choose to have the worst knee done first. They depend on the “better” knee during rehab. When the first knee replacement can support them, then they have the second knee done. Talk to your doctor about his or her suggestions 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 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 »

Arthroscopy vs. open repair for rotator cuff tear

August 19th — admin

I injured my rotator cuff years ago. I probably tore it more than once as it was healing. My surgeon has suggested doing a procedure to repair the damage and restore some function in that arm. I’d be happy just to have less pain at night. I know they can do these operations now without even opening you up. Do you think I can have that kind of surgery?

You may be referring to an arthroscopic procedure. The surgeon makes two or three puncture holes and slips a long, thin needle into the damaged area. A tiny TV camera on the end of the scope provides a look inside the joint. The type and location of tendon damage can be assessed using this technique.

But an open repair has some advantages. In this procedure, the surgeon can see the full extent of any damage. Details of the injury are clear and nothing is missed. Results are actually better after open repair compared to arthroscopic repair. There are fewer retears after open repair.

The main disadvantage of the open repair is that the deltoid muscle is split in half to give the surgeon access to the shoulder. The muscle is sewn back together afterwards, but it leaves the arm at a mechanical disadvantage until healing and full recovery take place.

Some surgeons begin with an arthroscopic examination. If the injury can be repaired arthroscopically, then they go ahead and complete the operation. But if the damage is extensive, then the shoulder can be opened up and the procedure completed. Magnetic resonance imaging (MRI) can help in the decision-making process. The MRI helps the surgeon assess tendon damage, healing, and anatomy. Size and location of the tear can be established. It can be determined whether the tear is partial or full-thickness. This makes a big difference in planning the surgical repair.

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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More people return to playing golf after joint replacement than any other sport

August 18th — admin

Do you have any idea how my golf game might be affected by having my hip replaced? Right now, the pain keeps me from going more than 9-holes once a week. And my drive falls way short of what it used to. Can I even play golf after this kind of surgery?

Golf is a low-impact activity that can be resumed after rehab for total hip replacement. If you let your physical therapist know of your interest in getting back on the golf course, your rehab program can be advanced to include specific sports-training for golf. This is a good idea in order to prevent further injuries and to spare your implant excess torque or load.

Studies show that of all the sports patients are involved in before joint replacement, golf is the one more people return to. There’s some evidence that your handicap may increase as well as the your drive length. The average change in handicap is an increase of 1.1 strokes. The average drive length increases by 3.3 yards.

Even though golfing can involve a fair amount of walking (which is good exercise), you may want to consider using a golf cart — especially at first until you see how well you do. Sometimes golfers with total joint replacements report mild pain or aching after playing golf. Using a golf cart can help reduce this by decreasing joint load and wear on the joint surface. Some golfers use the cart until they build up their strength and stamina. Try this yourself. Then you can reevaluate the benefit of continuing (or not).

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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