Fast-track program for hip replacement

September 30th — admin

Have you ever heard of a fast-track program for total hip replacements? That’s what my father is on, and we are just wondering what it means.

Patients and surgeons are both interested in a speedy, painless recovery from surgery after a total hip replacement. To reach that goal, surgeons have introduced something called a minimally-invasive surgery (MIS). Minimally invasive surgery refers to any operation where the surgeon changes how long or how deep the cut is made into the tissue. With some minimally invasive approaches, the surgeon can avoid cutting into most of the muscles around the hip that are normally removed from the bone during the standard hip replacement surgery. The hope is that with less trauma to the soft tissues (especially the muscles around the hip), the patient will be able to recover that much faster.

There are also some efforts to speed up the rehab or postoperative recovery process. A program called the fast-track has been designed to accomplish this. Several studies have shown that patients who are on the fast-track after surgery get better faster. The fast-track means they get a patient-controlled pump to manage their pain. They start rehab sooner, and the therapist provides a more aggressive program. In studies so far, patients in the fast-track groups are discharged sooner, can walk better, and are more satisfied than patients following the standard rehab protocol. This is true no matter what type of incision or approach was used to do the surgery.

Not everyone can participate in a fast-track program. Patients are selected based on general health, motivation, and compliance level. Complications after surgery such as infection, dislocation, or fracture can put an end to someone’s fast-track status. But for those who are able to complete the program, the results have been very impressive.

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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Scar placement for minimally invasive knee surgery

September 29th — admin

Ten years ago I had a total knee replacement. The staples got infected and I have a huge, ugly scar on my leg. I hear they can do it now with a much smaller cut. Where is the scar for the new method of knee replacement?

Surgeons are trying different ways to use the mini-incision for knee joint replacement. Reports are favorable for the mid-vastus approach. This is similar to the standard incision in the middle of the knee but smaller and slightly off-center.

The quadriceps muscle along the front of the thigh is made up of four major muscles. They work together to straighten the knee. The inside muscle group of the quadriceps is called the vastus medialis.

The surgeon splits the vastus medialis muscle in the direction of its fibers. The incision starts just above the patella (kneecap) and goes down to just below the patella.

A slightly different incision may be used for obese or very muscular patients. The surgeon still starts above the patella but curves the line around the edge of the kneecap rather than cutting straight down. The scar looks more like a question mark.

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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Patient wants tiny incision

September 28th — admin

I’m going to have a total hip replacement next week with the new minimally invasive surgery. The surgeon has explained how this is to my advantage, but mostly, I’m just interested in having a tiny incision. Am I going to be sorry I didn’t have the standard type of incision? Will my vanity come around and bite me in the butt, so-to-speak?

You’re not alone in your concern about form over function. Even if the minimally-invasive approach doesn’t yield better functional outcomes, patients like how it looks. A shorter incision just looks better, and patients are asking for that. Patients also want an implant that will last as long as possible. And that factor is more important to them than the length of the scar or how long they are in the hospital.

There are many advantages to a minimally-invasive approach. And we’re not talking about just a shorter incision line. Minimally invasive refers to the fact that the group of muscles usually cut to remove the old hip joint aren’t touched. The gluteus maximus (buttock) muscle is split to get to the hip joint, but the length of the split is much shorter. The incision into the joint capsule is also smaller and repaired without any negative effects.

Studies are ongoing to assess the results of minimally-invasive surgeries. There are mixed reviews as to outcomes. In some studies, the operating time is shorter and there’s less blood loss. In others, the operation is complex and may take more time if the surgeon hasn’t done quite a few of them. But the long-term results (a year or more later) don’t really show much of an advantage of the minimally invasive approach over the standard incision. Walking distance, walking speed, and muscle strength appear to even out between the two surgical approaches. There are still plenty of factors to consider when comparing the two approaches. Patient education, preoperative counseling, analgesia, and rehabilitation programs may be the real keys to recovery. While the surgical approach might make a difference, there’s at least enough preliminary information to suggest that the postoperative treatment process may be equally (if not more) 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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What makes a surgery count as “minimally invasive?”

September 27th — admin

What makes a surgery count as “minimally-invasive”? It seems like surgery is a major trauma to the body no matter how short the time it takes.

Minimally invasive refers to several factors. A shorter operating time as you suggest is one measure. A shorter operation means less anesthesia. Sometimes there’s less blood loss. Those two things alone can also mean “less invasive” to the pocketbook.

According to a task force of surgeons there are several ways to tell if an operation is minimally invasive. First, the size of the incision is half the length of the standard approach.

Second the location of the cut is often different. The goal is to avoid disrupting the joint capsule or some of the muscles. If the capsule is cut, a smaller incision is used.

Third, fewer muscles are cut or detached.

During knee surgery anytime the surgeon can avoid cutting the extensor mechanism, it’s considered “less invasive.” The extensor mechanism is made up of the quadriceps muscle as it comes down over the front of the thigh and attaches around the patella or kneecap.

Disrupting this muscle can cause weakness in knee extension. The patient may not be able to fully extend the knee, a condition called extensor lag.

There isn’t one single way to define minimally invasive but rather, a group of 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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Hip impingement explained

September 26th — admin

What is a hip impingement? That’s what I’ve been told is causing my hip pain.

The full medical term for this problem is femoroacetabular impingement. Impingement just means pinching. Femoroacetabular refers to the place in the hip where the round head of the femur (thigh bone) comes in contact with the acetabulum or hip socket.

Two types of impingement are known to cause pinching of the soft tissues in this area. The first is called cam-type impingement. This occurs when the round head of the femur isn’t as round as it should be. It’s more of a pistol grip shape. It’s even referred to as a pistol grip deformity. The femoral head isn’t round enough on one side and it’s too round on the other side to move properly inside the socket. The result is a shearing force on the labrum and articular cartilage, which is located next to the labrum. The labrum is a dense ring of fibrocartilage firmly attached around the acetabulum (socket). It provides depth and stability to the socket. The articular cartilage is the protective covering over the hip joint surface. Sometimes cam-type impingement occurs as a result of some other hip problem (e.g., Legg-Calvé-Perthes disease, slipped capital femoral epiphysis or SCFE). But most of the time, it occurs by itself and is the main problem. Men are affected by cam-type impingement more often than women.

The second type of impingement is called pincer-type (more common in women). In this type, the socket covers too much of the femoral head. As the hip moves, the labrum comes in contact with the femoral neck just below the femoral head. Repeated microtrauma at this site can cause the bone to overgrow, a condition called heterotopic bone growth. Pincer-type impingement is usually caused by some other problem. It could be as a result of 1) hip dysplasia, 2) a complication after osteotomy surgery to correct hip dysplasia, or 3) an abnormal position of the acetabulum called retroversion. Hip dysplasia is a deformity of the hip (either of the femoral head or the acetabulum, or both) that can lead to hip dislocation. The condition is brought to the orthopedic surgeon’s attention when the patient reports groin pain that occurs when the hip is bent or flexed. Although the condition is often present on both sides, the symptoms are usually only felt on one side. In some cases, the groin pain doesn’t start until the person has been sitting and starts to stand up. There is often a slight limp because of pain and limited motion. The diagnosis is usually confirmed through clinical tests and X-rays. Sometimes advanced imaging such as MRIs or CT scans are also ordered. Once all the test results are available, a course of action is determined. This may be conservative (nonoperative) care with antiinflammatories and physical therapy. In some cases, surgery is required.

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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How to find best joint replacement surgeon

September 23rd — admin

How can I find a surgeon who is certified to do the new minimally-invasive knee joint replacements?

Orthopedic surgeons aren’t certified in any of the individual surgical techniques that they do. When new methods come out, each surgeon must get the training and practice needed before operating on patients.

Right now researchers suggest the new minimally-invasive (MI) method of joint replacement should only be done by some surgeons. They should have a high-volume arthroplasty practice. This means they do a lot of joint replacements.

The best results reported have come from high-volume total joint centers. Not all patients are selected for this procedure. Surgeons who choose patients carefully tend to have better results. Some might say it’s more important that the patients are “certified” than the surgeons.

Your best bet is to find a center that focuses just on joint replacement. Ask how many minimally-invasive knee replacements the surgeon has done before making your final choice.

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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Pain on inside of hip could be arthritis

September 22nd — admin

I have a deep pain in my groin that my doctor diagnosed as a hip problem – arthritis. I always thought if you had hip pain, it was on the outside?

Hip pain from problems like osteoarthritis does often show up in the inner thigh or groin area, more so than the outside. This is because of the anatomy of the joint and where the ball of the femur, the thigh bone, fits into the socket of hip joint. It’s in the inner part of the hip that the motion takes place that allows you to move your leg inward and outward again.

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 knee implant is better – plastic or metal?

September 21st — admin

I’m used to walking three to four miles a day even with my painful, arthritic knees. If I have a new joint put in should I go with the plastic or metal implant? Which one holds up best for walkers like me?

Good question…and one that is highly debated in the literature. After decades of using the metal-backed implants surgeons are trying the new all-poly (molded plastic) implants.

They say the metal backed implants can get worn unevenly causing the bone to deteriorate. The implant can loosen, too. On the other hand there’s concern that the polypropylene type won’t hold up under daily use by active adults.

Researchers at the Lenox Hill Hospital in New York City report results of the all-poly implant for a group of active, younger (less than 60 years old) adults. A majority of the patients said that walking distance was unlimited. A smaller number reported walking limited to 10 blocks or less.

Many of these active adults were also involved in swimming, tennis, and golf.

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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Soccer player chooses surgery for snapping hip syndrome

September 20th — admin

After a very long and unsuccessful attempt at treating my snapping hip syndrome, I finally decided to have surgery to release the hip tendons on both sides. I’m hoping to be through rehab by the time soccer season starts again. How long does it take to get my full strength and motion back?

Some athletes are bothered by a painful snapping at the hip when moving the leg from a flexed to an extended position. There can be a variety of reasons why this happens. Some occur outside the joint such as when a tendon rubs over a bony prominence. Others are caused by something going on inside the joint. It could be a tear in the labrum (rim of cartilage around the hip socket) or a loose fragment inside the joint. The most common cause is the iliopsoas tendon rubbing over a bony bump called the iliopectineal eminence. Many times there is also a fraying or a tear of the labrum contributing to the problem.

Whatever the cause, treatment is needed to help the athlete get back into action. At first, conservative care with rest, stretching exercises, and antiinflammatory drugs is advised. A nonoperative approach should be tried for at least six months. Sometimes a steroid injection with a numbing agent into the iliopsoas bursa helps. When none of these approaches reduces or relieves painful snapping symptoms, then surgery may be advised. The surgeon can partially or fully cut the iliopsoas tendon away from the bone. The tendon retracts and reattaches to the nearby soft tissue.

Recovery and rehab takes at least 10 to 12 weeks. At first, you won’t be able to bend the hip. This makes you unstable when trying to walk or use coordinated movements of the legs. This new symptom will last two to four weeks until the tendon reattaches and heals in its new location. You’ll be given some simple exercises to do at first. You will probably work with a physical therapist who will supervise how much weight you put on the leg(s), how to use crutches or canes, and a progression of leg control exercises. Eventually stretching exercises will be included, then coordination exercises, and finally, sport-specific movements. When you can control your motion, have 90 per cent strength, and can handle impact activities, then you will be released to return to the soccer field.

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 patient need cane or walker after total knee replacement surgery?

September 19th — admin

If I have a total knee replacement on an outpatient basis will I still need to use crutches or a walker? I live in a tiny apartment and it would be easy to walk around holding onto the furniture.

Many people are able to go home with either a cane or using nothing. We can’t say for sure about you, but here are some things to think about. Do you use a walker or crutches now before the operation? If yes, then you’re more likely to need one afterwards…at least for a little while.

How strong is your other leg? Can it support you without the off-loading assistance provided by a walker or crutches? Many people have arthritis in both knees. They have the worst knee replaced first but this puts a lot of extra load on the other knee until the leg operated on gets stronger.

You may find it easy to navigate your apartment but need to use an assist when outside or walking in the community. The long-term goal is to walk unassisted and pain free.

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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