Standard vs. rapid recovery for hip replacement surgery

October 31st — admin

My mother is going to have a total hip replacement next month. My sisters and brothers are trying to figure out how much time each one of us can go and help her out after surgery. Can you give me any kind of time frame to plan on? How long should we plan on staying?

You’ll probably want to ask the orthopedic surgeon this question. He or she may have a general idea given the condition of your mother before surgery, the type of surgery being done, and the philosophy behind their rehab program.

Studies show that if things go smoothly, there are no complications or problems to delay recovery. The wound heals nicely, there are no infections, no blood clots, and no need for readmission to the hospital. When readmissions do occur, they tend to take place within the first month after the operation.

Some surgeons follow a standard rehab protocol but others have now adopted a more accelerated (faster) approach. Patients move through rehab with an aggressive program of mobility and exercises. They tend to do things with a group of patients having the same surgery rather than following a single or solitary path. By doing so, they regain motion, strength, and function much faster.

If your mother is in good health and moves through rehab quickly, she could be discharged early. She can go home and continue her exercises and navigate her daily self-care and household activities with less and less help. Expect at least a one to two week period of time providing assistance at home. With any complications or set backs, this time period could be extended up to a month or more.

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 knee to buckle?

October 28th — admin

Sometimes my knee clicks and then gives out from underneath me. What causes this kind of buckling?

Some doctors would say your knee is unstable. The true definition of instability is when the kneecap called the patella dislocates or shifts too far to one side.

Symptoms of buckling, collapsing, or giving way are more often caused by weakness. The quadriceps muscle along the front of the thigh helps hold the knee straight. Flexion or bending the knee without warning is a sign of quadriceps insufficiency.

Such giving way or insufficiency occurs as a result of pain, deconditioning, or swelling inside the joint. When the doctor examines you he or she will try and decide if your symptoms are coming from outside or inside the joint. If the problem is outside the knee joint then is it caused by the patella or something else?

A complete diagnosis may require exam, X-rays, and even arthroscopic 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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Joint replacement impossible by 2020?

October 27th — admin

I’ve heard that it may not be possible to even get a hip or knee replacement in the year 2020. Why is that?

It looks like the law of supply and demand is at issue here. Simply stated, more people will want and need a hip or knee replacement than there are surgeons to provide them. Right now, almost three-fourths of a million adults in the United States get a new hip or knee every year. That number is expected to top one million very quickly. It is predicted that by the year 2016, half of all patients who need a hip replacement won’t be able to get one. And three-fourths of all patients seeking a knee replacement will be on a waiting list for a very long time.

There are two groups who are going to be affected the most by this problem: adults in the 45 to 54-year age group and adults older than 80 years. In both cases, increased activity and desire for improved quality of life are the reasons behind the increased demand. Emotional health, social function, and physical comfort are all affected by the pain of an arthritic joint.

That 45- to 54 year age category is an interesting one. Right now, that’s the fastest growing group of patients seeking the services of an orthopedic surgeon for joint arthritis. And the group is growing in number by leaps and bounds. By the year 2030, the number of folks in this age range will increase from 59,000 to one million.

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, Knees. Tags: , , . No Comments »

Pain in arthritic knee not necessarily from arthritis!

October 26th — admin

My doctor told me that just because there are arthritic changes on my knee X-ray doesn’t mean the pain in my knee is coming from those changes. Why not? Doesn’t it make sense that the damage seen would be causing the problems?

It does make sense and that’s what’s got doctors and scientists scratching their heads. Many studies of the spine and joints show changes where there is no pain and pain where there are no changes. They don’t know how to explain it.

It may be a little like that old question: if a tree falls in the forest but no one is there to hear it, does it make any sound? Are X-ray findings pathologic if the patient doesn’t have any symptoms?

It’s possible the changes will eventually cause symptoms. But it might take an injury or repetitive load to bring on any pain.

Doctors also suggest the joint’s ability to hold up under heavy or repetitive loads may be based on more than just joint alignment. Maybe if the patient doesn’t stress the joint past a certain point, there are no symptoms no matter what shape it’s in.

More study is needed to end the debate of when to treat a joint. Should we apply medical treatment any time there are symptoms (with or without X-ray changes)? Or should we apply treatment anytime there are X-ray changes with or without symptoms.

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 »

Can metal implant hip replacement increase cancer risk?

October 25th — admin

I’ve heard that having a hip replacement with a metal implant can increase my chances for cancer. Is that really true?

Hip replacements are made from a variety of materials such as ceramic, polyethylene (plastic) and metals such as titanium, high-carbide cobalt, and chrome. A popular implant has a metal-on-metal (MOM) design. It gives the hip smooth action. But with repeated motions, flecks of metal ions are released into the joint and into the blood stream. Metal ion release may be a factor in implant loosening. Some patients are hypersensitive to these particles and develop hip pain as a result. And there’s been some question about the possibility of an immune system response to the foreign debris being linked with cancer.

Particles of both cobalt and chromium have been found in urine, blood, and organs of the immune system (e.g., spleen, lymph nodes) and in red blood cells and the liver. There are no reported cases of cancer linked with debris from hip replacements. For now, it’s just a theoretical possibility. This will bear warching in future studies. 

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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The seven P’s of anterior compartment syndrome

October 24th — admin

My 23-year old son had a bad stick injury playing ice hockey. There was obvious bleeding under the skin and swelling in his thigh. It was diagnosed as a compartment syndrome. The doctors did emergency surgery without even taking an X-ray. How could they tell it was that serious without any testing?

A well-trained physician will recognize signs and symptoms of anterior compartment syndrome (ACS), which is a true medical emergency. Most doctors say that the exam is still the best way to make the diagnosis of this condition. The classic signs of ACS are called the seven P’s and include:

  • More pain than expected for the injury
  • Area is very tense when touched or palpated
  • Pain increases when the part is moved passively
  • There is numbness (paresthesia) of the skin over the injured area
  • Paralysis occurs when the nerves or muscles are without blood supply
  • The pulses below the injury are still normal
  • The skin is discolored or loses color (pallor)

    • Fast response with early treatment is the key to a good result. Waiting too long can result in irreversible damage. Your son is lucky to have been seen by a physician who recognized the signs and didn’t wait for things to get 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 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 »

    New guidelines for treating hip osteoarthritis

    October 21st — admin

    I’ve heard there are some new rules for treating hip arthritis. I have arthritis in my left hip from a bad fall off a horse years ago. I try to keep up with the latest in arthritis treatment. Is there anything in these rules that could help someone like me?

    You may be referring to the recently published Clinical Practice Guidelines for physical therapists treating patients with primary or posttraumatic hip osteoarthritis. Although these were written for physical therapists, there’s nothing wrong with you taking these to your therapist and asking if you have covered everything in treatment that’s appropriate for your situation.

    The guidelines are based on evidence from published studies compiled, reviewed, and summarized by a panel of experts. The authors say the guideline will be reviewed again in five years (2013) or sooner if new evidence comes to light. Here’s a brief summary of the main points and recommendations given for physical therapists evaluating and treating patients with hip osteoarthritis:

  • Therapists should evaluate hip movement with special tests of the hip abductor muscles.
  • Therapists should assess patients for risk factors for hip osteoarthritis including age, developmental disorders, and previous hip joint injuries.
  • Patients with hip osteoarthritis have the following history and/or symptoms: pain along the front and/or side of the hip when putting weight on the leg. Age over 50. Morning stiffness lasting less than one hour (gets better with movement). Hip motions that are limited include internal rotation and flexion. Compare the involved side with the other nonpainful side. More than a 15-degree difference is significant.
  • Two good tests to use before and after treatment to measure results should include the Western Ontario and McMaster Universities Osteoarthritis Index and the Harris Hip Score. These are valid tests of functional outcomes. Other useful tests of physical performance include the 6-minute walk, timed up-and-go test, self-paced walk, and stair measure.
  • Evidence supports the importance of patient education about exercise, weight loss, activity modification, and balance training.
  • Manual therapy can help provide short-term pain relief and improve hip motion for patients with mild hip osteoarthritis. This treatment approach helps improve mobility 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 »

    What is compartment syndrome?

    October 20th — admin

    My father suffered serious burns in a car accident. He’s in stable condition but now they say he has compartment syndrome in his right leg. What happens next? What’s the treatment for this?

    Acute compartment syndrome is a serious medical condition that occurs most often after a traumatic injury such as fracture, contusion, or burns. In the case of a burn the skin can’t stretch and flex for swelling underneath. It starts to act like the outside covering of a sausage.

    There are serious consequences without proper treatment. The doctors may measure the compartment pressure several times before deciding on treatment. The measures will help them determine if the condition is getting better or worse. They may not take actual measurements but rather go on the basis of the history and clinical presentation.

    Sometimes all that’s needed is proper positioning so the blood can flow to the area. For example, the leg should be kept down below the level of the heart. Movement and active contraction of the muscle is important to keep the fluids moving and prevent swelling.

    If this doesn’t work, surgery may be needed. The surgeon may need to make a cut along the skin to release the pressure. Burn patients have some unique problems that require special consideration. The skin may need to be replaced with grafts. There’s always a concern for infection. Close monitoring is 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.

    Posted in Knees. Tags: . No Comments »

    The difference between osteoporosis and osteonecrosis

    October 19th — admin

    What’s the difference between osteoporosis and osteonecrosis? I have both conditions in my hip, but I can’t keep them straight in my mind.

    The first part of both terms (osteo) refers to bone. In the first word (osteonecrosis), necrosis means death — so, osteonecrosis is the death of bone. In the second word (osteoporosis), porosis refers to how porous the bone has become. Loss of bone density creates larger spaces between bone cells. As a result of these changes, the bone is more brittle.The differential diagnosis is made using advanced imaging. X-rays may not show osteoporosis clearly. Doctors rely on MRIs to see patterns in the signals that indicate the presence of osteoporosis. For example, low-signal lines in the subchondral bone called crescent lines are seen with osteoporosis. Subchondral refers to the first layer of bone just under the joint cartilage.

    When osteoporosis is present, MRIs can show fluid called bone edema. Bone edema can be present with stress fractures and bone tumors, so the presence of bone edema doesn’t necessarily confirm that the person has transient osteoporosis. Further tests may be required such as DEXA bone scans. DEXA stands for dual-energy X-ray absorptiometry. A more up-to-date abbreviation for that term is DXA. DXA provides means of measuring bone mineral density that can be compared to the expected norm.

    Osteonecrosis shows up on MRIs without the defects in bone seen with osteoporosis. Instead, there are clear changes in the subchondral bone of the femoral head. Subchondral refers to the first layer of bone just under the joint cartilage. The distinction between these two conditions (osteonecrosis and osteoporosis) is important because these are separate problems requiring individual treatment.

    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 »

    Options for senior citizen with broken kneecap

    October 18th — admin

    My 83-year old mother fell on some ice while trying to get across the street. She broke her kneecap. She already had arthritis in that knee and now this. The question is: should she wait and see if the fracture will heal? Have the kneecap replaced? Replace the entire joint? The doctor has left it up to her to decide and she’s depending on us to help her figure it out.

    Decisions like this can be very difficult. It’s nice that patients have options and choices. Without knowing what can and will happen makes it a bit of a guessing game. Let’s look at each option.

    Giving the bone time to heal can be a good choice. It’s non-invasive without the chance of surgical complications. However, if the person is a smoker, has a poor diet/nutrition, or other health issues, delayed healing can occur. Pain and stiffness may keep your mother from getting around during the six to eight weeks it will take to heal. Losing motion in an arthritic knee might cost her some function and independence. Under any of these circumstances it might be best to consider replacement.

    At age 83 a patellar arthroplasty (kneecap replacement) will likely last the rest of her natural life. It won’t change the underlying arthritis in the joint but it will help keep her moving.

    A recent long-term study of patients who had the kneecap replaced suggested older patients do better with a total knee replacement (TKR). With just the kneecap replacement, there are often revision operations needed. With the TKR motion is restored to the entire joint making it possible for the person to remain active.

    Given all the factors to consider may help your mother decide what’s best for her health and lifestyle. If she tries the wait-and-see approach, she can always have an operation later. If she goes with the TKR her final recovery after rehab will be that much sooner.

    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 »
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