After six years, my total knee replacement had to be replaced. How often does this happen?

December 30th — admin

Six years after my total knee replacement, the implant came loose and had to be replaced. The surgeon told me the first joint implant was turned in a few degrees too many and that’s what caused the problem. How often does this happen?

Alignment is one of the most difficult aspects of knee joint replacements for the surgeon. Instruments used to make the bone cuts are based on average bone shape. But bone size and shape can vary from patient to patient.

The surgeon can’t always tell when a joint with a new implant is still slightly flexed at the end of the operation. In fact it can be bent as much as 10 degrees when fitting the implant in but look straight. There is also a tendency to internally rotate the upper (femoral) half of the implant. The result is often loosening and failure of the prosthesis.

Scientists are working with surgeons to limit and eventually eliminate this problem. The use of 3-D computer programs before surgery may help surgeons plan ahead. Plotting out when and where to make bone cuts and forming a template of the patient’s joint may help improve accuracy of alignment.

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’m heading into arthroscopic surgery. What kind of recovery should I expect?

December 29th — admin

I’m heading into arthroscopic surgery for my right hip. The surgeon is going to take a look around but for sure remove some pieces of cartilage that are floating around in there. What kind of recovery or rehab should I expect?

Hip arthroscopy is becoming a more common orthopedic procedure now with more and more hip injuries among the athletic crowd. Better imaging technology has also made it possible to find what’s wrong or what’s causing painful symptoms. Loose bodies in the joint is just one of the many reasons why arthroscopic procedures are used so successfully.But you are right — there is a postoperative program. And it’s important that patients complete this program in order to restore full joint motion, strength, flexibility, and function.The specifics of the program depend somewhat on the type of surgery that was done. For example, removing free-floating debris in the joint is a much simpler procedure than repairing deep holes in the cartilage. Likewise, repairing a torn labrum (fibrous rim of cartilage around the hip socket) may only require a simple home program. But there are some procedures that take longer to recover from and involve a slower pace of recovery.And competitive athletes will follow a four-step process of rehab progression. These four phases include 1) mobility and initial exercise, 2) intermediate exercise and stabilization, 3) advanced exercise and neuromotor control, and 4) return to activity.A physical therapist will show you what to do, how to do it, and how to advance or progress the program. You will probably start out on crutches for the first week to 10 days and gentle active motion of the hip. When you have full motion, the exercises assigned next are designed to restore strength and normal contract/relax sequences of all the muscles around the hip.Core (pelvis and trunk) stabilization exercises are recommended next along with balance training. And finally, if you are active in a sport or specific activity, you’ll be shown how to prepare to return to that sport. The goal is to participate fully without fear of reinjury.

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’m too young and too heavy for a knee joint replacement. Are there other options for people like me?

December 28th — admin

I saw my own knee X-rays and know I have bad arthritis on one side of the joint. I’m too young (45 years old) for a joint replacement. I’m too heavy (100 pounds overweight) for an osteotomy. Aren’t there any other options for people like me (besides losing weight)?

Unicompartmental arthritis is not uncommon in some younger patients. Many have had the meniscus removed from a previous injury and now years later, arthritis has badly damaged the joint. Pain, stiffness, and loss of motion and function are common.

Joint replacement isn’t a good option yet for young adults. Too much bone loss and an implant that only lasts 10 to 15 years makes another replacement difficult. It is possible to have a unicompartmental replacement.

This is an attractive option for middle-aged patients. It only removes and replaces the portion of the joint that’s arthritic. Most of the bone is spared making it possible to have a total joint replacement later.

Ask your surgeon if you might be a good candidate for this procedure. You may also want to consider looking into gastric bypass surgery. If weight loss isn’t possible, it may be a way to lose weight and protect your joints from future deterioration. Talk to your doctor about your total health picture and find out what all your options are.

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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Our daughter dances and has been having problems with her hip snapping and popping. Can anything be done?

December 27th — admin

Our 19-year-old daughter is a dancer on a summer tour with a very prestigious dance group. She’s been having problems with snapping and popping of her left hip. It doesn’t hurt but it’s loud enough to be heard on stage. We’re trying to find out anything we can that might help her. Are there any tricks to keep this from happening without changing the way she dances?

Many dancers and other athletes are affected by an annoying hip condition that results in a snapping sound and feeling that occurs whenever they bend or flex their hip. Coxa sultans is the medical term for this condition. But it is better known by a more descriptive term: snapping hip.The treatment depends on the cause. If it’s something loose inside the joint (e.g., piece of bone or cartilage) that’s getting caught, it might have to be removed surgically. If it’s a tendon rubbing over a bone, then stretching might be the answer. Sometimes the only effective treatment is rest and stopping the motion that aggravates the condition. That’s a tough prescription for a young dancer on a special tour. The first step is to get a proper diagnosis. If possible, have her see an orthopedic surgeon who specializes in dancers or other athletes.If all other serious possibilities are ruled out, then conservative (nonoperative) care is the way to go. Antiinflammatories may be prescribed by the physician. The therapist shows the affected individual how to stretch properly. Rest is advised along with elimination (or at least moderation) of activities and motions that aggravate the problem.It may be necessary for the therapist to work with the patient to re-program how and when the hip muscles are activated. This is called neuromuscular re-education. If physical therapy is unable to alter the symptoms, then the physician may try injecting the hip. And if that doesn’t work, then surgery is the final treatment to try.But before we go any further down that path, get an evaluation and diagnosis. Then a proper plan of care can be put into effect.

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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My doctor is trying out a different way of doing my ACL surgery using a piece of my hamstring. Will this speed recovery?

December 26th — admin

I’m scheduled to have an ACL reconstruction in two weeks. The doctor is trying out a slightly different way of doing the operation. A piece of my hamstring will be used with a little piece of bone attached to give it greater stability. Will this speed up my recovery at all?

The use of multistrand hamstring tendon grafts and now hamstring tendon grafts with a bone plug to repair a ruptured anterior cruciate ligament (ACL) is gaining popularity.

Many studies have been done comparing the patellar tendon graft to the hamstring tendon graft. The results have been very favorable towards the hamstring tendon graft. Although the preparation of the graft takes longer, the stability of the knee afterwards may be worth it.

Patients have fewer problems at the donor site with the hamstring tendon graft. The patellar tendon graft is taken from the front of the knee causing painful kneeling afterwards. Sometimes the pain is severe. In most cases it never goes away.

Rehab is the same for both graft types. Recovery is not reported to be faster with one graft over another. Complications can occur with either method causing a delay in recovery. If no problems occur after the operation you should be back on your feet in two to four weeks. Full recovery and return to preinjury activities take longer (four to six months).

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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My 80 year old mother and my 18 year old son suffered a hip dislocations. Why is my mother recovering faster?

December 23rd — admin

My 80-year-old mother and our 18-year-old son both suffered a hip dislocation on the same day. What do you think the chances are of that happening!? But my real question is — why is Mother recovering so much faster than our son? It seems like he has age on his side but he’s really poking along compared to Mom.

Most of us are familiar with older adults who fall and break a hip — or break a hip and fall. It’s an unfortunate event that adds insult to injury. But young adults are also at risk for hip dislocation from trauma. This time it’s more likely as a result of a high-speed car crash. The incidence of hip dislocations is on the rise, not just from motor vehicle accidents, but also from falls, sports injuries, and getting hit by a moving vehicle if you are a walker.It’s easy to fall into the trap of thinking that young people can heal easily and quickly and go their merry way. But, in fact, the risk of hip joint arthritis on that side goes way up after a traumatic hip dislocation at a young age. Even more so when there are other injuries along with the dislocation. Bone fractures, torn ligaments, and damaged joint cartilage are often present when the force of the injury is enough to dislocate the hip. Final results can depend on how quickly treatment (especially surgery) is provided. The accuracy of diagnosis is also important. If there is debris in the joint from bleeding or if there are bits of torn cartilage floating around inside the joint that go undetected, the patient’s results can be compromised.There are many other factors affecting the outcomes such as type of dislocation, presence of additional damage in and around the joint, need for more invasive surgery, and so on. And the wisdom of age has its advantages. Older adults may know better how to rest, apply common sense, and progress forward bit by bit. Younger adults may overdo, fail to follow their surgeon’s advice, and reinjure themselves during the prescribed period of rehabilitation.

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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My father had a total knee replacement six months ago and still has pain and stiffness. Does this happen very often?

December 22nd — admin

My father had a total knee replacement six months ago and still has pain and stiffness. We think the surgery was a big failure. Does this happen very often?

Total knee replacement (TKR) is usually a very reliable way to give arthritis patients relief from their symptoms. About 95 percent of all TKR patients have a good result after surgery. But in five percent problems of pain, stiffness, and swelling can persist.

There are many possible causes for this outcome. If your father hasn’t been to his doctor, a re-examination is important. The surgeon will conduct a careful evaluation to see if the problem is coming from inside or outside the joint.

Many older adults have multiple health problems. These are called comorbid conditions. Neurologic problems, poor circulation, even depression are just a few comorbidities that can affect the results of 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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What’s a simple hip dislocation? That’s a term being used for my hip fracture and it seems like anything but simple.

December 21st — admin

What’s a simple hip dislocation? That’s a term being used for my hip fracture and to me it seems like anything but simple.

A simple hip dislocation refers to dislocation without a fracture. Complex fracture-dislocations involve popping the round head of the femur (thigh bone) out of the acetabulum (socket) with a fracture of the acetabulum at the same time. Acetabular fractures affect the joint surface where the head of the femur moves against the joint surface to provide joint motion.If you can look at it this way, a simple dislocation has some long-term benefits, too. Only one out of every four patients with a simple dislocation results in hip arthritis later. It’s the dislocations accompanied by an acetabular fracture that present later with problems including arthritis. About 88 per cent of those complex fracture-dislocations damage the joint resulting in death of the bone (osteonecrosis) and osteoarthritis.Simple dislocations are often easier to reduce (set back in place) without major surgery. The patient is still sedated to achieve deep relaxation of the surrounding muscles. But with a few quick and easy techniques, closed reduction is possible. The more complex dislocations with fractures or other injuries often require arthroscopic or even open-incision surgery. There is a greater risk of complications with loss of blood flow, osteonecrosis (death of bone), infection, and poor outcomes with complex dislocations.

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’s a lateral overhang of the kneecap? X-rays show that my daughter needs surgery for kneecap overhang problems.

December 20th — admin

What’s a lateral overhang of the kneecap? X-rays show that my daughter needs surgery for kneecap overhang problems.

The kneecap or patella sits over the knee joint and moves up and down along a track of cartilage. Connective tissue on each side called the retinaculum help hold it in place and guide it up and down in the track.

Patellar instability occurs when one side of the retinaculum is tighter or looser than the other. The kneecap can move out of the track and sublux or even dislocate. When this happens over and over the patella doesn’t always go back to the middle. One edge hangs over the side (as seen on X-ray).

Conservative care with physical therapy, exercises, and bracing or taping is the usual treatment. If these measures don’t help after three months then surgery to rebalance the retinaculum may be considered.

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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After his hip replacement, my father-in-law has balloon things on his legs. How do they work?

December 19th — admin

My father-in-law is in the hospital having just had a total hip replacement. They’ve got these balloon things on his legs that are supposed to prevent blood clots from forming. How does that work?

What you are probably seeing is a mechanical compression pump designed to increase the flow of blood from the legs back to the heart. The increase blood flow stimulated the release of different chemicals in the body that are clot busters and also relax the blood vessel walls. These two effects prevent blood clots from forming and keep blood clots that do form from attaching to the blood vessel. They also break down clots that start to form. The danger of blood clots is that they can break loose and travel to the heart (causing a heart attack) or to the brain (causing a stroke).The pump works by using and on/off cycle that applies intermittent but repeated pressure to the legs. The limb sleeves fit over the legs and are connected to the pump with a special hose attachment. The on cycle applies compression for a much shorter period of time compared to the off cycle (e.g., eight seconds on, 40 seconds off).The disadvantage of these units is they do keep the patient from getting up and walking. They are pretty bulky and uncomfortable for some folks. The on cycle can cause an impact sensation that bothers patients. Since blood clot prevention must be carried out for at least 10 days after surgery, these compression units aren’t always very practical. Newer, portable units that can be worn while walking are being developed now. The patient can get up and move around, even walk with the help of a small, battery-operated unit. The unit can apply intermittent compression for up to six hours before recharging is required. They function under the same principles described above for the hospital-based units you are seeing on your father-in-law.

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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