My teammate thinks my knee pain may be as a result of tight hip flexors. How do I check for this myself?

January 31st — admin

I’ve been having knee pain whenever I do running or squatting drills during football training. One of my other teammates says tight hip flexors can cause this problem. How do I check myself for this?

There are several tests used to measure hip flexor flexibility. An athletic trainer, physical therapist, or orthopedic surgeon can test you.

One test is called the Thomas flexion test. You lie down on your back on a table with a firm surface. The crease of your buttock should be at the edge of the table. Bring both knees up to your chest. Keeping your back flat on the table, lower one leg until it is straight out. Lower that leg toward the tabletop as much as you can without arching your low back or letting your pelvic bone tilt.

A tight hip flexor muscle will keep you from lowering your leg all the way down to the table. A flexible person will be able to get to a horizontal (normal) or beyond horizontal position (hyperflexible). The physical therapist uses a tool called a goniometer to measure the hip angle during this test.

Another test is the Ober test used to measure flexibility of the iliotibial band (ITB). This band of fascial tissue comes down along the side of the leg from hip to knee. For this test, you lie on your side with the leg in question on top. The lower leg can be bent to help support you on the table.

The upper leg is bent 90 degrees at the knee. The therapist lifts the leg away from the body to a horizontal position and then extends it backwards slightly. The leg is then lowered toward the table until it starts to rotate or can’t go any further.

A normal amount of motion allows the leg to be placed in the horizontal position. With a tight ITB, the leg stays up and won’t drop down towards the table. The extra flexible person can touch the knee to the table.

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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Does femoroacetabular impingement (FAI) surgery work? What are my chances for a successful FAI operation?

January 30th — admin

My question for you today is: does surgical treatment for femoroacetabular impingement (FAI) work? I’m facing the decision whether or not to have this surgery, and I want to know what my chances are for a successful operation.

We may find some helpful information to answer this question from a recent systematic review of studies done regarding surgery for femoroacetabular impingement (FAI). The statistical significance of any conclusions from a systematic review is worth noting. That’s because such a review combines the results of many smaller studies to give an overall view of the results of treatment like surgery for FAI of the hip.Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.Most studies on this condition are case studies. That’s because no one surgeon sees 100s or 1000s of patients with this problem. Case studies are good because surgeons have to start somewhere when trying to see the effects of treatment. The problem with published case studies is that this is considered a low level of evidence. A surgeon wouldn’t want to treat any patient with methods considered “successful” based on low levels of evidence. Conducting a systematic review like this one allowed the authors to examine the data on 970 different patients (collected from 23 reports of case studies). Now surgeons can see what the latest findings are and evaluate their own practices based on what is statistically significant.One of the questions specifically addressed in this review is the very same one you raise. Does surgical treatment for femoroacetabular impingement (FAI) work? The answer to this question may depend on how “success” is defined.If pain relief is the measured outcome, we know that the majority of the 970 patients included did have relief of painful symptoms. A second outcome was improved function. That was also a benefit of surgical repair for femoroacetabular impingement (FAI). Levels of patient satisfaction as an outcome measure were not so high. For those patients whose pain didn’t improve and especially those patients who ended up having a hip replacement, reported patient satisfaction was low. In some studies, the rate of dissatisfaction and/or conversion to hip replacement was as high as 30 per cent.The obvious next question is: can we predict who will have a poor result? That’s a simple question that doesn’t have a simple answer yet. One risk factor for worse outcomes with femoroacetabular impingement surgery is advanced joint arthritis at the time of the diagnosis. But there are two problems with relying solely on this factor.First, not everyone with severe damage has a poor outcome with surgery. Just as many patients with severe damage had good outcomes as those who had a failed treatment. The reasons for those differences remain unknown and will require further study. Second, even with X-rays and MRIs, it isn’t always possible for the surgeon to know the full extent of the damage. Sometimes, it isn’t until getting inside the joint that the surgeon can see what’s really going on. These tests are still important and the results should be discussed with you by your surgeon when making the final decision about the best treatment choice 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.

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About 10 years ago I had ACL surgery. Now, all of a sudden, I’m having painful grinding in the joint. What’s happening?

January 27th — admin

About 10 years ago I had an ACL repair. Everything’s been just fine and now all of a sudden, I’m having painful grinding behind my kneecap and in the joint. What’s happening?

Researchers at the Steadman-Hawkins Research Foundation in Vail, Colorado have been researching this very problem. They noticed some of their ACL patients were just fine for 10 years — a perfect outcome. Then all of a sudden, they developed arthritis.

They think the problem may be a lack of mobility between the patellar tendon and the tibia (lower leg bone). A condition referred to as patella infera may be part of the problem. With patella infera, there is a permanent shortening of the patellar ligament. The kneecap sits too low in relation to femur (thighbone). The result can be a severely limited range of motion of the knee joint.

Patella infera is a common complication of injury or surgery to the knee joint. It usually doesn’t show up until much time has passed after injury and/or surgical repair.

Treatment options include physical therapy to manually release the kneecap and/or surgery to revise the soft tissues around the knee. If the joint degeneration has gone too far for conservative care to be successful, then total knee replacement may be 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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If I have one bad hip from osteonecrosis, does it necessarily follow that the other hip will go bad too?

January 26th — admin

If I have one bad hip from osteonecrosis, does it necessarily follow that the other hip will go bad too?

Osteonecrosis means “bone death”. Loss of blood supply, bone death, and collapse can occur over a period of months to years. The femoral head is the round ball at the top of the thighbone that fits into the hip socket. Osteonecrosis can be caused by steroid use, alcohol, trauma, and blood-clotting problems like Sickle Cell Disease. In some cases, no cause can be found. Many people who have been diagnosed with osteonecrosis of the femoral head already have the same problem in the other hip. They just don’t know it because the disease can be “silent” or asymptomatic. In other words, there’s no pain. If it wasn’t for the telltale signs on X-ray, the affected individual wouldn’t even know there was a problem.The majority of people who have femoral osteonecrosis in one hip will go on to develop the same problem in the other hip. But this isn’t always the case and even if it does happen, treatment may not be needed.So how does a person decide what to do? The first goal in treating symptomatic (painful, limiting) osteonecrosis of the femoral head is to save the bone. The second goal is to keep function while relieving pain. Your surgeon will be able to advise you as to the best course of action for you. That still doesn’t answer the question about what to do for that asymptomatic hip. Is treatment needed at all? What’s the natural history (i.e., what happens over time if it is NOT treated)? In a recent systematic review of the literature, surgeons who conducted the study concluded that large lesions along the outer two-thirds of the femoral head are in the greatest danger of further destruction and collapse. Those should be treated right away. Small-to-medium lesions can be watched carefully and treated conservatively at first. Any sign of progression of disease should be addressed immediately. Anyone with known risk factors (Sickle cell disease, prolonged use of steroids, alcohol abuse) should be watched closely as well.

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 ACL surgery, my doctor doesn’t think my motion is returning fast enough. What should I do differently?

January 25th — admin

I had an ACL repair a week ago. The doctor doesn’t think I’m getting my motion back fast enough. What should I do differently?

Motion and mobility after ACL repair is a key factor in the long-term success of the operation. Studies show that without good motion, the joint is compressed and wears out faster. Ten years down the road, the patient develops degenerative arthritis and the ACL repair looks like a failure.

Patellar mobility (kneecap motion) is a key factor in regaining overall knee motion. It is always advised to get your motion back before you start strengthening exercises.

Your physical therapist or surgeon can assess patellar motion and teach you how to manually move it side to side, up and down, and along the diagonal planes of motion. This type of motion will help prevent scarring from occurring between the patellar tendon and the tibia and between the patella and the tibia.

Without an 80 percent return of motion early on, there’s a good chance another operation will be needed to release adhesions in the joint. You should have full motion by the end of six weeks. The right rehab program must match the type of surgery you had while regaining motion. Strength training comes after joint mobility is restored.

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 have active plans after my hip replacement surgery, therefore, I want to know the fastest & safest way to recover.

January 24th — admin

Okay, I want to know the fastest, yet safest way to get back up on my feet after hip replacement surgery. I have a wedding to go to, a trip to Europe planned, and two golf tournaments I’m signed up for in the next six months.

A recent study from the Cleveland Clinic in Ohio might be of interest to you. Surgeons from the Cleveland Clinic in Ohio divided a group of 103 total hip patients into two groups. One group (73 patients) had the traditional post-operative treatment after hip replacement. The second group (30 patients) tried a new rapid recovery program. The rapid recovery program combined several factors to enhance recovery. First, the surgeon used incisions that don’t cut through the abductor muscles. The abductor muscles are along the inside of the thigh and help bring the legs together. Second, nurses supervised the use of pain medications. Pain management began in the operating room where patients received a special injection of numbing agents around the joint just operated on. And third, the patients were seen right away by physical therapists on the multidisciplinary team. The traditional program allows patients to rest the first day after surgery. They get up and move much more slowly with the traditional approach compared with the rapid recovery program. Getting up the day of surgery and walking small amounts frequently throughout the day is part of the rapid recovery program. Walking is followed up with an exercise program that is supervised by the therapist twice a day.Surgeons around the country are trying different ways to speed up recovery and return to full function. This is just one example that seems to be working well. You may have to look around in your area to find a surgeon who is on board with a slightly different approach to thotal hip replacements. The traditional approach is tried and true but it may hold you back a bit.

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’ve had surgery to repair my ACL. Why doesn’t this ligament heal itself like other tissues in the body?

January 23rd — admin

I tore my anterior cruciate ligament (ACL) and had to have surgery to reconstruct it. Why doesn’t this ligament heal itself like other tissues in the body?

Scientists studying the field of tissue engineering are very interested in knowing the answer to your question. If we can understand the normal pathways of tissue healing, then maybe we can find a way for ligaments like the ACL to repair itself.

The poor healing capacity of the ACL can be explained in part by its biology. First there is a very thin lining or sheath around the ACL. Once this sheath is disrupted, the blood supply to the ligament is decreased greatly.

Normal healing and repair depend on the formation of a hematoma. A hematoma is a collection of blood cells trapped in the tissues after trauma or injury. Somehow the presence of the hematoma sets up the right environment needed for tissue healing. Without a blood supply, there can be no hematoma formation.

The hematoma provides a base camp so-to-speak for local growth factors and chemicals to come and set up a mesh or scaffold. Cells fill in around the scaffold forming collagen and scar tissue. It looks like there’s a complex interchange between repair cells, growth chemicals, and the scaffold needed for healing. Without the hematoma to get the process started, ligaments don’t recover on their own.

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 need a hip replacement, however, I’m afraid. How can I get over this hurdle?

January 20th — admin

I know I need a hip replacement and my family is bugging me to just do it. But I’m scared. I’m afraid I won’t be able to handle the pain after surgery. My hip hurts now but it’s a pain I’m familiar with and I know how to deal with it. How can I get over this hurdle?

Many seniors put off having a total hip replacement despite the pain and loss of function that the arthritic joint is causing. They are afraid that it will hurt even more after the surgery and take a long time to recover. At least right now, they can walk without a walker. After surgery, the thought of using a walker or cane is enough to keep them away.Yet every year there are nearly one million adults who do have a total hip or total knee replacement. And that figure is expected to increase to four million in the next 20 years. So while some are hesitant, those who aren’t may experience an even faster recovery time thanks to the results of some recent studies.Surgeons and physical therapists are working together to find the fastest way through surgery and rehab with the least amount of pain and disability. Sound like a tall order? Surprisingly, patients seem to adapt well and the results speak for themselves.Patients in a rapid recovery program go directly home two days (sometimes three days) after surgery. Patients in a traditional treatment group are more likely to be discharged to a rehabilitation center around day 4 after surgery. If the traditionally treated patient goes home directly from the hospital, then a treatment program continues at home.In a recent study at the Cleveland Clinic (Ohio), walking distance was twice as far in half the time for the rapid recovery group. That result alone brought smiles to the patients’ faces as they reported a much higher level of satisfaction compared with the traditional group. But there was another positive finding from that study. The rapid recovery group reported significantly less pain and less use of pain medication.The goal of the rapid recovery program is to cut costs while still maintaining patient safety and excellent results. Decreasing the number of days patients are in the hospital while increasing their level of independent function by the time they are discharged is possible.This type of multidisciplinary approach may be just what you need. With the support, guidance, and direction of your physician, nurses, and physical therapist, you may find your fears are put aside.

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 spontaneous ostenonecrosis and what causes it?

January 19th — admin

What is spontaneous ostenonecrosis and what causes it? My husband has been diagnosed with this problem in his left knee. We can’t figure it out.

You’re not alone in your questions. We know that osteonecrosis is the death of bone tissue. But spontaneous osteonecrosis (SON) is sudden, unexpected, and without known cause.

Some recent reports point to a possible increase in this condition in adults over age 60. At first doctors thought it was linked with arthroscopic surgery to remove a torn meniscus. But then five new cases were reported in patients who had meniscus degeneration but no surgery.

It appears that age-related wear and tear on the meniscus may be the start of the problem. But there are still many questions about what’s going on. For example, in one study of five patients, symptoms of knee pain were identified as medial meniscal degeneration.

At the time of the diagnosis, there were no changes in the bone seen on an MRI. The patients were all treated with physical therapy, exercise, and noninflammatory drugs. Two months later the symptoms increased. A second MRI showed osteonecrosis of the knee.

What happened in those two months between MRIs? Doctors just aren’t sure yet but further studies may offer some insight into SON.

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Early treatment of hip disorders can prevent later complications

January 18th — admin

Ever since I was a young teenager (maybe around 13 or 14), I’ve had a snapping hip problem. The general consensus at that time was to just ignore it. Now I’m in my late 30s and it is still bothering me. Should I see someone about this before another 20 years go by — or is it still considered a benign problem (don’t worry about it)?

It might depend on the cause of the problem. If you have a femoroacetabular impingement, then early osteoarthritis is possible, even probable. Just the slightest change in the morphology (shape and structure) of the hip joint can cause problems like this. Femoroacetabular impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket).

There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs. The first type of femoroacetabular impingement (FAI) is called pincer impingement. This type occurs when the rim of the acetabulum (hip socket) sticks out farther than normal. There are several causes of this problem. There can be an overgrowth of cartilage forming the rim or even extra bone that forms in the area. Sometimes the hip socket is tilted backward slightly. In either case, every time the athlete flexes the hip, the rim that’s sticking out too far pinches the labrum against the neck of the femur. The labrum is a fibrous rim of cartilage around the socket to help give it some depth. It is a normal part of the hip biology.

The second type of femoroacetabular impingement is called CAM impingement. Normally, the head of the femur is a smooth, round shape. It is even all around so it can rotate inside the socket evenly. But any change in the shape can cause it to hit one point of the socket more than the others as the head of the femur moves inside the socket. The asymmetrical rotation of the pistol-shaped femoral head is called the cam effect. Anytime something repeatedly rubs against something unevenly, there is uneven wear, tear, and damage. In this case, when the hip is flexed or bent, the unevenly shaped femoral head doesn’t glide over the labrum as it should. Instead, it bumps up against the edge of the cartilage. Over time, the labrum gets worn down to the bone.

And finally, the third type of femoroacetabular impingement is a combination of the two just described (pincer and cam). Cam impingement is more common in males and brings on symptoms earlier than the pincer type. The combination of both types together causes problems sooner than if only one type was present. The best thing to do is see an orthopedic surgeon for an examination and diagnosis. It may be good to do this before any more time passes by. Early recognition and treatment of most hip disorders involving the soft tissue structures help prevent serious complications 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.

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