2012 January | Naples Orthopedic Surgeon - Dr. Robert J. Zehr

I’m 62 and have been having some pain inside my right knee. Is this just age, or should it be checked by a doctor?

January 17th — admin

I’m 62-years old and in reasonably good health. Lately I’ve been having some pain along the inside of my right knee. I’ve waited for it to go away. I’ve tried ibuprofen. It’s not getting worse but it’s not getting better. How do you know what’s just a sign of getting older and what should be checked out by a doctor?

Sometimes it’s impossible to tell the serious from the not-so-serious medical conditions. With aging come age-related changes in the body. With the knee, joint cartilage such as the meniscus starts to wear out. Early signs of arthritis start to set in.

But most experts agree that early intervention can make a big difference in many kinds of problems. Don’t wait to see your doctor. An X-ray may be all that’s needed. In some cases an MRI is best. If conservative care doesn’t improve your symptoms, then a second MRI may be needed.

Recently several studies have documented cases of spontaneous osteonecrosis in adults over age 60 who had some meniscus degeneration. Osteonecrosis is the death of bone. Spontaneous means it came on suddenly with no warning and no known cause. These are the kinds of problems you want to avoid by checking with your doctor sooner than 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.

Posted in Knees. Tags: age-related changes in the body, aging, arthritic joint, arthritis, conservative care, death of bone, early intervention, good health, ibuprofen, meniscus degeneration, MRI, pain inside the knee, spontaneous osteonecrosis, symptoms, X-ray. No Comments »

I have a labral tear of the hip. What kind of surgery can they do for this problem?

January 16th — admin

I’ve been diagnosed with a labral tear of the hip. I’m scheduled to see a specialist next week but thought I’d do a little research of my own on the Internet before my appointment. What kind of surgery can they do for this problem?

The labrum is a thin but helpful extra layer of cartilage around the hip and shoulder joints. In the hip, it helps extend the edges of the joint socket to form a deeper cup for the round head of the femur (thigh bone). This helps keep the joint in the socket while still allowing a wide range of movements needed by the leg.Damage to the labrum can result in painful symptoms. Sometimes there is a clicking sensation and the hip can even get locked up if the torn labrum gets caught between two structures of the hip. Loss of hip motion is the outcome of either of these symptoms. There is a chance that the labrum can heal itself but most of the time, surgery to remove the ragged edges of the torn labrum is required. This procedure is called debridement. The surgeon shaves off the ragged edges of the labrum and smoothing the remaining edges.A more extensive surgery called a partial labrectomy may be needed. This involves removing the unstable part of the labrum. Studies show that partial labrectomies have better outcomes when there isn’t damage to the underlying layer of cartilage attached to bone. The success rate drops from 90 per cent without chondral lesions down to 21 per cent for those patients with chondral defects.A newer approach to labral tears is now in use: labral repair. During a labral repair, the surgeon uses stitches and surgical anchors to reattach the torn labrum. Results of labral repairs have not been published yet in English-language medical journals. Most of the research that has been done has been published in European or Spanish-language journals. When valid and reliable tools are available, the results of debridement, partial labrectomy, and labral repair can be compared.Your surgeon will probably go over the various surgical options available to you and recommend the one that will work the best for the type of injury and damage you have.

Is it possible to predict who will and who won’t have a good result from a total knee replacement?

January 13th — admin

My father-in-law is going to have a total knee replacement next week. Call me a pessimist but I think he’s going to have problems. He’s old (83 years old) and frail. Is it possible to predict who will and who won’t have a good result?

Researchers are studying many problems patients face with the idea of predicting who will have a good/poor result. The hope is to give the right care to each group to get the most benefit.

When it comes to total knee replacements (TKRs), there are quite a few studies already done on this topic. One of the most recent ones looked at over 200,000 patients who had a TKR between 1991 and 2001. Rates of infection, blood clots, and death were compiled. Factors such as age, gender, health, and type of insurance were matched against the data.

They reported that age over 65 was a risk factor for problems. Likewise, patients with more than one other health problem had worse outcomes. High blood pressure, diabetes, and a previous history of blood clot(s) are all risk factors for problems after surgery.

Previous studies have shown that surgeon experience makes a difference. Surgeons who do more TKRs have the best results. It turns out that hospitals have similar track records. High volume hospitals have the lowest death rate and rate of infection after TKRs.

Your father-in-law’s best chances for a good recovery depend on his health, his surgeon’s skill, and the type of hospital he will be staying at. Type of insurance seems to have an impact, too. Medicare patients have worse results than patients covered by private insurance.

I’m a Catholic priest and every time I kneel down my hip replacement squeaks. What can I do?

January 12th — admin

I am a Catholic priest with a strange problem. Every time I kneel down and get back up, my hip replacement squeaks. And it’s loud enough to be heard by every one at Mass. What can I do about this?

You are not alone though your situation is certainly unique. The problem of squeaking hips after joint replacement has increased in the last 10 years with the increased use of hard-on-hard bearings. What do we mean by hard-on-hard bearings? The two main parts of the hip that are replaced include the round head at the top of the femur (thigh bone) and the cup-shaped hip socket.The materials used for these component parts can be ceramic-on-ceramic, metal-on-metal, or metal-on-polyethylene (plastic). Metal-on-metal and ceramic-on-ceramic are the hard-on-hard bearings. Ceramic-on-polyethylene and metal-on-polyethylene are considered hard-on-soft bearings.It appears that there are three main factors involved and usually more than one reason for the squeaking. Patient factors such as body size and mass (larger), height (taller), and activity (hip flexion) may be part of the problem. There’s not much a person can do about their height to change the squeaking. But they can be advised to avoid activities or movements that cause the squeaking. That’s a bit tricky for a priest who must genuflect (bend on one knee down and up) or kneel repeatedly. Whenever possible, replace kneeling with bowing. When genuflecting is required, try using the other leg as the bending side. And if possible, find the range-of-motion that is squeak-free and stay within that range. This may mean you don’t go down as far when genuflecting. Sometimes, it’s not the patient at all but rather the way the implant was placed in the hip. The wrong angle, a slight twist of the cup (socket) piece, or a little bit of both has been linked with squeaking.But the most likely factor is the implant itself and in particular, the materials it is made of. The newer implants made of titanium alloy are more flexible and less stiff. This feature could increase the vibrational force that creates friction and squeaking. Other contributing factors include loss of fluid lubricating the hip, tiny particles of metal or other debris from the implant, or damage to the surface of the implant.See your surgeon, if you are unable to find ways to avoid the squeaking. A simple revision surgery may be all that’s needed. Replacing the liner or altering soft tissue tension could make all the difference.

Has anything much changed in ACL repairs over the years?

January 11th — admin

ACL repairs have been around for a long time. I had one when I was a college athlete. Now my daughter who is a collegiate basketball player is having one. Has anything much changed over the years?

Anterior cruciate ligament (ACL) repairs have indeed been around for 30 years or more. Surgeons keep finding ways to improve it. In a recent review of ACL repairs, Dr. Ben Graf from the University of Wisconsin (Madison) gave a good summary of the last 30 years.

He said the first 10 years was spent proving ACL repairs were needed. The second 10 years worked on repairing it from the inside out. And the last decade has been looking at types of grafts (hamstring versus patellar tendon grafts).

The newest change is the use of a double-bundle repair to (maybe) replace the single-bundle method. No matter what kind of graft type used, there’s still a problem with early arthritis in the grafted knee. By studying normal anatomy, scientists think this may have to do with motion that is restricted by the ACL repair.

It seems that the standard single-bundle repair doesn’t allow the normal rotation of the tibia (lower leg bone). This type of motion is needed when an athlete pivots and shifts his or her weight to move in a different direction. The double-bundle repair attaches the tendon graft in two places instead of one. The idea is to mimic the anterior and posterior (front and back) attachments of the normal ACL.

But like many new things on the horizon, this one hasn’t been fully tested and approved. The next decade may bring many innovative changes. Improved technology and new surgical instruments will bring about these changes.

Posted in Knees. Tags: ACL, arthritis, basketball player, double-bundle repair, improved technology, innovative changes, lower leg bone, normal rotation of the tibia, not approved, not fully tested, pivots, shifts weight, single-bundle method, tendon grafts. No Comments »

There was little concern about my hip pain until I mentioned it was always worse at night. Why?

January 10th — admin

No one seemed particularly concerned about my hip pain until I mentioned it was always worse at night. Then all of a sudden, I had a ticket to the MRI machine. They found a benign tumor (osteoid osteoma) in the upper portion of the femur. Why was this night pain the “hop to it” symptom?

Bone pain from osteoid osteomas usually occurs in young men between the ages of five and 24 (though it has been reported in older adults). Without knowing there’s a tumor present (and without a more dramatic presentation), it’s easy to think that the fellow is having growing pains. But pain at night that wakes the person up from a sound sleep is a red flag for cancer. Then the picture of a young person with bone pain at night suddenly becomes more compelling.Why does this type of pain develop? It turns out that cancer cells can signal the normal healthy tissue to form tiny blood vessels between the healthy tissue and the cancer. The process is called angiogenesis. The net effect is to siphon off blood to the tumor. This creates a loss of blood supply to the surrounding healthy tissue, a condition called ischemia. Without oxygen, the body sets up a pain response. Since most of this happens at night when the body is in a semi-state of hybernation, the symptoms don’t occur during the day.

Posted in Hips. Tags: angiogenesis, benign tumor, blood supply, bone pain, cancer, femur, growing pains, hip pain, hybernation, ischemia, MRI, night, osteoid osteoma, oxygen, pain at night, wake up at night. No Comments »

I had one knee replaced. Can I use the mininally invasive (MIS) method if I get the other knee replaced?

January 9th — admin

I have rheumatoid arthritis that has bothered my knees for years. Two years ago I had the right knee replaced. I see now there’s an even better operation with a small incision that doesn’t cut through the muscle. If I have my other knee replaced, could I have it done with this new method?

You may be talking about the minimally invasive (MIS) quadriceps-sparing total knee replacement (TKR). In the standard TKR operation the quadriceps muscle in front of the knee and thigh is either split open or cut and moved out of the way while replacing the joint.

Problems can occur when the muscle is disrupted this way. Blood vessels and nerves can be cut causing swelling and weakness after the operation. Quadriceps sparing doesn’t avoid the muscle completely, but it reduces the amount of trauma by quite a bit.

Patients with rheumatoid arthritis who do not have osteoporosis can have this operation. Younger patients with normal weight and no knee deformity have the best chances of a good result from surgery.

Posted in Knees. Tags: blood vessels, knee deformity, minimally invasive, MIS, muscle, osteoporosis, quadriceps-sparing, rheumatoid arthritis, surgery, swelling, thigh, TKR, trauma, weakness, Younger patients. No Comments »

I have a very painful buttock. I don’t recall any injuries. What could be causing this?

January 6th — admin

Ouchie — I don’t know how else to say this but I have one painful buttock. I can barely sit down and can’t put any weight on that side. It just seemed to come on all of a sudden. I don’t recall twisting wrong or doing anything sudden. What could be causing this?

Pain along the back of the hip or buttock can be a very complex and puzzling condition to figure out. Sometimes a muscle gets overworked and goes into spasm. There could be an alignment problem of the spinal joints in the lumbar spine causing your symptoms. There could even be a disc pressing on a nerve creating your symptoms.The best way to find out is to see a musculoskeletal specialist. This could be a sports medicine physician, orthopedic surgeon, or physical therapist. Give some thought to your symptoms because the physician or therapist will ask you many questions about where it hurts, how it feels, what makes it better or worse, how long it lasts, and so on. The answers to these questions are key to understanding what’s going on.Pain along the back of the hip is rarely coming from inside the joint. We know this from anatomy studies and understanding the nerve pathways that supply the joint and surrounding soft tissues. It is most likely coming from elsewhere — like the sacroiliac joint, low back, or knee. It could be from a muscle strain, hernia, bursitis, degenerative disc disease, fracture, or even from a hip dislocation. Rarely, buttock pain can be caused by more serious problems like infection or tumor.There are many clinical tests that can be done to sort out what anatomical structure is getting pinched, overworked, or is out of balance or alignment. Change in joint motion, areas of muscle weakness, muscle tightness, and even the way you stand and walk will provide the necessary clues to identify the underlying problem.Sometimes, X-rays or other imaging studies such as MRIs, CT scans, or ultrasound studies are needed. But most of the time, the problem clears up with conservative care and doesn’t require expensive or invasive tests. If your symptoms don’t improve or go away with a few days rest, warm baths, and stretching, then make an appointment for an evaluation. Early diagnosis and treatment preventing worsening of the problem often saves both the pocketbook and the buttock from further suffering.

Is there more that I can do for the stiffness and pain in my football injured knees besides exercises and using braces?

January 5th — admin

I’m 23-years old and already blown the meniscus in both my knees playing football. I’ve done exercises and used braces but there’s still so much pain and stiffness. Isn’t there anything else I can do?

Treatment depends somewhat on your goals. If you are planning to return to competitive sports, then analgesics to control the pain and rehab may be your best options. However, you should be aware that without the meniscus, your knees are at increased risk for damage and changes from arthritis.

If possible, the meniscus is repaired rather than removed. Most patients are encouraged to put aside strenuous, high-impact activities to protect their joints.

For some younger patients, meniscal transplantation may be the answer. Cartilage freshly donated or stored in a frozen state may be used. The knee must be stable and in good alignment. There can’t be any bone spurs.

A surgeon will conduct a physical exam. How you stand and walk is evaluated. Knee joint motion and alignment are important. Too much angle at the knee may keep you from being a good candidate for this surgery.

This treatment option is only considered for younger patients (less than 40 years old). The down side is that long-term studies haven’t been done to show results 10, 20, or more years ater.

Talk with your doctor about what’s best for you given your age, activity level, and sporting goals.

Posted in Knees. Tags: analgesics, arthritis, bone spurs, exercises, football, high-impact activities, injury, joints, knee, knee braces, meniscus, rehab, stiffness, surgeon. No Comments »

My boyfriend, a football player, has a big bruise on his hip/thigh area. Shouldn’t he tell someone?

January 4th — admin

My boyfriend is on our college football team. When we were at a party last night sitting in a hot tub, I noticed he had a big bruise on the side of his hip/thigh. He says he got hit pretty hard in practice but that it’s nothing. I’m really worried. Should he at least tell his coach about this?

Players are often unwilling to report injuries to the team athletic trainer or coach for two reasons. One, it might keep them out of the game. And two, they don’t want to be seen as a weakling or baby.Every player experiences his fair share of injuries that leave bruises. Most of the time, the injuries are minor and will heal on their own. We call these problems self-limiting. But there are those rare times when what seems like a simple problem turns out to be more serious than originally suspected.From your description, it sounds like your boyfriend may have what’s called a hip pointer. Athletes who collide with others or who take the force of a helmeted head into the lateral hip can end up with a hip pointer. This injury or contusion is visible as blood under the skin leaves a large bruise. It is treated with a leave it alone approach. Ice, rest, and compression help the body complete its natural course of healing.Pain that doesn’t go away with an injury like this could be a sign of a bone fracture. X-rays may be needed to know for sure. The biggest risk is for recurrent bleeding. Athletes are advised to rest and avoid vigorous activity for at least 48 hours after an injury like this.

Posted in Hips. Tags: 48 hours, athletes, bone fracture, bruise, contusion, football, football player, hip, hip pointer, injury, recurrent bleeding, self-limiting, thigh, trainer, X-rays. No Comments »

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Naples Orthopedic Surgeon – Dr. Robert J. Zehr The Zehr Center

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I have a labral tear of the hip. What kind of surgery can they do for this problem?

Is it possible to predict who will and who won’t have a good result from a total knee replacement?

I’m a Catholic priest and every time I kneel down my hip replacement squeaks. What can I do?

Has anything much changed in ACL repairs over the years?

There was little concern about my hip pain until I mentioned it was always worse at night. Why?

I had one knee replaced. Can I use the mininally invasive (MIS) method if I get the other knee replaced?

I have a very painful buttock. I don’t recall any injuries. What could be causing this?

Is there more that I can do for the stiffness and pain in my football injured knees besides exercises and using braces?

My boyfriend, a football player, has a big bruise on his hip/thigh area. Shouldn’t he tell someone?

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