My doctor says I have hip bursitis. Is there really such a thing?

February 29th — admin

Is there really such a thing as hip bursitis? My grandma used to complain of that but I thought it was an old lady complaint like lumbago. Now my doctor says this is what I have. So my original question still stands: is there such a thing?

Pain along the side of the hip is still a common spot for bursitis (also known as greater trochanter pain syndrome. A large tendon passes over the bony bump on the side of the hip called the greater trochanter. Inflammation in the bursa (a protective gel sac) between the tendon and the greater trochanter is called trochanteric bursitis or lateral hip bursitis. You can see there are many names for this problem.Hip bursitis is common in older individuals. Women seem affected more often than men. It may also occur in younger patients who are extremely active in exercises such as walking, running, or biking.Sometimes a bursa can become inflamed (swollen and irritated) because of too much friction or because of an injury to the bursa. An inflamed bursa can cause pain because movement makes the structures around the bursa rub against it. Friction can build in the bursa during walking if the long tendon on the side of the thigh is tight. It is unclear what causes this tightening of the tendon. The gluteus maximus attaches to this long tendon. As you walk, the gluteus maximus pulls this tendon over the greater trochanter with each step. When the tendon is tight, it rubs against the bursa. The rubbing causes friction to build in the bursa, leading to irritation and inflammation. Friction can also start if the outer hip muscle (gluteus medius) is weak, if one leg is longer than the other, or if you walk or run on banked (slanted) surfaces.Most cases of trochanteric bursitis appear gradually with no obvious underlying injury or cause. Trochanteric bursitis can occur after artificial replacement of the hip joint or other types of hip surgery. The cause may be a combination of changes in the way the hip works, the way it is aligned, or the way scar tissue has formed from the healing incision.So, in answer to your question — yes! Hip bursitis is still a real problem with a real diagnosis. Treatment early on can prevent this painful condition from becoming a chronic problem that might require surgery. Short-term use of nonsteroidal anti-inflammatory medications along with physical therapy may be all the person needs. The physical therapist will correct any postural components, muscle imbalances, and help restore normal function of the affected hip muscles.

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’s having his knee joint replaced. Should he have the kneecap replaced also?

February 28th — admin

My father is going to have his left knee joint replaced. The kneecap is in pretty good shape, so they are going to leave it alone. Are there any disadvantages of this? Maybe it’s better to replace everything all at one time.

There is much debate about this topic. The surgeon has several options available. The patella can be left unchanged while the rest of the joint is replaced. The patella can be resurfaced. This means the back of the kneecap is smoothed. It may be left that way to heal or a smooth, polypropylene (plastic) liner may be attached to the back of the patella.

Knee pain is the main problem with leaving the patella unchanged. Second to that, the arthritis may continue to get worse in the patella. The cartilage along the back of the patella that comes in contact with the rest of the knee joint can get worn unevenly, form bone spurs, or thicken in an attempt to protect the joint. When this happens, the patient may report “tightness” and loss of motion in the joint.

The surgeon will make a judgment call during the operation. Which option to choose is based on the present condition of the patella, your father’s age, and his activity level.

One of the most important considerations in leaving the patient’s patella intact is: how long will the cartilage surface hold up moving against the metal implant. Early studies show that leaving the patella unchanged may not have the best results.

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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Is there any way that I can squeeze a few extra years out of my hip replacement?

February 27th — admin

My orthopedic surgeon says to expect 10 to 15 years out of my new hip replacement. That doesn’t seem like much since I’m only 65 and longevity runs in the family. If my parents are any indication, I could live well into my 90s. Is there any way I can squeeze a few extra years out of my hip replacement?

Your surgeon is giving you the typical average lifespan of a joint replacement. For some people, it’s less while for others it can be longer. There are more than a few cases where people report excellent results 20 to 25 years later!

But the truth is that even with today’s modern improvements in hip replacements, active adults and overweight patients have a greater chance of creating wear and tear on the implant resulting in its eventual failure. Sometimes, it’s just a matter of replacing the liner — that can be a fairly simple revision surgery. There is a polyethylene (plastic) liner that goes inside the hip socket. The head of the femur fits into the liner. The liner or insert helps absorb impact on the implant so it must be as durable as possible.

Extensive wear of the liner or insert can result in failure of the entire implant, the release of debris into the joint, and osteolysis (bone loss). Too much wear of the liner or insert can result in the need for a revision surgery to remove the worn liner or insert and to replace it with a new liner or insert. Liner wear is one of the most common problems.

Other complications include heterotopic ossification (HO) (formation of bone in the muscles and soft tissues around the joint), hip dislocations, bone fractures around the implant, infections, and deep vein thrombosis (DVTs or blood clots).

Any of these complications can put you at risk for early implant failure.How can you squeeze out a few more years? Stay active but don’t overdo. Running marathons (or other similar repetitive motions) will definitely increase the risk of wear and tear on the implant. It’s not indestructible.

If you are overweight, take measures to lose a few pounds. Your surgeon may be able to offer other suggestions based on the type of implant you have and the surgical technique used to insert it. Don’t hesitate to ask him or her this same question.

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 Patello-Femoral Syndrome. Will I ever be able to get just my kneecaps replaced?

February 24th — admin

I have very severe patellofemoral pain syndrome. Would it ever be possible to just have my kneecaps replaced?

Patello-Femoral Syndrome (PFS) is a condition that causes pain in and around the kneecap (patella). In the normal, healthy adult, the patella moves smoothly over a groove on the femur (thigh bone). PFS can develop when the patella is not moving or tracking properly over the femur. This is a common knee problem in runners and athletes but anyone can be affected.

Where the patella and femur meet forms a joint called the patellofemoral joint. Many muscles and ligaments control this joint. Any change in alignment of the bone, ligaments, and/or muscles around the patellofemoral joint can affect how the patella tracks along the femoral groove.

Patellofemoral joint replacement is usually a treatment for patients with severe osteoarthritis. The articular cartilage covering the back of the kneecap becomes worn and torn causing painful movement. Replacing the patellofemoral joint in PFS doesn’t address the real problem of soft tissue imbalance and structure causing tracking problems.

Conservative treatment for PFS with bracing and exercise may be the best option. If the back of the patella has worn more on one side than the other from the uneven forces of PFS, then the surgeon can smooth the surface without replacing the entire bone. An orthopedic surgeon is the best person to look at your situation and advise you about treatment options including patellofemoral replacement.

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 dislocated my hip and it popped right back in. What should I do?

February 23rd — admin

I accidentally dislocated my hip this morning. It popped right back in but I am freaked. This has never happened to me before. Should I use crutches? What should I do?

You may be experiencing a condition referred to as hip instability. Hip instability can include subluxation (partial dislocation), complete dislocation, and microinstability. The last classification (microinstability) is just what it sounds like — too much looseness in the joint but without a big enough shift in hip position to cause a subluxation.

Many people with hip instability have a known etiology (cause). It could be from a stretching of the ligamentous joint capsule that helps hold the hip in the socket. Or a tear in the labrum (fibrous cartilage around the rim of the hip socket). If there’s no known history of injury, then the condition is referred to as atraumatic (without trauma) instability.

With atraumatic hip instability, there may not be a specific injury but there is still usually a reason the problem develops. There could be an underlying systemic disease affecting the soft tissues (e.g., Ehlers-Danlos, Marfan, or Down syndrome). Abnormal anatomy of the bones or soft tissues could also contribute to the problem. Whether or not you should be putting weight on that leg after a dislocation event is something many experts debate. Studies don’t show that weight-bearing leads to loss of blood supply to the hip — or even to another hip dislocation. Even so, the best thing is to see an orthopedic surgeon and have him or her take a look at what’s going on. There may be a simple explanation and treatment for the problem.

There may be an anatomical explanation for what happened (e.g., perhaps you have a shallow hip socket from birth or loose ligaments that have gotten overstretched).

Whatever the cause, the goal is to prevent further hip instability (dislocations). You may benefit from a short course of physical therapy. Even with hip capsular laxity (looseness), physical therapy to improve core (trunk and abdominal) strength can be helpful. But the first step remains to find out what’s going on and why this may have happened. Once that information is obtained, the course of treatment will follow.

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 had a total knee replacement about three months ago. Why don’t I have my full motion back?

February 22nd — admin

I had a total knee replacement about three months ago. I never did get my full motion back. The doctor mentioned manipulating the joint and sending me back to PT for an intense rehab program. How soon should I do this?

Your surgeon may have a time frame in mind so be sure to ask for his or her best recommendation. For some patients manipulation is enough. The patient is anesthetized and the surgeon moves the joint through its full range of motion while the body is completely relaxed. Tiny adhesions and fibrotic tissue tear during this process.

Manipulation is best done in the first 90 days after the joint replacement. If the surgeon waits too long, the risk of fracture goes up.

Some patients need a more aggressive treatment. An operation called arthrotomy is done to clean the joint of any scar tissue. Many surgeons debate the timing of this treatment. Some experts suggest this type of surgery only after four to six months of intense physical therapy first.

With either type of procedure, intense rehab for weeks to months is needed afterwards. Exercise may be aided by stretching, bracing, and electrical therapy. The patient should show steady improvement in range of motion over the first two to three weeks in PT. Communication between the patient, therapist, and surgeon is also extremely important for the best outcome possible.

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 am in rehab after a total hip replacement. What should I use to gauge my progress?

February 21st — admin

I am in rehab for a total hip replacement. I confess I’m a type A person. Even though I try not to compare myself to others, I always end up checking to see how I’m doing based on how others are doing. What should I really be using to gauge my progress?

You’ll be relieved to know that the most common question patients have after hip replacement surgery is: “How am I doing compared to everyone else?” This seems to be the result of a natural human tendency not necessarily based on how competitive you are. Most patients ask their surgeon or physical therapist this question sometime during the postoperative period. With information from a new study on recovery following a total hip replacement, there are some ballpark answers to this question.

For example, it appears there are two phases to recovery. The first occurs during the 12 to 15 weeks following the procedure. Rapid change occurs in the first three months and then starts to slow between 15 and 20 weeks.

By the end of four months, most patients have been discharged from treatment. They are well on their way to resuming all physical activities and exercise they are interested in.

Thirty (30) weeks (seven and a half months) later, patients experience another leveling out as they are now able to walk again at a normal pace. Physical function involving the legs continues to improve though at a much slower pace than early on. Balance and postural stability seem to take longer to recover.

If you continue to follow the exercise program prescribed by your physical therapist, then by the end of 12 months (one full year), you should be fully recovered. At that point, hip muscle strength, joint motion, and leg function should test within normal limits for your age.

Patients who quit doing their exercises too soon often have muscle weakness and report falls two years after hip replacement. The therapist can use several tools to measure how you are doing. A popular (valid and reliable) test of physical activity is the six minute walk test (6MWT). In this test, how far you can walk (and how fast) in six-minutes is measured.

For both men and women after total hip replacement, the peak distance walked occurs around that 30-week postoperative timeframe. Women don’t walk as far as men and their early recovery time is a little slower but in the end (a year later), walking ability evens out between the sexes. Other measures may include whether or not you still need a walking aid (e.g., walking sticks or cane), your pain level, and how much medication you are still taking for pain. How well you can go up and down stairs is a functional skill of importance. Your ability to carry out daily activities may also be examined closely. You can use these known guidelines to establish your own goals and check your recovery against the average.

More physical therapy with a supervised rehab program may still be needed if you have not experienced good improvement or the results you expected.Setting too high of expectations can discourage you — especially in those early weeks of recovery. Just compete against yourself rather than against others who may be ahead or behind you for specific (individual) reasons. Adopt a “can do” attitude, follow your therapist’s and surgeon’s advice, and give yourself the time you need to recover.

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 mother has both dementia and arthritis. Can she handle a knee replacement?

February 20th — admin

My mother is in a nursing home and has early stages of dementia. She also has severe arthritis in her left knee. Some of the staff think if she had a knee replacement she would be more active and this might help with the dementia. Can people with dementia handle surgery and rehab?

There are no known studies of patients with dementia having total hip or total knee joint replacements. Most physicians agree that dementia is one reason patients should NOT have this surgery. There are great concerns for patient safety after joint replacement.

On the other hand, improvements in the implant design and surgical technique have changed the course of treatment. Patients have fewer restrictions. They can get up and walk on the new joint right away.

Physical activity and exercise are very important in all patients. This is especially true for nursing home residents. They are often at risk for other health conditions made worse by inactivity.

The decision to give your mother a knee replacement must be made by the entire team. The group should include family, physicians, nurses, social workers, and rehab staff. Both her primary care physician and gerontologist (if she has one) along with the orthopedic surgeon should assess all aspects of her health, the operation, and the goals for surgery.

If everyone is in agreement, then the surgeon will make further decisions about the type of implant and type of surgical approach to use. Likewise the nursing staff and physical therapists will develop a plan of care to see her safely through the rehab program.

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 having my third hip replacement. What’s changed recently?

February 17th — admin

As my father used to say, “Here we go again!” I’m having my third(!) hip replacement. The first two have been great but I’ve worn one of them out. It was put in 20 years ago, so I’m doing a little research to find out what’s changed since that time and what I should look out for.

Probably the thing that has changed the most in the last 15 to 20 years is the shift from cemented to cementless implants.

Around about 1995, the National Institutes of Health (NIH) said the research showed using a hybrid implant with one part cemented in and one part cementless was the way to go. Gradually, with improved designs, materials, and surgical techniques, surgeons are now using completely cementless joint replacements in up to 90 per cent of all cases.

Sometimes bone loss from osteoporosis and/or deformities dictate the use of a specific type of implant design and cemented fixation. But otherwise, there are six basic designs to choose from and all have equally good results.With your previous surgery, these two factors (condition of the bone and alignment) may be critical or important enough to guide a specific implant choice. Your surgeon will be able to make that determination based on physical examination, X-rays, MRIs and/or CT scans.

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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Do knee replacements require revision surgery often?

February 16th — admin

My father had to have his total knee replacement taken out and replaced a second time. Does this happen very often?

The rate of revision surgery for total knee replacements (TKRs) varies from country to country. According to a recent study, England has the lowest revision rate at four percent. New Zealand and Australia have the highest rate at around nine percent. The United States comes in just below that at eight percent.

Research shows that surgeons who do the most number of these surgeries have the lowest rate of problems and revisions. Likewise, high-volume surgery centers also have the best results. They may have a more skilled operative team that coordinates pre- and post-operative care. Rehab teams take up patient management where the operative team leaves off.

There is some evidence to suggest the implants are partly at fault. The hope is that rates of revision will decline as implant design improves and surgeons gain experience using them.

Even with a revision TKR most patients say it was worth the cost and extra hassle. The pain relief and improved function increased their overall quality of health. Health economists say anything that costs less than $20,000 per well-year is an excellent deal.

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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