How can I tell if my hip pain is bursitis or arthritis?

The doctor sent me to a physical therapist for hip bursitis. I’ve had the same pain off and on for five years. After doing a lot of tests, the therapist seemed to think it could be arthritis. My internal rotation and hip flexion are especially limited in motion. How can I find out for sure if this is arthritis?

Early, mild osteoarthritis can be difficult to diagnose. Sometimes it isn’t until the patient has been treated on and off for several years that it becomes clear what is the true problem. By that time changes in the joint space start to show up.

Morning stiffness and stiffness after sitting are common with hip arthritis. If there’s no fever and only mild to moderate pain, a diagnosis of hip synovitis can often be ruled out. Hip bursitis doesn’t usually last five years. Limited hip internal rotation and hip flexion aren’t typical with hip bursitis. These motions are limited more often with arthritis.

There are two ways to approach this problem. The first is to treat the hip as if it were a case of arthritis. Improved motion, strength, and function are the goals. If you get better then follow whatever program the therapist suggests. If you don’t get better or the symptoms get worse, make a follow-up appointment with the doctor. You may need further tests, including X-rays.

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.

Why are the results inconsistent after steroid injections in the knee?

I was very disappointed with my latest steroid injection for knee pain. The first one I had worked great. This second one increased my pain at first. After a few days the pain level just went back to what it was before the injection. Why didn’t I get the same pain relief as the first time?

From time to time, patients report uneven results with steroid injections. There’s been some question about whether the results are based on the type of steroid used. Some doctors questioned if maybe one type of steroid worked better than another.

A recent study comparing two commonly used steroids showed no difference between them. Patients with knee arthritis or shoulder rotator cuff problems received either methylprednisolone or betamethasone. The steroid was mixed with lidocaine (a type of novocaine).

The authors of the study suggest that immediate pain relief is obtained with steroid injections when the injection is done correctly. The correct placement of the needle into the joint is important.

Typically patients experience immediate pain relief. This is a sign that the placement was correct. There is often a slight increase in pain about three days after the injection. The pain subsides and by the end of three weeks, patients report overall improved pain.

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.

How is the length of incision decided for the hip replacement?

I saw a videotape in my doctor’s office showing two ways to do a total hip replacement. One had a much smaller incision than the other. How do they decide which method to use?

The small incision is a fairly new method for hip joint replacement. It’s called a mini-incision. Many studies are being done to compare the mini-incision method with the standard way to replace the hip joint.

Right now doctors choose patients who aren’t overweight. Compared to the standard-incision group the mini-incision group is more likely to be male, taller, and thinner. In fact, the standard-incision group is six times more likely to be obese than the mini-incision patients. The mini-group also has fewer problems in general after surgery.

Researchers are working to find out what type of patient is best suited for each method. That information will help doctors guide their patients in choosing the right operation for each one.

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.

Why must I take a blood thinner for my knee replacement?

My doctor says I’m at high risk for blood clots so I have to take a blood thinner when I have my total knee replacement. What makes me so risky? How long will I have to take this drug?

Blood clots called deep venous thrombosis (DVT) can be a serious complication. It’s important to try and reduce or eliminate as many risk factors as possible. You may want to ask your surgeon to review your personal risk factors with you.

Risk factors you can do something about are called modifiable risk factors. Things you can’t change about yourself are nonmodifiable risks. For example, age over 75 is a nonmodifiable risk factor.

Most of the risk factors for DVT are nonmodifiable. Other nonmodifiable risk factors include previous history of blood clots, cancer, or immobility. History of blood clots includes you or anyone in your immediate family.

Having hip or knee surgery increases your risk dramatically. Less powerful risk factors include being overweight, having varicose veins, and pregnancy.

Your doctor can conduct a screening test for DVT risk factors. A simple test of adding risks up can help predict your risk. Each risk is given a point value. After adding up your points, your risk can be judged as low, moderate, or high.

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.

What is an intertrochanteric fracture?

My mother has an unstable intertrochanteric fracture. She’s having a special set of pins and a plate put in place to hold it together. The doctor thinks she’s too old and too unstable for a hip replacement. What kind of fracture is this?

Unstable means the broken ends of bone could come further apart under stress. The two ends of bone can even slide past each other causing what’s called a displaced fracture.

Intertrochanteric refers to a place high up on the thigh bone. It’s at the base of the femoral neck. The neck is a bridge of bone between the femur and the ball at the end of the femur that fits into the hip socket.

Intertrochanteric is one of two common hip fractures. Older patients in poor health and with poor function are most likely to have this type of break.

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.

Will losing weight help lessen my knee pain?

My doctor tells me that if I lose 50 pounds, my knees won’t hurt so much. I might even be able to avoid or at least delay surgery. Losing weight is very difficult for me. How can I know for sure this will work?

Weight loss can be very difficult for some people. But there are many anecdotal stories and research results to show that obesity does contribute to joint degeneration and pain.

Many patients obtain relief of painful joint symptoms with a combination of treatments. Increasing their exercise and decreasing body weight combined with anti-inflammatories or pain relievers has helped many people with joint OA.

In fact, this is the first line of treatment recommended. Some people are even able to stop taking medications after a significant weight loss.

There are many other added benefits reported from weight loss. Decreased fatigue, increased function, and improved mobility are just a few directly related improvements to your joint health. But the risk of diabetes, cancer, and heart disease also goes down resulting in improved longevity and quality of life.

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.

I’m 47, why shouldn’t I have a total hip replacement?

The doctor says I’m too young (I’m 47) for a total hip replacement even though I have severe arthritis in one hip. What’s the worst that could happen if I went ahead and had it done anyway?

Total hip replacement (THR) has always been reserved for older adults with pain and loss of function from arthritis. More and more young patients (less than 50 years old) are in need of help for severe arthritis.

Yet joint implants don’t last a lifetime, so doctors want to wait as long as possible before replacing the joint. Studies show young, active patients have a high rate of revision surgeries after THR. Early loosening of the implant is common. Debris from the joint eats away at the bone causing this loosening.

A failed implant with revision surgery can leave the patient with one leg shorter than the other. Muscle weakness and scar tissue can also make daily activities difficult. Active adults find they can’t engage in sports or recreational activities as they once did.

Doctors often suggest a hip osteotomy for the young patient with only one hip involved. This is a joint-saving operation that can buy the patient some extra time. It can reduce pain, increase motion, and improve function.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

When is it time to have a knee replacement?

How do you know when it’s time to have a knee replacement? I don’t really have much pain, but I can’t do much with that knee.

The decision to have a joint replacement takes into consideration many factors. First, your age and general health are important. Previous treatment for arthritis is reviewed. There may be some conservative (nonoperative) care you haven’t tried that can help before thinking about surgery.

X-rays are taken to view the condition of the joint. The surgeon looks at the joint space and bone density when advising you. During the physical exam, joint range of motion and strength are measured. Function, activities of daily living (ADLs), and quality of life are also part of the decision-making process.

If you’ve tried all the recommended steps in conservative care without success, then you may be a good candidate for surgery. Even without pain, function and quality of life may be improved enough by a joint replacement to make it worth doing.

Your orthopedic surgeon is the best one to advise you on all the treatment options and timing.

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.

After my hip replacement, why is one leg shorter than the other?

Eighteen months ago I had a left total hip replacement. Everything went well but now the left leg is shorter than the right side. Should I have the right leg done now to even them out?

That may not be necessary. The first step is to bring this problem to your doctor’s attention. It’s possible a simple revision of the left hip implant is all that’s needed. Sometimes a plastic spacer can be inserted into the hip socket to make up the difference in leg length.

If the hip can’t be changed, then perhaps a shoe insert or shoe lift would help. A physical therapist can help you with this decision. It’s important to make sure that whatever measures are taken, your spine remains straight and your hips are level. This will help prevent other problems later on.

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.

Can I get arthritis pain relief any other way than knee surgery?

I have painful knee arthritis but I don’t want surgery for a joint replacement. What else can I do to get pain relief?

Patients often want to delay or avoid joint replacement. Many doctors suggest pain relievers or nonsteroidal anti-inflammatory drugs combined with exercise as an early treatment program. Patient education for improving posture and reducing biomechanical imbalances may be provided by a physical therapist.

Other treatment options can include steroid injections, glucosamine supplements, or bracing. Minor surgery such as arthroscopic debridement may be advised. The surgeon removes any frayed edges or loose fragments of cartilage.

This type of treatment is not routinely advised for all patients but may be most effective for low-grade OA.

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.