Naples Orthopedic Surgeon - Dr. Robert J. Zehr » Hips

Careful monitoring needed for hip dysplasia

admin — Wed, 28 Jul 2010 14:00:17 +0000

I just came back from the doctor’s where I found out I have hip dysplasia. My hip started hurting about six months ago and the X-rays showed this deformity. How often does this happen, and what does it mean in the long-run?

Developmental hip dysplasia (DDH) is probably present at birth or occurs during development in the early years. A change in the normal anatomy results in a shallow hip socket. The angle or tilt of the femur (thigh bone) and rotation of the femoral shaft (long part of the bone) are also different from normal. The patient is at increased risk of partial dislocation called subluxation or even full dislocation.

According to at least one study, this condition occurs in about five to 13 percent of the adult population. The person may not even know it’s there until pain sends him or her to the doctor for an X-ray.

There is some evidence that dysplastic hips have an uneven load across the joint. The cartilage on the surface of the joint can get damaged directly. Abnormal stresses on the soft tissues supporting the joint can lead to wear and tear of ligaments and cartilage.

Damage to the cartilage around the rim of the socket changes the pressure inside the joint. Synovial fluid that lubricates the joint may leak out adding to the wearing away of the cartilage.

No one is quite sure if these changes always occur or how long it takes before they result in arthritis. One study from Denmark reported no adverse changes even after 10 years of untreated DDH. It may be best to treat the hip conservatively but keep contact with your doctor. Any change in symptoms should be re-evaluated sooner than later to prevent excessive damage.

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 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 you get arthritis in a joint replacement?

admin — Fri, 23 Jul 2010 14:00:56 +0000

Have you ever heard of getting arthritis in a joint replacement? That’s what my doctor tells me is causing my hip pain. How is that possible?

Prosthetic arthritis is a very real condition. It is caused by erosion or damage to the joint cartilage. This type of problem occurs with a joint implant called a unipolar hemiarthroplasty.

The unipolar implant is one of the first type of partial hip replacements designed. It replaces the round head of the femur (thigh bone). It has a stem attached to it that goes down inside the shaft of the femur to hold it in place.

Younger, more active patients are more likely to develop this kind of problem. The implant moving inside the hip socket chips away small pieces of bone and cartilage leading to cartilage erosion also known as prosthetic arthritis.

A newer type of implant was made to try and avoid this problem. It’s called the bipolar prosthesis. Besides the femoral implant, a plastic-lined, metal cup is inserted into the patient’s own natural acetabulum (hip socket). Instead of just the femoral head moving in the acetabulum (unipolar implant), the bipolar allows for two points of motion. The femoral head moves and rotates inside the cup and the cup moves and rotates inside the acetabulum.

The bipolar hemiarthroplasty is more expensive but recommended for active patients younger than 65.

Snapping hip syndrome affects this ballerina

admin — Tue, 20 Jul 2010 14:00:36 +0000

Whenever I lift my leg straight up in front or to the side, I feel (and I think I can hear) a snapping sound. It doesn’t hurt but it’s very annoying. I’m taking a ballet class and we use this movement often. What can cause this problem?

You may be experiencing a condition called snapping hip syndrome. In medical terms it’s called external coxa saltans. The sound is caused by the iliotibial band (ITB) sliding over a part of the hipbone called the greater trochanter.

The ITB is a long piece of fascia (a thick layer of connective tissue) attached at the top to a hip muscle. It goes from the hip all the way down to the outside edge of the knee.

In between the ITB and the greater trochanter is a small, round cushion called the trochanteric bursa. As the ITB rubs over the greater trochanter, the bursa tries to cushion the friction. But repeated snapping back and forth can cause inflammation of the bursa called bursitis. When bursitis occurs the patient has both snapping and pain.

The first step may be to ask your dance instructor to watch how you are doing the barre or floor exercises that cause snapping. There may be an acceptable way to change your form. Stretching the ITB may also help. Doing something now before a painful response begins is always a good idea!

Most hip fractures occur in women over 65. Why?

admin — Thu, 15 Jul 2010 14:00:32 +0000

I heard that most hip fractures are in women over 65. Can you explain why this happens?

Two major factors account for the number of hip fractures in older adults, especially women over age 65. The first is osteoarthritis of the joints — wear and tear on the joints that seems to be part of the aging process for many adults. The second is osteoporosis (brittle bones), which often occurs as a result of menopause for women. Osteoporosis can also affect men in this age group.

Loss of balance and falls are a major cause of hip fractures. There are many risk factors for falls for both men and women. Muscle weakness and decreased reaction time when the balance is challenged are part of the problem. Medications that cause dizziness or dehydration can also contribute to falls.

Sometimes simple household situations can cause problems. For example slippery floors, throw rugs, animals under foot, or stairs without handrails can lead to falls. Problems with vision and hearing so common in older age can add to the risk. Use of alcohol or other substances is another risk factor.

Doctors, nurses, and physical therapists are working together to teach older adults about the dangers and risks that can lead to falls and hip fractures. Osteoporosis prevention for men and women begins with nutrition and exercise early in life. Staying active and doing specific balance exercises can also make a difference.

Criteria for determining the need for rehab

admin — Mon, 12 Jul 2010 14:00:05 +0000

My 87-year old mother fell and broke her hip. She had surgery and she’s still in the hospital. The staff is talking about sending her to rehab. How is this decided?

When it comes to rehab after hip fracture, each hospital has its own algorithm or formula for decision-making. Some of this is based on what services are available. Does the hospital have a rehab unit? Would the patient have to be transferred? How far? Health care coverage (insurance or Medicare) is a factor.

The patient’s status is also very important. Patients which have advanced dementia may not be suitable for rehab. The same is true for someone who was wheelchair bound, weak, and deconditioned before the surgery.

Age is a factor but doesn’t limit patients from receiving services that can help them. For example, studies show patients 85 years old and older are less likely to have a good outcome. But this doesn’t mean that someone in this age range can’t do very well.

It may be best to talk with the hospital social worker assigned to your mother’s case. Find out how they make this decision. The family and family support is a very important part of the discharge planning.

Frozen hip is similar to frozen shoulder

admin — Wed, 07 Jul 2010 14:00:25 +0000

Is it possible to have a “frozen” hip? I’ve had a frozen shoulder before and now my hip feels just like that shoulder did.

Yes, in fact the first study of nine cases of “frozen hip” or hip adhesive capsulitis has just been reported. All but one of the patients was a middle-aged woman. This is typical of shoulder adhesive capsulitis, too.

Patients had pain and loss of motion in a particular pattern that identifies the capsule as the source of the problem. X-rays and MRIs were normal, making the diagnosis more difficult.

Treatment was with surgical manipulation. Under anesthesia, the hip is gently forced through the full range of motion. Adhesions are torn in the process without injuring the hip. Patients were able to recover full motion and function.

A year later they were still doing well. The author thinks with early diagnosis physical therapy to restore full joint motion may be all that’s needed. Get an early start while you can — check with your doctor or therapist as soon as possible about your hip.

MRA or arthroscopy needed to diagnose hip pain

admin — Fri, 02 Jul 2010 14:36:13 +0000

How can I find out what’s wrong with my hip? I’ve had an X-ray and an MRI. Both were “normal”. But I can tell you that hip is not “normal”. I have pain and can’t bend it all the way or turn it in. Sometimes I have trouble turning my hip out, too. Where do I go from here?

If you’ve had some imaging studies it sounds like a physician has started the diagnostic process. The next step is to go back to the doctor. You may need an MRA or magnetic resonance arthrography. A liquid dye is injected into the joint space. This allows the radiologist to see the outlines of the joint capsule that don’t show up otherwise.

One other step is to look inside the joint with an arthroscope. A long, thin needle is inserted into the joint. A tiny TV camera on the end of the tool allows the physician to view the joint.

This doesn’t always work without manipulating the joint first. Manipulation is done while the patient is sedated. The doctor moves the joint through its full range of motion. Some pressure may be needed to break loose any adhesions or bits of scar tissue holding the joint back.

Ask your doctor what your options are given your symptoms, history, and results of early imaging studies.

One leg shorter than other as a result of hip replacement?

admin — Mon, 28 Jun 2010 12:45:37 +0000

A year ago I had a total hip replacement. I did all my exercises and I’m almost back to normal. There is one problem. It feels like that leg is longer than my other leg. Is this possible or am I just imagining it?

You may be quite right. In a small number of patients after total hip replacement the leg either is longer or seems longer. An X-ray and exam are needed to find out for sure.

If the leg is truly longer than the other one, the doctor will see this on X-ray. Sometimes this can happen because of the implant. Usually the patient has pain along the outside of the hip or around the incision. The pelvis drops on the short side to make up the difference. A shoe lift may be all that’s needed.

If the legs are truly equal in length on X-ray then the problem is considered called a functional leg length difference. This means the soft tissues around the hip are tight or off-balance pulling the leg up or down. In these cases physical therapy may be helpful. An aggressive program of stretching and/or strengthening may restore limb length and function.

Make an appointment today with your orthopedic surgeon for a follow-up visit. This kind of problem should be addressed sooner than later.

Could soccer playing wear out my hip?

admin — Wed, 23 Jun 2010 18:20:49 +0000

I’m 45-years old and need a hip replacement because of arthritis. I played soccer from the time I was in pre-school all the way through college. Even as an adult I played on coed rec teams. Could the soccer playing wear my hip out?

Playing soccer may not be the issue. Studies show it’s the sports injuries players get that increase the risk of osteoarthritis. Ankle and knee injuries are common among soccer players. Since these two joints are in a direct line-up with the hip, it makes sense that such injuries can lead to arthritis later.

Another risk factor for injury and thus arthritis is left-leg dominance. At this point we know more about what isn’t a risk than what is. In studies of soccer players ages 12 to 18, there was no apparent increase in risk of injury linked with body size or type, balance, strength, or flexibility. Preseason play didn’t seem to make a difference either.

MRA more accurate than MRI for ddetermining cause of hip pain

admin — Fri, 18 Jun 2010 16:32:59 +0000

What is magnetic resonance arthrography (MRA)? I’ve heard of MRI but not MRA. My doctor wants me to have an MRA to help figure out what’s wrong with my hip.

Magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) are very similar tools. MRA is basically MRI for the joints. It is more accurate in detecting joint problems. MRI can confirm there’s a problem in the joint. MRA shows exactly what is the abnormality.

CT scans work well for bone lesions around the hip. CT scan shows places where the bone might have a tumor, abnormal anatomy, or necrosis (dead cells).

If you ever need surgery on the hip, advanced imaging studies of this type are very important. The more details the surgeon can see ahead of time, the better the surgical plan with no (or very few) last minute surprises.