Missteps are not a vision problem

September 1st — admin

I notice as I get older that I seem to misstep when climbing unfamiliar steps or stepping down off curbs. My vision is perfectly fine. The problem seems to be my knees. What could be causing this?

As we all know, there are many changes that occur with aging. Overall posture starts to change. We aren’t as stable in the upright position as we once were. Around the knee the quadriceps muscle strength is less. Aging often brings arthritic changes that affect the knee.

At the same time there is a reduced amount of joint position sense. Position sense (knowing where the joint is in space) is called proprioception. Scientists aren’t sure what comes first, the arthritis or the decreased proprioception.

It’s even possible that arthritic and disc changes in the neck can lead to changes in knee proprioception. One study has shown that patients with pressure on the spinal cord in the neck have altered knee proprioception. Another study confirms that patients with arthritis in one knee have decreased joint position sense in the other knee.

More study is needed to sort these factors out. In the meantime, make an appointment with your family doctor. It might be a good idea to rule out anything more serious going on and get a baseline. You may just need a conditioning or strengthening 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 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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Will total knee replacement stop senior marathon runner?

August 27th — admin

I’ve been a marathon runner all my adult life. At age 66 I’m going to have my right knee replaced. What are my chances of being able to run again?

There’s much interest and debate around this topic. The materials used in a total knee replacement (TKR) are designed to give the implant movement like a normal joint. The implant is usually made of sturdy materials such as stainless steel, alloys of cobalt and chrome, and titanium. Plastic liners may be part of the implant. These are durable and wear resistant.

Orthopedic surgeons, engineers, and other scientists are working together to improve the surgery and implant materials. Right now these materials are not made to withstand the stresses of running, heavy physical work, or contact sports. Engaging in these types of activities after TKR may lead to damage or early wear of the implant. The estimated lifespan of a knee implant is 10 to 15 years.

Impact sports like running are not usually advised. No-impact or low-impact sports are acceptable. Be sure to tell your doctor your interests in activities. Sometimes the type of implant used can make a difference. Find out what to expect. Your implant last the longest if you follow your doctor’s advice.

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.

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NASA pressure chamber could help speed rehab

August 24th — admin

I’ve heard there’s a pressure chamber designed for NASA that might be used in the future for rehab after knee and hip injuries. What can you tell me about this?

Astronauts are subject to many possible problems due to travel in a gravity free environment. Muscles start to waste away. Bones get brittle and the heart and lungs start to get deconditioned.

Exercise in space has not been able to help staff keep muscle strength and mass. Treadmills with bungee cords have been tried but the harness is uncomfortable. A lower body negative pressure chamber has been devised to help with this problem.

The chamber is a rectangle-shaped box that forms a vacuum around the lower body. It’s sealed at the waist. A special saddle helps the legs stay relaxed while supported. Pressure can be lowered to reduce the force on the joints equal to 20 percent of the person’s body weight.

Using this idea might be helpful with patients who need to get up and moving but can’t put weight on their leg. This could apply to patients with hip and knee surgeries, amputations, and even strokes. It’s not available for commercial use yet. It’s still being tested for patient use.

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.

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Unicompartmental knee arthroplasty not always the answer

August 19th — admin

I had a unicompartmental knee joint replacement last year. That means they only replaced the inside half of my left knee. I thought it was going to be the answer to all my problems. Instead I ended up with more problems. Would it have been better to have a total knee replacement?

Many studies support the use of the unicompartmental knee arthroplasty (UKA). It’s been shown to have a faster rehab time, give better function, and cost less than a total knee replacement.

Failure in a small number of cases does occur. There are several reasons why this can happen. Sometimes the arthritis continues to get worse. The bone around the implant wears away and the implant loosens.

In other patients the hip, knee, and ankle don’t line up as well as they used to. Finally, overcorrecting a deformity at the time of surgery can cause too much load on the knee joint. The wear and tear on bone and ligaments can lead to failure of the implant.

It may still be possible to salvage your “new” knee. Sometimes surgery to revise the implant is the answer. In other cases, replacing the unicompartmental implant with a total knee replacement is the next step. Be sure and ask your doctor what are your options. Perhaps get a second opinion from another surgeon.

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.

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Best options for treating knee osteoarthritis

August 16th — admin

My doctor has given me several options for treating the moderate osteoarthritis in my right knee. I can keep active and “do nothing” while waiting to see what will happen. I can have the joint scraped of any rough edges and torn pieces of ligament. Or I can have the joint replaced. Any advice for me?

All of those options are possible. In fact, you may want to use them all one at a time. Usually the wait-and-see approach is accompanied by an exercise program to keep the muscles around your knee toned and strong. Some of the medications available control both the pain and the disease.

If the joint starts to deteriorate more, then surgery to keep the joint surfaces clean and smooth may be the next step. The doctor may put a special fluid called hyaluronan in the joint to keep the tissue from sticking together.

When the joint space narrows too much and the bone is in danger of rubbing against bone, a joint replacement will be needed. Today’s treatment approach for osteoarthritis is to save the bone and joint for as long as possible. Taking it one step at a time is a good way to accomplish this goal.

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.

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Constrained implants may help severe knock-knees

August 11th — admin

What is a constrained knee replacement? I have very bad knock-knees. The doctor says this is the best kind for me.

Constraint implants are linked together with a hinged mechanism. This type of knee replacement is used when the knee is very unstable. The patient’s ligaments won’t support the other type of knee replacements.

Surgeons choose the constrained implant in cases of severely damaged knees. Sometimes it’s used when an elderly adult is having a second joint replacement on the same knee. The disadvantage of this type of knee joint is that it doesn’t last as long as the other types.

A non-constrained implant is the most common type of knee joint replacement. Non-constrained means the artificial parts are inserted into the knee but aren’t linked to each other. There’s no stability built into the system. The patient uses his or her own ligaments and muscles for stability.

Two other types are the semi-constrained and unicondylar knee replacements. The semi-constrained implant has some stability built into it. It’s used when the surgeon has to take out all of the inner knee ligaments. Some surgeons use it when they feel the new knee will be more stable with this type of implant.

The unicondylar implant just replaces half of the joint. This type is used when only one side of the joint is damaged or worn down.

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.

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Could arthritic knee cancel exercise program?

August 6th — admin

I joined a group of seniors in an exercise group at the local seniors’ center. I was doing good until last week when my arthritic knee started acting up again. Does this mean I just won’t be able to exercise anymore?

Not at all. You may have just done a bit too much or progressed your exercises too fast. Once your arthritic symptoms are under control, try again. Start at a very slow pace with only a few repetitions of each exercise. Wait a day to see how you feel. Most people don’t know they’ve done too much while they are exercising. It’s not until 24 to 36 hours later that the body shows signs of distress from overdoing it.

Give some thought to the kind of exercise you are doing. Arthritic knees do respond well to the right kind of movement and exercise. Using a stationary bike is a good idea. This keeps the knee in a straight plane of motion without any twisting motions. It keeps the joint moving through its range of motion without the weight of your body putting a load on it.

An aquatics program is also ideal. If you have one in your area, this is an excellent way to exercise while “unloading” or taking the pressure off the joint. In the pool, the effects of gravity are eliminated. At the same time, the joint is supported by the buoyancy and warmth of the water.

If none of these options work for you, see your doctor or a physical therapist. They are trained to find out what exercise is best for each individual based on their age, weight, overall health, and level of fitness.

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.

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Knee brace or immobilizer after ACL repair?

August 3rd — admin

What is the difference between a knee immobilizer and a knee brace used for patients after an ACL repair?

Sometimes the term “immobilizer” and brace are used interchangeably. It may be necessary to know exactly what type of device is being called an immobilizer or a brace. A true immobilizer keeps the joint from moving at all.

An immobilizer may be used after ACL repair to keep the knee fully extended for the first few weeks after surgery. Some doctors think this kind of immobilization is needed to prevent loss of knee extension. The immobilizer can be removed and usually is taken off during physical therapy every day.

Braces usually have a metal hinge joint that allows the knee to bend and straighten. It keeps the joint stable and protects the healing ligament from too much strain or load during activity. In some braces, the joint can be set to allow some, but not all motion.

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.

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Surgery on torn ACL may be needed to protect the joint

July 29th — admin

My 21-year old daughter hurt her knee when she slipped and fell on some ice. The doctor says the ACL is torn and she needs surgery to protect the joint. Protect it from what?

There are some studies that show patients are at greater risk for knee re-injury after anterior cruciate ligament (ACL) tears if the damage isn’t repaired. The most common injuries later are meniscus and joint cartilage tears.

If the joint cartilage is damaged, the bone underneath is unprotected. Wear and tear can cause damage to the bone. Painful arthritis can develop much later.

A recent study of over 6,000 adults confirmed these beliefs. Patients who didn’t have an ACL repair and opted for conservative care were twice as likely to injure the meniscus later and 30 percent more likely to damage the joint cartilage.

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.

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Tissue grafts often used to repair torn ACL

July 26th — admin

I’m going to have an ACL repair using my own patellar tendon as the graft. What can you tell me about this kind of graft?

There are many different kinds of tissue grafts that can be used to repair a torn or ruptured anterior cruciate ligament (ACL). The bone-patellar tendon-bone (BPTB) is called the “gold standard.” It’s used the most with the best results.

The graft is made up of the middle third of the patellar tendon and a piece of bone on either end. The bone is taken at one end from the kneecap and at the other end from the lower leg bone (tibia).

This graft works well because the patellar tendon has a high strength and stiffness. The bone plugs make it possible to get a good solid hold with screws to keep it in place. The graft seems to take hold quickly.

There are a few problems with the BPTB. Some patients have pain and swelling where the graft is taken from. It can be very difficult to kneel. Other patients report numbness, most likely caused by damage to a branch of the saphenous nerve. Loss of quadriceps muscle strength and even fracture of the patella are also possible problems.

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.

Posted in Knees. Tags: , , , . No Comments »
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