Research shows that about eight per cent of the general population develops arthritis. This is probably an under estimate as it is based on X-rays and many people don’t have routine X-rays that reveal this diagnosis. In an effort to prevent arthritis, there are some experts who suggest routine screening for problems that might result in arthritis. But the cost of performing X-rays and/or MRIs on everyone may not be cost-effective.One condition that can lead to early degenerative changes is called femoroacetabular impingement (FAI). Perhaps one or more of your family members has had this diagnosed as the predisposing factor for their arthritis.Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.A recent study was done to see how many people in the general population have this problem. They took MRIs of the hips of 200 adult volunteers (ages 21 to 50) for a total of 400 hips. By examining the MRIs against other tests performed, they were able to see that 14 per cent of the people had femoroacetabular impingement and didn’t know it.In this study, they specifically looked at age, gender (male versus female), body-mass index (a measure of obesity), and ethnicity. These potential factors may put people at increased risk for impingement and then for going on to develop arthritis later.There were some significant findings from the measurements taken of each volunteer when compared with their MRI results. The elevated angle measured on X-ray (called the alpha angle) wasn’t diagnostic of femoroacetabular impingement by itself. (Though it was a predictor of hip pain and joint cartilage damage). When combined with restricted hip internal rotation, the alpha angle could be used to predict impingement. A positive impingement sign was a reliable indicator of a problem with the labrum (rim of cartilage around the hip socket).What this tells us is that your orthopedic physician can examine you and offer some direction as to whether or not an X-ray or MRI is even needed. If you are painfree and there are no clinical signs of impingement or arthritis, then it may be appropriate to just monitor your situation. This will avoid unnecessary costs and exposure to X-rays while still keeping an eye out for any signs of developing 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 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.

Treatment for patellofemoral pain syndrome (PFPS) has traditionally relied on quadriceps strength training. Some patients also benefit from neuromuscular training, which focuses more on motor control than improving strength.

So far no one has found a “one size fits all” kind of program. Some people seem to get better with one type of exercise while others have less pain and more function with other types of training.

Some time ago researchers saw that hip strength may be an important key to PFPS. One by one studies have been done to confirm this suspicion. Most recently physical therapists at the Nicholas Institute of Sports and Medicine and Athletic Trauma in New York City studied hip strength and flexibility as it relates to PFPS.

They found that 60 percent of patients with PFPS got better after a six-week training program. Exercises to improve hip flexor strength and flexibility resulted in decreased pain and improved function.

The goal was to prevent inward rotation of the thighbone (femoral rotation). Maintaining good alignment of the patella as it moves up and down over the knee reduces the tension on the soft tissues around the knee. This new treatment approach may help you as well!

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.

Not necessarily though many individuals with femoroacetabular impingement (FAI) do indeed eventually develop degenerative changes that lead to arthritis. This is most likely to happen in cases of untreated FAI.Let’s define femoroacetabular impingement and talk about how it can lead to osteoarthritis of the hip joint. Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.The cam-type of impingement is the most likely to set up conditions ripe for joint wear and tear. This type occurs when the round head of the femur isn’t as round as it should be. It’s more of a pistol grip shape. It’s even referred to as a tilt or pistol grip deformity. The femoral head isn’t round enough on one side (and it’s too round on the other side) to move properly inside the socket.The result is a shearing force on the labrum and the articular cartilage, which is located next to the labrum. The labrum is a dense ring of fibrocartilage firmly attached around the acetabulum (socket). It provides depth and stability to the hip socket. The articular cartilage is the protective covering over the hip joint surface. This abnormal contact between the femur and acetabulum is the leading cause of labral tears and degenerative hip arthritis.Treatment is advised when impingement is painful, limits function, and/or X-rays show potential for joint changes. You may be able to follow a conservative path by modifying activities and carrying out a program of strengthening and stretching exercises. In some cases, surgery is indicated to correct the problem.No one knows for sure who will develop arthritis. Studies are underway to determine how common is the problem and what factors might increase the likelihood of developing arthritis. Your orthopedic surgeon will follow your case and advise you if and when treatment (and what treatment) is appropriate.

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.

There are several tests used to measure hip flexor flexibility. An athletic trainer, physical therapist, or orthopedic surgeon can test you.

One test is called the Thomas flexion test. You lie down on your back on a table with a firm surface. The crease of your buttock should be at the edge of the table. Bring both knees up to your chest. Keeping your back flat on the table, lower one leg until it is straight out. Lower that leg toward the tabletop as much as you can without arching your low back or letting your pelvic bone tilt.

A tight hip flexor muscle will keep you from lowering your leg all the way down to the table. A flexible person will be able to get to a horizontal (normal) or beyond horizontal position (hyperflexible). The physical therapist uses a tool called a goniometer to measure the hip angle during this test.

Another test is the Ober test used to measure flexibility of the iliotibial band (ITB). This band of fascial tissue comes down along the side of the leg from hip to knee. For this test, you lie on your side with the leg in question on top. The lower leg can be bent to help support you on the table.

The upper leg is bent 90 degrees at the knee. The therapist lifts the leg away from the body to a horizontal position and then extends it backwards slightly. The leg is then lowered toward the table until it starts to rotate or can’t go any further.

A normal amount of motion allows the leg to be placed in the horizontal position. With a tight ITB, the leg stays up and won’t drop down towards the table. The extra flexible person can touch the knee to the table.

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.

We may find some helpful information to answer this question from a recent systematic review of studies done regarding surgery for femoroacetabular impingement (FAI). The statistical significance of any conclusions from a systematic review is worth noting. That’s because such a review combines the results of many smaller studies to give an overall view of the results of treatment like surgery for FAI of the hip.Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.Most studies on this condition are case studies. That’s because no one surgeon sees 100s or 1000s of patients with this problem. Case studies are good because surgeons have to start somewhere when trying to see the effects of treatment. The problem with published case studies is that this is considered a low level of evidence. A surgeon wouldn’t want to treat any patient with methods considered “successful” based on low levels of evidence. Conducting a systematic review like this one allowed the authors to examine the data on 970 different patients (collected from 23 reports of case studies). Now surgeons can see what the latest findings are and evaluate their own practices based on what is statistically significant.One of the questions specifically addressed in this review is the very same one you raise. Does surgical treatment for femoroacetabular impingement (FAI) work? The answer to this question may depend on how “success” is defined.If pain relief is the measured outcome, we know that the majority of the 970 patients included did have relief of painful symptoms. A second outcome was improved function. That was also a benefit of surgical repair for femoroacetabular impingement (FAI). Levels of patient satisfaction as an outcome measure were not so high. For those patients whose pain didn’t improve and especially those patients who ended up having a hip replacement, reported patient satisfaction was low. In some studies, the rate of dissatisfaction and/or conversion to hip replacement was as high as 30 per cent.The obvious next question is: can we predict who will have a poor result? That’s a simple question that doesn’t have a simple answer yet. One risk factor for worse outcomes with femoroacetabular impingement surgery is advanced joint arthritis at the time of the diagnosis. But there are two problems with relying solely on this factor.First, not everyone with severe damage has a poor outcome with surgery. Just as many patients with severe damage had good outcomes as those who had a failed treatment. The reasons for those differences remain unknown and will require further study. Second, even with X-rays and MRIs, it isn’t always possible for the surgeon to know the full extent of the damage. Sometimes, it isn’t until getting inside the joint that the surgeon can see what’s really going on. These tests are still important and the results should be discussed with you by your surgeon when making the final decision about the best treatment choice for you.

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.

Researchers at the Steadman-Hawkins Research Foundation in Vail, Colorado have been researching this very problem. They noticed some of their ACL patients were just fine for 10 years — a perfect outcome. Then all of a sudden, they developed arthritis.

They think the problem may be a lack of mobility between the patellar tendon and the tibia (lower leg bone). A condition referred to as patella infera may be part of the problem. With patella infera, there is a permanent shortening of the patellar ligament. The kneecap sits too low in relation to femur (thighbone). The result can be a severely limited range of motion of the knee joint.

Patella infera is a common complication of injury or surgery to the knee joint. It usually doesn’t show up until much time has passed after injury and/or surgical repair.

Treatment options include physical therapy to manually release the kneecap and/or surgery to revise the soft tissues around the knee. If the joint degeneration has gone too far for conservative care to be successful, then total knee replacement may be needed.

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.

Osteonecrosis means “bone death”. Loss of blood supply, bone death, and collapse can occur over a period of months to years. The femoral head is the round ball at the top of the thighbone that fits into the hip socket. Osteonecrosis can be caused by steroid use, alcohol, trauma, and blood-clotting problems like Sickle Cell Disease. In some cases, no cause can be found. Many people who have been diagnosed with osteonecrosis of the femoral head already have the same problem in the other hip. They just don’t know it because the disease can be “silent” or asymptomatic. In other words, there’s no pain. If it wasn’t for the telltale signs on X-ray, the affected individual wouldn’t even know there was a problem.The majority of people who have femoral osteonecrosis in one hip will go on to develop the same problem in the other hip. But this isn’t always the case and even if it does happen, treatment may not be needed.So how does a person decide what to do? The first goal in treating symptomatic (painful, limiting) osteonecrosis of the femoral head is to save the bone. The second goal is to keep function while relieving pain. Your surgeon will be able to advise you as to the best course of action for you. That still doesn’t answer the question about what to do for that asymptomatic hip. Is treatment needed at all? What’s the natural history (i.e., what happens over time if it is NOT treated)? In a recent systematic review of the literature, surgeons who conducted the study concluded that large lesions along the outer two-thirds of the femoral head are in the greatest danger of further destruction and collapse. Those should be treated right away. Small-to-medium lesions can be watched carefully and treated conservatively at first. Any sign of progression of disease should be addressed immediately. Anyone with known risk factors (Sickle cell disease, prolonged use of steroids, alcohol abuse) should be watched closely as well.

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.

Motion and mobility after ACL repair is a key factor in the long-term success of the operation. Studies show that without good motion, the joint is compressed and wears out faster. Ten years down the road, the patient develops degenerative arthritis and the ACL repair looks like a failure.

Patellar mobility (kneecap motion) is a key factor in regaining overall knee motion. It is always advised to get your motion back before you start strengthening exercises.

Your physical therapist or surgeon can assess patellar motion and teach you how to manually move it side to side, up and down, and along the diagonal planes of motion. This type of motion will help prevent scarring from occurring between the patellar tendon and the tibia and between the patella and the tibia.

Without an 80 percent return of motion early on, there’s a good chance another operation will be needed to release adhesions in the joint. You should have full motion by the end of six weeks. The right rehab program must match the type of surgery you had while regaining motion. Strength training comes after joint mobility is restored.

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.

A recent study from the Cleveland Clinic in Ohio might be of interest to you. Surgeons from the Cleveland Clinic in Ohio divided a group of 103 total hip patients into two groups. One group (73 patients) had the traditional post-operative treatment after hip replacement. The second group (30 patients) tried a new rapid recovery program. The rapid recovery program combined several factors to enhance recovery. First, the surgeon used incisions that don’t cut through the abductor muscles. The abductor muscles are along the inside of the thigh and help bring the legs together. Second, nurses supervised the use of pain medications. Pain management began in the operating room where patients received a special injection of numbing agents around the joint just operated on. And third, the patients were seen right away by physical therapists on the multidisciplinary team. The traditional program allows patients to rest the first day after surgery. They get up and move much more slowly with the traditional approach compared with the rapid recovery program. Getting up the day of surgery and walking small amounts frequently throughout the day is part of the rapid recovery program. Walking is followed up with an exercise program that is supervised by the therapist twice a day.Surgeons around the country are trying different ways to speed up recovery and return to full function. This is just one example that seems to be working well. You may have to look around in your area to find a surgeon who is on board with a slightly different approach to thotal hip replacements. The traditional approach is tried and true but it may hold you back a bit.

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.

Scientists studying the field of tissue engineering are very interested in knowing the answer to your question. If we can understand the normal pathways of tissue healing, then maybe we can find a way for ligaments like the ACL to repair itself.

The poor healing capacity of the ACL can be explained in part by its biology. First there is a very thin lining or sheath around the ACL. Once this sheath is disrupted, the blood supply to the ligament is decreased greatly.

Normal healing and repair depend on the formation of a hematoma. A hematoma is a collection of blood cells trapped in the tissues after trauma or injury. Somehow the presence of the hematoma sets up the right environment needed for tissue healing. Without a blood supply, there can be no hematoma formation.

The hematoma provides a base camp so-to-speak for local growth factors and chemicals to come and set up a mesh or scaffold. Cells fill in around the scaffold forming collagen and scar tissue. It looks like there’s a complex interchange between repair cells, growth chemicals, and the scaffold needed for healing. Without the hematoma to get the process started, ligaments don’t recover on their own.

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.