Naples Orthopedic Surgeon - Dr. Robert J. Zehr

Playing tennis after a total hip replacement

admin — Fri, 03 Sep 2010 16:30:51 +0000

My husband had a total hip replacement about six months ago. He’s back to running and playing tennis as if nothing ever happened. Is there any danger of being too active after a joint replacement?

There isn’t a simple yes/no answer to this question. Many doctors caution their patients to avoid high-impact activities such as running and tennis. There’s some concern that the implant won’t last more than 10 to 15 years. That could mean another surgery on the same hip.

On the other hand, it’s clear that weight-bearing activities are important to maintain good bone strength and density. Studies show that patients who are less active and more sedentary actually lose bone. Bone loss around the implant can cause it to loosen and require revision surgery.

Your husband’s surgeon is probably the best one to ask this question. Knowing the type of implant and surgical procedure used can make a difference, too. When patients are educated and informed about their joint replacements, then they can make the best decisions about activity and lifestyle.

For active, healthy adults, being more active than is advised may improve their quality of life enough to make it worth the risk.

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.

Volleyball player surprised by shoulder dislocation

admin — Thu, 02 Sep 2010 16:30:02 +0000

I dislocated my shoulder playing a neighborhood pick up game of volleyball. I never knew it was coming. One minute I spiked the ball over the net and the next I was on the ground in pain. How is that possible?

Many shoulder dislocations occur at work or during recreational or sports activities. Most people give the same report the first time it happens. They didn’t have pain, popping, or any symptoms to suggest the shoulder wasn’t stable.

Once a shoulder has dislocated, it can happen again. Warning signs and symptoms of repeated dislocations called prodromal symptoms may not be present. Most of the symptoms of first or repeat shoulder dislocation such as pain, muscle spasm, and loss of motion occur after it’s already happened.

Some people can pop their own shoulder out of the socket. This is called voluntary dislocation. Patients are advised not to do this since the soft tissue around the shoulder can get stretched, putting the person at greater risk of chronic dislocation.

The more times a shoulder is dislocated, the greater chance there is for rotator cuff tears around the shoulder.

The specific dynamics of the first dislocation may not be fully understood. Repetitive motion is a likely factor. Was there a partial tear of the rotator cuff already present? Or do the rotator cuff tears seen with shoulder dislocations happen after the joint dislocates? Researchers are investigating these questions with the hope of preventing shoulder dislocation and the damage that can occur.

Missteps are not a vision problem

admin — Wed, 01 Sep 2010 16:30:38 +0000

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.

What is hip osteoarthritis?

admin — Tue, 31 Aug 2010 16:30:57 +0000

My doctor thinks I have the start of hip osteoarthritis. What is this disease anyway?

Osteoarthritis (OA) is more of a condition than a disease. It occurs slowly over time as the loss of cartilage begins. The layer of bone just under the cartilage starts to harden, a process called sclerosis. Bone spurs start to form around the edges of the joint.

Patients affected by OA report pain, loss of motion, and loss of function. Hip OA can cause pain in the groin, thigh, and upper outer part of the leg. Pain can go from the hip down to the knee. Morning stiffness is common. Patients often have trouble putting weight on the affected leg.

Early identification and treatment may help patients stay active and avoid surgery for years. Exercise has been shown to reduce pain and disability. The use of manual physical therapy combined with exercise seems to give patients greater return of function that lasts longer.

If you haven’t already, talk with your doctor about the various treatment options. Find out what is recommended for you.

Options for hang glider who crashed, tearing rotator cuff

admin — Mon, 30 Aug 2010 16:30:02 +0000

I’m a certified hang gliding instructor with 20 years of experience. Even so I hit an updraft and crashed, tearing three of the tendons in my shoulder. I’ve had two surgeries to try and repair this massive tear. They didn’t work. Are there any other options left to me?

Repair of massive tears of the rotator cuff can be problematic. In some cases they are considered irreparable. Studies have been done trying different surgical methods of treatment for this problem. So far there hasn’t been a single type of surgery that works best.

For the most part the best approach seems to be cleaning up the damaged tendons. This is called debridement. Then the bone across the top of the shoulder (acromion) is removed. This is called an acromioplasty. If just the underside of the acromion is shaved, it’s called a subacromial decompression.

When any part of the rotator cuff is torn and can’t be repaired, an imbalance occurs at the shoulder. That’s why the rest of the rotator cuff can get impinged. Reducing or removing the acromion leaves room for the remaining tendons of the rotator cuff to slide and glide without getting pinched.

Other surgeries used to reconstruct massive rotator cuff tears include tendon transfers, fusion, and tendon grafting. No one method seems to have better results than the others.

Will total knee replacement stop senior marathon runner?

admin — Fri, 27 Aug 2010 16:30:36 +0000

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.

Partial hip replacement may result in fracture

admin — Thu, 26 Aug 2010 16:30:35 +0000

My mother just had a partial hip replacement. I guess it was like having a tooth capped. Just the top of his femur was replaced. She ended up with a hip fracture afterward. Is this common?

It sounds like your mother had an operation called joint resurfacing. This type of operation has been around since the 1930s. It has come and gone based on problems afterward and materials available. Most recently, new metals have made it possible to resurface the head of the femur (thigh bone) with good results.

Fracture (usually of the femoral neck) is the most likely complication of hip joint resurfacing. It happens in up to four per cent of the cases. Studies show fracture occurs most often in the first 100 cases done by a surgeon. Fracture rates go down as the surgeon becomes more familiar with this technique.

Causes of fracture are both patient and technique-related. Obesity, decreased bone mass, and arthritis make a difference on the patient side. Anyone with a femoral neck cyst should get a total hip replacement instead of resurfacing. Putting the implant in with too much of a tilt or twist can also result in fracture.

Women seem to have a higher risk of fracture after hip joint resurfacing. The reason for this remains unknown at this time. Short-term results of hip joint resurfacing are good to excellent. Long-term studies aren’t available yet. Total hip replacement may be needed by patient who have a fracture after resurfacing.

Rodeo rider may want shoulder replacement, not fusion

admin — Wed, 25 Aug 2010 16:30:40 +0000

I’m a professional rodeo rider and had a bad calf roping accident. My right shoulder was dislocated severely and the muscles around the joint ruptured. After three surgeries already I’m going to have it fused. How do they do this operation? What can I expect during recovery?

Shoulder fusion is not used as commonly as it once was. Shoulder replacement has replaced fusion in many cases. If you haven’t already talked to your surgeon about a total shoulder replacement, you may want to ask about this as an option before shoulder fusion.

Shoulder fusion or arthrodesis is called a salvage procedure. The arm is saved from amputation but full shoulder motion isn’t preserved. You may not have enough motion to swing a rope over your head or enough strength to wrestle a calf to the ground.

The fusion is done using metal plates and screws. The reconstruction plate is actually one normally used in the hip or pelvic area. It goes up along the outside of the upper arm and over the top of the shoulder along the bony ridge of the shoulder blade. Screws help compress the bones together to fuse the area. Sometimes bone grafts are used to fill in any spaces left open.

Your arm will be immobilized for at least eight to 10 weeks. Some doctors use a special abduction pillow. Others put the arm in a full cast from wrist to shoulder. Once there is evidence of fusion on X-ray, rehab exercises can begin.

NASA pressure chamber could help speed rehab

admin — Tue, 24 Aug 2010 16:30:14 +0000

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.

Is a total hip replacement necessary for just one part?

admin — Mon, 23 Aug 2010 16:30:29 +0000

I just got the results of my hip X-rays. One hip has arthritis but just at the top of the thigh bone. The round ball in the socket is all broken down. It’s not really round anymore. Do I have to have a whole hip replacement just for one part?

Maybe not! You may have a couple choices. The first is called a hemiarthroplasty. The surgeon removes the round top of the femur (thighbone) and drills out some of the bone down inside the shaft. Then a replacement top and stem are inserted down into the bone.

Or if you are younger than 60 and have good bone stock, you may be able to have a hip resurfacing arthroplasty (HRA). In this operation, just the top or cap of the femoral head is removed and replaced. It’s a lot like having a tooth capped by the dentist.

Your surgeon will be able to tell you both what is possible and what he or she can do. Not all surgeons perform all types of joint implants. Experience is important so it’s a good idea to go with what your surgeon is skilled at doing. If you are a good candidate for a HRA, then you may want to go to a center where this operation is done routinely.