Naples Orthopedic Surgeon - Dr. Robert J. Zehr

After a hip replacement, can one become too active?

admin — Wed, 22 May 2013 10:00:43 +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 with 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 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 knee surgery, is it okay to exercise the knee?

admin — Tue, 21 May 2013 10:00:39 +0000

I hurt my knee many years ago and it was fixed by surgery. I would like to exercise my knee to keep it from getting hurt again. Is that a good idea and if so, what type of exercises should I be doing?

The only person who can tell you if exercising your knee would be a good idea is your own doctor. So much depends on the type of injury you had, the type of surgery you had and the wear and tear that your knee has undergone since the surgery.

That being said, there are general knee exercises that can be done with healthy knees and on problem knees if your doctor has given the ok. They include:

Maintaining a good range of motion by using the knee regularly, keeping it moving naturally

Keeping your leg muscles strong and protecting the knee by walking, climbing stairs, or doing exercises that strengthen the leg muscles.

Before doing any type of exercise that may put stress on your knee, please speak with your doctor.

After hip replacement, is it bad to not be active?

admin — Mon, 20 May 2013 10:00:51 +0000

My mother had a total hip replacement for her very bad arthritis. The pain seems much better but she’s really not any more active. She just seems to sit a lot. Is that bad for her hip?

Activity, especially weight bearing is needed to maintain bone strength with or without a joint replacement. But after a total hip, the load and compression from activity becomes even more important.

This is because the implant itself changes the force and direction of load through the bone. The effect is called stress shielding. Studies show that the shape and density of the bone can even change as a result of stress shielding. Bone loss can occur, which would be a problem if your mother ever needed further surgery on that hip.

In general, there are so many health benefits from activity your mother should be encouraged to resume former activities and regain more function. She may need some help in this area. Perhaps there is an exercise group she could attend. Or maybe a membership at a local health club or YMCA would get her going in the right direction.

How long does knee cartilage transplantation last?

admin — Fri, 17 May 2013 10:00:22 +0000

I’ve had the cartilage in both my knees scraped and smoothed over. It only seemed to last a couple of years. Now there’s another hole in the cartilage of my left knee. If I go for the more expensive transplantation treatment, how long does that last?

Healthy cartilage cells called chondrocytes can be harvested from a patient, grown in a lab, and transplanted back into the knee. The entire process takes about four to six weeks.

Since the patient donates his or her own chondrocytes, the procedure is called autologous chondrocyte implantation (ACI).

ACI is a fairly new procedure. Long-term studies are not available yet. Some of the earlier studies do show positive results. After having an ACI, symptoms improve. The patients report less pain and better function.

Activities of daily living are restored and quality of motion returns to normal. ACI clearly helps many patients who are in pain but do not have enough knee damage to need a total knee replacement.

At least one study followed patients for four years with good results. The main problem after ACI involves hypertrophy or overgrowth of tissue. Additional surgery may be needed after ACI to remove the excess tissue and smooth the surface over.

What is hip osteoarthritis?

admin — Thu, 16 May 2013 10:00:09 +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.

Is there a way I can grow my own cells to repair my knee?

admin — Wed, 15 May 2013 10:00:42 +0000

I’ve had two failed surgeries for a hole in my knee cartilage. I’ve been told there’s another way to grow my own cells to repair this problem but it’s really expensive. What is it?

You may be referring to a procedure called autologous chondrocyte implantation (ACI). First the surgeon (removes dead cells) from the damaged area. This creates a hole that is covered with a thin piece of bone.

Normal, healthy cartilage cells are removed before closing up the hole. These are called chondrocytes. They are sent to a special lab where scientists use them to grow more chondrocytes. Up to 10 million new cells can be made this way.

When the cells are ready, the surgeon injects them underneath the bone flap right into the defect. As they grow and mature, the hole fills in with smooth cartilage once again.

Although the cost can be as high as $25,000, this may be worth it. High-level performance athletes who need to get back into sports play may find the overall time savings well worth it. The shortened duration of painful symptoms with less time on the bench or in rehab offset the expense.

Likewise, anyone trying to keep a job, supporting self and/or a family may find the cost of restoring the joint surface acceptable.

How long does physical therapy for arthritis take?

admin — Tue, 14 May 2013 10:00:04 +0000

I’ve been seeing a physical therapist for hip pain from arthritis. How long before I can expect to see some improvement?

Each patient is different. The therapist will examine you and design a program to meet your specific needs. This can be based on your pain levels, range of motion, strength, and/or flexibility. Your personal goals will be taken into consideration, too.

Recent reports from physical therapists using manual therapy (mobilization and manipulation of the joint) show measurable changes right away. The therapist uses a combination of measures to know when to discharge the patient.

For example, patients are often discharged with a home program when the motion is the same on one side to the other or when the end of the motion feels ‘normal’.

If no change is seen after three sessions, the therapist may send the patient home with an exercise program. Progress may be rechecked in one to three weeks. Patients may decide for themselves if the pain is completely gone and they are able to get back to their daily activities.

Why are women less likely than men to get a knee replacement?

admin — Mon, 13 May 2013 10:00:03 +0000

I saw a report on TV that women are much less likely to get a knee replacement compared with men. Is this because women aren’t offered the option? Or do they just refuse?

There is much debate around this question. It is clear that women are more likely to have knee osteoarthritis (OA) compared to men. And their symptoms are usually worse. They are also more likely to be disabled from this condition compared to men.

Researchers are trying to account for the differences. They have looked at male versus female anatomy as one possible cause. Even though there are differences in the knee joint between men and women, no one has been able to show that it’s these anatomical variations that make a difference.

Studies also show that women are much less likely to have a knee or hip replacement compared with men. In fact, it’s estimated that women are four times more likely to need a joint replacement but don’t have one.

It does not appear to be because women are unwilling to have surgery. It may be more likely that the option is not offered to women as often as it is to men. This may be a gender bias on the part of physicians. It could be the way men communicate with their doctors compared with women.

The pattern of gender differences extends beyond joint replacement. Studies also show that women who need coronary artery bypass surgery or kidney transplant are also less likely to have these operations compared with men.

Some experts think these differences can be changed with patient education. Teaching women what to say to their doctors or what questions to ask may help. Better understanding of their own health and treatment options available for any condition may also help.

After my hip replacement, why do I need this brace?

admin — Fri, 10 May 2013 10:00:33 +0000

I had a total hip replacement about two weeks ago. I have to wear a special brace that keeps my legs apart. It’s supposed to prevent the hip from dislocating. It feels like I could get around a lot better without this contraption. Do I really need this thing?

Only your surgeon can discontinue the use of your abduction brace. As you said, it is designed to help prevent a hip dislocation. After all you’ve been through, you don’t want to end up with a hip dislocation and another operation.

When the hip is replaced, many of the muscles around the hip are cut. This leaves your joint unstable and at risk for dislocation until everything heals.

Some doctors advise using an abduction brace for daytime wear. Most require an abduction pillow for sleeping at night. Keeping this position prevents the hip from popping out of the socket.

However, some new research has called the use of abduction braces and pillows into question. It seems that patient function is less with these devices. They may not be needed as much as was once thought.

New, less invasive surgery with smaller incisions and less damage to the muscles may be helping. Depending on the type of surgery done, some surgeons are doing away with this device. Even so, it’s best to check with your doctor before leaving the brace off.

Is there any link between having osteoporosis and knee osteoarthritis?

admin — Thu, 09 May 2013 10:00:34 +0000

Is there any link between having osteoporosis and knee osteoarthritis? I’ve just been told I have osteoporosis. My mother had knee arthritis pretty bad. I don’t know if she had osteoporosis. I was wondering if there’s some kind of genetic connection.

Genetics may very well be a part of developing either osteoporosis (brittle bones) or osteoarthritis (OA). And there may be a link between osteoporosis and OA. It isn’t clear yet if there is a genetic link here.

The relationship between OA and osteoporosis may surprise you. Some studies show that women with low bone mass from osteoporosis may be less likely to have OA. But once OA is found, a higher bone mass density (no osteoporosis) means a milder case of OA. Just what all this means and what the actual connections are between OA and osteoporosis remains unclear.

One important risk factor for knee OA (such as your mother had) is a previous knee injury. Men and women are both more likely to develop knee OA after an anterior cruciate ligament (ACL) tear. And women are twice as likely to develop an ACL injury compared with men.

All in all, it looks like osteoporosis may have a protective effect. It may actually prevent OA from developing. Scientists are studying this phenomenon carefully. It’s possible they may discover something that could help prevent either or both of these conditions.