What are hip socket cysts and how do you get rid of them?

When I was a child the doctor diagnosed me with hip dysplasia. Now that I’m older (53 years old), arthritis has set in. The X-rays show quite a few cysts in the hip socket. What causes these and how do I get rid of them?

Bone cysts of this type are an indication of uneven or excessive weight-bearing load. If you have hip dysplasia, the hip socket or acetabulum is probably shallow with shortened margins.

The head of the femur (thighbone) is round and normally fits inside the acetabulum. The curved socket forms a shelf or roof over the femoral head to keep it from dislocating. With hip dysplasia, the round head of the femur isn’t covered by the acetabulum. It can slip upward and even dislocate.

The cysts are a likely sign that there is uneven wear and load from the hip instability. The joint may be trying to cushion itself by forming cysts of this type.

In some patients, a procedure called a rotational acetabular osteotomy can be done for unstable hip dysplasia. The surgeon removes a wedge of bone and uses it to re-angle the joint. A small piece of bone is also used to improve the roof angle.

Studies show that cysts of the acetabulum or femoral head often disappear after this operation. Patients report decrease in pain and improved function.

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.

Can a joint replacement get arthritis?

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.

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.

Why does my ceramic hip squeak?

I have a brand new ceramic hip replacement and it squeaks when I walk. What in the world causes this? Will it go away?

Total hip replacements come in two parts. There’s the cup to replace the acetabulum (socket) and the round head at the top of the femur (thigh bone) and femoral neck. These component parts can be made out of a variety of different materials.

Ceramic was first introduced about 30 years ago. It wears well but tends to fracture. Improvements in materials and design have increased its popularity again in the last few years. Ceramic-on-ceramic implants have the lowest wear rate but squeaking can be a problem.

Surgeons aren’t quite sure yet what might be causing this to happen. Not all patients are affected. And sometimes it goes away on its own. Studies so far suggest there may be two main reasons for this squeaking.

The first is a lack of lubrication in the joint. This is called dry joint. But what causes the dryness is still unknown. There are many theories so far. It could be the liner inside the socket is mismatched in size. Or ceramic particles may chip off the implant and rub inside the joint.

Most likely there are either many possible causes or several factors that occur at the same time resulting in squeaking. A solution to the problem hasn’t been discovered yet. Once researchers pinpoint the cause, then surgeons can find ways to avoid or eliminate the problem.

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.

What is femoroacetabular impingement and what causes it?

What is femoroacetabular impingement and what causes it?

Femoroacetabular refers to the place where the femur (thigh bone) and acetabulum (hip socket) meet. Impingement means pinching.

In the case of femoroacetabular impingement (FAI), the head of the femur butts up against the cartilage and pinches it. Normally, the femoral head moves smoothly inside the hip socket. The socket is just the right size to hold the head in place.

If the acetabulum is too shallow or too small, the hip can dislocate. In the case of FAI, the socket may be too deep. The rim of the cartilage hangs too far over the head. When the femur flexes and rotates, the cartilage gets pinched.

This causes deep groin pain with activities that stress hip motion. Prolonged walking is especially difficult.

The cause of the problem is under considerable debate. For a long time it was assumed that overload of the joint caused this kind of OA. But no one could identify what was causing the stress overload.

Now with better imaging studies, we know that some subtle changes in the shape of the femoral head may be the cause of FAI. Other anatomical changes in the angle of the hip may also contribute to this problem. And as mentioned, FAI can occur if the hip socket is too deep.

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.

How is the type of hip surgery needed determined?

My husband broke his hip in a skiing accident this morning. He’s in surgery now. They didn’t know what kind of operation he would have — he could even end up with a total hip replacement. How is this decided, anyway?

Age of the patient, condition of the bone, type of fracture, and mental capacity are just a few factors the surgeon takes into consideration. Adults less than 60 years of age who need surgery for a broken hip usually have a pin and/or metal plate to hold the bones together. This is called internal fixation.

If there is severe arthritic disease, bone cancer, or severe osteoporosis, then a total hip replacement may be needed. Depending on the fracture type, the patient may end up with a hemiarthroplasty. The hemiarthroplasty replaces the head and neck of the femur (thighbone) but leave the patient’s own acetabulum (socket) in place.

Total hip replacement (THR) is more common in older adults. There are benefits and disadvantages for each type of surgery. Hemiarthroplasty only replaces the broken side but can result in bone erosion and a painful hip. This is more likely to happen in a younger, active adult.

THR is subject to hip dislocations. There’s also a limited life to a THR. In younger adults, a THR may have to be replaced again 10 to 15 years later. This can mean more bone loss, more scarring, and decreased function for some patients.

After the operation and while your husband is still in recovery, the surgeon will come out to the waiting area and tell you what was done. Use that opportunity to ask any questions you may have about what was done and why.

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.

Why do I have cysts in my hip socket and how do I get rid of them?

When I was a child the doctor diagnosed me with hip dysplasia. Now that I’m older (53 years old), arthritis has set in. The X-rays show quite a few cysts in the hip socket. What causes these and how do I get rid of them?

Bone cysts of this type are an indication of uneven or excessive weight-bearing load. If you have hip dysplasia, the hip socket or acetabulum is probably shallow with shortened margins.

The head of the femur (thighbone) is round and normally fits inside the acetabulum. The curved socket forms a shelf or roof over the femoral head to keep it from dislocating. With hip dysplasia, the round head of the femur isn’t covered by the acetabulum. It can slip upward and even dislocate.

The cysts are a likely sign that there is uneven wear and load from the hip instability. The joint may be trying to cushion itself by forming cysts of this type.

In some patients, a procedure called a rotational acetabular osteotomy can be done for unstable hip dysplasia. The surgeon removes a wedge of bone and uses it to re-angle the joint. A small piece of bone is also used to improve the roof angle.

Studies show that cysts of the acetabulum or femoral head often disappear after this operation. Patients report decrease in pain and improved function.

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.

Having hip dysplasia and dislocations, should I get a hip replacement?

I was born with hip dysplasia. I’ve had five operations to keep the hip from dislocating. It worked pretty well until I reached my 40s. Now I’m starting to have hip problems again with frequent dislocations. Would a hip replacement be a good idea now?

Hip joint reconstruction can be a complex treatment for patients with developmental hip dysplasia. For someone with hip dysplasia, the acetabulum or socket is usually the problem. A shallow socket often leads to partial or total dislocation.

In young children, the surgeon tries to shape the socket to prevent dislocation. Now as an adult, part or all of the joint can be replaced. You may be a good candidate for an acetabular implant. Partial hip replacement of this type is called a hemiarthroplasty.

The surgeon will remove the socket and press-fit into the space a hemisphere-shaped cup. It’s made of a porous material to allow bone to grow in and around the implant. This helps lock and hold it in place. With a proper shaped socket in place, the head of the femur will stay in place. Further dislocations can be prevented.

Long-term results of cementless acetabular components in patients with severe developmental dysplasia have been tracked. Most patients have excellent results the first 15 years after getting the new socket. After 15 years, the number of patients who have problems goes up.

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.

How is a neck fracture treated?

What is a femoral neck fracture and how is it treated? We just got word that our elderly father is in the operating room having surgery for this problem.

In a recent article, Dr. Robert Probe, an orthopedic surgeon in Texas offered a review of and some insight into surgical treatment of femoral neck fractures.

There are different types of hip fractures based on location. The femur is the long thigh bone with a round bony “head” at the top. The femoral head fits inside the acetabulum or hip socket. Fractures can occur anywhere in the long shaft of the femur, the neck (between the shaft and the femoral head), and the acetabulum. There is also intertrochanteric fractures. The intertrochanteric region of the hip is just below the femoral neck.

Two of the major problems that develop with femoral neck fractures are loss of blood to the femoral head and shortening of the femoral neck. Unless the patient cannot tolerate surgery for some reason, femoral fractures are best treated surgically. But that’s where the decision becomes much more complicated. Is the fracture stable enough to pin it back together until it heals? Will it heal? Are there patient factors that might result in a nonunion? How likely is a nonunion? Should the femoral head be replaced? If the decision is made to replace the femoral head, then the surgeon must choose between a cemented or uncemented stem (the piece that fits down into the shaft of the femur). That’s not the end of the possibilities.

The femoral head is available in several different models with different options (e.g., unipolar, bipolar) for achieving movement of the femoral head. It may be necessary to perform a complete hip joint replacement (femoral head and stem along with replacing the acetabulum). Should the surgeon try and save the hip knowing the patient may end up in surgery again in order to replace a failed fixation? Fixation refers to the use of screws, nails, pins, and metal plates to hold the broken pieces of bone together until healing can take place. This option is only available to a limited number of patients. The fracture must be stable.

If displaced (separated), it must be possible to bring the pieces together and precisely match them up again. Dr. Strobe describes the technique he uses when placing screws in the hip for a stable femoral neck fracture. He also discusses the use of a fixed-angle hip compression screw fixation. The compression screw keeps the femur from further bone displacement that would change the angle of the femur as it places the femoral head in the acetabulum (hip socket).

If the surgeon sees reasons and predictive factors that point to the strong possibility of nonunion and failed fixation, then hip replacement is the treatment of choice. Older adults who are active and wish to remain active may prefer this approach as well. It bypasses the possibility of a second surgery (from fixation to replacement). Current studies show fixation failure at 25 per cent right now.Results of total hip replacement (measured by pain, function, and revision rates) have been good-to-excellent for the “active and fit” older adults. Benefits and risks of this surgery for this age group with femoral neck fractures are still being investigated and reported.

Dr. Probe summarizes the article by saying that femoral neck fractures in older adults can be complex and challenging to treat. The surgeon makes every effort to save the natural anatomy. Patient health, strength of the bone, mobility, level of community activity, and predicted life span are all taken into consideration when making a decision about fracture fixation versus hip replacement.

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.

What is a comminuted acetabular fracture?

What is a comminuted acetabular fracture? That’s what my brother just texted me that his wife has. What do they do for that?

To help you understand your brother-in-law’s condition, let’s define an acetabular fracture. The acetabulum is the socket side of the hip joint. It is made of cartilage over bone just like every other joint. The reason it breaks is because the person falls (and lands) in such a way that the head of the femur (thigh bone) is driven up into the hip socket (acetabulum) with enough force to break bone. When that happens, there can be a single break or fracture line but more often the acetabular bone breaks into many tiny pieces. That type of break is called a comminuted fracture.

Older men are affected more often than women by this type of damage. Their femoral bones are thicker, stronger, and transfer a greater destructive force into the acetabulum. Women tend to develop a break in the neck of the femur — long before there is any force up into the socket.

Until recently, this type of fracture was always treated conservatively (without surgery). And many times, this is still the most appropriate treatment. The presence of dementia, poor health, severe bone loss, and non-ambulatory status before the fracture are reasons why surgery may not be possible.

So long as the fracture isn’t displaced (shifted), those patients who could walk before the injury are allowed to walk with the support of a walker. But only minimal weight through the hip is allowed until healing occurs. A physical therapist helps move the hip through its motions but with some limitations to protect it. Bed rest (even for displaced fractures) with traction was once prescribed. But this is no longer recommended due to the many complications that arise with immobility in this age group (e.g., blood clots, bed sores, pneumonia, deconditioning).

For those patients who will have to have surgery, there are several options. A procedure called open reduction and internal fixation (ORIF) pretty much describes what happens. The surgeon makes an incision to open up the hip, lines everything back up as much as possible, and uses plates, screws, pins, and/or wires to hold it all together until it heals. The more closely the hip is restored to its normal shape and configuration, the better the results will be. The more bone fragments and the farther apart the bone fragments separate, the poorer the prognosis. If the patient is not a good candidate for ORIF (or if the ORIF procedure fails), then a total hip replacement may be the next step.

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.

Twin boys have identical mishaped hips, but not identical problems!

We have twin boys who are both active in different sports. It turns out that they also both have a slightly misshaped hip. For one boy this has caused all kinds of hip problems, groin pain, and lost playing time on his soccer team. The other boy doesn’t seem affected at all. How come?

With impingement, the soft tissues around the joint get caught between the femur and the hip socket. There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.

Femoroacetabular impingement occurs when abnormal hip anatomy is aggravated by repetitive movements of the hip. There could be a slightly off center placement of the hip in the socket or a femoral head that isn’t perfectly round that is contributing to the problem. Or the hip socket may be too deep for the size of the femoral head or the rim of the hip socket is too prominent. Sometimes the angle of the femoral neck is bent or twisted just a tad from normal. There could be a separate piece of bone called the os acetabulum along the front rim of the hip socket. Any of these morphologic changes can lead to impingement.

The labrum, a fibrous rim of cartilage around the hip socket is the most likely area to get pinched. Add repetitive motion and you get repetitive pinching or compression until the labrum starts to fray and tear. No one knows for sure just yet why some athletes with this problem are affected while others seem not to notice a problem. With your sons, it could be there is just enough difference in the shape of one boy’s hip that he is spared the painful loss of motion and function. There could be differences in the degree of pinching that is going on or the tension of the soft tissues, muscles, and tendons around the joint.

Studies show that some high level athletes with abnormal hip joints never develop problems. Who does develop femoroacetabular impingement and how to predict if/when it should be treated are areas where further study is 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.