Patient wants tiny incision

September 28th — admin

I’m going to have a total hip replacement next week with the new minimally invasive surgery. The surgeon has explained how this is to my advantage, but mostly, I’m just interested in having a tiny incision. Am I going to be sorry I didn’t have the standard type of incision? Will my vanity come around and bite me in the butt, so-to-speak?

You’re not alone in your concern about form over function. Even if the minimally-invasive approach doesn’t yield better functional outcomes, patients like how it looks. A shorter incision just looks better, and patients are asking for that. Patients also want an implant that will last as long as possible. And that factor is more important to them than the length of the scar or how long they are in the hospital.

There are many advantages to a minimally-invasive approach. And we’re not talking about just a shorter incision line. Minimally invasive refers to the fact that the group of muscles usually cut to remove the old hip joint aren’t touched. The gluteus maximus (buttock) muscle is split to get to the hip joint, but the length of the split is much shorter. The incision into the joint capsule is also smaller and repaired without any negative effects.

Studies are ongoing to assess the results of minimally-invasive surgeries. There are mixed reviews as to outcomes. In some studies, the operating time is shorter and there’s less blood loss. In others, the operation is complex and may take more time if the surgeon hasn’t done quite a few of them. But the long-term results (a year or more later) don’t really show much of an advantage of the minimally invasive approach over the standard incision. Walking distance, walking speed, and muscle strength appear to even out between the two surgical approaches. There are still plenty of factors to consider when comparing the two approaches. Patient education, preoperative counseling, analgesia, and rehabilitation programs may be the real keys to recovery. While the surgical approach might make a difference, there’s at least enough preliminary information to suggest that the postoperative treatment process may be equally (if not more) important.

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.

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Hip impingement explained

September 26th — admin

What is a hip impingement? That’s what I’ve been told is causing my hip pain.

The full medical term for this problem is femoroacetabular impingement. Impingement just means pinching. Femoroacetabular refers to the place in the hip where the round head of the femur (thigh bone) comes in contact with the acetabulum or hip socket.

Two types of impingement are known to cause pinching of the soft tissues in this area. The first is called cam-type impingement. This 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 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 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 socket. The articular cartilage is the protective covering over the hip joint surface. Sometimes cam-type impingement occurs as a result of some other hip problem (e.g., Legg-Calvé-Perthes disease, slipped capital femoral epiphysis or SCFE). But most of the time, it occurs by itself and is the main problem. Men are affected by cam-type impingement more often than women.

The second type of impingement is called pincer-type (more common in women). In this type, the socket covers too much of the femoral head. As the hip moves, the labrum comes in contact with the femoral neck just below the femoral head. Repeated microtrauma at this site can cause the bone to overgrow, a condition called heterotopic bone growth. Pincer-type impingement is usually caused by some other problem. It could be as a result of 1) hip dysplasia, 2) a complication after osteotomy surgery to correct hip dysplasia, or 3) an abnormal position of the acetabulum called retroversion. Hip dysplasia is a deformity of the hip (either of the femoral head or the acetabulum, or both) that can lead to hip dislocation. The condition is brought to the orthopedic surgeon’s attention when the patient reports groin pain that occurs when the hip is bent or flexed. Although the condition is often present on both sides, the symptoms are usually only felt on one side. In some cases, the groin pain doesn’t start until the person has been sitting and starts to stand up. There is often a slight limp because of pain and limited motion. The diagnosis is usually confirmed through clinical tests and X-rays. Sometimes advanced imaging such as MRIs or CT scans are also ordered. Once all the test results are available, a course of action is determined. This may be conservative (nonoperative) care with antiinflammatories and physical therapy. In some cases, surgery is required.

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.

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Pain on inside of hip could be arthritis

September 22nd — admin

I have a deep pain in my groin that my doctor diagnosed as a hip problem – arthritis. I always thought if you had hip pain, it was on the outside?

Hip pain from problems like osteoarthritis does often show up in the inner thigh or groin area, more so than the outside. This is because of the anatomy of the joint and where the ball of the femur, the thigh bone, fits into the socket of hip joint. It’s in the inner part of the hip that the motion takes place that allows you to move your leg inward and outward again.

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.

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Soccer player chooses surgery for snapping hip syndrome

September 20th — admin

After a very long and unsuccessful attempt at treating my snapping hip syndrome, I finally decided to have surgery to release the hip tendons on both sides. I’m hoping to be through rehab by the time soccer season starts again. How long does it take to get my full strength and motion back?

Some athletes are bothered by a painful snapping at the hip when moving the leg from a flexed to an extended position. There can be a variety of reasons why this happens. Some occur outside the joint such as when a tendon rubs over a bony prominence. Others are caused by something going on inside the joint. It could be a tear in the labrum (rim of cartilage around the hip socket) or a loose fragment inside the joint. The most common cause is the iliopsoas tendon rubbing over a bony bump called the iliopectineal eminence. Many times there is also a fraying or a tear of the labrum contributing to the problem.

Whatever the cause, treatment is needed to help the athlete get back into action. At first, conservative care with rest, stretching exercises, and antiinflammatory drugs is advised. A nonoperative approach should be tried for at least six months. Sometimes a steroid injection with a numbing agent into the iliopsoas bursa helps. When none of these approaches reduces or relieves painful snapping symptoms, then surgery may be advised. The surgeon can partially or fully cut the iliopsoas tendon away from the bone. The tendon retracts and reattaches to the nearby soft tissue.

Recovery and rehab takes at least 10 to 12 weeks. At first, you won’t be able to bend the hip. This makes you unstable when trying to walk or use coordinated movements of the legs. This new symptom will last two to four weeks until the tendon reattaches and heals in its new location. You’ll be given some simple exercises to do at first. You will probably work with a physical therapist who will supervise how much weight you put on the leg(s), how to use crutches or canes, and a progression of leg control exercises. Eventually stretching exercises will be included, then coordination exercises, and finally, sport-specific movements. When you can control your motion, have 90 per cent strength, and can handle impact activities, then you will be released to return to the soccer field.

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.

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Diagnosing snapping hip syndrome

September 16th — admin

Whenever I extend my leg and then bend it again, I get a painful snapping across the front of my hip. It’s loud enough you can actually hear it. The orthopedic surgeon says it’s a snapping hip syndrome. Nothing showed up on an X-ray. Would it be helpful to have a CT scan or an MRI to make sure that’s really what’s wrong?

The diagnosis of snapping hip syndrome usually only requires a careful patient history and examination. Many times, the patient and/or examiner are able to reproduce the symptoms. This helps identify the soft tissue structures that are involved.

The cost of more advanced imaging is always taken into consideration. Since the first step in treatment is the same regardless of the exact diagnosis, your surgeon may hold off on further imaging studies for a while. Conservative care with rest, stretching exercises, and avoiding repetitive motions that aggravate the condition is advised. A physical therapist may also use deep heating treatments such as ultrasound or iontophoresis (antiinflammatory medications pushed through the skin to the tendon).

Magnetic resonance imaging or ultrasound for imaging (rather than for providing heat treatment) becomes helpful if and when the surgeon is considering a steroid injection into the iliopsoas bursa. The bursa is a small, oval-shaped soft tissue structure between the bone and the tendon. It helps reduce friction and provides smooth action of the tendon-muscle unit.

In the case of snapping hip syndrome, magnetic resonance arthrography (MRA) may be a better choice. A contrast dye is injected into the joint to help look for problems within (inside) the joint. This could be a loose fragment of cartilage or bone — or a frayed or torn piece of the labrum (rim of cartilage around the hip socket). Dynamic ultrasound is another good diagnostic option. Images of the iliopsoas tendon show signs of tendon thickening, enlarged burse, pockets of fluid collection, or signs of inflammation. Each of these tests has its own sensitivity and specificity making them useful for certain patients. The surgeon is able to identify which test is best and when to use it to avoid unnecessary test procedures but gain important and necessary information when it’s 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.

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What is a cervical hip fracture?

September 14th — admin

Have you ever heard of a cervical hip fracture? What is that? I thought the cervical bones were in the neck, not in the hip.

There are many types of hip fractures, usually named for their location. A basic understanding of the hip anatomy will help visualize where the fractures occur.

The hip joint is one of the true ball-and-socket joints of the body. The hip socket is called the acetabulum. It forms a deep cup that surrounds the ball of the upper thighbone, or femoral head. The femoral head is attached to the rest of the femur by a short section of bone called the femoral neck. A bony bump on the outside of the femur just below the femoral neck is called the greater trochanter. A smaller bony bump on the femur called the lesser trochanter is located on a diagonal from the greater trochanter.

These two bumps on the femur are where some of the hip muscles attach. A cervical hip fracture refers to the fact that the break is inside the joint itself. Either the top of the femur (called a subcapital fracture) or the acetabulum (hip socket) have a break. Another term for the location of these fractures is intracapsular or cervical.

When the break affects the hip, but is not right inside the hip, the fracture is referred to as an extracapsular hip fracture. The fracture may occur in the neck of the femur (femoral neck fracture), between the two trochanters (intertrochanteric fracture), or in the main shaft of the femur just below the lesser trochanter and may extend down the shaft of the femur. This last type of hip fracture is called a subtrochanteric fracture.

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.

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Dislocate hip to fix it?

September 12th — admin

I saw a surgeon who wants to do surgery to dislocate my hip in order to fix it so it won’t keep pinching the joint cartilage when I bend and rotate my leg. I’m thinking, no thanks. Is there a better way to take care of this problem?

It sounds like you might have a condition called femoroacetabular impingement (FAI). With FAI, the top of the femur (thigh bone) pinches the rim of the hip socket. The area that gets compressed is referred to as the acetabular rim. This type of impingement occurs most often when the hip is flexed and internally rotated.

Surgery is often recommended as the most successful treatment for this problem. There are three surgical choices: 1) surgical hip dislocation, 2) periacetabular osteotomy, and 3) hip arthroscopy. Surgical hip dislocation is considered the current gold standard, though some experts expect improved arthroscopic techniques will change that in the future. Surgical dislocation refers to taking the femoral head out of the socket and making adjustments and repairs as necessary, and then putting the head back in place. The operation can be done without cutting through the muscles and with the least amount of trauma possible.  Any damage to the labrum (rim of cartilage around the hip socket) can be repaired. Any problems with mismatch of the femoral head and neck with the acetabulum (hip socket) can be taken care of. This type of surgery allows for preservation of the joint, which is important in young, active adults.

Periacetabular osteotomy corrects the retroversion (tipped or tilted position of the acetabulum). The capsule surrounding the hip joint is cut open. The femoral head and neck are reshaped by shaving or cutting off portions of the bone. The goal is to correct the placement of the femoral head in the hip socket.

The third surgical option (hip arthroscopy) to treat FAI allows the surgeon to gain access to the inside of the joint without cutting it open. This avoids pulling the femoral head away from the socket. Arthroscopic surgery also makes it possible to reattach (rather than remove) a torn labrum.

Studies show that the best way to approach this problem is by restoring as normal hip anatomy as possible. Surgical hip dislocation is used with good success for patients with mild to moderate (but not severe) degeneration of the joint cartilage, surface, and surrounding capsule. It sounds like your surgeon is right on track with current evidence for best practice. You can always seek a second opinion to help you understand your condition and the various treatment options available.

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.

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Even loose-jointed yoga instructor has hip pain

September 8th — admin

I am a yoga instructor with a very painful hip. I can’t figure it out because my joints are very loose. But every time I flex my hip past 90-degrees or try to cross my legs, I get a very sharp pain deep in my hip. What could be causing this?

Hip pain with limitations on full hip motion in an active adult requires special attention — especially if you are in your 20s or 30s. Early diagnosis and treatment is imperative to avoid degenerative changes in the hip joint later in life. There are many possible causes of this type of hip pain.

Given your description, one of the most likely would be femoroacetabular impingement (FAI). Femoroacetabular impingement (FAI) describes a condition where the top of the femur (thigh bone) pinches the rim of the hip socket. The area that gets compressed is referred to as the acetabular rim. This type of impingement occurs most often when the hip is flexed and internally rotated. For a long time, it was believed that FAI only occurred in people with some kind of abnormal anatomy of the hip. There was either a backward tilted angle of the hip socket called retroversion, a larger socket than the ball (head of the femur) inside the socket, or flattening of the femoral head. One type of abnormal shape of the hip was labeled a pistol grip because of the resemblance to the grip of a handgun.

More recent studies have shown it’s possible to develop FAI even when the hip structure and anatomy are essentially normal. But, in general, more people with acetabular retroversion end up with hip pain and problems leading to degenerative hip osteoarthritis than any others.

To get to the bottom of the cause of hip pain, a thorough history and examination are required. An orthopedic surgeon is the best one to see. The physician will look at your foot position, leg angles, leg length differences from one side to the other, hip motion, and muscle strength. Gait (walking) patterns will be evaluated. Special tests such as the impingement test are done to identify the presence of an underlying FAI as the cause of the painful symptoms and restricted motion. X-rays, CT scans and/or MRIs may be used to confirm the diagnosis.

The results of all of these tests are important pieces of information when deciding on the best treatment approach. With early diagnosis and treatment of young, active patients with FAI the problem can be managed by conservative measures. Surgery may be needed to restore as normal hip anatomy as possible. But before jumping to any conclusions, make an appointment and see a specialist to find out for sure what might be causing the problem. If you’ve had this for a while and it hasn’t gone away (even with your yoga practice), don’t wait any longer.

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.

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Why Mom won’t get her hip replaced

September 6th — admin

We are trying to help Mother make up her mind about having a hip replacement. Dad had it done a year ago and everything went quite well. We can’t figure out her hesitation. What do you suggest?

It’s not uncommon for women to lag behind men when it comes to having elective surgery such as a total hip or total knee replacement. Women tend to worry more about taking care of their families after surgery. The unknown factors of how long it will take to get back up on their feet and independent can hold them back. In many cultures, men are more used to being taken care of and provided for in the home. Becoming more dependent in these areas after surgery is not such a stumbling block for them. Women may have a more difficult time asking for and accepting help from others.

The first step may be just to have her evaluated by your surgeon of choice. He or she may be able to answer any questions you or your mother may have. Asking questions about healing time, length of hospitalization, expected time for recovery may help your mother decide what’s best for her. Most patients are seen right away in the hospital by a physical therapist. The therapist helps them get up and get moving again. Joint motion and muscle strengthening are part of the rehab program. The therapist will advise patients about what’s needed at home. If your father had this surgery a year ago, it’s likely they already have everything they need (e.g., raised toilet seat, walker or cane, grab bars in the bathroom).

These are just a few suggestions for getting to the bottom of your mother’s hesitation. If you think she could (and would) tell you, perhaps asking her straight out might help solve the issue. It is a big step for many people but most patients agree that the benefits are well worth the effort.

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.

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