Is it typical to be walking the day after a hip joint replacement?

July 12th — admin

I had a total hip joint replacement last month. The physical therapist got me up and walking on the day after the operation. Is this typical?

Doctors make this decision based on many factors. These include the reasons for the joint replacement, the type of joint implant used, and the amount of damage to the joint.

For example, a severely arthritic joint may be treated differently from a broken hip. Each doctor has a schedule of what activities can be done after an operation and when to start each one. This is called a protocol. Putting weight on the new hip joint on the first day after the operation is not unusual. In fact, studies show that early motion helps prevent blood clots and other 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.

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I need a hip replacement, however, I’m afraid. How can I get over this hurdle?

January 20th — admin

I know I need a hip replacement and my family is bugging me to just do it. But I’m scared. I’m afraid I won’t be able to handle the pain after surgery. My hip hurts now but it’s a pain I’m familiar with and I know how to deal with it. How can I get over this hurdle?

Many seniors put off having a total hip replacement despite the pain and loss of function that the arthritic joint is causing. They are afraid that it will hurt even more after the surgery and take a long time to recover. At least right now, they can walk without a walker. After surgery, the thought of using a walker or cane is enough to keep them away.Yet every year there are nearly one million adults who do have a total hip or total knee replacement. And that figure is expected to increase to four million in the next 20 years. So while some are hesitant, those who aren’t may experience an even faster recovery time thanks to the results of some recent studies.Surgeons and physical therapists are working together to find the fastest way through surgery and rehab with the least amount of pain and disability. Sound like a tall order? Surprisingly, patients seem to adapt well and the results speak for themselves.Patients in a rapid recovery program go directly home two days (sometimes three days) after surgery. Patients in a traditional treatment group are more likely to be discharged to a rehabilitation center around day 4 after surgery. If the traditionally treated patient goes home directly from the hospital, then a treatment program continues at home.In a recent study at the Cleveland Clinic (Ohio), walking distance was twice as far in half the time for the rapid recovery group. That result alone brought smiles to the patients’ faces as they reported a much higher level of satisfaction compared with the traditional group. But there was another positive finding from that study. The rapid recovery group reported significantly less pain and less use of pain medication.The goal of the rapid recovery program is to cut costs while still maintaining patient safety and excellent results. Decreasing the number of days patients are in the hospital while increasing their level of independent function by the time they are discharged is possible.This type of multidisciplinary approach may be just what you need. With the support, guidance, and direction of your physician, nurses, and physical therapist, you may find your fears are put aside.

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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I’m 62 and have been having some pain inside my right knee. Is this just age, or should it be checked by a doctor?

January 17th — admin

I’m 62-years old and in reasonably good health. Lately I’ve been having some pain along the inside of my right knee. I’ve waited for it to go away. I’ve tried ibuprofen. It’s not getting worse but it’s not getting better. How do you know what’s just a sign of getting older and what should be checked out by a doctor?

Sometimes it’s impossible to tell the serious from the not-so-serious medical conditions. With aging come age-related changes in the body. With the knee, joint cartilage such as the meniscus starts to wear out. Early signs of arthritis start to set in.

But most experts agree that early intervention can make a big difference in many kinds of problems. Don’t wait to see your doctor. An X-ray may be all that’s needed. In some cases an MRI is best. If conservative care doesn’t improve your symptoms, then a second MRI may be needed.

Recently several studies have documented cases of spontaneous osteonecrosis in adults over age 60 who had some meniscus degeneration. Osteonecrosis is the death of bone. Spontaneous means it came on suddenly with no warning and no known cause. These are the kinds of problems you want to avoid by checking with your doctor sooner than later.

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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Does joint injury always lead to arthritis?

October 14th — admin

I was in a car accident and crashed my left knee against the dashboard hard enough to break it. I’m only 23-years old and I know this might get arthritic later in life. What are options now to help prevent this from happening?

Good question. We don’t have studies to show the long-term results of each possible treatment option. Some may say don’t worry about it — what will be, will be. Others say don’t borrow trouble before it happens. In other words, not everyone develops arthritis in a joint after a traumatic injury. The event increases your risk but doesn’t guarantee it.

You didn’t mention what treatment you’ve had for this problem now. Sometimes even young people damage the patella enough that fracture healing isn’t possible. In those cases, the kneecap may be removed, a procedure called a patellectomy. Older folks might opt for a total knee replacement, especially if they already have arthritis in the knee. Middle-aged patients may be given the choice of just a kneecap replacement.

The biggest factor in long-term results may have to do with your knee alignment. Does the patella track up and down well during knee motion? Is it balanced and in the center? Does it tend to track more to one side or the other?

The knee joint axis is also important. Are you slightly knock-kneed or bow-legged? These positions can affect how well the knee holds up over the years.

Ask your doctor for his or her recommendations. It could be there’s nothing to be done just now. Or there may be an exercise program that could correct any weaknesses or misalignments.

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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Accurate diagnosis of hip pain can be elusive

July 28th — admin

I saw my primary care physician for hip pain that just won’t go away. Despite a huge amount of time testing me every which way, there’s no known cause for the problem. Should I insist on X-rays or an MRI?

There are many, many possible causes of hip pain. An accurate diagnosis is needed to direct treatment. But this can be elusive and take a long time to make. The physician’s examination takes into account the possible etiology or cause of the problem. Was there some trauma? The mechanism of acute hip pain caused by injury is often a twisting motion. Overuse, repetitive motion, and diseases or degenerative conditions are other potential causes of hip pain. Pain patterns associated with hip problems start with a deep aching and stiffness in the hip. True hip pain is experienced in the front of the body down into the groin area. Hip pain along the pelvic rim, down the side of the leg, or down the back of the leg is usually a sign that the cause of the pain is extraarticular (outside the hip joint). This could be coming from pinching of the soft tissues, nerve entrapment, or other extraarticular lesions. Loss of motion and/or function can help point to the specific soft tissue structures affected.

It sounds like your physician has been very thorough. Evaluation of hip pain may require imaging studies such as X-rays or MRIs. But unnecessary X-rays and other imaging studies should be avoided. Results are viewed cautiously as many changes in and around the hip may be observed but may not be the cause of the painful symptoms. The most obvious pathologies that must be treated include tumors, fractures, hematoma from bleeding after a fall, and infections.

Often in the face of an unknown cause of joint pain, a short course of physical therapy can be a diagnostic aid for the physician and helpful to the patient. As experts in human movement dysfunction, the therapist can evaluate and treat the soft tissues and postural issues that could be the underlying cause of 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.

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What is calcific bursitis of the hip?

July 25th — admin

Have you ever heard of calcific bursitis of the hip? That’s what I have. What can you tell me about it?

Calcific bursitis occurs as a result of tiny calcium deposits in the collagen tissue around the hip. The cause is chronic inflammation of the bursae. The bursa is a normal structure. It is a thin sac of tissue that contains fluid to lubricate areas and reduce friction between muscles, tendons, and bones. The patient reports pain and/or tenderness along the side of the hip. This is the area of the greater trochanter. The greater trochanter is a large bump of bone that juts outward from the top of the femur (thigh bone). Large and important muscles connect to the greater trochanter. Sometimes these muscles are referred to as the rotator cuff of the hip. Chronic tendinitis of the hip rotator cuff can also contribute to this problem. The calcium deposits are called calcification. They can occur as long as there is inflammation of the bursae (or tendons). The deposits don’t always go away after the inflammation has been taken care of, but the symptoms improve.

Treatment can help to prevent further calcification as well as relieve pain and stiffness. Antiinflammatory drugs, cortisone injections into the bursa, and physical therapy have been shown effective. In rare cases, the inflamed bursa is surgically removed.

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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Can hip arthritis be diagnosed without an x-ray?

July 20th — admin

My doctor thinks I might have hip arthritis. She would like me to have an X-ray. I’d like to avoid any more exposure to radiation. Can this condition be diagnosed without X-rays?

X-rays are still the number one tool physicians rely on to make an accurate diagnosis of osteoarthritis (OA). The radiograph shows changes that can’t be seen with a clinical exam. For example, narrowing of the joint space and bone spurs associated with OA are easily seen on X-rays.

Other changes common with OA that can be observed with X-rays include changes at the joint margins and subchondral bone. Subchondral bone refers to the first layer of bone underneath cartilage. Once the joint cartilage is destroyed by the OA process, the subchondral bone can be affected, too.

Without X-rays, there are some clinical tests that can be helpful in diagnosing hip OA. Hip range-of-motion (quantity and quality) is a key factor. A quick and easy screening test for the hip is to try assuming a squat position. If this position aggravates the symptoms (or you cannot do it because of hip pain), the hip is involved in some way.

The examiner looks for a specific pattern of motion typical with OA. Loss of hip internal rotation is a positive sign of OA. The examiner also relies on how the joint feels during testing motions. There should be a smooth, easy give through the full arc of motion. The examiner feels for a slight spring at the end of the motion. Any blocks or resistance to movement caused by pain or a bone-on-bone sensation may be an indication of degenerative joint disease.

X-rays may still be needed if all these tests are positive. But if they are negative, it may rule out OA and X-rays can be avoided. It’s likely that your physician found enough suspicious test results to suggest further testing with X-ray imaging. Don’t be afraid to ask your doctor about her findings so far and express your concerns about radiation exposure.

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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Torn rotator cuff? Reverse total shoulder replacement may be the answer

July 13th — admin

My father is going to have a shoulder replacement but the doctor said it is a “reverse” replacement. What does that mean?

While regular shoulder replacements can be very successful for the right patients, if the patients have torn rotator cuffs, this is not the ideal solution. The movement of the shoulder places a lot of strain on the rotator cuff. The regular shoulder replacements include replacing the ball at the top of the humerus (the upper arm bone) with a metal ball. The socket in the scapula (shoulder blade) is replaced with a plastic socket. However, if the patient has a torn rotator cuff, this replacement can come loose. In the reverse replacement, the ball is at the top, where the scapula is, and the socket is part of the humerus. With this arrangement, the upper arm muscle, the deltoid takes on the responsibility of the movement rather than the rotator cuff.

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 hip pain is a red flag for total hip replacement patients

July 12th — admin

My right hip has been bugging me off and on for two weeks. I have a hip replacement on that side so I’m a little worried. Could this be caused by a problem with the implant?

For anyone with a total hip replacement (THR), hip pain is a red flag. Medical evaluation is important because of the risk of joint infection. Treatment depends on knowing if there is (or isn’t) an infection. There are many possible causes for the pain you are having. They may or may not be related to the implant. The first thing the orthopedic surgeon will examine is the hip itself. Your history along with the clinical presentation are very helpful. But then the spine (above) and the knee (below) will be tested as possible sources of referred pain. X-rays and lab tests may be needed to rule out a fracture, implant loosening or infection. Other possible causes include bursitis, ossification (bone formation in the muscle or surrounding soft tissue), or synovitis. Cultures of the joint taken directly from the area during surgery are the most accurate way to confirm (or rule out) joint infection. But this type of testing is not practical for the patient who doesn’t have an infection or who doesn’t need surgery. And there is a fair amount of false-positive test results with intraoperative cultures due to errors in sampling technique. Instead, the physician may rely on lab tests that are sensitive, reliable, and accurate with a low false-positive and high true-positive results. The following tests may be needed to evaluate for hip infection: erythrocyte sedimentation (SED rate), C-reactive protein (CRP), and synovial fluid white blood cell count (WBC). Don’t wait to get tested. See your surgeon now. Early diagnosis can prevent a lot of complications from delayed treatment.

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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How many patients who have surgery for shoulder dislocation develop arthritis?

June 24th — admin

About five years ago, I dislocated my shoulder repeatedly. Eventually I had surgery to clean out the joint and tighten it up. I’m starting to notice some crackling noise in that joint when I move my arm overhead. Does this mean something has come loose? Do I need to do something for this before it becomes a problem?

You may be noticing some early signs of joint degeneration. Arthritic changes aren’t uncommon after shoulder surgery for recurrent shoulder dislocations. In fact, some studies show up to 20 per cent of patients who have surgery for shoulder instability develop postoperative arthritis.

Sometimes early arthritic changes are already present in the shoulder before the surgery. This has been observed in about nine per cent of patients with chronic shoulder instability. Loss of shoulder motion and function seem to be linked with deficiencies leading to arthritis.

A follow-up visit with your orthopedic surgeon may be in order. At the very least, an X-ray of the joint will be done to rule out fracture or loose fragments in the joint. The X-ray can also confirm the presence of arthritic changes.

Early diagnosis of orthopedic problems is always recommended. Taking care of a minor problem can help prevent major problems later.

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.

Posted in Arthritis, Shoulders. Tags: , , , , . No Comments »
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