After having a total hip replacement, can you break that hip?

May 24th — admin

My 90-year old grandma just broke her hip. She has a total hip replacement on that side, so how can she break a hip?

She may have what’s called a periprosthetic fracture of the femur. The femur is the thighbone. Periprosthetic means the fracture is in the bone next to the implant. The fracture is probably just below the implant and close enough to the hip to be generally referred to as a hip fracture.

Sometimes joint implants crack or fracture but these cases are usually referred to as implant failure rather than hip fracture. Fracture of the femur is not uncommon in patients with either a hip or a knee joint replacement.

Advancing age puts the older adult at risk for bone fracture. Many of the problems that come with aging are also risk factors for fracture. Other age-related risk factors include osteoporosis, diabetes, and arthritis. Anyone who is already experiencing problems with balance and falling is also at risk for bone fracture. Medications such as corticosteroids can weaken the muscles and bones putting patients at increased risk for falls as well.

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 the safe age for a partial joint replacement?

May 23rd — admin

I’ve been told that younger, active patients with arthritis can have part of the joint replaced when uneven wear causes problems. How young do you have to be? I’m 62-years-old and not quite ready for a complete knee replacement. Am I too old for this operation?

The unicompartmental knee arthroplasty (UKA) has several advantages over a total knee replacement (TKR). As you mentioned, it is an acceptable alternative to TKR when only one side of the joint needs to be replaced.

UKA is less invasive and removes less bone compared to a TKR. Improved computer-assisted surgical methods and improved implant quality have made it possible for younger patients to benefit from the UKA.

The exact definition of younger has not been statistically determined. Each patient is evaluated by the orthopedic surgeon for this type of implant. Studies report surgeons are using the UKA in adults ages 47 to 83.

Older age is not as much of a challenge as younger age. The reason for this is concern over how many years of wear and tear the implant can handle. The average TKR lasts about 15 years. Older adults who have a TKR usually die before the knee wears out. The average life of the UKA is unknown. Mid- and long-term results of UKA are slowly trickling into the published literature.

Patients with UKA report their motion and feeling with the implant are more like a normal joint. Computer analysis shows knee joint biomechanics with a UKA are closer to a normal knee compared to the biomechanics provided by a TKR. That’s because the cruciate ligaments inside the joint are not cut or removed with a UKA (but they often are with a TKR).

At age 62, you may be a good candidate for a UKA. With increasing life expectancy for many adults, the UKA may give you added years of quality knee function. Then if you need to convert to a TKR later, it may be an available option.

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

May 20th — admin

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.

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 long does physical therapy for arthritis take?

May 14th — admin

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.

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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Is it common for a partial hip replacement to cause a hip fracture?

May 8th — admin

My mother just had a partial hip replacement. I guess it was like having a tooth capped. Just the top of her femur was replaced. She ended up with a hip fracture afterwards. 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 afterwards 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.

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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If part of my hip is damaged, do I need a whole hip replacement?

May 6th — admin

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.

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 hip dysplasia and how will it affect me?

April 24th — admin

I just came back from the doctor’s where I found out I have hip dysplasia. My hip started hurting about six months ago and the X-rays showed this deformity. How often does this happen, and what does it mean in the long-run?

Developmental hip dysplasia (DDH) is probably present at birth or occurs during development in the early years. A change in the normal anatomy results in a shallow hip socket. The angle or tilt of the femur (thigh bone) and rotation of the femoral shaft (long part of the bone) are also different from normal. The patient is at increased risk of partial dislocation called subluxation or even full dislocation.

According to at least one study, this condition occurs in about five to 13 percent of the adult population. The person may not even know it’s there until pain sends him or her to the doctor for an X-ray.

There is some evidence that dysplastic hips have an uneven load across the joint. The cartilage on the surface of the joint can get damaged directly. Abnormal stresses on the soft tissues supporting the joint can lead to wear and tear of ligaments and cartilage.

Damage to the cartilage around the rim of the socket changes the pressure inside the joint. Synovial fluid that lubricates the joint may leak out adding to the wearing away of the cartilage.

No one is quite sure if these changes always occur or how long it takes before they result in arthritis. One study from Denmark reported no adverse changes even after 10 years of untreated DDH. It may be best to treat the hip conservatively but keep contact with your doctor. Any change in symptoms should be re-evaluated sooner than later to prevent excessive damage.

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 does my knee click and occasionally lock up?

April 23rd — admin

I seem to have some kind of knee problem but it’s only noticeable when I am go from standing on that leg to walking. Then it clicks. Sometimes (not very often) it locks up on me. What could be causing this to happen?

You may have a tear in the articular cartilage of the knee. This is the fibrous layer of cartilage that covers the end of the femur (thighbone). The only way to know for sure is to have a physician examine you and order some imaging studies.

Weight-bearing X-rays with the knees straight will be taken. Then several other views with the knees bent 30 and 45 degrees are viewed. MRI is the best imaging test for this problem. The signals help identify where and how deep the full-thickness tear has occurred. The MRI also shows the condition of the bone underneath the cartilage.

Depending on the location and size of the tear, you may or may not have symptoms. Or you may have very mild pain and symptoms even when there is a serious tear. Some patients only notice pain when the knee is loaded at a specific range of motion. Symptoms of locking, catching, and clicking with motion are common.

If the tear or lesion is present within the weight-bearing axis, pain occurs only when the joint is loaded at a specific angle. This may be what you are experiencing. It’s best to have a physician examine you. Left untreated, these types of injuries can develop into arthritis.

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 a joint replacement get arthritis?

April 16th — admin

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.

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What should I do about knee arthritis?

April 3rd — admin

I’ve been a faithful exerciser to help my knee arthritis for the last five years. Now my pain is starting to get worse so the doctor has advised me to try the knee injections to put fluid in there. If this works will I still need to do the exercises?

Joint fluid therapy sometimes referred to as viscosupplementation or hyaluronan injections is a thick, elastic substance made from hyaluronan. Hyaluronan, also known as hyaluronic acid or hyaluronate (HYL) is found in normal joint fluid.

When injected directly into the knee joint, HYL helps restore the cushioning and lubricating properties of normal joint fluid. Three to five injections are used for knee osteoarthritis in patients who have not responded to more conservative therapy.

A recent study from the New Jersey Medical School suggests that combining HYL with a home exercise program is actually better than just HYL alone. Exercise by itself seems to benefit knee OA. Biochemical changes in the synovial fluid have been reported with exercise alone and with HYL alone.

Combining the two together may help increase the amount of hyaluronan that moves into the cartilage. Exercise seems to have the added benefit of helping expand and cleanse the cartilage to keep it in good condition. All indications are that exercise is very helpful for osteoarthritis and should be continued on a daily basis.

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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