Naples Orthopedic Surgeon - Dr. Robert J. Zehr » arthritis

Surgery on torn ACL may be needed to protect the joint

admin — Thu, 29 Jul 2010 14:00:42 +0000

My 21-year old daughter hurt her knee when she slipped and fell on some ice. The doctor says the ACL is torn and she needs surgery to protect the joint. Protect it from what?

There are some studies that show patients are at greater risk for knee re-injury after anterior cruciate ligament (ACL) tears if the damage isn’t repaired. The most common injuries later are meniscus and joint cartilage tears.

If the joint cartilage is damaged, the bone underneath is unprotected. Wear and tear can cause damage to the bone. Painful arthritis can develop much later.

A recent study of over 6,000 adults confirmed these beliefs. Patients who didn’t have an ACL repair and opted for conservative care were twice as likely to injure the meniscus later and 30 percent more likely to damage the joint cartilage.

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 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.

Careful monitoring needed for hip dysplasia

admin — Wed, 28 Jul 2010 14:00:17 +0000

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.

Can you get arthritis in a joint replacement?

admin — Fri, 23 Jul 2010 14:00:56 +0000

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.

Will arthroscopic surgery solve problems with knee arthritis?

admin — Tue, 13 Jul 2010 14:00:11 +0000

I have some mild, but painful arthritis in my left knee. I’m thinking about having arthroscopic surgery done. The doctor wants to take a look inside and smooth out any rough edges. Will that take care of the problem?

Short-term results (six months to two years) after arthroscopic surgery for mild to moderate arthritis are good. Reports show at least 75 percent (three-fourths) of all patients get better. The have less pain and more function.

After three years, only half the patients stay pain free. Those with rough cartilage behind the knee cap (a condition called chondromalacia) often have return of painful symptoms. Patients who are overweight have pain much more often than patients of normal weight.

Patients with mild degenerative changes but no arthritis who aren’t overweight have the best results with arthroscopic surgery.

Partial vs. total shoulder replacement

admin — Fri, 25 Jun 2010 19:18:24 +0000

I have severe pain and limited motion in my left shoulder. My problems all come from arthritis. My doctor thinks I should have a partial shoulder replacement. If the arthritis gets worse I can always have a total replacement later. Does it really work that way?
Many doctors hold to this idea. A recent review of the studies on partial (hemiarthroplasty) versus total shoulder replacements might call that plan into question.

Some studies show that even with a hemiarthroplasty the surface of the shoulder socket continues to wear down and deteriorate. Then when it’s time to convert to a total shoulder, there isn’t enough good, solid bone for the implant.

On the other hand, starting with a total shoulder arthroplasty (TSA) leaves the patient with no place to go if problems occur. There isn’t a good replacement for the replacement.

Overall the studies done comparing hemiarthroplasty to a TSA show the TSA gives patients better function over a longer period of time. More studies are needed to fully compare these two treatment options.

Exercising on your own after total knee replacement surgery

admin — Thu, 24 Jun 2010 12:31:41 +0000

I had a total knee replacement six months ago. After physical therapy in the hospital, I had more therapy at home. Now I’m doing my own exercises everyday. How long should I keep this up?

It might be time for a follow-up visit with your doctor or therapist. Tests of motion, strength, balance, and coordination can guide you. Patients exercising on their own can still show major weakness even years after a total knee replacement. This can put you at risk for falls and other injuries.

Every person is different and has his or her own unique needs for rehab after joint replacement. A closer look at what you’re doing and how you doing can lead to an answer to your question.

It’s likely that some form of exercise will be advised. Regular exercise and physical activity has been shown to keep joints healthy, even joints already affected by arthritis. Make it worth your while to exercise. Find out what’s best for you in this phase of your recovery.

Could soccer playing wear out my hip?

admin — Wed, 23 Jun 2010 18:20:49 +0000

I’m 45-years old and need a hip replacement because of arthritis. I played soccer from the time I was in pre-school all the way through college. Even as an adult I played on coed rec teams. Could the soccer playing wear my hip out?

Playing soccer may not be the issue. Studies show it’s the sports injuries players get that increase the risk of osteoarthritis. Ankle and knee injuries are common among soccer players. Since these two joints are in a direct line-up with the hip, it makes sense that such injuries can lead to arthritis later.

Another risk factor for injury and thus arthritis is left-leg dominance. At this point we know more about what isn’t a risk than what is. In studies of soccer players ages 12 to 18, there was no apparent increase in risk of injury linked with body size or type, balance, strength, or flexibility. Preseason play didn’t seem to make a difference either.

Pain control after total hip replacement surgery – what helps?

admin — Tue, 15 Jun 2010 23:51:18 +0000

Two months ago I had a total hip replacement. I wasn’t prepared for how painful it was afterwards — worse than my arthritis. Now I’m glad I had it done but I can’t help but wonder why they can’t do more for patients to reduce the pain.

Pain control after major orthopedic surgery has really come a long way. General anesthesia (putting the patient to sleep) was the standard way to operate for years. But there were serious problems with blood loss and blood clots.

Over time doctors have been able to narrow the anesthesia down to the specific area being operated on. This is the use of nerve blocks called regional anesthesia. The risk of blood clots is much less. Patients are also less likely to have nausea, vomiting, fever, and breathing problems.

Postoperative pain is still a problem. The latest effort to control pain after a hip replacement is the continuous use of nerve blocks. The doctor keeps the leg from feeling any pain for hours to days after the surgery. The hope is to find a drug that will do the same thing but still allow the patient to go home.

For now, a combination of anesthesia and narcotics seems to work well. Each patient is different so it’s never clear what dose of each drug is ideal. Doctors and nurses must adjust both to find the optimal treatment for each person.

Double hip replacement an option?

admin — Mon, 07 Jun 2010 12:01:38 +0000

I have pretty bad hip arthritis. The doctor is going to do a hip replacement on the worst side first. The other side isn’t really too good. How will I manage with one bum hip and the other one just operated on?

You may want to ask your doctor about having both hips done at the same time. If you are in good health and qualify, this may be the best option for you. Without the stiffness and pain on the nonoperative side after a single replacement, you can move along faster in rehab, too!

There’s also a cost savings. Even though you’ll be in the hospital longer than if only one hip was done at a time, the overall number of days is less when both hips are done together.

You can have bilateral hip replacements in one of three ways. First, they can both be done in the same surgery. Second, you could do one and finish rehab before having the second one done. There’s usually at least six to eight weeks between operations. Some people wait longer. Third, you could have one hip done and wait five to seven days. If your health is stable and you’re up for it then have the second one done. With this third method, you don’t leave the hospital between operations.

If you still opt for one hip replacement at a time, then a physical therapist will help you. Your home may need to be adapted to make toileting, bathing, sleeping, and household chores easier. You will likely need a family member or live-in assistant for a few days to weeks, depending on the speed of your recovery.

Time for total shoulder replacement? Not so fast!

admin — Fri, 04 Jun 2010 13:41:18 +0000

I have arthritis in my left shoulder. It hurts constantly, but I can use it for most things. How can you tell when it’s time for a shoulder replacement?

The first place to start is with a medical exam. An orthopedic doctor is the specialist to see for this kind of problem. In some cases, medications and exercise may be all that’s needed. Muscle weakness can cause pain. A good rehab program can reduce pain, improve motion, and increase strength.

Sometimes, surgery to repair a torn tendon or muscle is advised. Many patients with shoulder pain have undiagnosed soft tissue damage. This could have happened years ago after a fall or other injury. A total joint replacement isn’t always the first answer to shoulder problems.