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

My family has a history of hip problems. Is there value in having my hips X-rayed to see if they are okay?

admin — Fri, 03 Feb 2012 11:00:49 +0000

My family seems to have a history of hip problems. We don’t all have the same condition but quite a few have arthritis. Is there any value in going in and having X-rays taken to see if my hips are okay? I don’t have any pain but I’m getting up there in age.

Research shows that about eight per cent of the general population develops arthritis. This is probably an under estimate as it is based on X-rays and many people don’t have routine X-rays that reveal this diagnosis. In an effort to prevent arthritis, there are some experts who suggest routine screening for problems that might result in arthritis. But the cost of performing X-rays and/or MRIs on everyone may not be cost-effective.One condition that can lead to early degenerative changes is called femoroacetabular impingement (FAI). Perhaps one or more of your family members has had this diagnosed as the predisposing factor for their arthritis.Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.A recent study was done to see how many people in the general population have this problem. They took MRIs of the hips of 200 adult volunteers (ages 21 to 50) for a total of 400 hips. By examining the MRIs against other tests performed, they were able to see that 14 per cent of the people had femoroacetabular impingement and didn’t know it.In this study, they specifically looked at age, gender (male versus female), body-mass index (a measure of obesity), and ethnicity. These potential factors may put people at increased risk for impingement and then for going on to develop arthritis later.There were some significant findings from the measurements taken of each volunteer when compared with their MRI results. The elevated angle measured on X-ray (called the alpha angle) wasn’t diagnostic of femoroacetabular impingement by itself. (Though it was a predictor of hip pain and joint cartilage damage). When combined with restricted hip internal rotation, the alpha angle could be used to predict impingement. A positive impingement sign was a reliable indicator of a problem with the labrum (rim of cartilage around the hip socket).What this tells us is that your orthopedic physician can examine you and offer some direction as to whether or not an X-ray or MRI is even needed. If you are painfree and there are no clinical signs of impingement or arthritis, then it may be appropriate to just monitor your situation. This will avoid unnecessary costs and exposure to X-rays while still keeping an eye out for any signs of developing 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.

If you have femoroacetabular impingement, is it inevitable that arthritis will eventually set into that hip?

admin — Wed, 01 Feb 2012 11:00:30 +0000

Is it always the case that if you have femoroacetabular impingement (which I have) that arthritis will eventually set into that hip?

Not necessarily though many individuals with femoroacetabular impingement (FAI) do indeed eventually develop degenerative changes that lead to arthritis. This is most likely to happen in cases of untreated FAI.Let’s define femoroacetabular impingement and talk about how it can lead to osteoarthritis of the hip joint. Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.The cam-type of impingement is the most likely to set up conditions ripe for joint wear and tear. This type 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 tilt or 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 the 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 hip socket. The articular cartilage is the protective covering over the hip joint surface. This abnormal contact between the femur and acetabulum is the leading cause of labral tears and degenerative hip arthritis.Treatment is advised when impingement is painful, limits function, and/or X-rays show potential for joint changes. You may be able to follow a conservative path by modifying activities and carrying out a program of strengthening and stretching exercises. In some cases, surgery is indicated to correct the problem.No one knows for sure who will develop arthritis. Studies are underway to determine how common is the problem and what factors might increase the likelihood of developing arthritis. Your orthopedic surgeon will follow your case and advise you if and when treatment (and what treatment) is appropriate.

About 10 years ago I had ACL surgery. Now, all of a sudden, I’m having painful grinding in the joint. What’s happening?

admin — Fri, 27 Jan 2012 11:00:24 +0000

About 10 years ago I had an ACL repair. Everything’s been just fine and now all of a sudden, I’m having painful grinding behind my kneecap and in the joint. What’s happening?

Researchers at the Steadman-Hawkins Research Foundation in Vail, Colorado have been researching this very problem. They noticed some of their ACL patients were just fine for 10 years — a perfect outcome. Then all of a sudden, they developed arthritis.

They think the problem may be a lack of mobility between the patellar tendon and the tibia (lower leg bone). A condition referred to as patella infera may be part of the problem. With patella infera, there is a permanent shortening of the patellar ligament. The kneecap sits too low in relation to femur (thighbone). The result can be a severely limited range of motion of the knee joint.

Patella infera is a common complication of injury or surgery to the knee joint. It usually doesn’t show up until much time has passed after injury and/or surgical repair.

Treatment options include physical therapy to manually release the kneecap and/or surgery to revise the soft tissues around the knee. If the joint degeneration has gone too far for conservative care to be successful, then total knee replacement may be needed.

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?

admin — Tue, 17 Jan 2012 11:00:58 +0000

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.

Has anything much changed in ACL repairs over the years?

admin — Wed, 11 Jan 2012 11:00:06 +0000

ACL repairs have been around for a long time. I had one when I was a college athlete. Now my daughter who is a collegiate basketball player is having one. Has anything much changed over the years?

Anterior cruciate ligament (ACL) repairs have indeed been around for 30 years or more. Surgeons keep finding ways to improve it. In a recent review of ACL repairs, Dr. Ben Graf from the University of Wisconsin (Madison) gave a good summary of the last 30 years.

He said the first 10 years was spent proving ACL repairs were needed. The second 10 years worked on repairing it from the inside out. And the last decade has been looking at types of grafts (hamstring versus patellar tendon grafts).

The newest change is the use of a double-bundle repair to (maybe) replace the single-bundle method. No matter what kind of graft type used, there’s still a problem with early arthritis in the grafted knee. By studying normal anatomy, scientists think this may have to do with motion that is restricted by the ACL repair.

It seems that the standard single-bundle repair doesn’t allow the normal rotation of the tibia (lower leg bone). This type of motion is needed when an athlete pivots and shifts his or her weight to move in a different direction. The double-bundle repair attaches the tendon graft in two places instead of one. The idea is to mimic the anterior and posterior (front and back) attachments of the normal ACL.

But like many new things on the horizon, this one hasn’t been fully tested and approved. The next decade may bring many innovative changes. Improved technology and new surgical instruments will bring about these changes.

Is there more that I can do for the stiffness and pain in my football injured knees besides exercises and using braces?

admin — Thu, 05 Jan 2012 11:00:00 +0000

I’m 23-years old and already blown the meniscus in both my knees playing football. I’ve done exercises and used braces but there’s still so much pain and stiffness. Isn’t there anything else I can do?

Treatment depends somewhat on your goals. If you are planning to return to competitive sports, then analgesics to control the pain and rehab may be your best options. However, you should be aware that without the meniscus, your knees are at increased risk for damage and changes from arthritis.

If possible, the meniscus is repaired rather than removed. Most patients are encouraged to put aside strenuous, high-impact activities to protect their joints.

For some younger patients, meniscal transplantation may be the answer. Cartilage freshly donated or stored in a frozen state may be used. The knee must be stable and in good alignment. There can’t be any bone spurs.

A surgeon will conduct a physical exam. How you stand and walk is evaluated. Knee joint motion and alignment are important. Too much angle at the knee may keep you from being a good candidate for this surgery.

This treatment option is only considered for younger patients (less than 40 years old). The down side is that long-term studies haven’t been done to show results 10, 20, or more years ater.

Talk with your doctor about what’s best for you given your age, activity level, and sporting goals.

What happens if a total knee joint replacement fails?

admin — Tue, 03 Jan 2012 11:00:34 +0000

What happens if a total knee joint replacement fails? My father just got the bad news that his new joint isn’t working. Infection has caused it to become loose. The pain and loss of function is worse than his arthritis before the joint replacement.

The surgeon will make every effort to get the infection under control and save the implant. If this doesn’t work then the implant may have to be removed. At this point treatment is still focused on clearing up the infection.

A revision surgery may be possible. After the implant is removed and the infection is under control, then a second implant may be inserted into the joint. If this is not possible, then a fusion may be needed.

With a fusion or knee arthrodesis, the patient can still put weight on that leg and walk but motion is very restricted. Getting in and out of a car or on and off a bus can be very difficult. Sometimes the surgeon has to shorten the leg so the patient can swing the leg through when walking.

Knee arthrodesis isn’t ideal but it does save the leg.

My father had a total knee replacement six months ago and still has pain and stiffness. Does this happen very often?

admin — Thu, 22 Dec 2011 11:00:00 +0000

My father had a total knee replacement six months ago and still has pain and stiffness. We think the surgery was a big failure. Does this happen very often?

Total knee replacement (TKR) is usually a very reliable way to give arthritis patients relief from their symptoms. About 95 percent of all TKR patients have a good result after surgery. But in five percent problems of pain, stiffness, and swelling can persist.

There are many possible causes for this outcome. If your father hasn’t been to his doctor, a re-examination is important. The surgeon will conduct a careful evaluation to see if the problem is coming from inside or outside the joint.

Many older adults have multiple health problems. These are called comorbid conditions. Neurologic problems, poor circulation, even depression are just a few comorbidities that can affect the results of surgery.

My knee replacement heats up after exercise. Should I be worried?

admin — Mon, 21 Nov 2011 11:00:25 +0000

I can tell my new knee replacement heats up inside after I start to exercise. It seems to happen most often after I walk 20 to 40 minutes. Biking the same amount of time causes some warmth but not as much. Should I be worried?

There may be some cause for concern. Temperature increases in the joint can cause cell death and fibrous tissue to form. These changes can lead to pain and implant loosening.

A recent study at the University of Washington (Seattle) compared the temperature inside three types of knees. They measured the knees of normal adults, adults with arthritis, and patients with total knee replacements. The normal knees increased temperature by about one-degree after 20 to 40 minutes of activity (biking, walking).

Some of the implants had 2 to 3-degree changes. Knee replacements made of cobalt-chromium seem to generate the greatest amount of heat. Find out what kind of implant you have and what’s normal for that replacement. Make sure you go to your follow-up appointments with the surgeon. X-rays can be used to detect any early problems with the implant. Warmth can also be a sign of infection, which should be evaluated by your doctor.

Pain on inside of hip could be arthritis

admin — Thu, 22 Sep 2011 11:00:03 +0000

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.