Arthroscopy vs. open repair for rotator cuff tear

August 19th — admin

I injured my rotator cuff years ago. I probably tore it more than once as it was healing. My surgeon has suggested doing a procedure to repair the damage and restore some function in that arm. I’d be happy just to have less pain at night. I know they can do these operations now without even opening you up. Do you think I can have that kind of surgery?

You may be referring to an arthroscopic procedure. The surgeon makes two or three puncture holes and slips a long, thin needle into the damaged area. A tiny TV camera on the end of the scope provides a look inside the joint. The type and location of tendon damage can be assessed using this technique.

But an open repair has some advantages. In this procedure, the surgeon can see the full extent of any damage. Details of the injury are clear and nothing is missed. Results are actually better after open repair compared to arthroscopic repair. There are fewer retears after open repair.

The main disadvantage of the open repair is that the deltoid muscle is split in half to give the surgeon access to the shoulder. The muscle is sewn back together afterwards, but it leaves the arm at a mechanical disadvantage until healing and full recovery take place.

Some surgeons begin with an arthroscopic examination. If the injury can be repaired arthroscopically, then they go ahead and complete the operation. But if the damage is extensive, then the shoulder can be opened up and the procedure completed. Magnetic resonance imaging (MRI) can help in the decision-making process. The MRI helps the surgeon assess tendon damage, healing, and anatomy. Size and location of the tear can be established. It can be determined whether the tear is partial or full-thickness. This makes a big difference in planning the surgical repair.

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 just starting to research the idea of a metal hip joint resurfacing procedure. What can you tell me about this treatment?

April 29th — admin

I’m just starting to research the idea of a metal hip joint resurfacing procedure. What can you tell me about this treatment?

Hip resurfacing arthroplasty is a type of hip replacement that replaces the arthritic surface of the joint but removes far less bone than the traditional total hip replacement.

Because the hip resurfacing removes less bone, it may be used for younger patients. Hip joint resurfacing is a good idea for those who are expecting to need a second, or revision, hip replacement surgery. The need for a revision operation increases as they grow older and wear out the original artificial hip replacement.

During the procedure, the femoral head is dislocated out of the socket. Special powered instruments are used to shape the bone of the femoral head so that a new metal surface will fit snugly like a cap on top of the bone. The cap is held in place with a small peg that fits down into the bone. The hip socket may stay the same, but more often it is replaced with a thin metal cup.

The patient must have enough healthy bone to support the cap. The metal materials hold up well under the increased activity of a younger adult group of patients. There is a lower risk of hip dislocation after joint resurfacing compared with a total hip replacement. This may be because the fit is so much closer and better for hip resurfacing.

There have been some problems with metal-on-metal hip joint resurfacing. For example, tiny pieces of metal can fleck off the implant with prolonged wear and tear. Those metal ions can create irritating debris in the joint contributing to increased wear and tear.

Long-term reports of metal-on-metal hip resurfacing are fairly limited in number. Future research efforts are needed to observe the natural history after hip joint resurfacing and report on long-term results.

One study after 12-months reported a 75 per cent satisfaction rate. But this means that one-quarter of the patients were not happy with the results. Factors contributing to suboptimal recovery are unknown. It could be a lack of rehabilitation after the operation. It could be a different type of rehab is needed for hip joint 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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I am under 55 and my doctor says I should have a partial hip replacement. Can you explain what that is?

March 10th — admin

My hip is going to be replaced but I am under 55. My doctor says that people my age who are active should have something called a partial hip replacement. Can you explain what that is?

A total hip replacement, called a total hip arthroplasty (THA) literally replaces the hip joint. The implant is attached to the bones and is set into place.

A partial replacement, called total hip resurfacing, replaces only part of the hip, which provides an advantage for many people.

With hip resurfacing, the surgeon reshapes the head (top) of the femur (thigh bone) and fits a lining over it, as opposed to the total replacement that will remove that part of the bone and replace it with an implant. With the resurfacing, the bones need to be strong and able to withstand the force of the procedure, so people who have weakened bones are not able to have this type of surgery.

The benefits to the resurfacing are that it appears to have a lower dislocation rate, the healing time is faster, and because the head of the femur is preserved, there is enough bone left for further surgery if it is 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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Advancements in hip replacement surgery yield improved outcome

September 28th — admin

A hip that is painful as a result of osteoarthritis (OA) can severely affect your ability to lead a full, active life. Over the last 25 years, major advancements in hip replacement have improved the outcome of the surgery greatly. Hip replacement surgery (also called hip arthroplasty) is becoming more and more common as the population of the world begins to age.

For a complete overview of hip replacement surgery, download this booklet.

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. For more information on this subject, visit www.zehrcenter.com.

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Sling or Surgery? What's Best for Dislocated Shoulder?

August 19th — admin
One of my rugby buddies is going to have surgery for a shoulder dislocation. My shoulder has dislocated three times since I first injured it last season. I haven’t had surgery and don’t even know if I was given the option. Should I have surgery?

 
In a recent study of people under 30 years old with a shoulder dislocation, arthroscopy surgery was compared to the more traditional approach of slinging the shoulder. Nearly everyone who chose surgery had an excellent return to strength and movement without having a future dislocation. Most of the sling-only patients had another dislocation within the year. Share your concerns with your orthopedist.

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. For more information on this subject, visit www.zehrcenter.com

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Loosening socket most common reason for failure of shoulder arthroplasty.

July 21st — admin
What’s the most likely thing to go wrong with a total shoulder arthroplasty?

 
The most common reason total shoulder arthroplasties fail is loosening of the glenoid, or socket, component. Sometimes the new socket doesn’t line up right, or it may loosen, move, or even dislocate. Loosening occurs in about 10 percent of cases.

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. For more information on this subject, visit www.zehrcenter.com 

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