After six years, my total knee replacement had to be replaced. How often does this happen?

December 30th — admin

Six years after my total knee replacement, the implant came loose and had to be replaced. The surgeon told me the first joint implant was turned in a few degrees too many and that’s what caused the problem. How often does this happen?

Alignment is one of the most difficult aspects of knee joint replacements for the surgeon. Instruments used to make the bone cuts are based on average bone shape. But bone size and shape can vary from patient to patient.

The surgeon can’t always tell when a joint with a new implant is still slightly flexed at the end of the operation. In fact it can be bent as much as 10 degrees when fitting the implant in but look straight. There is also a tendency to internally rotate the upper (femoral) half of the implant. The result is often loosening and failure of the prosthesis.

Scientists are working with surgeons to limit and eventually eliminate this problem. The use of 3-D computer programs before surgery may help surgeons plan ahead. Plotting out when and where to make bone cuts and forming a template of the patient’s joint may help improve accuracy of alignment.

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 an “incomplete” repair of the meniscus?

July 27th — admin

Three years after a meniscal repair I started having painful clicking in my knee again. The doctor says the repair was “incomplete.” What does that mean? I may have to have another operation to repair the problem.

Incomplete healing of a torn mensicus is usually found by having a second arthroscopy.

The surgeon makes one or more puncture holes in the skin and inserts a long, thin needle called a cannula into the joint.

Tiny tools can be passed through the cannula including a miniature TV camera to take a look inside the joint. What the surgeon sees as an incomplete healing of meniscal tears is a cleft or gap at the site of the tear. It may go down 10 to 50 percent of the thickness of the meniscus.

A gap of more than 50 percent is a nonhealed repair. A second operation is often needed in such cases.

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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When can patient play tennis again after arthoscopic shoulder surgery?

June 21st — admin

I’m going to have an arthroscopic surgical procedure for a problem with a chronic left shoulder dislocation. I’d like to get back on the tennis court in time for the adult summer league. What kind of rehab program should I expect?

Rehab programs after a shoulder stabilization procedure may be the same whether it was an open versus closed procedure. Sometimes this depends on the surgeon’s preferences. Type of sutures used, amount of damage to the soft tissues, and condition of the joint capsule are only three of the important considerations.

Most often, the protocol used during the early phase of rehab is one that can be modified for each patient. Your therapist will advance you along as quickly as possible. The rehab protocol is really just a guideline.

Most likely you will be put in a shoulder immobilizer (sling) in the operating room. This is worn for two to four weeks. Exercises are started at two weeks. Passive and active-assisted partial range of motion is allowed. Full, active range of motion is permitted at six weeks.

The therapist will progress you to and through a series of strengthening exercises. The speed at which you will be able to advance may depend on your level of pain, degree of stiffness, and strength. You will be able to start training for tennis participation between eight and 12 weeks. If there are no complications or problems, you may expect to return to your sport about four months after surgery.

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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Arthroscopic vs. incision approach for golfer’s shoulder, which is better?

June 16th — admin

I’m a semi-pro golfer with a bad shoulder from chronic dislocations. The surgeon has offered to do a stabilization procedure with either an open incision or arthroscopically. Is there much difference between these two operations?

Improvements in both surgical procedures has narrowed the gap of advantages of one over the other. The arthroscopic approach uses two or three puncture wounds to insert a long, thin scope into the joint. It has been suggested that this approach has a more pleasing appearance and shorter operative and recovery time.

The incision approach uses a fairly small open incision to access the joint. The main difference is that the subscapularis muscle is split during the open surgery. Some surgeons feel this puts the patient at a strength disadvantage.

To check out this theory, a team of surgeons and sport medicine staff from Canada put it to the test. They compared before and after muscle strength of the shoulder for an equal number of patients treated arthroscopically versus with an open incision.

They were surprised to find out that patients in both groups had significant strength deficits. External rotation was affected more than internal rotation for both groups. But there wasn’t a discernible difference between the two groups. The reason for these two findings remains unknown but a point of interest for future research.

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 ever too late for surgery to repair torn rotator cuff?

June 22nd — admin

I have a large rotator cuff tear in my left shoulder. I’ve been putting off surgery and trying everything else first. I’m ready to throw the towel in and have the surgery. How do you know when it’s too late for an operation to help?

There’s nothing wrong with trying conservative care before going for a rotator cuff repair. In some cases, anti-inflammatory drugs help. In other cases, cortisone injections or physical therapy can make a difference.

But for patients who still have pain, loss of motion, and reduced function, surgery may be the best option. Many patients put it off for months and even years. They still report a good result after the operation.

New methods using arthroscopic surgery and tiny incisions have changed the results of this operation. Even full-thickness tears or tendons that have retracted far away from the place where they normally attach can have a good outcome.

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.

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How long is the recovery period after shoulder surgery?

April 2nd — admin

I’m going to have arthroscopic surgery to repair a torn rotator cuff. I really need full motion to do my job. How long will it take to get it back?

Right after surgery, you’ll probably be wearing a sling. This is kept on for a week to ten days according to your comfort level. You will be allowed to move your shoulder in two directions so long as it doesn’t hurt. The first is shoulder flexion (forward) and the second is outward rotation (elbow is held next to the body, hand moves away from the body).

By the end of the month, you may be given exercises using as much motion in all directions as pain will allow. Your full motion should be returned by 12 weeks. A recent study showed that patients who have a rotator cuff repair using only arthroscopic surgery regain motion faster. Patients who have an open incision get back their full motion, but it takes longer.

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.

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Arthroscopy may be answer to cyst removal at knee joint

February 8th — admin

I’ve had the fluid removed from a cyst behind my knee twice now. Why does it keep coming back?

Doctors think there are several reasons for this. First, the cysts have thick walls with twisted, deep roots. The body can’t dissolve or absorb this tissue. There’s also a valve between the cyst and the joint. This opening allows fluid to move from the joint into the cyst.

Often other damage in the knee adds to the problem. A new study by two doctors in South Korea report better results for cyst removal using arthroscopy. A special tool with a tiny TV camera is inserted into the cyst. The fluid is taken out. Then the cyst wall is removed with a motorized shaver. Any other damage in the joint is repaired at the same time. They’ve had 100 percent success in treating cysts this way.

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.

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Knee surgery video reveals lots of tools in use, but how?

February 3rd — admin

I had some pretty fancy surgery done last week inside my knee joint. The doctor gave me a video of the entire operation. What I can’t figure out is how they got all those tools I saw on the video inside my knee. What can you tell me?

It sounds like your surgeon used an arthroscope to enter the joint. This long, slender tool pokes through the skin and tissue right into the knee joint. A tiny TV camera on the end allows the physician to see inside the joint.

There’s a special part of the arthroscope called a cannula. The cannula can be a rigid or flexible tube. It’s used to drain fluid or guide other instruments into the joint.

New tools have been made for arthroscopic surgery. There are forceps, shavers, measuring rods, and even tiny drills that can pass through the cannula. Once inside, the doctor uses special foot pedals and hand held devices to guide the camera and operate the tools. Frayed tissue can be shaved smooth. Torn cartilage can be sewn or glued back down. Bone chips can be removed and so on.

You can watch a total knee replacement surgery and get more information on Dr. Zehr’s Web site.

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.

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Arthroscopic procedure to relieve frozen shoulder pain described here

January 20th — admin

I’m going to have an arthroscopic release of a frozen shoulder next week. Can you tell me what is done during this operation?

The basic steps to this operation are the same from patient to patient. There may be some small differences based on what the doctor finds during the procedure.

First you will be anesthetized or put to sleep (some patients have a nerve block and remain awake but feel no pain). The doctor will gently mobilize the shoulder joint. This means while lying on your back, your arm will be lifted and rotated inwardly. This shows the doctor how the back (posterior) half of the joint capsule is moving (or not moving if it’s stuck or bound down).

Then the arm is gently moved out to the side away from the body. This motion is called abduction. Next the arm is rotated outward. This is done first with the elbow bent and then with the elbow straight with the arm down at the side. This gives the doctor information about the front (anterior) half of the joint capsule.

In the final step, the doctor uses a special tool (arthroscope) to look inside the joint for any areas of scar tissue, inflammation, or tears in the capsule. The scar tissue will be released and any rough spots shaved smooth. The doctor may cut and remove the joint capsule from the front and the back. Any other damage will be repaired and space made for all structures to move freely.

Most patients are seen in physical therapy right away. Rehab often continues after discharge from the hospital. A home program is essential.

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.

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