I have a labral tear of the hip. What kind of surgery can they do for this problem?

January 16th — admin

I’ve been diagnosed with a labral tear of the hip. I’m scheduled to see a specialist next week but thought I’d do a little research of my own on the Internet before my appointment. What kind of surgery can they do for this problem?

The labrum is a thin but helpful extra layer of cartilage around the hip and shoulder joints. In the hip, it helps extend the edges of the joint socket to form a deeper cup for the round head of the femur (thigh bone). This helps keep the joint in the socket while still allowing a wide range of movements needed by the leg.Damage to the labrum can result in painful symptoms. Sometimes there is a clicking sensation and the hip can even get locked up if the torn labrum gets caught between two structures of the hip. Loss of hip motion is the outcome of either of these symptoms. There is a chance that the labrum can heal itself but most of the time, surgery to remove the ragged edges of the torn labrum is required. This procedure is called debridement. The surgeon shaves off the ragged edges of the labrum and smoothing the remaining edges.A more extensive surgery called a partial labrectomy may be needed. This involves removing the unstable part of the labrum. Studies show that partial labrectomies have better outcomes when there isn’t damage to the underlying layer of cartilage attached to bone. The success rate drops from 90 per cent without chondral lesions down to 21 per cent for those patients with chondral defects.A newer approach to labral tears is now in use: labral repair. During a labral repair, the surgeon uses stitches and surgical anchors to reattach the torn labrum. Results of labral repairs have not been published yet in English-language medical journals. Most of the research that has been done has been published in European or Spanish-language journals. When valid and reliable tools are available, the results of debridement, partial labrectomy, and labral repair can be compared.Your surgeon will probably go over the various surgical options available to you and recommend the one that will work the best for the type of injury and damage you have.

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 heading into arthroscopic surgery. What kind of recovery should I expect?

December 29th — admin

I’m heading into arthroscopic surgery for my right hip. The surgeon is going to take a look around but for sure remove some pieces of cartilage that are floating around in there. What kind of recovery or rehab should I expect?

Hip arthroscopy is becoming a more common orthopedic procedure now with more and more hip injuries among the athletic crowd. Better imaging technology has also made it possible to find what’s wrong or what’s causing painful symptoms. Loose bodies in the joint is just one of the many reasons why arthroscopic procedures are used so successfully.But you are right — there is a postoperative program. And it’s important that patients complete this program in order to restore full joint motion, strength, flexibility, and function.The specifics of the program depend somewhat on the type of surgery that was done. For example, removing free-floating debris in the joint is a much simpler procedure than repairing deep holes in the cartilage. Likewise, repairing a torn labrum (fibrous rim of cartilage around the hip socket) may only require a simple home program. But there are some procedures that take longer to recover from and involve a slower pace of recovery.And competitive athletes will follow a four-step process of rehab progression. These four phases include 1) mobility and initial exercise, 2) intermediate exercise and stabilization, 3) advanced exercise and neuromotor control, and 4) return to activity.A physical therapist will show you what to do, how to do it, and how to advance or progress the program. You will probably start out on crutches for the first week to 10 days and gentle active motion of the hip. When you have full motion, the exercises assigned next are designed to restore strength and normal contract/relax sequences of all the muscles around the hip.Core (pelvis and trunk) stabilization exercises are recommended next along with balance training. And finally, if you are active in a sport or specific activity, you’ll be shown how to prepare to return to that sport. The goal is to participate fully without fear of reinjury.

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’s a lateral overhang of the kneecap? X-rays show that my daughter needs surgery for kneecap overhang problems.

December 20th — admin

What’s a lateral overhang of the kneecap? X-rays show that my daughter needs surgery for kneecap overhang problems.

The kneecap or patella sits over the knee joint and moves up and down along a track of cartilage. Connective tissue on each side called the retinaculum help hold it in place and guide it up and down in the track.

Patellar instability occurs when one side of the retinaculum is tighter or looser than the other. The kneecap can move out of the track and sublux or even dislocate. When this happens over and over the patella doesn’t always go back to the middle. One edge hangs over the side (as seen on X-ray).

Conservative care with physical therapy, exercises, and bracing or taping is the usual treatment. If these measures don’t help after three months then surgery to rebalance the retinaculum may be considered.

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’s a bucket handle tear? That’s the kind of meniscal tear I have.

December 12th — admin

What’s a bucket handle tear? That’s the kind of meniscal tear I have.

The knee joint has two horseshoe or C-shaped pieces of hard cartilage called the menisci. There’s a medial (inside edge) and lateral (outside edge) meniscus. Both menisci are attached to the bone.

The medial meniscus is also attached to the joint capsule and one of the ligaments. These extra attachments make it less mobile but also more likely to tear under force. In fact the medial meniscus is torn twice as often as the lateral.

When the meniscus is torn and the tear goes the length of the cartilage it’s called a bucket handle tear. If you could touch the torn meniscus, it’s possible to lift the torn section up like a bucket handle.

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 do I decide which knee replacement to use?

November 9th — admin

My orthopedic surgeon showed me half a dozen different joint implants that could be used for my knee replacement. How do they decide which one to use?

There are many factors involved in choosing the right implant for each patient. The goal is to use the implant that can give the most motion and function without losing stability. Some implants have more constraint or limits than others.

The condition of the soft tissues in and around the joint is a big factor in implant selection. The surgeon must try and balance these structures to allow as much flexion and extension as possible.

Sometimes the ligaments are torn or the cartilage is damaged. The surgeon may try to save these structures. Or it may be necessary to remove them. Certain knee implants are designed based on whether the ligaments are present or absent.

The patient’s activity level can also make a difference. Implants with greater constraint puts more stress and load on the implant-bone interface. A very active person may experience implant loosening and failure with this type of joint replacement.

There are other things the surgeon must think about. It makes a difference if the patient is bow-legged or knock-kneed. If the kneecap must be removed (or has already been taken out), the load on the ligaments increases. Choosing the right implant is a challenging and important task for any surgeon.

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 a bone bruise? After a car accident that dislocated my hip, I found out I also had a bone bruise around my knee.

May 6th — admin

What is a bone bruise? After a car accident that dislocated my hip, I found out I also had a bone bruise around my knee.

Pain around the knee after traumatic hip dislocation is often caused by a bone bruise. The force of the impact through the knee may cause tiny fractures. These occur just under the cartilage in the first layer of bone called subchondral bone.

Bone bruises can also occur as a result of falls, sports injuries, or a direct blow to the knee from people or objects. Bruises can be painful (mild to severe) and last from days to months. MRI shows swelling inside the bone marrow as a sign of a bone bruise. The injury usually heals on its own without treatment. Surgery may be needed if there’s a large fracture of any of the bones around the knee.

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 using an ice pack on my knee, the joint feels really frozen. Is there any actual change in the temperature inside the joint? Or is it just the skin that gets cold?

April 12th — admin

After using an ice pack on my knee, the joint feels really frozen. Is there any actual change in the temperature inside the joint? Or is it just the skin that gets cold?

Today’s technology has brought us new temperature measuring systems. These tools allow scientists to measure and graph temperatures inside the knee joint. This is helpful because keeping a cool joint can help prevent painful swelling after surgery.

A recent study from Spain measured the temperature inside the knee joint. Measurements were taken during and after arthroscopic surgery. A temperature probe in the joint fluid took the joint temperature every 30 seconds during the operation.

They found the temperature inside the joint was lowered by four degrees after using a saline solution to flush the joint out. The saline solution was kept at room temperature. Other studies also show that the normal temperature inside the knee joint is lower than normal body temperature.

Normal core body temperature is between 97 and 99 degrees F for most people. Internal knee temperature is between 90 and 95 degrees. The difference is most likely due to a fact lack of blood supply to the cartilage in the normal knee. 

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’ve heard a lot about ACL tears in the knee. Are PCL tears just as bad?

March 22nd — admin

I’ve heard a lot about ACL tears in the knee. Are PCL tears just as bad?

There are two major ligaments in the knee joint: the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). By far, the ACL is injured or damaged more often than the PCL. Not as much is known about what happens when the PCL is torn. A recent study in Germany tracked 181 patients with PCL tears who did not have surgery to repair the injury. They found that damage to the joint cartilage after a PCL tear is common. In fact, more than half of all patients with a PCL tear develop cartilage damage and arthritis after that.After a PCL tear, there is a change in where the knee joint comes together during movement. A weak PCL causes more pressure on the inside edge of the knee. Higher loads and greater force act on the cartilage. The cartilage gets worn down and damaged.

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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The torn meniscus has been repaired, should I bother with a second surgery for the damaged anterior cruciate ligament?

January 26th — admin

I have a torn meniscus and a damaged anterior cruciate ligament in my left knee. The meniscus was repaired with arthroscopic surgery. The surgeon couldn’t repair the ligament at the same time. I’ll need a second surgery for that. Right now my knee is much better. Should I even bother having the ligament fixed?

One of the jobs of the anterior cruciate ligament (ACL) is to keep the lower leg bone (tibia) from sliding too far forward on the upper leg bone (femur). A weak, lax, or insufficient ACL means higher stress on the knee cartilage.

The medial meniscus is affected the most. This is the C-shaped piece of cartilage on the inner (medial) side of the knee joint. Repairing the ACL will unload the medial meniscus and make it less prone to further damage or degeneration.

Your surgeon will be able to guide you in making this decision based on your symptoms, the result of tests, and the peek he or she had inside the joint during the meniscal repair. The results of many studies suggest a better long-term result if the ligament is repaired either at the same time as the meniscal tear or soon after.

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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Are stem cells used to grow cartilage?

March 3rd — admin

I’ve heard there’s a way to regrow torn cartilage in the knee. Are they using stem cells to do this?

Not yet. Researchers at Johns Hopkins have tried using stem cells to grow into tissue that’s like cartilage. They are testing a method injecting fluid filled with stem cells into the joint. The liquid hardens into a stable gel when placed under a special light. Stem cells inside the gel start to multiply and form new cartilage. So far only animals have been used in these studies.

In the meantime, doctors have found two other ways to get cartilage to repair itself. The first is called microfracture. Surgeons use a blunt awl (a tool for making small holes) to poke a few tiny holes in the bone under the cartilage. This causes new tissue, mainly scar tissue, to grow and fill in the holes.

The second is autologous chondrocyte implantation. Normal, healthy cartilage cells are taken out of the knee. They are sent to a special lab where more cells are grown from the original cells. The new batch of cells are put into the joint surface where the damage is located.

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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