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

February 3rd — admin

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.

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

February 1st — admin

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.

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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Does femoroacetabular impingement (FAI) surgery work? What are my chances for a successful FAI operation?

January 30th — admin

My question for you today is: does surgical treatment for femoroacetabular impingement (FAI) work? I’m facing the decision whether or not to have this surgery, and I want to know what my chances are for a successful operation.

We may find some helpful information to answer this question from a recent systematic review of studies done regarding surgery for femoroacetabular impingement (FAI). The statistical significance of any conclusions from a systematic review is worth noting. That’s because such a review combines the results of many smaller studies to give an overall view of the results of treatment like surgery for FAI of the hip.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.Most studies on this condition are case studies. That’s because no one surgeon sees 100s or 1000s of patients with this problem. Case studies are good because surgeons have to start somewhere when trying to see the effects of treatment. The problem with published case studies is that this is considered a low level of evidence. A surgeon wouldn’t want to treat any patient with methods considered “successful” based on low levels of evidence. Conducting a systematic review like this one allowed the authors to examine the data on 970 different patients (collected from 23 reports of case studies). Now surgeons can see what the latest findings are and evaluate their own practices based on what is statistically significant.One of the questions specifically addressed in this review is the very same one you raise. Does surgical treatment for femoroacetabular impingement (FAI) work? The answer to this question may depend on how “success” is defined.If pain relief is the measured outcome, we know that the majority of the 970 patients included did have relief of painful symptoms. A second outcome was improved function. That was also a benefit of surgical repair for femoroacetabular impingement (FAI). Levels of patient satisfaction as an outcome measure were not so high. For those patients whose pain didn’t improve and especially those patients who ended up having a hip replacement, reported patient satisfaction was low. In some studies, the rate of dissatisfaction and/or conversion to hip replacement was as high as 30 per cent.The obvious next question is: can we predict who will have a poor result? That’s a simple question that doesn’t have a simple answer yet. One risk factor for worse outcomes with femoroacetabular impingement surgery is advanced joint arthritis at the time of the diagnosis. But there are two problems with relying solely on this factor.First, not everyone with severe damage has a poor outcome with surgery. Just as many patients with severe damage had good outcomes as those who had a failed treatment. The reasons for those differences remain unknown and will require further study. Second, even with X-rays and MRIs, it isn’t always possible for the surgeon to know the full extent of the damage. Sometimes, it isn’t until getting inside the joint that the surgeon can see what’s really going on. These tests are still important and the results should be discussed with you by your surgeon when making the final decision about the best treatment choice for you.

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

January 27th — admin

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.

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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Early treatment of hip disorders can prevent later complications

January 18th — admin

Ever since I was a young teenager (maybe around 13 or 14), I’ve had a snapping hip problem. The general consensus at that time was to just ignore it. Now I’m in my late 30s and it is still bothering me. Should I see someone about this before another 20 years go by — or is it still considered a benign problem (don’t worry about it)?

It might depend on the cause of the problem. If you have a femoroacetabular impingement, then early osteoarthritis is possible, even probable. Just the slightest change in the morphology (shape and structure) of the hip joint can cause problems like this. Femoroacetabular 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 first type of femoroacetabular impingement (FAI) is called pincer impingement. This type occurs when the rim of the acetabulum (hip socket) sticks out farther than normal. There are several causes of this problem. There can be an overgrowth of cartilage forming the rim or even extra bone that forms in the area. Sometimes the hip socket is tilted backward slightly. In either case, every time the athlete flexes the hip, the rim that’s sticking out too far pinches the labrum against the neck of the femur. The labrum is a fibrous rim of cartilage around the socket to help give it some depth. It is a normal part of the hip biology.

The second type of femoroacetabular impingement is called CAM impingement. Normally, the head of the femur is a smooth, round shape. It is even all around so it can rotate inside the socket evenly. But any change in the shape can cause it to hit one point of the socket more than the others as the head of the femur moves inside the socket. The asymmetrical rotation of the pistol-shaped femoral head is called the cam effect. Anytime something repeatedly rubs against something unevenly, there is uneven wear, tear, and damage. In this case, when the hip is flexed or bent, the unevenly shaped femoral head doesn’t glide over the labrum as it should. Instead, it bumps up against the edge of the cartilage. Over time, the labrum gets worn down to the bone.

And finally, the third type of femoroacetabular impingement is a combination of the two just described (pincer and cam). Cam impingement is more common in males and brings on symptoms earlier than the pincer type. The combination of both types together causes problems sooner than if only one type was present. The best thing to do is see an orthopedic surgeon for an examination and diagnosis. It may be good to do this before any more time passes by. Early recognition and treatment of most hip disorders involving the soft tissue structures help prevent serious complications later.

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 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 a Catholic priest and every time I kneel down my hip replacement squeaks. What can I do?

January 12th — admin

I am a Catholic priest with a strange problem. Every time I kneel down and get back up, my hip replacement squeaks. And it’s loud enough to be heard by every one at Mass. What can I do about this?

You are not alone though your situation is certainly unique. The problem of squeaking hips after joint replacement has increased in the last 10 years with the increased use of hard-on-hard bearings. What do we mean by hard-on-hard bearings? The two main parts of the hip that are replaced include the round head at the top of the femur (thigh bone) and the cup-shaped hip socket.The materials used for these component parts can be ceramic-on-ceramic, metal-on-metal, or metal-on-polyethylene (plastic). Metal-on-metal and ceramic-on-ceramic are the hard-on-hard bearings. Ceramic-on-polyethylene and metal-on-polyethylene are considered hard-on-soft bearings.It appears that there are three main factors involved and usually more than one reason for the squeaking. Patient factors such as body size and mass (larger), height (taller), and activity (hip flexion) may be part of the problem. There’s not much a person can do about their height to change the squeaking. But they can be advised to avoid activities or movements that cause the squeaking. That’s a bit tricky for a priest who must genuflect (bend on one knee down and up) or kneel repeatedly. Whenever possible, replace kneeling with bowing. When genuflecting is required, try using the other leg as the bending side. And if possible, find the range-of-motion that is squeak-free and stay within that range. This may mean you don’t go down as far when genuflecting. Sometimes, it’s not the patient at all but rather the way the implant was placed in the hip. The wrong angle, a slight twist of the cup (socket) piece, or a little bit of both has been linked with squeaking.But the most likely factor is the implant itself and in particular, the materials it is made of. The newer implants made of titanium alloy are more flexible and less stiff. This feature could increase the vibrational force that creates friction and squeaking. Other contributing factors include loss of fluid lubricating the hip, tiny particles of metal or other debris from the implant, or damage to the surface of the implant.See your surgeon, if you are unable to find ways to avoid the squeaking. A simple revision surgery may be all that’s needed. Replacing the liner or altering soft tissue tension could make all the difference.

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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There was little concern about my hip pain until I mentioned it was always worse at night. Why?

January 10th — admin

No one seemed particularly concerned about my hip pain until I mentioned it was always worse at night. Then all of a sudden, I had a ticket to the MRI machine. They found a benign tumor (osteoid osteoma) in the upper portion of the femur. Why was this night pain the “hop to it” symptom?

Bone pain from osteoid osteomas usually occurs in young men between the ages of five and 24 (though it has been reported in older adults). Without knowing there’s a tumor present (and without a more dramatic presentation), it’s easy to think that the fellow is having growing pains. But pain at night that wakes the person up from a sound sleep is a red flag for cancer. Then the picture of a young person with bone pain at night suddenly becomes more compelling.Why does this type of pain develop? It turns out that cancer cells can signal the normal healthy tissue to form tiny blood vessels between the healthy tissue and the cancer. The process is called angiogenesis. The net effect is to siphon off blood to the tumor. This creates a loss of blood supply to the surrounding healthy tissue, a condition called ischemia. Without oxygen, the body sets up a pain response. Since most of this happens at night when the body is in a semi-state of hybernation, the symptoms don’t occur during the day.

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 simple hip dislocation? That’s a term being used for my hip fracture and it seems like anything but simple.

December 21st — admin

What’s a simple hip dislocation? That’s a term being used for my hip fracture and to me it seems like anything but simple.

A simple hip dislocation refers to dislocation without a fracture. Complex fracture-dislocations involve popping the round head of the femur (thigh bone) out of the acetabulum (socket) with a fracture of the acetabulum at the same time. Acetabular fractures affect the joint surface where the head of the femur moves against the joint surface to provide joint motion.If you can look at it this way, a simple dislocation has some long-term benefits, too. Only one out of every four patients with a simple dislocation results in hip arthritis later. It’s the dislocations accompanied by an acetabular fracture that present later with problems including arthritis. About 88 per cent of those complex fracture-dislocations damage the joint resulting in death of the bone (osteonecrosis) and osteoarthritis.Simple dislocations are often easier to reduce (set back in place) without major surgery. The patient is still sedated to achieve deep relaxation of the surrounding muscles. But with a few quick and easy techniques, closed reduction is possible. The more complex dislocations with fractures or other injuries often require arthroscopic or even open-incision surgery. There is a greater risk of complications with loss of blood flow, osteonecrosis (death of bone), infection, and poor outcomes with complex dislocations.

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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To test my knee, doctors plant my foot flat with my knee bent and pull on the lower leg. Why?

December 6th — admin

I have a bum knee that probably needs replacing. Over the years whenever I see a doctor they always do the same thing: plant my foot flat with my knee bent and pull on the lower leg. What kind of test is this anyway?

You may be describing the anterior drawer test. This is a test for ligament laxity or looseness. The lower leg bone (tibia) slides or glides forward underneath the thighbone (femur). A certain amount of slide or glide is normal. Too much sliding around is a sign that one of the ligaments inside the knee joint may be torn or damaged.

There is a series of tests for knee ligaments. If you’ve had the anterior drawer test, you’ve probably also been tested for side-to-side and rotational motion. All of these movements are needed for normal motion. Too much or not enough joint “play” or laxity can cause problems and put you at risk for future injury.

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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