What is the risk of breaking a thighbone after revision knee surgery?

May 31st — admin

I had to have my knee replacement revised as we were having problems with it. I had a lot of pain and now that seems to be fixed. But, I read that if you have a revision, you have a higher risk of breaking the thigh bone later. Is this true?

After a knee replacement, the femur, or thigh bone, can be fractured, either due to a trauma like a fall, or just from stress from the bone and the replacement. This does not happen often, but it does happen.

Researchers have found that of the people with these fractures, more patients had had revisions than first time surgery. Therefore, having had a revision, you do have a higher risk of a fracture.

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 are hip socket cysts and how do you get rid of them?

May 30th — admin

When I was a child the doctor diagnosed me with hip dysplasia. Now that I’m older (53 years old), arthritis has set in. The X-rays show quite a few cysts in the hip socket. What causes these and how do I get rid of them?

Bone cysts of this type are an indication of uneven or excessive weight-bearing load. If you have hip dysplasia, the hip socket or acetabulum is probably shallow with shortened margins.

The head of the femur (thighbone) is round and normally fits inside the acetabulum. The curved socket forms a shelf or roof over the femoral head to keep it from dislocating. With hip dysplasia, the round head of the femur isn’t covered by the acetabulum. It can slip upward and even dislocate.

The cysts are a likely sign that there is uneven wear and load from the hip instability. The joint may be trying to cushion itself by forming cysts of this type.

In some patients, a procedure called a rotational acetabular osteotomy can be done for unstable hip dysplasia. The surgeon removes a wedge of bone and uses it to re-angle the joint. A small piece of bone is also used to improve the roof angle.

Studies show that cysts of the acetabulum or femoral head often disappear after this operation. Patients report decrease in pain and improved function.

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 a fracture in the thigh bone necessarily have to be fixed?

May 29th — admin

My father had a knee replacement a few months ago and now he said that his x-ray shows that he has a fracture in his thigh bone. But, the doctor said that surgery isn’t needed. Wouldn’t it be better to fix the break than to just leave it?

One of the most common fractures that can happen to complicate a knee replacement is a fracture in the femur, or thigh bone. Many patients who have such a fracture don’t have any pain or experience any problems with their knee. In fact, often the fracture is only found by the doctor during a routine check up and x-rays.

If your father’s fracture isn’t causing any pain or discomfort and the knee is working well, the doctor takes that into consideration when deciding on treatment. As well, when the fracture is found on the x-ray, it is possible that it has already healed and it is an older fracture that the doctor saw. In this case, there is no reason to perform any repairs.

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 having a total hip replacement, can you break that hip?

May 24th — admin

My 90-year old grandma just broke her hip. She has a total hip replacement on that side, so how can she break a hip?

She may have what’s called a periprosthetic fracture of the femur. The femur is the thighbone. Periprosthetic means the fracture is in the bone next to the implant. The fracture is probably just below the implant and close enough to the hip to be generally referred to as a hip fracture.

Sometimes joint implants crack or fracture but these cases are usually referred to as implant failure rather than hip fracture. Fracture of the femur is not uncommon in patients with either a hip or a knee joint replacement.

Advancing age puts the older adult at risk for bone fracture. Many of the problems that come with aging are also risk factors for fracture. Other age-related risk factors include osteoporosis, diabetes, and arthritis. Anyone who is already experiencing problems with balance and falling is also at risk for bone fracture. Medications such as corticosteroids can weaken the muscles and bones putting patients at increased risk for falls as well.

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 common for a partial hip replacement to cause a hip fracture?

May 8th — admin

My mother just had a partial hip replacement. I guess it was like having a tooth capped. Just the top of her femur was replaced. She ended up with a hip fracture afterwards. Is this common?

It sounds like your mother had an operation called joint resurfacing. This type of operation has been around since the 1930s. It has come and gone based on problems afterwards and materials available. Most recently, new metals have made it possible to resurface the head of the femur (thigh bone) with good results.

Fracture (usually of the femoral neck) is the most likely complication of hip joint resurfacing. It happens in up to four per cent of the cases. Studies show fracture occurs most often in the first 100 cases done by a surgeon. Fracture rates go down as the surgeon becomes more familiar with this technique.

Causes of fracture are both patient and technique-related. Obesity, decreased bone mass, and arthritis make a difference on the patient side. Anyone with a femoral neck cyst should get a total hip replacement instead of resurfacing. Putting the implant in with too much of a tilt or twist can also result in fracture.

Women seem to have a higher risk of fracture after hip joint resurfacing. The reason for this remains unknown at this time. Short-term results of hip joint resurfacing are good to excellent. Long-term studies aren’t available yet. Total hip replacement may be needed by patient who have a fracture after 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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If part of my hip is damaged, do I need a whole hip replacement?

May 6th — admin

I just got the results of my hip X-rays. One hip has arthritis but just at the top of the thigh bone. The round ball in the socket is all broken down. It’s not really round anymore. Do I have to have a whole hip replacement just for one part?

Maybe not! You may have a couple choices. The first is called a hemiarthroplasty. The surgeon removes the round top of the femur (thighbone) and drills out some of the bone down inside the shaft. Then a replacement top and stem are inserted down into the bone.

Or if you are younger than 60 and have good bone stock, you may be able to have a hip resurfacing arthroplasty (HRA). In this operation, just the top or cap of the femoral head is removed and replaced. It’s a lot like having a tooth capped by the dentist.

Your surgeon will be able to tell you both what is possible and what he or she can do. Not all surgeons perform all types of joint implants. Experience is important so it’s a good idea to go with what your surgeon is skilled at doing. If you are a good candidate for a HRA, then you may want to go to a center where this operation is done routinely.

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 hip dysplasia and how will it affect me?

April 24th — admin

I just came back from the doctor’s where I found out I have hip dysplasia. My hip started hurting about six months ago and the X-rays showed this deformity. How often does this happen, and what does it mean in the long-run?

Developmental hip dysplasia (DDH) is probably present at birth or occurs during development in the early years. A change in the normal anatomy results in a shallow hip socket. The angle or tilt of the femur (thigh bone) and rotation of the femoral shaft (long part of the bone) are also different from normal. The patient is at increased risk of partial dislocation called subluxation or even full dislocation.

According to at least one study, this condition occurs in about five to 13 percent of the adult population. The person may not even know it’s there until pain sends him or her to the doctor for an X-ray.

There is some evidence that dysplastic hips have an uneven load across the joint. The cartilage on the surface of the joint can get damaged directly. Abnormal stresses on the soft tissues supporting the joint can lead to wear and tear of ligaments and cartilage.

Damage to the cartilage around the rim of the socket changes the pressure inside the joint. Synovial fluid that lubricates the joint may leak out adding to the wearing away of the cartilage.

No one is quite sure if these changes always occur or how long it takes before they result in arthritis. One study from Denmark reported no adverse changes even after 10 years of untreated DDH. It may be best to treat the hip conservatively but keep contact with your doctor. Any change in symptoms should be re-evaluated sooner than later to prevent excessive damage.

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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Why does my knee click and occasionally lock up?

April 23rd — admin

I seem to have some kind of knee problem but it’s only noticeable when I am go from standing on that leg to walking. Then it clicks. Sometimes (not very often) it locks up on me. What could be causing this to happen?

You may have a tear in the articular cartilage of the knee. This is the fibrous layer of cartilage that covers the end of the femur (thighbone). The only way to know for sure is to have a physician examine you and order some imaging studies.

Weight-bearing X-rays with the knees straight will be taken. Then several other views with the knees bent 30 and 45 degrees are viewed. MRI is the best imaging test for this problem. The signals help identify where and how deep the full-thickness tear has occurred. The MRI also shows the condition of the bone underneath the cartilage.

Depending on the location and size of the tear, you may or may not have symptoms. Or you may have very mild pain and symptoms even when there is a serious tear. Some patients only notice pain when the knee is loaded at a specific range of motion. Symptoms of locking, catching, and clicking with motion are common.

If the tear or lesion is present within the weight-bearing axis, pain occurs only when the joint is loaded at a specific angle. This may be what you are experiencing. It’s best to have a physician examine you. Left untreated, these types of injuries can develop into arthritis.

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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Can a joint replacement get arthritis?

April 16th — admin

Have you ever heard of getting arthritis in a joint replacement? That’s what my doctor tells me is causing my hip pain. How is that possible?

Prosthetic arthritis is a very real condition. It is caused by erosion or damage to the joint cartilage. This type of problem occurs with a joint implant called a unipolar hemiarthroplasty.

The unipolar implant is one of the first type of partial hip replacements designed. It replaces the round head of the femur (thigh bone). It has a stem attached to it that goes down inside the shaft of the femur to hold it in place.

Younger, more active patients are more likely to develop this kind of problem. The implant moving inside the hip socket chips away small pieces of bone and cartilage leading to cartilage erosion also known as prosthetic arthritis.

A newer type of implant was made to try and avoid this problem. It’s called the bipolar prosthesis. Besides the femoral implant, a plastic-lined, metal cup is inserted into the patient’s own natural acetabulum (hip socket). Instead of just the femoral head moving in the acetabulum (unipolar implant), the bipolar allows for two points of motion. The femoral head moves and rotates inside the cup and the cup moves and rotates inside the acetabulum.

The bipolar hemiarthroplasty is more expensive but recommended for active patients younger than 65.

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 can happen if you don’t obey doctors orders on revision hip surgery?

March 27th — admin

My father just had surgery to revise a total hip he had done last year. The doctor has given him strict warnings not to put any weight on that leg just yet. He’s also been told not to abduct his operated leg. Dad’s pretty cantankerous. He’s likely to do it anyway. What can happen if he doesn’t follow orders?

It sounds like your father has been given instructions called trochanteric precautions. These precautions include no active hip abduction and no weight on the affected leg for six weeks.

Such precautions are advised when a patient has had a trochanteric osteotomy as part of the revision operation. In this procedure, the outside edge of the femur (thigh bone) is removed. A large knob of bone at the top called the trochanter is part of the bone that is cut off.

The surgeon performs this type of osteotomy to gain better access to the hip joint. It is reattached with wires or cables. The instructions given are to help prevent nonunion and/or migration (movement) of the bone fragment during the healing process.

Hip muscles that attach to the trochanter can exert a tremendous pull on the bone. Until it has healed and re-united with the main part of the bone, compressive, shear, and load forces can cause problems.

Your father must be given as much information as possible to insure compliance with these instructions. The successful outcome of surgery may depend on it. Early breakage of the fixation system with migration can cause chronic hip pain, a limp, and an unstable hip.

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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