To repair my ACL, the surgeon used part of a tendon as a graft. Won’t that cause problems for the tendon now?

December 16th — admin

When the surgeon repaired my torn ACL he took a piece of my patellar tendon and used it as a graft. How can they do this without causing problems in that tendon now?

A very good question. First of all, only a piece of the hamstring tendon is removed. At least half or more of the tendon is left intact. The postharvest strength of the graft tendon must be strong enough for early rehab and daily activities.

If the graft doesn’t hold it usually pulls away from the bone with a little piece of bone attached. This is called bone avulsion.

Before these grafts were ever used on patients, scientists used animal and cadaver studies to test the strength of the tendons before and after grafting. This is how they know which tendons will hold up after a piece is removed for use as a graft.

They also found that ACL tensile strength decreased over 50 percent between age 20 and 50. This isn’t true of the patellar tendon. During this same time period, tensile strength of the patellar tendon doesn’t change. That makes the patellar tendon a good graft choice.

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 cervical hip fracture?

September 14th — admin

Have you ever heard of a cervical hip fracture? What is that? I thought the cervical bones were in the neck, not in the hip.

There are many types of hip fractures, usually named for their location. A basic understanding of the hip anatomy will help visualize where the fractures occur.

The hip joint is one of the true ball-and-socket joints of the body. The hip socket is called the acetabulum. It forms a deep cup that surrounds the ball of the upper thighbone, or femoral head. The femoral head is attached to the rest of the femur by a short section of bone called the femoral neck. A bony bump on the outside of the femur just below the femoral neck is called the greater trochanter. A smaller bony bump on the femur called the lesser trochanter is located on a diagonal from the greater trochanter.

These two bumps on the femur are where some of the hip muscles attach. A cervical hip fracture refers to the fact that the break is inside the joint itself. Either the top of the femur (called a subcapital fracture) or the acetabulum (hip socket) have a break. Another term for the location of these fractures is intracapsular or cervical.

When the break affects the hip, but is not right inside the hip, the fracture is referred to as an extracapsular hip fracture. The fracture may occur in the neck of the femur (femoral neck fracture), between the two trochanters (intertrochanteric fracture), or in the main shaft of the femur just below the lesser trochanter and may extend down the shaft of the femur. This last type of hip fracture is called a subtrochanteric 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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Why treat osteoporosis after hip is already broken?

August 23rd — admin

I fell and broke my hip two weeks ago. I finally made it out of the hospital and home again. Now my doctor is after me to take drugs for osteoporosis. I don’t see what’s all the fuss. I already broke the hip. How is taking some medication going to change anything?

There is a mistaken belief that by the time a fracture has occurred, it’s too late to do anything about the underlying osteoporosis. Nothing could be further from the truth. Study after study has confirmed the benefit of a three-arm approach to the prevention and treatment of osteoporosis (which includes preventing a second fracture).

The first is calcium supplementation with Vitamin D. The second is exercise. Weight-bearing exercises on land (not a swimming or aquatic program) helps bone formation. When the muscles contract and their tendons pull on the bone, it has the effect of stimulating bone formation. And third is the use of anti-osteoporotic medications called bisphosphonates.

Bisphosphonates such as alendronate (Fosamax), ibandronate (Boniva), or risedronate (Actonel) help slow down how fast the bone is resorbed (destroyed). Everyday new bone cells are formed and old bone cells are resorbed or destroyed. During childhood, new bone cells are formed faster than old ones are destroyed. In the aging adult, resorption exceeds formation. Despite the number of older adults with osteoporosis and even a history of hip fracture, not very many people are taking these medications. And for those patients who do have a prescription, taking it on a regular basis is not consistent. But they have been proven effective in reducing hip fractures and the death rate associated with hip fractures in patients with osteoporosis. And since your risk of a second fracture goes up dramatically after the first one, your doctor is right in strongly urging you to take this medication. It’s important to take it as prescribed over a long period of time. Follow your doctor and pharmacist’s directions when taking this (or any) medication. Report any side effects. The drug dosage or specific drug can be changed or altered. The goal is to give you the maximum benefit with the least amount of adverse effects.

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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Joint pain vs. postoperative pain – which is worse?

July 1st — admin

My adult children are pushing me to have a hip replacement. I don’t really want to have surgery. I think I can put up with the pain. But the kids are worried that I’m not active enough. Would a new hip really make that much difference? Doesn’t having surgery cause pain, too?

Pain can be a big stumbling block to activity and quality of life. Hip replacements have become very common and very successful. Patients are able to perform daily activities, sleep better, and get around better. The implants and techniques for putting them in have improved so they last longer with fewer problems. Relieving pain improves physical function and activity level. This is important in promoting general health and preventing specific diseases such as heart disease and diabetes.

The positive benefit of movement and activity on bone structure is very important for the older adult. Good bone health helps prevent fractures and falls, which can cause serious disability and even death.You may want to just make an appointment with an orthopedic surgeon and find out what are your options. Knowledge and understanding of the process and expectations can help calm your anxious thoughts. Then you’ll be making a decision based on facts, not fears.

You can expect a period of some postoperative pain during recovery. The postoperative plan provides medications to help with the pain. The physical therapist will help you get up and get moving. That always helps alleviate pain and aching from stiffness. Most patients report the postoperative pain is different from the joint pain they had before surgery. They say the new pain is much more tolerable and goes away with time and exercise.

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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90-year old tennis player breaks hip – will he walk unaided?

June 20th — admin

My husband fell playing tennis at age 90 and broke his hip. He was always so proud he could still play. Despite his good mobility before the fracture, they are saying he probably won’t walk alone again. What do they base these absurd predictions on? How do they know what he will or won’t do?

Studies show that advanced age is a predictor of poor function after hip fracture. Although it is entirely possible that your husband will regain independent mobility, only two per cent of the population aged 90 and older are able to return to their prefracture level of independence. Many older adults end up using a walker but are able to gradually progress in their rehab program to use two canes. Eventually, it may be possible to eliminate one cane and just walk with one assistive aid (or none at all).

The fact that your husband was still playing tennis suggests good health and good mobility. Both of these factors are in his favor in terms of recovery and rehab. If all goes well, he may very well be among the two per cent who regains his previous level of independence and 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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Strength training recomended for 81-year old golfer following hip fracture

June 15th — admin

I’m 81-years old and doing pretty good. I did break my hip last winter but I’m back on the golf course now. I do notice that side seems weaker and gets tired faster when walking. What can I do to catch the bad side up to the good side?

Uneven strength from side-to-side is fairly common after a hip fracture, especially among older adults. Studies show that a strength training program can make a difference. Low loads and resistance are usually used at first. This is to ensure safety and prevent further bone fractures.

In the average, healthy adult, it takes about six weeks of consistent exercise to make a change in strength and power. It may take longer in seniors who have had a bone fracture. It’s always best to have medical approval before starting a new exercise program. Check with your orthopedic surgeon and schedule an appointment with your primary care physician. Your doctor will examine you and rule out any health problems that might put you at risk for heart attack, aneurysm, or stroke. A physical therapist can provide you with an individually tailored exercise program. The therapist will be able to monitor your vital signs before, during, and after exercise to make sure your exercise program is safe but still effective. Compliance and cooperation (following the program daily or as prescribed) will help you gain strength quickly. After six to 12-weeks of consistency, a maintenance program can be designed for use as long as possible.

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 it make a difference in recovery for patients based on the type of hip fracture they have?

April 26th — admin

Does it make a difference in recovery for patients based on the type of hip fracture they have? My aging aunt has what’s called an intertrochanteric hip fracture. I got the impression from the hospital staff that this is the worst kind. Why is that?

There are many different types of fractures classified by location and specific type. For example, in the hip, the most common fractures in older adults affect the femur (thigh bone). These fractures include: ty

  • femoral neck
  • femoral head
  • subtrochanteric
  • intertrochantericFemoral neck fracture is a fracture in the femur (thighbone). The break is between the (long part of the femur) and the round round head at the top of the femur. This is where the femoral neck attaches the shaft to the head. These fractures often damage the blood supply to the femoral head. Loss of blood to the top of the bone can lead to death of the bone cells. This condition is called avascular necrosis.

    Femoral head fracture is a break in the femoral head. This is usually the result of high-energy trauma. Dislocation of the hip joint often occurs with this fracture. Subtrochanteric fracture involves the shaft. The break is right below the lesser trochanter (bony knob on the femur). Subtrochanteric fractures may also go down the shaft of the femur.

    When the break is between the greater and lesser trochanter, it’s considered an intertrochanteric fracture. This is the most common type of hip fracture. The prognosis for bony healing is usually pretty positive if the patient is in good health.

    But older age, poor nutrition, and poor health (especially combined together) puts a patient at risk for a poor prognosis. Immobilization after a hip fracture increases the risk of infections that can be life-threatening. A simple urinary tract infection or pneumonia can compromise the health of an older adult hospitalized with hip fracture. Deep vein thrombosis (blood clot) is also a risk in these cases.

    Many people beat the odds. So just having the risk factors doesn’t guarantee that your aunt will have a poor outcome. There may be other health issues or concerns that caused the hospital staff to react this way. You may need more information before coming to any firm conclusions.

    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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    Dad is in the hospital with a hip fracture. This is a first for our family. What can we do to help him maintain his independent lifestyle once he’s home?

    April 13th — admin

    Dad is in the hospital with a hip fracture. This is a first for our family. What can we do to help him maintain his independent lifestyle once he’s home?

    Many older adults who survive a hip fracture are left with problems they didn’t have before the fracture. For example, they may have to use a walker or cane to get around. Walking and managing stairs can be major disabilities now. Dressing and undressing can be difficult. And some patients are unable to get back to their regular community or social activities. Recovery can take up to two years.  

    Most patients receive physical therapy while in the hospital. But PT after discharge isn’t always ordered or provided. Yet studies show that patients with this injury who have PT after going home are less likely to be rehospitalized. They are also less likely to die from complications of this condition.

    The therapist will help the patient regain motion, balance, and strength needed to resume normal activities of daily living. These skills are also needed to get back to regular social activities. Breathing exercises and aerobic conditioning may help prevent problems such as pneumonia that can cause rehospitalization and even death.

    Most states in the U.S. now have consumer access or direct access to PTs. This means you can contact the therapist directly without requiring a physician’s referral. The therapist’s evaluation will include screening for conditions that require medical attention.

    After a few weeks of PT, many patients can be set up on a supervised home program they can follow on their own. The therapist will also help identify safety concerns in the home environment. Anything you can do to make sure safety feature are installed (e.g., lighting, tub bars) will go a long way to prevent future falls and subsequent fractures. 

    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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    Skylight sign shows how to avoid fracture during hip replacement

    November 16th — admin

    What is a skylight sign? When the surgeon showed me Dad’s hip X-rays, she said a skylight sign tipped her off to avoid a hip fracture during Dad’s hip replacement operation.

    Thinning of the bone allows light coming from the other side to stream through the thin section. This light stream through the bone is called the skylight sign. It can only be seen from the side. The surgeon must use a lateral (from the side) approach to see the skylight sign.

    From this angle, the bone is exposed as the muscles are cut away. Using other methods won’t allow the surgeon to check for the skylight sign. Patients with a positive skylight sign are at increased risk for fracture. Fracture can be prevented by changing the surgical technique or size of the implant.

    Sometimes reinforcing the bone with wire cables can help prevent fracture during the operation. The cables are placed around the bone. If a fracture occurs during the surgery, the cables can be left in place to help stabilize the bone during recovery and rehab.

    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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    More hip replacements means more hip fractures

    August 5th — admin

    I’ve been a nurse on the med-surg floor for over 20 years. I think we are seeing more and more hip fractures in patients with a hip replacement. What’s causing this increase in numbers?

    Several studies have confirmed your observations: the number of femoral (thigh bone) fractures after total hip replacement (THR) is on the rise. There may be several reasons for this change.

    First of all, more people are having THRs. Good results from the surgery has also increased the number of people and types of problems that can be helped by THR.

    Third, with more people having THRs, the number of revision operations is increasing, too. Patients who have had a THR 20 years ago are still alive and going strong. Increased physical activity decreases the life of the implant. Many of these patients have revision surgery to replace the first implant. Fractures are more likely and more common after revision surgery.

    Finally, implant design may be a factor. A recent study from Sweden pointed out the fact that implants with a straight and short stem are more likely to loosen causing dislocation and/or fracture. Complications such as fracture and implant loosening may be further reduced with continued research and improved implant design features.

    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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