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.

Posted in Hips. Tags: , , , , , , , , , , , , , , , , , , , , , , , . No Comments »

My wife’s revised hip surgery didn’t work. Can she avoid another surgery?

March 25th — admin

My wife had a very complicated hip surgery to revise the first hip replacement she got last year. They had to cut off part of her hip bone and then reattach it with wires. X-rays show that the wire didn’t hold the bone in place and it has slid up. We’re trying to decide what to do. Can she avoid another surgery?

The operation to remove a portion of the femur is called a trochanteric osteotomy. This is done to help give the surgeon better access to the hip joint. It’s a procedure used most often in complex cases requiring revision surgery of a total hip replacement already in place.

The trochanteric bone removed is reattached using a wire or cable system of fixation. Sometimes the device breaks or it isn’t tightened enough and the bone migrates (moves).

Trochanteric migration can be a major complication. It causes the hip muscles to lose their mechanical advantage. Walking without pain and/or a limp may become impossible.

The surgeon will use X-rays to measure how much the fragment has moved. Migration less than two centimeters can be watched and monitored carefully. If functional changes are already present, then surgery to stabilize the fixation is usually advised.

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.

Posted in Hips. Tags: , , , , , , , , , , , , , , , , , , , . No Comments »

How often do hip resurfacings fail?

February 11th — admin

I am very disappointed because I had a hip joint resurfacing in order to avoid having a total hip replacement. At 38, my surgeon thought I’m too young for a total hip replacement. Unfortunately, my hip fractured shortly after the operation. I ended up with a total hip replacement anyway. Does this happen very often?

Premature failure is the main complication of a hip joint resurfacing procedure. Loosening of the implant and fracture of the femoral neck are the two most common causes of early failure.

A recent study by orthopedic surgeons using the hip resurfacing technique may help us understand what’s going on. It seems that the round head of the femur that fits into the hip socket doesn’t have a very good blood supply normally.

Hip resurfacing requires the surgeon to dislocate the hip joint. Then the head of the femur is smoothed with a tool called a cylindrical reamer. The reamer prepares the femoral head for a smooth metal cap that is fit over the bone.

During this process of dislocation, preparation, and reaming of the femoral head, the blood supply to the head is decreased by as much as 70 per cent. This loss of blood flow is a major risk factor for loosening of the implant or fracture of the bone.

Although it’s not common, enough cases have been reported to bring this to the attention of orthopedic surgeons using this technique. Future studies will help surgeons identify ways to prevent this from happening.

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.

Posted in Hips. Tags: , , , , , , , , , , , , , , , . No Comments »

Is it typical to be walking the day after a hip joint replacement?

July 12th — admin

I had a total hip joint replacement last month. The physical therapist got me up and walking on the day after the operation. Is this typical?

Doctors make this decision based on many factors. These include the reasons for the joint replacement, the type of joint implant used, and the amount of damage to the joint.

For example, a severely arthritic joint may be treated differently from a broken hip. Each doctor has a schedule of what activities can be done after an operation and when to start each one. This is called a protocol. Putting weight on the new hip joint on the first day after the operation is not unusual. In fact, studies show that early motion helps prevent blood clots and other 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.

Posted in Hips. Tags: , , , , , , , , , . No Comments »

Does diastrophic dysplasia always lead to arthritis?

July 10th — admin

My son was born with diastrophic dysplasia. His 42-year old uncle also has this condition and now has severe arthritis. Will this happen to my son, too?

Diastrophic dysplasia is a change in the size and shape of the hip joint. It’s caused by the abnormal development of bone and cartilage. The bone is bent or curved and results in deformity.

All patients with diastrophic dysplasia develop early arthritis of the hips. This can occur even before middle age. Pain and loss of motion prevent walking and carrying out daily activities.

Treatment for diastrophic dysplasia is improving with new medical discoveries. Perhaps by the time your child is an adult, the effects of this condition will be mild. Early treatment with joint replacements can help.

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.

Posted in Hips. Tags: , , , , , , , , , , , . No Comments »

What is “bead shedding”?

June 4th — admin

My 82-year old mother had a new hip joint put in two years ago. After months of pain, the doctor says she needs a hip revision. The report says, “bead shedding” is the problem. What is this and how do we make sure she doesn’t get it again?

Bead shedding means the implant has come loose. The hip joint may be replaced with a variety of material, including metal, polyethylene, and ceramic. With metal implants, tiny pieces of metal come loose from the surface of the implant. Bead shedding has also been reported with other types of implants.

Bead shedding causes abnormal motion and then pain occurs. It’s the most common cause of joint replacement failures requiring revision. Scientists aren’t sure how to keep the problem from happening a first or second time. They are actively studying the problem by trying different materials with and without cement to hold the implant in place.

Ask your mother’s doctor if there is any way to tell what caused her problem. Be sure and mention your concern about the problem occurring again. Her doctor may already have a plan in mind for preventing this from happening.

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.

Posted in Hips. Tags: , , , , , , , , , , . No Comments »

How is the length of incision decided for the hip replacement?

May 29th — admin

I saw a videotape in my doctor’s office showing two ways to do a total hip replacement. One had a much smaller incision than the other. How do they decide which method to use?

The small incision is a fairly new method for hip joint replacement. It’s called a mini-incision. Many studies are being done to compare the mini-incision method with the standard way to replace the hip joint.

Right now doctors choose patients who aren’t overweight. Compared to the standard-incision group the mini-incision group is more likely to be male, taller, and thinner. In fact, the standard-incision group is six times more likely to be obese than the mini-incision patients. The mini-group also has fewer problems in general after surgery.

Researchers are working to find out what type of patient is best suited for each method. That information will help doctors guide their patients in choosing the right operation for each one.

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.

Posted in Hips. Tags: , , , , , , , , , , . No Comments »

I’m 47, why shouldn’t I have a total hip replacement?

May 23rd — admin

The doctor says I’m too young (I’m 47) for a total hip replacement even though I have severe arthritis in one hip. What’s the worst that could happen if I went ahead and had it done anyway?

Total hip replacement (THR) has always been reserved for older adults with pain and loss of function from arthritis. More and more young patients (less than 50 years old) are in need of help for severe arthritis.

Yet joint implants don’t last a lifetime, so doctors want to wait as long as possible before replacing the joint. Studies show young, active patients have a high rate of revision surgeries after THR. Early loosening of the implant is common. Debris from the joint eats away at the bone causing this loosening.

A failed implant with revision surgery can leave the patient with one leg shorter than the other. Muscle weakness and scar tissue can also make daily activities difficult. Active adults find they can’t engage in sports or recreational activities as they once did.

Doctors often suggest a hip osteotomy for the young patient with only one hip involved. This is a joint-saving operation that can buy the patient some extra time. It can reduce pain, increase motion, and improve 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.

Posted in Hips. Tags: , , , , , , , , , , , , , , , , . No Comments »

What is a comminuted acetabular fracture?

March 8th — admin

What is a comminuted acetabular fracture? That’s what my brother just texted me that his wife has. What do they do for that?

To help you understand your brother-in-law’s condition, let’s define an acetabular fracture. The acetabulum is the socket side of the hip joint. It is made of cartilage over bone just like every other joint. The reason it breaks is because the person falls (and lands) in such a way that the head of the femur (thigh bone) is driven up into the hip socket (acetabulum) with enough force to break bone. When that happens, there can be a single break or fracture line but more often the acetabular bone breaks into many tiny pieces. That type of break is called a comminuted fracture.

Older men are affected more often than women by this type of damage. Their femoral bones are thicker, stronger, and transfer a greater destructive force into the acetabulum. Women tend to develop a break in the neck of the femur — long before there is any force up into the socket.

Until recently, this type of fracture was always treated conservatively (without surgery). And many times, this is still the most appropriate treatment. The presence of dementia, poor health, severe bone loss, and non-ambulatory status before the fracture are reasons why surgery may not be possible.

So long as the fracture isn’t displaced (shifted), those patients who could walk before the injury are allowed to walk with the support of a walker. But only minimal weight through the hip is allowed until healing occurs. A physical therapist helps move the hip through its motions but with some limitations to protect it. Bed rest (even for displaced fractures) with traction was once prescribed. But this is no longer recommended due to the many complications that arise with immobility in this age group (e.g., blood clots, bed sores, pneumonia, deconditioning).

For those patients who will have to have surgery, there are several options. A procedure called open reduction and internal fixation (ORIF) pretty much describes what happens. The surgeon makes an incision to open up the hip, lines everything back up as much as possible, and uses plates, screws, pins, and/or wires to hold it all together until it heals. The more closely the hip is restored to its normal shape and configuration, the better the results will be. The more bone fragments and the farther apart the bone fragments separate, the poorer the prognosis. If the patient is not a good candidate for ORIF (or if the ORIF procedure fails), then a total hip replacement may be the next step.

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.

Posted in Hips. Tags: , , , , , , , , , , , , , , , , , , , . No Comments »

My doctor says I have hip bursitis. Is there really such a thing?

February 29th — admin

Is there really such a thing as hip bursitis? My grandma used to complain of that but I thought it was an old lady complaint like lumbago. Now my doctor says this is what I have. So my original question still stands: is there such a thing?

Pain along the side of the hip is still a common spot for bursitis (also known as greater trochanter pain syndrome. A large tendon passes over the bony bump on the side of the hip called the greater trochanter. Inflammation in the bursa (a protective gel sac) between the tendon and the greater trochanter is called trochanteric bursitis or lateral hip bursitis. You can see there are many names for this problem.Hip bursitis is common in older individuals. Women seem affected more often than men. It may also occur in younger patients who are extremely active in exercises such as walking, running, or biking.Sometimes a bursa can become inflamed (swollen and irritated) because of too much friction or because of an injury to the bursa. An inflamed bursa can cause pain because movement makes the structures around the bursa rub against it. Friction can build in the bursa during walking if the long tendon on the side of the thigh is tight. It is unclear what causes this tightening of the tendon. The gluteus maximus attaches to this long tendon. As you walk, the gluteus maximus pulls this tendon over the greater trochanter with each step. When the tendon is tight, it rubs against the bursa. The rubbing causes friction to build in the bursa, leading to irritation and inflammation. Friction can also start if the outer hip muscle (gluteus medius) is weak, if one leg is longer than the other, or if you walk or run on banked (slanted) surfaces.Most cases of trochanteric bursitis appear gradually with no obvious underlying injury or cause. Trochanteric bursitis can occur after artificial replacement of the hip joint or other types of hip surgery. The cause may be a combination of changes in the way the hip works, the way it is aligned, or the way scar tissue has formed from the healing incision.So, in answer to your question — yes! Hip bursitis is still a real problem with a real diagnosis. Treatment early on can prevent this painful condition from becoming a chronic problem that might require surgery. Short-term use of nonsteroidal anti-inflammatory medications along with physical therapy may be all the person needs. The physical therapist will correct any postural components, muscle imbalances, and help restore normal function of the affected hip muscles.

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.

Posted in Hips. Tags: , , , , , , , , , , , , , , , , . No Comments »
« Older posts «
»