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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I’m getting a new hip joint. The incision will be along the back of the hip. Why don’t they go in from the front?

November 10th — admin

My surgeon described the way she is going to cut me open and install a new hip joint. The incision is going to be along the back of my hip (maybe slightly between the back and the side). I guess that’s okay but why don’t they just go in from the front (or even the side) instead of cutting through my butt muscles?

It is possible to perform a total hip replacement from an anterior (front) approach as well as from the side lateral or posterolateral (halfway between the back and side). But over the years, studies have shown the best results and easiest access is from the posteriolateral direction.Some of the success with this incision location is the fact that it gives the surgeon access to the entire joint. It also makes it possible to put the implant in its best location for optimal motion and function. Even a degree or two off in one direction or the other can cause long-term problems. To avoid that, the surgeon likes an open enough incision and open wound site to see what he or she is doing.The posterior approach also makes it possible for the surgeon to size up the bone and choose the best size of implant for the patient. Getting a just the right size implant on the femoral side and placing it in the optimal location is key to full, pain-free motion. Newer techniques are being developed all the time. One surgeon has already mastered a minimally invasive technique for hip joint resurfacing.Using a three and three quarters- to four-inch length incision, the head of the femur can be accessed and cut off all inside the body. There’s no need to pull the head of the femur out of the open wound site to gain access to the arthritic component. Muscles are split in two rather than cutting them off and moving them out of the way. The joint capsule still has to be cut through to get to the joint, but these other refinements in surgical technique certainly reduce the overall trauma.

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 happens if a hip replacement dislocates?

October 6th — admin

My mother fell and dislocated her new hip replacement. They took her back into surgery and put the joint back in place. She’ll be going to a step-down transition unit. What should we expect for a prognosis? Will it hold? What happens if it doesn’t?

Dislocation is every patient’s fear after getting a new hip replacement. The surgeons call it instability. No matter what name you give it, the problem is troublesome for the patient and a complex challenge for the surgeon. Conservative (nonoperative) care is usually tried first. Once the hip is back in the socket, a brace may be applied and the patient is sent to physical therapy.

Not all surgeons use bracing in these situations. If they do, the brace used is called an abduction brace. It holds the hips apart and in a neutral position (not turned in or rotated out). The physical therapist will help your mother learn how to move safely while strengthening the muscles around the hip.

A special focus of treatment is to restore normal joint proprioception (sense of joint position) and kinesthesia (awareness of movement). Balance training is also very important. Before discharging her to home, the therapist will interview the family to find out what kind of changes need to be made at home. For example, throw rugs will have to be removed, additional lighting (especially for at night) may be needed, grab bars installed in and around the bathroom, and so on.

If a conservative approach doesn’t work and the hip dislocates again and again, then surgery may be needed. The surgeon may have to tighten up loose tissue and restore a balance to soft-tissue tension on all sides of the hip joint. If the implant is improperly positioned, it must be removed and realigned. The surgeon may need to replace the femoral head with a larger one. The goal is to prevent a recurrent (second) hip dislocation.

The good news is that only 10 per cent of patients who dislocate the hip after receiving a total hip replacement will dislocate it a second time. Your surgeon and the rehab team will help you navigate through this difficult time. Don’t hesitate to bring up your concerns and questions. They have knowledge of your mother’s health and hip condition that they can draw on to provide you with answers.

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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Hip resurfacing vs. hip replacement

October 4th — admin

I’m looking into the possibility of having a hip joint resurfacing procedure done instead of a total hip replacement. I’ve heard all about the positives of this operation from my surgeon. Could you fill me in on any down sides there might be?

Hip resurfacing arthroplasty is a type of hip replacement that replaces the arthritic surface of the joint but removes far less bone than the traditional total hip replacement. Because the hip resurfacing removes less bone, it may be preferable for younger patients that are expected to need a second, or revision, hip replacement surgery as they grow older and wear out the original artificial hip replacement.

You are asking, how well do they work? And what are the potential problems or complications? Using data from the 1000s of hips done outside of the United States along with studies done in the states, it’s clear that the overall revision rate is still higher for resurfacing than for standard total hip replacements. But the rate is still small enough to make it worth having the procedure for the many patients who aren’t ready yet for a complete total hip replacement.

The most common complications are femoral neck fracture, implant dislocation, and metal ion hypersensitivity. Because the component parts of the implant are metal, tiny pieces of metal ions flake off and get trapped inside the joint forming a tumor-like cyst or entering the blood stream. This could become a problem for anyone with metal hypersensitivity.

Studies show that women are more likely to have a failed resurfacing procedure. So are patients who’ve had a previous hip surgery or anyone who has osteonecrosis (loss of blood supply to the top of the femur or thighbone causing death of bone cells). And anyone with inflammatory arthritis or developmental dysplasia of the hip is at increased risk for implant failure.

Joint resurfacing is a stop-gap measure for patients with painful arthritic conditions. By preserving as much bone as possible, it buys them some time before converting to a total hip replacement. This plan allows younger patients to remain active and put off the inevitable hip replacement.

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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Pain on inside of hip could be arthritis

September 22nd — admin

I have a deep pain in my groin that my doctor diagnosed as a hip problem – arthritis. I always thought if you had hip pain, it was on the outside?

Hip pain from problems like osteoarthritis does often show up in the inner thigh or groin area, more so than the outside. This is because of the anatomy of the joint and where the ball of the femur, the thigh bone, fits into the socket of hip joint. It’s in the inner part of the hip that the motion takes place that allows you to move your leg inward and outward again.

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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Dislocate hip to fix it?

September 12th — admin

I saw a surgeon who wants to do surgery to dislocate my hip in order to fix it so it won’t keep pinching the joint cartilage when I bend and rotate my leg. I’m thinking, no thanks. Is there a better way to take care of this problem?

It sounds like you might have a condition called femoroacetabular impingement (FAI). With FAI, the top of the femur (thigh bone) pinches the rim of the hip socket. The area that gets compressed is referred to as the acetabular rim. This type of impingement occurs most often when the hip is flexed and internally rotated.

Surgery is often recommended as the most successful treatment for this problem. There are three surgical choices: 1) surgical hip dislocation, 2) periacetabular osteotomy, and 3) hip arthroscopy. Surgical hip dislocation is considered the current gold standard, though some experts expect improved arthroscopic techniques will change that in the future. Surgical dislocation refers to taking the femoral head out of the socket and making adjustments and repairs as necessary, and then putting the head back in place. The operation can be done without cutting through the muscles and with the least amount of trauma possible.  Any damage to the labrum (rim of cartilage around the hip socket) can be repaired. Any problems with mismatch of the femoral head and neck with the acetabulum (hip socket) can be taken care of. This type of surgery allows for preservation of the joint, which is important in young, active adults.

Periacetabular osteotomy corrects the retroversion (tipped or tilted position of the acetabulum). The capsule surrounding the hip joint is cut open. The femoral head and neck are reshaped by shaving or cutting off portions of the bone. The goal is to correct the placement of the femoral head in the hip socket.

The third surgical option (hip arthroscopy) to treat FAI allows the surgeon to gain access to the inside of the joint without cutting it open. This avoids pulling the femoral head away from the socket. Arthroscopic surgery also makes it possible to reattach (rather than remove) a torn labrum.

Studies show that the best way to approach this problem is by restoring as normal hip anatomy as possible. Surgical hip dislocation is used with good success for patients with mild to moderate (but not severe) degeneration of the joint cartilage, surface, and surrounding capsule. It sounds like your surgeon is right on track with current evidence for best practice. You can always seek a second opinion to help you understand your condition and the various treatment options available.

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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Even loose-jointed yoga instructor has hip pain

September 8th — admin

I am a yoga instructor with a very painful hip. I can’t figure it out because my joints are very loose. But every time I flex my hip past 90-degrees or try to cross my legs, I get a very sharp pain deep in my hip. What could be causing this?

Hip pain with limitations on full hip motion in an active adult requires special attention — especially if you are in your 20s or 30s. Early diagnosis and treatment is imperative to avoid degenerative changes in the hip joint later in life. There are many possible causes of this type of hip pain.

Given your description, one of the most likely would be femoroacetabular impingement (FAI). Femoroacetabular impingement (FAI) describes a condition where the top of the femur (thigh bone) pinches the rim of the hip socket. The area that gets compressed is referred to as the acetabular rim. This type of impingement occurs most often when the hip is flexed and internally rotated. For a long time, it was believed that FAI only occurred in people with some kind of abnormal anatomy of the hip. There was either a backward tilted angle of the hip socket called retroversion, a larger socket than the ball (head of the femur) inside the socket, or flattening of the femoral head. One type of abnormal shape of the hip was labeled a pistol grip because of the resemblance to the grip of a handgun.

More recent studies have shown it’s possible to develop FAI even when the hip structure and anatomy are essentially normal. But, in general, more people with acetabular retroversion end up with hip pain and problems leading to degenerative hip osteoarthritis than any others.

To get to the bottom of the cause of hip pain, a thorough history and examination are required. An orthopedic surgeon is the best one to see. The physician will look at your foot position, leg angles, leg length differences from one side to the other, hip motion, and muscle strength. Gait (walking) patterns will be evaluated. Special tests such as the impingement test are done to identify the presence of an underlying FAI as the cause of the painful symptoms and restricted motion. X-rays, CT scans and/or MRIs may be used to confirm the diagnosis.

The results of all of these tests are important pieces of information when deciding on the best treatment approach. With early diagnosis and treatment of young, active patients with FAI the problem can be managed by conservative measures. Surgery may be needed to restore as normal hip anatomy as possible. But before jumping to any conclusions, make an appointment and see a specialist to find out for sure what might be causing the problem. If you’ve had this for a while and it hasn’t gone away (even with your yoga practice), don’t wait any longer.

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 Mom won’t get her hip replaced

September 6th — admin

We are trying to help Mother make up her mind about having a hip replacement. Dad had it done a year ago and everything went quite well. We can’t figure out her hesitation. What do you suggest?

It’s not uncommon for women to lag behind men when it comes to having elective surgery such as a total hip or total knee replacement. Women tend to worry more about taking care of their families after surgery. The unknown factors of how long it will take to get back up on their feet and independent can hold them back. In many cultures, men are more used to being taken care of and provided for in the home. Becoming more dependent in these areas after surgery is not such a stumbling block for them. Women may have a more difficult time asking for and accepting help from others.

The first step may be just to have her evaluated by your surgeon of choice. He or she may be able to answer any questions you or your mother may have. Asking questions about healing time, length of hospitalization, expected time for recovery may help your mother decide what’s best for her. Most patients are seen right away in the hospital by a physical therapist. The therapist helps them get up and get moving again. Joint motion and muscle strengthening are part of the rehab program. The therapist will advise patients about what’s needed at home. If your father had this surgery a year ago, it’s likely they already have everything they need (e.g., raised toilet seat, walker or cane, grab bars in the bathroom).

These are just a few suggestions for getting to the bottom of your mother’s hesitation. If you think she could (and would) tell you, perhaps asking her straight out might help solve the issue. It is a big step for many people but most patients agree that the benefits are well worth the effort.

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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Accurate diagnosis of hip pain can be elusive

July 28th — admin

I saw my primary care physician for hip pain that just won’t go away. Despite a huge amount of time testing me every which way, there’s no known cause for the problem. Should I insist on X-rays or an MRI?

There are many, many possible causes of hip pain. An accurate diagnosis is needed to direct treatment. But this can be elusive and take a long time to make. The physician’s examination takes into account the possible etiology or cause of the problem. Was there some trauma? The mechanism of acute hip pain caused by injury is often a twisting motion. Overuse, repetitive motion, and diseases or degenerative conditions are other potential causes of hip pain. Pain patterns associated with hip problems start with a deep aching and stiffness in the hip. True hip pain is experienced in the front of the body down into the groin area. Hip pain along the pelvic rim, down the side of the leg, or down the back of the leg is usually a sign that the cause of the pain is extraarticular (outside the hip joint). This could be coming from pinching of the soft tissues, nerve entrapment, or other extraarticular lesions. Loss of motion and/or function can help point to the specific soft tissue structures affected.

It sounds like your physician has been very thorough. Evaluation of hip pain may require imaging studies such as X-rays or MRIs. But unnecessary X-rays and other imaging studies should be avoided. Results are viewed cautiously as many changes in and around the hip may be observed but may not be the cause of the painful symptoms. The most obvious pathologies that must be treated include tumors, fractures, hematoma from bleeding after a fall, and infections.

Often in the face of an unknown cause of joint pain, a short course of physical therapy can be a diagnostic aid for the physician and helpful to the patient. As experts in human movement dysfunction, the therapist can evaluate and treat the soft tissues and postural issues that could be the underlying cause of the problem.

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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