Naples Orthopedic Surgeon - Dr. Robert J. Zehr » hip joint

MRA more accurate than MRI for ddetermining cause of hip pain

admin — Fri, 18 Jun 2010 16:32:59 +0000

What is magnetic resonance arthrography (MRA)? I’ve heard of MRI but not MRA. My doctor wants me to have an MRA to help figure out what’s wrong with my hip.

Magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) are very similar tools. MRA is basically MRI for the joints. It is more accurate in detecting joint problems. MRI can confirm there’s a problem in the joint. MRA shows exactly what is the abnormality.

CT scans work well for bone lesions around the hip. CT scan shows places where the bone might have a tumor, abnormal anatomy, or necrosis (dead cells).

If you ever need surgery on the hip, advanced imaging studies of this type are very important. The more details the surgeon can see ahead of time, the better the surgical plan with no (or very few) last minute surprises.

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.

Alcohol abuse a factor in broken hip

admin — Thu, 22 Apr 2010 12:35:32 +0000

My 66-year old father fell and broke his hip. He was drinking at the time the accident happened. The doctors think the hip broke first and then he fell because he has osteonecrosis. What is this?

The term osteonecrosis refers to the death of bone and bone marrow. This occurs when there’s a loss of blood flow to the area. Two other terms for this condition are: avascular necrosis and aseptic necrosis. Avascular means without blood and aseptic means without infection.

Alcohol abuse leads to a change in how fat is broken down and used. This process is called fat metabolism. Tiny pieces of fat can break off like a blood clot and block the blood vessel. This is what happens in the case of osteonecrosis from alcoholism.

Once the blood flow to the hip is cut off, bone cells start to die. The bone weakens and collapses or breaks. A fall or other injury may be the first sign there’s a problem.

Is hip joint replacement the answer for dysplasia?

admin — Tue, 13 Apr 2010 13:09:37 +0000

I was born with developmental hip dysplasia. Physical therapy and a hip operation at age six have kept me pain free. Now at age 46, I am having constant pain. My hip dislocates from time to time. Would a hip joint replacement help me?

Studies of hip replacement for developmental dysplasia show a wide range of results. A recent report from Japan shows the results after hip replacement for this problem. Some patients were followed for 26 years. Besides the new joint, each patient had a large bone graft used to form a deeper hip socket.

They found that problems are more likely to occur in patients under age 50 with this operation. The authors suggest that other operations can be tried first before removing the joint and replacing it. Patients must be advised about the right level of activities. This will help preserve the hip before surgery.

Is shorter leg just your imagination?

admin — Mon, 05 Apr 2010 13:35:23 +0000

I broke my right hip last winter when I slipped and fell on the ice. I had surgery to pin the fracture. Now it seems like my right leg is shorter than the left. I’m off-balance. Is this really possible or am I just imagining it?

It’s very likely that the fracture couldn’t be put back together evenly. If the pieces of broken bone couldn’t be put back in place exactly, then the bone (and your leg) could indeed be shorter than it was before the fracture.

Ask your doctor to take an X-ray or measure you for a leg length discrepancy. Measurements with a plastic tape measurer should be taken lying down. The doctor can measure from your belly button to the inside ankle bone and compare the right to left legs. Sometimes the hip bone is used as the starting point.

You can also try an experiment at home. Stand in front of a mirror and put your hands on your hips. Use your index fingers to find the front pelvic bones. Are they level? Or is one hip higher than the other? Put a thin book or magazine under the foot of the leg with the lower hip. Keep adding layers of books or magazines until the pelvic bones are level.

Measure how thick the books are and try a lift the same height inside your shoe. If this works you can continue using a lift or have your shoe modified by a shoe repair shop to make up the difference. If you have any back, leg, or hip pain from doing this, have your doctor or a physical therapist help you out.

How can having a total hip replacement improve my sleep?

admin — Wed, 10 Mar 2010 19:27:27 +0000

I’ve been dealing with an arthritic hip for years. Now it’s affecting my sleep. I heard that having a total hip replacement could help me sleep better. How does that work?

Arthritis sufferers are known to have poor sleep patterns caused by pain. Conditions such as osteoarthritis are a common source of hip pain in the older adult.

A recent study in New Zealand showed that sleep is improved after hip joint replacement. All patients had painful symptoms from arthritis that woke them up at night. Less hip pain after the operation meant better sleep. If the patients were awakened from sleep, it was for some other reason than from hip pain.

Uneven wear in hip joint replacement result of third-body wear.

admin — Fri, 05 Mar 2010 15:54:41 +0000

I had a joint hip replacement for severe arthritis three years ago. The doctor tells me that third-body wear is likely the cause of some uneven wear in the joint. What does this mean?

When patients with hip joint replacements are compared, there are very different results in wear patterns of the new joint. This is true even when the same replacement parts are used from patient to patient.

In fact, one study looked at patients with both hips replaced using the same implant. The researchers compared one side to the other and found that the wear pattern was different from side to side. One of the reasons for this is third-body wear.

This is the presence of tiny particles in the joint. These pieces may be bits of bone or fragments of glue or cement used to hold the new joint in place. Even metal debris from the coating around the joint implant can cause the joint liner to be scratched and roughed up. Joint wear and tear is increased when the surfaces are roughened.

Dehydration can complicate recovery from total hip replacement surgery

admin — Mon, 15 Feb 2010 15:51:05 +0000

My older sister had a total hip replacement 2 months ago. She has had set backs and delays from the beginning. Dehydration seems to be the central problem. What causes this?

Even healthy older adults are at risk for dehydration (fluid loss). There is a decrease in thirst as we age and thus, a tendency to stop drinking liquids as much. Many Americans confuse thirst with hunger and eat instead of drinking.

Older adults who have hip joint surgery are also at increased risk of dehydration. There is blood loss with this operation. The problem gets worse if the patient has nausea and vomiting from medications. The presence of any other medical condition such as diabetes, high blood pressure, or thyroid problems adds to the mix.

Even mild to moderate dehydration can slow a patient down. Dizziness, weakness, and fatigue are common. Just getting through the daily activities or dressing, eating, and personal care can zap a patient’s strength. There may be no energy left for exercise needed after this operation.

Compare these two total hip replacement surgeries

admin — Thu, 31 Dec 2009 20:49:20 +0000

I’ve had two total hip replacements. The first was a full incision and took me six months to get back on my feet and up to speed. The second one was three weeks ago with two tiny cuts. I’m already walking without a walker for up to 30 minutes. I still have a little trouble with stairs but that seems to be coming. Is a smaller incision really all that makes the difference?

The operation you had is called a minimally invasive total hip replacement (THR). Two small incisions are made: one in the front of the hip and one to the side. Besides the small cuts, there are other important differences from the standard THR.

No muscles or tendons are cut in a minimally invasive THR. The joint capsule is cut, but not removed. The joint itself is removed in several pieces. No cement is used to hold the new implant in place.

Overall, less trauma to the soft tissues and joint mean less pain and a faster recovery time. Patients can stop taking pain killers and get back to normal function faster. In fact most patients are able to put weight on the operated leg the same day as the surgery. Many go home in the first 24 hours.

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. For more information on this subject, visit www.zehrcenter.com.

Don’t know the cause of your hip pain? Scour test will tell.

admin — Fri, 04 Dec 2009 17:20:40 +0000

What does a “scour test” show? I read a medical report on my son that said he had a positive scour test.

The scour test is usually done when a patient has hip pain of unknown cause. The examiner bends the patient’s leg up so the knee is pointing to the shoulder. The examiner moves (scours) the hip in an arc of motion while putting pressure down through the leg into the hip joint.

The object is to look for any “catches” or bumps in the joint movement. Pain or apprehension on the part of the client are also positive findings during the scour test. This tells the doctor or therapist that the problem is coming from the hip joint and not some other source.

Is there a link between leukemia and metal joint implants?

admin — Mon, 24 Aug 2009 13:09:10 +0000

Is there any connection between leukemia and metal implants used for joint replacement? I know it sounds like a long shot but my father was just diagnosed with leukemia. His blood work has shown elevated levels of chromium in the past. The doctor always thought this was from his metal hip joint replacement but didn’t think it was a problem. Could there be a link?

Implants made of metal have a thin coating around them to prevent flecks of metal from going into the body and blood stream. This coating can breakdown, releasing potentially toxic chemicals into the body.

Several studies have been done that show an increased number of patients with metal hip implants developing cancer. Leukemia and lymphoma are the two types of cancer seen in patients with cobalt-alloy total joint replacements. The same has been reported for metal-on-metal hip replacement.

There’s no proof yet that the metals are the problem. More study is needed before we know for sure.