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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What is calcific bursitis of the hip?

July 25th — admin

Have you ever heard of calcific bursitis of the hip? That’s what I have. What can you tell me about it?

Calcific bursitis occurs as a result of tiny calcium deposits in the collagen tissue around the hip. The cause is chronic inflammation of the bursae. The bursa is a normal structure. It is a thin sac of tissue that contains fluid to lubricate areas and reduce friction between muscles, tendons, and bones. The patient reports pain and/or tenderness along the side of the hip. This is the area of the greater trochanter. The greater trochanter is a large bump of bone that juts outward from the top of the femur (thigh bone). Large and important muscles connect to the greater trochanter. Sometimes these muscles are referred to as the rotator cuff of the hip. Chronic tendinitis of the hip rotator cuff can also contribute to this problem. The calcium deposits are called calcification. They can occur as long as there is inflammation of the bursae (or tendons). The deposits don’t always go away after the inflammation has been taken care of, but the symptoms improve.

Treatment can help to prevent further calcification as well as relieve pain and stiffness. Antiinflammatory drugs, cortisone injections into the bursa, and physical therapy have been shown effective. In rare cases, the inflamed bursa is surgically removed.

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 hip arthritis be diagnosed without an x-ray?

July 20th — admin

My doctor thinks I might have hip arthritis. She would like me to have an X-ray. I’d like to avoid any more exposure to radiation. Can this condition be diagnosed without X-rays?

X-rays are still the number one tool physicians rely on to make an accurate diagnosis of osteoarthritis (OA). The radiograph shows changes that can’t be seen with a clinical exam. For example, narrowing of the joint space and bone spurs associated with OA are easily seen on X-rays.

Other changes common with OA that can be observed with X-rays include changes at the joint margins and subchondral bone. Subchondral bone refers to the first layer of bone underneath cartilage. Once the joint cartilage is destroyed by the OA process, the subchondral bone can be affected, too.

Without X-rays, there are some clinical tests that can be helpful in diagnosing hip OA. Hip range-of-motion (quantity and quality) is a key factor. A quick and easy screening test for the hip is to try assuming a squat position. If this position aggravates the symptoms (or you cannot do it because of hip pain), the hip is involved in some way.

The examiner looks for a specific pattern of motion typical with OA. Loss of hip internal rotation is a positive sign of OA. The examiner also relies on how the joint feels during testing motions. There should be a smooth, easy give through the full arc of motion. The examiner feels for a slight spring at the end of the motion. Any blocks or resistance to movement caused by pain or a bone-on-bone sensation may be an indication of degenerative joint disease.

X-rays may still be needed if all these tests are positive. But if they are negative, it may rule out OA and X-rays can be avoided. It’s likely that your physician found enough suspicious test results to suggest further testing with X-ray imaging. Don’t be afraid to ask your doctor about her findings so far and express your concerns about radiation exposure.

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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Change in hip flexibility is a warning sign for postmenpausal women

July 15th — admin

I’m 56, postmenopausal, and noticing a sudden change in my hip flexibility. My older sister has pretty bad hip arthritis. She started having this same change when she was around my age. Does it sound like I’m going to get arthritis too?

Arthritis is a very common problem for adults 55 and older. In fact, it’s estimated that up to one in four (25 per cent) of older adults will be diagnosed with this condition. Early and accurate diagnosis is the number one key to stay as functional and independent as possible for as long as possible.

For women who are postmenopausal, declining estrogen levels are linked with changes in soft tissue. Decreased blood circulation of estrogen contributes to reduced elasticity of ligaments and joint capsules. In the hip, ligaments surround the joint forming a capsule to support and stabilize the joint. With less estrogen available, these structures tighten up and become less supple or flexible and inflexible. The change in your flexibility could also be caused by a sedentary (inactive) lifestyle. But before you assign blame or cause to your problem, it might be a good idea to see your primary care physician for an accurate diagnosis.

If it turns out that you do have osteoarthritis, in order to prevent disability pay attention to good nutrition, getting enough fluids, and exercise. These four steps in self-care are all equally important. With or without early signs of arthritis, if you are overweight, weight loss is always advised. See a physical therapist for help with an exercise program designed to help you maintain flexibility, joint motion, strength, and endurance.

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 hip pain is a red flag for total hip replacement patients

July 12th — admin

My right hip has been bugging me off and on for two weeks. I have a hip replacement on that side so I’m a little worried. Could this be caused by a problem with the implant?

For anyone with a total hip replacement (THR), hip pain is a red flag. Medical evaluation is important because of the risk of joint infection. Treatment depends on knowing if there is (or isn’t) an infection. There are many possible causes for the pain you are having. They may or may not be related to the implant. The first thing the orthopedic surgeon will examine is the hip itself. Your history along with the clinical presentation are very helpful. But then the spine (above) and the knee (below) will be tested as possible sources of referred pain. X-rays and lab tests may be needed to rule out a fracture, implant loosening or infection. Other possible causes include bursitis, ossification (bone formation in the muscle or surrounding soft tissue), or synovitis. Cultures of the joint taken directly from the area during surgery are the most accurate way to confirm (or rule out) joint infection. But this type of testing is not practical for the patient who doesn’t have an infection or who doesn’t need surgery. And there is a fair amount of false-positive test results with intraoperative cultures due to errors in sampling technique. Instead, the physician may rely on lab tests that are sensitive, reliable, and accurate with a low false-positive and high true-positive results. The following tests may be needed to evaluate for hip infection: erythrocyte sedimentation (SED rate), C-reactive protein (CRP), and synovial fluid white blood cell count (WBC). Don’t wait to get tested. See your surgeon now. Early diagnosis can prevent a lot of complications from delayed treatment.

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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Pros and cons of hip joint resurfacing

June 28th — admin

My father had a hip joint resurfacing surgery. He’s fairly active and thought this would help save the hip in case he needed a hip replacement later. Unfortunately, exactly four months later, his hip broke and he ended up with a total hip anyway. Is this a common problem? We don’t know what to think about it.

Hip joint resurfacing has the main advantage of preserving bone in the neck of the femur (thigh bone). The main disadvantage is the risk of overloading the femoral neck causing fracture or loosening of the implant. Patients are chosen carefully for this procedure to avoid these problems. But sometimes unexpected complications occur anyway.

Joint resurfacing is fairly new, so we don’t know all the risk factors or variables that might lead to implant failure. One new area of study has been to look at the amount of load placed on the femoral neck before and after implantation. It’s possible that too much load on the hip too early after the surgery could lead to fractures. How much load the hip can take isn’t known yet. This could vary from patient to patient depending on their bone density, anatomical angles of the hip, and body weight.

Studies are also being done to examine the effect of slight variations in the placement of the implant. Even a 10-degree rotation of the implant can make a difference. More study is needed to look at patient risk factors and surgical techniques that might lead to hip fracture. Reducing these risk factors will help decrease the number of fractures and other complications of joint 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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Hip joint resurfacing vs. hip joint replacement

June 23rd — admin

I thought I was going to be spared having a total hip replacement by going for joint resurfacing. But I ended up with a hip fracture and a second surgery to replace the hip anyway. No one seems to know what caused the problem. What are some possible reasons for this happening to me?

Hip joint resurfacing instead of a total hip joint replacement is fairly new. Resurfacing replaces the arthritic surface of the joint but removes far less bone than the traditional total hip replacement. It saves bone in the femoral neck but can put strain on the femoral neck leading to fractures.

There are two main groups of risk factors for fracture after joint resurfacing. The first has to do with the patient. Bone quality is important. Decreased bone-mineral density and cystic bone changes can contribute to weakened bone. The bone has a decreased ability to withstand forces leading to fracture. Any changes in natural alignment of the hip can result in mechanical abnormalities. The most common of these malalignments are coxa varus (angled inward) and coxa breva (short femoral neck).

The second group of risk factors is related to the surgical procedure. Placement of the component is important. If the implant is tilted or angled too far in any direction, loading patterns change. The risk of fracture increases. The surgeon also uses a special technique called notching as part of the procedure. Studies show that notching reduces the bone’s resistance to fracture.

Sometimes it isn’t clear what went wrong. Efforts are being made to identify patients who are good candidates for joint resurfacing. Bone quality, general health, and past medical history are important features to consider. At the same time, surgeons are looking for ways to improve the implant and surgical techniques used.

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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Are rehab and recovery the same for joint resurfacing as for joint replacement?

June 7th — admin

I’m 59-years old. I’ve had one total hip replacement on the right. Now I’m looking at a joint resurfacing procedure for the left. I understand this new procedure is less invasive. Will the rehab and recovery afterwards be easier, too?

Hip joint resurfacing is a type of hip replacement that removes the arthritic surface of the joint but takes far less bone than the traditional total hip replacement. Recovery may be faster after joint resurfacing for some patients.

The rehab protocol remains the same. The main difference is how fast you move through the progression from range-of-motion to strengthening and beyond. In some places, physical therapy begins pre-operatively. You are evaluated for strength, motion, and function. And while you are free from the effects of anesthesia and post-operative pain, the therapist will teach you how to manage crutches (including stairs). This may be a review for you since you’ve had hip surgery before.

Even if you aren’t seen pre-operatively, you will be in physical therapy on the first postoperative day. Ankle and knee movements are used to help pump swelling out of the leg and to prevent the formation of blood clots. You’ll be wearing compressive stockings placed on your legs right after the surgery. Exercises and walking with assistance are initiated.

You probably won’t be putting your full weight yet on that leg, so you’ll need a walker, crutches, or canes at first. Eventually, you’ll progress to full weight-bearing without the use of any aids. Hip strengthening exercises, endurance activities, and a program to restore joint proprioception (sense of position) will be added. When you are safe in putting full weight through the leg, several types of balance exercises can be chosen to further stabilize and control the hip. This usually happens around six weeks post-op. Since you are familiar with a rehab program for total hip replacement, you won’t have any trouble adapting to a similar program following a joint resurfacing procedure.

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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