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

Careful monitoring needed for hip dysplasia

admin — Wed, 28 Jul 2010 14:00:17 +0000

I just came back from the doctor’s where I found out I have hip dysplasia. My hip started hurting about six months ago and the X-rays showed this deformity. How often does this happen, and what does it mean in the long-run?

Developmental hip dysplasia (DDH) is probably present at birth or occurs during development in the early years. A change in the normal anatomy results in a shallow hip socket. The angle or tilt of the femur (thigh bone) and rotation of the femoral shaft (long part of the bone) are also different from normal. The patient is at increased risk of partial dislocation called subluxation or even full dislocation.

According to at least one study, this condition occurs in about five to 13 percent of the adult population. The person may not even know it’s there until pain sends him or her to the doctor for an X-ray.

There is some evidence that dysplastic hips have an uneven load across the joint. The cartilage on the surface of the joint can get damaged directly. Abnormal stresses on the soft tissues supporting the joint can lead to wear and tear of ligaments and cartilage.

Damage to the cartilage around the rim of the socket changes the pressure inside the joint. Synovial fluid that lubricates the joint may leak out adding to the wearing away of the cartilage.

No one is quite sure if these changes always occur or how long it takes before they result in arthritis. One study from Denmark reported no adverse changes even after 10 years of untreated DDH. It may be best to treat the hip conservatively but keep contact with your doctor. Any change in symptoms should be re-evaluated sooner than later to prevent excessive damage.

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.

Can you get arthritis in a joint replacement?

admin — Fri, 23 Jul 2010 14:00:56 +0000

Have you ever heard of getting arthritis in a joint replacement? That’s what my doctor tells me is causing my hip pain. How is that possible?

Prosthetic arthritis is a very real condition. It is caused by erosion or damage to the joint cartilage. This type of problem occurs with a joint implant called a unipolar hemiarthroplasty.

The unipolar implant is one of the first type of partial hip replacements designed. It replaces the round head of the femur (thigh bone). It has a stem attached to it that goes down inside the shaft of the femur to hold it in place.

Younger, more active patients are more likely to develop this kind of problem. The implant moving inside the hip socket chips away small pieces of bone and cartilage leading to cartilage erosion also known as prosthetic arthritis.

A newer type of implant was made to try and avoid this problem. It’s called the bipolar prosthesis. Besides the femoral implant, a plastic-lined, metal cup is inserted into the patient’s own natural acetabulum (hip socket). Instead of just the femoral head moving in the acetabulum (unipolar implant), the bipolar allows for two points of motion. The femoral head moves and rotates inside the cup and the cup moves and rotates inside the acetabulum.

The bipolar hemiarthroplasty is more expensive but recommended for active patients younger than 65.

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.

Pain control after total hip replacement surgery – what helps?

admin — Tue, 15 Jun 2010 23:51:18 +0000

Two months ago I had a total hip replacement. I wasn’t prepared for how painful it was afterwards — worse than my arthritis. Now I’m glad I had it done but I can’t help but wonder why they can’t do more for patients to reduce the pain.

Pain control after major orthopedic surgery has really come a long way. General anesthesia (putting the patient to sleep) was the standard way to operate for years. But there were serious problems with blood loss and blood clots.

Over time doctors have been able to narrow the anesthesia down to the specific area being operated on. This is the use of nerve blocks called regional anesthesia. The risk of blood clots is much less. Patients are also less likely to have nausea, vomiting, fever, and breathing problems.

Postoperative pain is still a problem. The latest effort to control pain after a hip replacement is the continuous use of nerve blocks. The doctor keeps the leg from feeling any pain for hours to days after the surgery. The hope is to find a drug that will do the same thing but still allow the patient to go home.

For now, a combination of anesthesia and narcotics seems to work well. Each patient is different so it’s never clear what dose of each drug is ideal. Doctors and nurses must adjust both to find the optimal treatment for each person.

When is it time to replace a total hip replacement?

admin — Fri, 11 Jun 2010 13:15:57 +0000

My husband is having severe thigh pain from a total hip replacement. How do you know when a problem is bad enough to need more surgery?

Good question and of course, it probably varies from person to person. The first thing to find out is if the problem is something that can be fixed with another operation. Perhaps the surgeon has already told you the implant needs revision.

In some cases patients wait so long to have the hip replacement that they can’t recover fully. More surgery may not make a difference. In other cases, the problem isn’t with the new implant. The person may have spinal stenosis or some other low back problem causing referred pain to the hip.

When a patient’s quality of life or activity level is severely affected, then something needs to be done. Pain can disrupt daily activities and lead to further problems. If you haven’t seen the orthopedic surgeon who did the first operation, it would be a good idea to make an appointment now before things get worse.

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.

Can hip pain be caused by a back problem and vice versa?

admin — Tue, 19 Jan 2010 22:15:23 +0000

Can back pain be caused by a hip problem? My doctor thinks my low back pain is really coming from the hip on that side.

Pain from one area of the body can be referred to another part of the body. Back pain can be caused by the hip. The opposite is true, too: hip pain can be caused by a problem in the spine.

Sometimes the pain is close by but at other times it can travel far away from the source. A standard rule of thumb for any part of the body is to check for problems at least one level above and below the site of pain.

There are special tests that can be done to find out where pain is really coming from. For example rotating the hip inward can help screen for problems coming from the hip. Likewise, bending the hip and knee and putting pressure through the hip can help identify back versus hip pain. Your doctor has probably used these tests to come to this diagnosis.

The final proof will be in treating the hip. Expect to see your back pain go away by improving hip motion and function.