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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Why not replace hips before they break?

August 31st — admin

I know that this sounds way off, but why not just replace hips before they get broken? So many old people break them anyway.

That’s an interesting idea but not all that practical. First of all, not all seniors do break their hip, so it would become difficult to have to decide who would get a replacement and who wouldn’t. But, setting that all aside, this type of question shows that there is a misconception about the risks of surgery. Any type of surgery has its risks. Not everyone is healthy enough to have a major surgery like a hip replacement. Illnesses such as heart disease, asthma, and diabetes, can cause problems post-surgery. Hip replacement surgery requires that a patient go under a general anesthetic (risky on its own) and be subject to many of the potential surgical complications, such as infections, blood loss, and malfunction of the implant, to name a few. Then after the surgery, the patient has to be confined to bed and chair for a while and then undergo physiotherapy to regain the strength in the leg and hip. For some people, this is easy, for others, this is much more difficult. So, while the idea is certainly an interesting one, it’s not a practical 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.

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Why treat osteoporosis after hip is already broken?

August 23rd — admin

I fell and broke my hip two weeks ago. I finally made it out of the hospital and home again. Now my doctor is after me to take drugs for osteoporosis. I don’t see what’s all the fuss. I already broke the hip. How is taking some medication going to change anything?

There is a mistaken belief that by the time a fracture has occurred, it’s too late to do anything about the underlying osteoporosis. Nothing could be further from the truth. Study after study has confirmed the benefit of a three-arm approach to the prevention and treatment of osteoporosis (which includes preventing a second fracture).

The first is calcium supplementation with Vitamin D. The second is exercise. Weight-bearing exercises on land (not a swimming or aquatic program) helps bone formation. When the muscles contract and their tendons pull on the bone, it has the effect of stimulating bone formation. And third is the use of anti-osteoporotic medications called bisphosphonates.

Bisphosphonates such as alendronate (Fosamax), ibandronate (Boniva), or risedronate (Actonel) help slow down how fast the bone is resorbed (destroyed). Everyday new bone cells are formed and old bone cells are resorbed or destroyed. During childhood, new bone cells are formed faster than old ones are destroyed. In the aging adult, resorption exceeds formation. Despite the number of older adults with osteoporosis and even a history of hip fracture, not very many people are taking these medications. And for those patients who do have a prescription, taking it on a regular basis is not consistent. But they have been proven effective in reducing hip fractures and the death rate associated with hip fractures in patients with osteoporosis. And since your risk of a second fracture goes up dramatically after the first one, your doctor is right in strongly urging you to take this medication. It’s important to take it as prescribed over a long period of time. Follow your doctor and pharmacist’s directions when taking this (or any) medication. Report any side effects. The drug dosage or specific drug can be changed or altered. The goal is to give you the maximum benefit with the least amount of adverse effects.

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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More people return to playing golf after joint replacement than any other sport

August 18th — admin

Do you have any idea how my golf game might be affected by having my hip replaced? Right now, the pain keeps me from going more than 9-holes once a week. And my drive falls way short of what it used to. Can I even play golf after this kind of surgery?

Golf is a low-impact activity that can be resumed after rehab for total hip replacement. If you let your physical therapist know of your interest in getting back on the golf course, your rehab program can be advanced to include specific sports-training for golf. This is a good idea in order to prevent further injuries and to spare your implant excess torque or load.

Studies show that of all the sports patients are involved in before joint replacement, golf is the one more people return to. There’s some evidence that your handicap may increase as well as the your drive length. The average change in handicap is an increase of 1.1 strokes. The average drive length increases by 3.3 yards.

Even though golfing can involve a fair amount of walking (which is good exercise), you may want to consider using a golf cart — especially at first until you see how well you do. Sometimes golfers with total joint replacements report mild pain or aching after playing golf. Using a golf cart can help reduce this by decreasing joint load and wear on the joint surface. Some golfers use the cart until they build up their strength and stamina. Try this yourself. Then you can reevaluate the benefit of continuing (or not).

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 sports can hip replacement patient participate in?

August 15th — admin

Since my new hip replacement, I’ve become much more interested in exercise. I have no pain and feel like I could tackle some fun activities. I remember the surgeon telling me to avoid certain activities like jogging or tennis. How about horseback riding or cross-country skiing? I used to do those when I was younger. I wouldn’t mind trying them again now.

In a recently published review of athletic activity after joint replacement, experts in the field tried to give patients and surgeons an idea what is safe and appropriate athletic activity after total joint replacement. They base their comments on information taken from several studies published on athletic activity after hip and knee replacements. They also used surveys of surgeons collected by the Hip and Knee Society.

In general, it looks like there is agreement that patients with total joint replacements CAN participate in demanding sports. Some of the high-demand sports patients were involved in included tennis, jogging, downhill skiing, racquetball or squash, and basketball. But it’s not clear whether or not it is wise to do so. Most surgeons advise avoiding these activities because of the high-impact loading and twisting motions required.

Other activities such as bowling, horseback riding, cross-country skiing (even downhill skiing), or weight lifting are allowed but with certain precautions. Patients must have some prior experience with these activities. They should be aware of the risks associated with each activity. Training is a must.

At least six to eight weeks of back, hip, and knee rehab along with core strength training is advised. This can protect the joint, prevent injury, and reduce your risk of implant failure from wear or loosening. If you choose your sport carefully, understand the risks, train to protect, then there’s no reason why you can’t engage in those activities and have fun!

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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Should dementia prevent hip replacement surgery?

August 10th — admin

Do you think dementia should prevent my father from having a total hip replacement? He is still in good health and otherwise mobile. But we are worried he’ll get up and walk on it when he shouldn’t.

Quality of life is an important issue at any age and in any circumstance. The presence of Alzheimer’s, dementia, or other neurologic problem must be considered but isn’t a reason to withhold treatment.

In the case of hip replacements, an assessment of need should be done. An orthopedic surgeon is the best one to consult for this. There may be other less invasive treatments that can make a difference. Physical therapy to help restore motion and strength can help. If they haven’t been tried yet, cortisone injections and/or antiinflammatory medications may provide some effective relief. And if it turns out that surgery really is the best option, the surgeon will modify treatment to take the cognitive condition of the patient into account. For example, there are minimally invasive surgical techniques that can be used to take the old joint out and put the new implant in. The postoperative protocol allows for early weight-bearing. There are fewer restrictions on movements and positions.

The type of implant used can be chosen based on the patient’s specific needs. A larger femoral head component helps reduce the risk of dislocation. Cementing the prosthesis in place also makes for a more stable joint. Preventing complications is a key factor in cases like this. Having a team approach with family, patient, and health care providers will go a long way to provide a good result.

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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Does high-risk patient require intervention?

August 5th — admin

Well, I hate to admit it, but Mother is a bit of a drinker. We didn’t tell the doctor, and now she has fallen and dislocated her new hip replacement. Should we say something? Or is it already too late?

Most surgeons perform a screening exam to look for high-risk patients. Patients who are considered high-risk don’t just have problems with alcohol use and abuse. They may have other significant health problems. Dementia, Alzheimer’s, diabetes, and heart disease are common in older adults who need a hip replacement. The presence of a drinking problem doesn’t mean the patient can’t be treated.

First of all, even older adults can get help for an addiction problem with alcohol or other drugs. A psychologist or social worker in the community who specializes in this type of problem can be very helpful.

Second, precautions can be taken to prevent falls and hip trauma. A physical therapist is the best one to assess both the patient and his or her home for ways to reduce the risk of falls and fractures or dislocations.

Third, if revision surgery is needed, the surgeon may want to put the patient in a brace or cast to slow him or her down and give the soft tissues a chance to heal. Sometimes, for the older adult (and especially someone with weak muscles or lax (loose) soft tissues), a specific type of implant is used that is less likely to dislocate. The surgeon may choose an implant with a larger femoral head and then cement the socket portion in place. Both of these steps help stabilize the joint.

So, it’s never too late to offer information that can help direct and guide treatment as well as prevent further complications. It may be best if the patient (in this case, your mother) disclose this type of information to the physician. Encourage your mother to confide in her surgeon. Having them work together to solve the problem is usually more helpful than family members stepping in without the patient’s permission.

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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