What is femoroacetabular impingement and what causes it?

March 5th — admin

What is femoroacetabular impingement and what causes it?

Femoroacetabular refers to the place where the femur (thigh bone) and acetabulum (hip socket) meet. Impingement means pinching.

In the case of femoroacetabular impingement (FAI), the head of the femur butts up against the cartilage and pinches it. Normally, the femoral head moves smoothly inside the hip socket. The socket is just the right size to hold the head in place.

If the acetabulum is too shallow or too small, the hip can dislocate. In the case of FAI, the socket may be too deep. The rim of the cartilage hangs too far over the head. When the femur flexes and rotates, the cartilage gets pinched.

This causes deep groin pain with activities that stress hip motion. Prolonged walking is especially difficult.

The cause of the problem is under considerable debate. For a long time it was assumed that overload of the joint caused this kind of OA. But no one could identify what was causing the stress overload.

Now with better imaging studies, we know that some subtle changes in the shape of the femoral head may be the cause of FAI. Other anatomical changes in the angle of the hip may also contribute to this problem. And as mentioned, FAI can occur if the hip socket is too deep.

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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How often do hip resurfacings fail?

February 11th — admin

I am very disappointed because I had a hip joint resurfacing in order to avoid having a total hip replacement. At 38, my surgeon thought I’m too young for a total hip replacement. Unfortunately, my hip fractured shortly after the operation. I ended up with a total hip replacement anyway. Does this happen very often?

Premature failure is the main complication of a hip joint resurfacing procedure. Loosening of the implant and fracture of the femoral neck are the two most common causes of early failure.

A recent study by orthopedic surgeons using the hip resurfacing technique may help us understand what’s going on. It seems that the round head of the femur that fits into the hip socket doesn’t have a very good blood supply normally.

Hip resurfacing requires the surgeon to dislocate the hip joint. Then the head of the femur is smoothed with a tool called a cylindrical reamer. The reamer prepares the femoral head for a smooth metal cap that is fit over the bone.

During this process of dislocation, preparation, and reaming of the femoral head, the blood supply to the head is decreased by as much as 70 per cent. This loss of blood flow is a major risk factor for loosening of the implant or fracture of the bone.

Although it’s not common, enough cases have been reported to bring this to the attention of orthopedic surgeons using this technique. Future studies will help surgeons identify ways to prevent this from happening.

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 the life expectancy of hip resurfacing?

January 24th — admin

In the early 1980s I had hip surgery to resurface the joint rather than replace it. Everything was fine for the first 10 years. After that it was one thing and then another. I finally had to have a total hip replacement. Did this happen often or am I a rare bird?

Hip joint resurfacing was very popular in the late 1970s and early 1980s as a way to preserve bone in younger patients. Instead of replacing the joint completely, the top of the femur (thighbone) is smoothed and capped. The same may be done to the hip socket.

Years ago the materials used for hip joint resurfacing (plastics) wore down and failed. Today, metal-on-metal is used instead. And cement used back then also caused problems with loosening. Newer techniques use a cementless fixation technique.

Over time studies showed a high failure rate for joint resurfacing. As many as two thirds of the patients had to have the joint resurfacing replaced with a total hip. And long-term studies into the third decade now continue to show a poor survival rate for the hip resurfacing procedure.

So you weren’t a rare bird at all but merely an early bird. Surgeons are advised to use this procedure with caution. It’s still a good choice for some patients –especially younger patients. It helps preserve bone and makes revision easier when and if you do need a total 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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Do hip sockets fracture often during surgery?

January 8th — admin

My 72-year old grandpa just had a total hip replacement. They said the socket fractured during the operation. Does this happen very often? What happens now?

According to a recent study from the Mayo Clinic in Rochester, Minnesota intraoperative acetabular fractures are rare. Out of 7,121 total hips done, only 21 patients had such a fracture. This is about a 0.4 per cent rate.

The Mayo study was able to identify the possible cause for this problem. They looked at the cup design used most often that fractured during the procedure. It looks like the elliptical shape and flare of the edges caused the most problem. Usually the shape of the opening for the cup didn’t match the shape of the cup.

Uncemented cups tend to fracture more often than cemented cups. This may be because more force is needed to set the cup up against the bone. If a fracture does happen, the surgeon checks to see if the hip is still stable. If it is, then bone chips are used to reinforce the fracture site. If it’s not, then the cup is taken out and a new one put in.

Your grandfather may have to wait a little longer to put his full weight on the leg. Otherwise, his rehab will continue as planned. He should be up and about fully in about six to eight weeks.

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 an intertrochanteric fracture?

May 25th — admin

My mother has an unstable intertrochanteric fracture. She’s having a special set of pins and a plate put in place to hold it together. The doctor thinks she’s too old and too unstable for a hip replacement. What kind of fracture is this?

Unstable means the broken ends of bone could come further apart under stress. The two ends of bone can even slide past each other causing what’s called a displaced fracture.

Intertrochanteric refers to a place high up on the thigh bone. It’s at the base of the femoral neck. The neck is a bridge of bone between the femur and the ball at the end of the femur that fits into the hip socket.

Intertrochanteric is one of two common hip fractures. Older patients in poor health and with poor function are most likely to have this type of break.

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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After my hip replacement, why is one leg shorter than the other?

May 21st — admin

Eighteen months ago I had a left total hip replacement. Everything went well but now the left leg is shorter than the right side. Should I have the right leg done now to even them out?

That may not be necessary. The first step is to bring this problem to your doctor’s attention. It’s possible a simple revision of the left hip implant is all that’s needed. Sometimes a plastic spacer can be inserted into the hip socket to make up the difference in leg length.

If the hip can’t be changed, then perhaps a shoe insert or shoe lift would help. A physical therapist can help you with this decision. It’s important to make sure that whatever measures are taken, your spine remains straight and your hips are level. This will help prevent other problems later on.

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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Where is my ligamentum teres?

May 1st — admin

I was in a car accident and broke my pelvis in two places. After the injury finally healed, I still had deep groin pain and my hip kept giving way. I had MRIs, X-rays, and CT scans done for my pelvis and nothing ever showed up. Finally I had arthroscopic surgery and the doctor found a tear in the ligamentum teres. Where is this and why doesn’t it show up on all these tests?

If you pull a chicken leg out of its socket, you’ll see a fibrous white ligament. That’s the equivalent of the ligamentum teres in the human. It helps hold the head of the femur (thigh bone) in the hip socket.

Traumatic or twisting injuries can cause this ligament to tear. Hip dislocation can stretch it to the tearing point, too.

Doctors don’t have a test to help them find this type of tear. In fact, it wasn’t until arthroscopic surgery came along that they even knew it occurs as often as it does. Now that we know it’s a problem, more studies will be done to find easier ways to diagnose it.

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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How is a neck fracture treated?

March 12th — admin

What is a femoral neck fracture and how is it treated? We just got word that our elderly father is in the operating room having surgery for this problem.

In a recent article, Dr. Robert Probe, an orthopedic surgeon in Texas offered a review of and some insight into surgical treatment of femoral neck fractures.

There are different types of hip fractures based on location. The femur is the long thigh bone with a round bony “head” at the top. The femoral head fits inside the acetabulum or hip socket. Fractures can occur anywhere in the long shaft of the femur, the neck (between the shaft and the femoral head), and the acetabulum. There is also intertrochanteric fractures. The intertrochanteric region of the hip is just below the femoral neck.

Two of the major problems that develop with femoral neck fractures are loss of blood to the femoral head and shortening of the femoral neck. Unless the patient cannot tolerate surgery for some reason, femoral fractures are best treated surgically. But that’s where the decision becomes much more complicated. Is the fracture stable enough to pin it back together until it heals? Will it heal? Are there patient factors that might result in a nonunion? How likely is a nonunion? Should the femoral head be replaced? If the decision is made to replace the femoral head, then the surgeon must choose between a cemented or uncemented stem (the piece that fits down into the shaft of the femur). That’s not the end of the possibilities.

The femoral head is available in several different models with different options (e.g., unipolar, bipolar) for achieving movement of the femoral head. It may be necessary to perform a complete hip joint replacement (femoral head and stem along with replacing the acetabulum). Should the surgeon try and save the hip knowing the patient may end up in surgery again in order to replace a failed fixation? Fixation refers to the use of screws, nails, pins, and metal plates to hold the broken pieces of bone together until healing can take place. This option is only available to a limited number of patients. The fracture must be stable.

If displaced (separated), it must be possible to bring the pieces together and precisely match them up again. Dr. Strobe describes the technique he uses when placing screws in the hip for a stable femoral neck fracture. He also discusses the use of a fixed-angle hip compression screw fixation. The compression screw keeps the femur from further bone displacement that would change the angle of the femur as it places the femoral head in the acetabulum (hip socket).

If the surgeon sees reasons and predictive factors that point to the strong possibility of nonunion and failed fixation, then hip replacement is the treatment of choice. Older adults who are active and wish to remain active may prefer this approach as well. It bypasses the possibility of a second surgery (from fixation to replacement). Current studies show fixation failure at 25 per cent right now.Results of total hip replacement (measured by pain, function, and revision rates) have been good-to-excellent for the “active and fit” older adults. Benefits and risks of this surgery for this age group with femoral neck fractures are still being investigated and reported.

Dr. Probe summarizes the article by saying that femoral neck fractures in older adults can be complex and challenging to treat. The surgeon makes every effort to save the natural anatomy. Patient health, strength of the bone, mobility, level of community activity, and predicted life span are all taken into consideration when making a decision about fracture fixation versus 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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What is a comminuted acetabular fracture?

March 8th — admin

What is a comminuted acetabular fracture? That’s what my brother just texted me that his wife has. What do they do for that?

To help you understand your brother-in-law’s condition, let’s define an acetabular fracture. The acetabulum is the socket side of the hip joint. It is made of cartilage over bone just like every other joint. The reason it breaks is because the person falls (and lands) in such a way that the head of the femur (thigh bone) is driven up into the hip socket (acetabulum) with enough force to break bone. When that happens, there can be a single break or fracture line but more often the acetabular bone breaks into many tiny pieces. That type of break is called a comminuted fracture.

Older men are affected more often than women by this type of damage. Their femoral bones are thicker, stronger, and transfer a greater destructive force into the acetabulum. Women tend to develop a break in the neck of the femur — long before there is any force up into the socket.

Until recently, this type of fracture was always treated conservatively (without surgery). And many times, this is still the most appropriate treatment. The presence of dementia, poor health, severe bone loss, and non-ambulatory status before the fracture are reasons why surgery may not be possible.

So long as the fracture isn’t displaced (shifted), those patients who could walk before the injury are allowed to walk with the support of a walker. But only minimal weight through the hip is allowed until healing occurs. A physical therapist helps move the hip through its motions but with some limitations to protect it. Bed rest (even for displaced fractures) with traction was once prescribed. But this is no longer recommended due to the many complications that arise with immobility in this age group (e.g., blood clots, bed sores, pneumonia, deconditioning).

For those patients who will have to have surgery, there are several options. A procedure called open reduction and internal fixation (ORIF) pretty much describes what happens. The surgeon makes an incision to open up the hip, lines everything back up as much as possible, and uses plates, screws, pins, and/or wires to hold it all together until it heals. The more closely the hip is restored to its normal shape and configuration, the better the results will be. The more bone fragments and the farther apart the bone fragments separate, the poorer the prognosis. If the patient is not a good candidate for ORIF (or if the ORIF procedure fails), then a total hip replacement may be the next step.

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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Twin boys have identical mishaped hips, but not identical problems!

March 6th — admin

We have twin boys who are both active in different sports. It turns out that they also both have a slightly misshaped hip. For one boy this has caused all kinds of hip problems, groin pain, and lost playing time on his soccer team. The other boy doesn’t seem affected at all. How come?

With impingement, the soft tissues around the joint get caught between the femur and the hip socket. There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.

Femoroacetabular impingement occurs when abnormal hip anatomy is aggravated by repetitive movements of the hip. There could be a slightly off center placement of the hip in the socket or a femoral head that isn’t perfectly round that is contributing to the problem. Or the hip socket may be too deep for the size of the femoral head or the rim of the hip socket is too prominent. Sometimes the angle of the femoral neck is bent or twisted just a tad from normal. There could be a separate piece of bone called the os acetabulum along the front rim of the hip socket. Any of these morphologic changes can lead to impingement.

The labrum, a fibrous rim of cartilage around the hip socket is the most likely area to get pinched. Add repetitive motion and you get repetitive pinching or compression until the labrum starts to fray and tear. No one knows for sure just yet why some athletes with this problem are affected while others seem not to notice a problem. With your sons, it could be there is just enough difference in the shape of one boy’s hip that he is spared the painful loss of motion and function. There could be differences in the degree of pinching that is going on or the tension of the soft tissues, muscles, and tendons around the joint.

Studies show that some high level athletes with abnormal hip joints never develop problems. Who does develop femoroacetabular impingement and how to predict if/when it should be treated are areas where further study is needed.

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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