How many hip replacement surgeries are safe?

December 7th — admin

How many replacement surgeries can someone have on their hip. My mother-in-law had a replacement that lasted about 12 years and then it broke. The doctor fixed it but now, just a year later, it’s broken again and they want to operate again. Is that a good idea or is enough enough?

Without knowing your mother-in-law’s history and knowing anything about her hip, it isn’t possible to tell if the second revision surgery is a good idea. However, revision surgeries are done to remove the broken piece, regain lost motion and reduce or eliminate pain. When the surgeon feels that surgery will help with one or all of those goals, then it could be an option, if the patient agrees. In order to do revision surgery, the patient must have enough healthy bone available to attach to the prosthesis. If your mother-in-law’s doctor is suggesting surgery, it is likely that he or she feels that your mother-in-law has the bone that 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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Is a labra tear with impingement diagnosis really that complicated?

November 8th — admin

I finally got a diagnosis for my hip pain: a labral tear with impingement. Seems like they did every imaginable test to figure it out. Is it really that complicated?

The hip is a fairly complex joint. Problems that often seem like they are in the hip really originate from the low back, sacroiliac joint, and even the knee. True hip pain usually occurs in the groin and front of the thigh. But even knowing the problem is in the hip doesn’t identify the true cause. It could be the soft tissues in and around the joint, the articular cartilage inside the joint, or the rim of cartilage around the rim of the hip socket called the labrum.When the labrum is tored, frayed, or damaged in some way, it can get pinched between the head of the femur and the acetabulum (hip socket). This pinching or impingement is what causes the groin pain, loss of hip motion, and sometimes grinding, catching, or locking sensation with certain hip motions. Labral tears can be especially difficult to diagnose because there are often other changes going on in the hip at the same time. The physician relies on a standard physical exam, history, and then special tests to sort it all out. Joint range-of-motion, strength, and a postural assessment provide helpful information. The patient’s report of what makes it better and what makes it worse is also very useful.There is also a pain test that can be done. The surgeon injects a numbing agent similar to novocaine into the hip joint. If the pain goes away, it’s an indiction that the source of the pain is coming from inside the joint. If the pain doesn’t go away, it could still be something around or just outside the joint.But X-rays and sometimes MRIs are often needed to confirm the presence of a torn labrum. And even then, it isn’t until the surgeon performs an arthroscopic exam that the true extent (and possibly cause) of the problem are uncovered.

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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Fast-track program for hip replacement

September 30th — admin

Have you ever heard of a fast-track program for total hip replacements? That’s what my father is on, and we are just wondering what it means.

Patients and surgeons are both interested in a speedy, painless recovery from surgery after a total hip replacement. To reach that goal, surgeons have introduced something called a minimally-invasive surgery (MIS). Minimally invasive surgery refers to any operation where the surgeon changes how long or how deep the cut is made into the tissue. With some minimally invasive approaches, the surgeon can avoid cutting into most of the muscles around the hip that are normally removed from the bone during the standard hip replacement surgery. The hope is that with less trauma to the soft tissues (especially the muscles around the hip), the patient will be able to recover that much faster.

There are also some efforts to speed up the rehab or postoperative recovery process. A program called the fast-track has been designed to accomplish this. Several studies have shown that patients who are on the fast-track after surgery get better faster. The fast-track means they get a patient-controlled pump to manage their pain. They start rehab sooner, and the therapist provides a more aggressive program. In studies so far, patients in the fast-track groups are discharged sooner, can walk better, and are more satisfied than patients following the standard rehab protocol. This is true no matter what type of incision or approach was used to do the surgery.

Not everyone can participate in a fast-track program. Patients are selected based on general health, motivation, and compliance level. Complications after surgery such as infection, dislocation, or fracture can put an end to someone’s fast-track status. But for those who are able to complete the program, the results have been very impressive.

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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My mother was told that she should lie in bed a certain way after her hip replacement. Why is that?

March 15th — admin

My mother was told that she should lie in bed a certain way after her hip replacement. Why is that?

After patients have hip surgery, there are some positions that they must avoid for a while and others that are most comfortable and will help the hip heal properly. As a result, a physiotherapy regimen is important so patients and families can learn what the patient should and should not do.

Immediately after surgery and for a set amount of time, patients should not bend their hip more than 90 degrees. Patients should not cross their legs while sitting, recline with their legs at more than 90 degrees, or pivot their hip outwards or inwards. When lying in bed, the hip can twist if a patient is lying on the side. This happens as the knee tries to rest on the mattress.

When lying in bed after hip surgery, if lying on the side, a pillow should be placed under the “higher” leg to rest on, so the hip stays straight and in line with the body.

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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Delaying hip surgery for elderly improves recovery

March 26th — admin

My mother fell and broke her hip. The doctors say she has a better chance of recovery if we delay surgery. Why is this?

Mortality (death) rate during the first year after hip fracture repair is 55 percent in older adults when the surgery is done within the first 48 hours. The death rate goes down to 24 percent for surgery done 48 hours to one week later. Surgery done more than a week after injury is linked with only 14 percent death rate.

The reason for this? Doctors think many older patients are in poor condition when they fall. Medical treatment before surgery can make a difference. The person gets fluids and proper nutrition. Their medications are reviewed and adjusted. Those who have diabetes get their blood sugars regulated. Other health concerns can be taken care of.

All these things help improve the patient’s general condition and give them a chance for a better surgical 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 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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Delay in surgery for hip fracture could be fatal

November 25th — admin

I heard a report that older folks who break a hip on Sunday are more likely to die. Is there some religious significance to this?

The answer to this question lies more in the fact that a fracture on the weekend may not get treated until Monday at the earliest. Often the surgery schedules are full for Monday and the patient must wait until Tuesday.

Surgical delays caused by low staffing on weekends are the real culprit, not the fact that the break occurred on a Sunday. A recent study of over 18,000 patients with hip fracture showed a much higher chance of dying in patients whose surgery was delayed two days or more.

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.

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