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

I have a very painful buttock. I don’t recall any injuries. What could be causing this?

admin — Fri, 06 Jan 2012 11:00:27 +0000

Ouchie — I don’t know how else to say this but I have one painful buttock. I can barely sit down and can’t put any weight on that side. It just seemed to come on all of a sudden. I don’t recall twisting wrong or doing anything sudden. What could be causing this?

Pain along the back of the hip or buttock can be a very complex and puzzling condition to figure out. Sometimes a muscle gets overworked and goes into spasm. There could be an alignment problem of the spinal joints in the lumbar spine causing your symptoms. There could even be a disc pressing on a nerve creating your symptoms.The best way to find out is to see a musculoskeletal specialist. This could be a sports medicine physician, orthopedic surgeon, or physical therapist. Give some thought to your symptoms because the physician or therapist will ask you many questions about where it hurts, how it feels, what makes it better or worse, how long it lasts, and so on. The answers to these questions are key to understanding what’s going on.Pain along the back of the hip is rarely coming from inside the joint. We know this from anatomy studies and understanding the nerve pathways that supply the joint and surrounding soft tissues. It is most likely coming from elsewhere — like the sacroiliac joint, low back, or knee. It could be from a muscle strain, hernia, bursitis, degenerative disc disease, fracture, or even from a hip dislocation. Rarely, buttock pain can be caused by more serious problems like infection or tumor.There are many clinical tests that can be done to sort out what anatomical structure is getting pinched, overworked, or is out of balance or alignment. Change in joint motion, areas of muscle weakness, muscle tightness, and even the way you stand and walk will provide the necessary clues to identify the underlying problem.Sometimes, X-rays or other imaging studies such as MRIs, CT scans, or ultrasound studies are needed. But most of the time, the problem clears up with conservative care and doesn’t require expensive or invasive tests. If your symptoms don’t improve or go away with a few days rest, warm baths, and stretching, then make an appointment for an evaluation. Early diagnosis and treatment preventing worsening of the problem often saves both the pocketbook and the buttock from further suffering.

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.

My boyfriend, a football player, has a big bruise on his hip/thigh area. Shouldn’t he tell someone?

admin — Wed, 04 Jan 2012 11:00:10 +0000

My boyfriend is on our college football team. When we were at a party last night sitting in a hot tub, I noticed he had a big bruise on the side of his hip/thigh. He says he got hit pretty hard in practice but that it’s nothing. I’m really worried. Should he at least tell his coach about this?

Players are often unwilling to report injuries to the team athletic trainer or coach for two reasons. One, it might keep them out of the game. And two, they don’t want to be seen as a weakling or baby.Every player experiences his fair share of injuries that leave bruises. Most of the time, the injuries are minor and will heal on their own. We call these problems self-limiting. But there are those rare times when what seems like a simple problem turns out to be more serious than originally suspected.From your description, it sounds like your boyfriend may have what’s called a hip pointer. Athletes who collide with others or who take the force of a helmeted head into the lateral hip can end up with a hip pointer. This injury or contusion is visible as blood under the skin leaves a large bruise. It is treated with a leave it alone approach. Ice, rest, and compression help the body complete its natural course of healing.Pain that doesn’t go away with an injury like this could be a sign of a bone fracture. X-rays may be needed to know for sure. The biggest risk is for recurrent bleeding. Athletes are advised to rest and avoid vigorous activity for at least 48 hours after an injury like this.

I’m heading into arthroscopic surgery. What kind of recovery should I expect?

admin — Thu, 29 Dec 2011 11:00:43 +0000

I’m heading into arthroscopic surgery for my right hip. The surgeon is going to take a look around but for sure remove some pieces of cartilage that are floating around in there. What kind of recovery or rehab should I expect?

Hip arthroscopy is becoming a more common orthopedic procedure now with more and more hip injuries among the athletic crowd. Better imaging technology has also made it possible to find what’s wrong or what’s causing painful symptoms. Loose bodies in the joint is just one of the many reasons why arthroscopic procedures are used so successfully.But you are right — there is a postoperative program. And it’s important that patients complete this program in order to restore full joint motion, strength, flexibility, and function.The specifics of the program depend somewhat on the type of surgery that was done. For example, removing free-floating debris in the joint is a much simpler procedure than repairing deep holes in the cartilage. Likewise, repairing a torn labrum (fibrous rim of cartilage around the hip socket) may only require a simple home program. But there are some procedures that take longer to recover from and involve a slower pace of recovery.And competitive athletes will follow a four-step process of rehab progression. These four phases include 1) mobility and initial exercise, 2) intermediate exercise and stabilization, 3) advanced exercise and neuromotor control, and 4) return to activity.A physical therapist will show you what to do, how to do it, and how to advance or progress the program. You will probably start out on crutches for the first week to 10 days and gentle active motion of the hip. When you have full motion, the exercises assigned next are designed to restore strength and normal contract/relax sequences of all the muscles around the hip.Core (pelvis and trunk) stabilization exercises are recommended next along with balance training. And finally, if you are active in a sport or specific activity, you’ll be shown how to prepare to return to that sport. The goal is to participate fully without fear of reinjury.

My new hip replacement squeaks and clicks. Can anything be done about this?

admin — Thu, 15 Dec 2011 11:00:16 +0000

Everyone told me to get a ceramic type of hip replacement. They are so smooth, they said. I’ll be able to dance again with no pain and with ease. Well, that’s all true but guess what? My new implant squeaks and clicks like a bird. It is positively embarrassing, and I am so disappointed. Can anything be done about this?

Have you reported this to your surgeon and had it evaluated yet? That’s the first step to eliminating the problem. Sometimes the squeaking goes away by itself over time (that’s more likely when the implant is made of metal). Squeaks that develop after getting a new hip implant are not uncommon. But everyone shares your reaction to this problem — clearly, it is not acceptable! The cause of the squeak can be multifactorial (meaning multiple causes combined together to create the problem). The surgeon must re-evaluate the size and type of implant used and alignment obtained during surgery for both components (cup and stem). X-rays can be used to look for an obvious cause of the problem. There could be issues of alignment. Is the cup tilted or angled off a bit? Was the correct-sized femoral head and neck length used for that individual? Or perhaps infection or loosening of the implant is a contributing factor.Unfortunately, sometimes squeaks generated by a ceramic-on-ceramic implant can’t be identified and never go away. The surgeon ends up removing the ceramic lining inside the metal socket and replacing it with polyethylene (plastic) liner instead. That solution is almost 100 per cent foolproof.

The doctor wants my father, who needs a new hip, to participate in an implant study. Why?

admin — Fri, 09 Dec 2011 11:00:45 +0000

My father has to have a total hip replacement and his doctor wants him to participate in a study for different types of implants. Why should he do this?

Without knowing more about your father, his hip problems, and the study goals, it isn’t possible to say why your father should or shouldn’t participate. However, speaking about studies in general, there are advantages to participating if you meet the requirements.When people participate in studies held at academic centers and hospitals, they are usually exposed to intense scrutiny. They are examined thoroughly before the study and during the study. In non-study situations, a patient may only be seen briefly by his or her surgeon, with some follow up. For patients in studies, they are seen more often by doctors and nurses who work within the study and are often available to answer questions and troubleshoot if there are any problems.The major drawback that some people see with studies is that the study subjects, the patients, don’t usually know what treatment they are getting, the new one that is being tried, or the old one, or a sham treatment – depending on what the trial is. Ultimately, the decision has to be the patient’s.

I’ve heard so many rumors. Please tell me the truth about the restrictions on my hip movement after my hip replacement?

admin — Mon, 05 Dec 2011 11:00:25 +0000

I’ve heard there are lots of restrictions on how and when I can move my hip after I have a hip replacement. I’ve even heard I can’t sit in a car for the first month. If that’s true, how do I get home?

Standard precautions following a total hip replacement usually do include avoiding bending the hip more than 90 degrees. That usually means not bending forward from the waist over the legs or lifting the leg up past 90 degrees. There is also a limit on how much hip rotation is allowed.The concern is for safety and avoiding dislocation of the new hip implant. Studies show that hip dislocations after a hip replacement occur in two to four out of every 100 patients treated this way. To help patients avoid this unpleasant complication, movements that could stress the hip are avoided. A raised toilet seat is used for the first four to six weeks. Riding in a car is avoided. But with pillows and proper positioning, patients are allowed that one car trip from hospital to home. You will also likely be sleeping with a wedge strapped between the legs. Again, this is to keep the legs in the right position to avoid dislocating the hip. You’ll only be able to sleep on your back while the wedge is in place.Restrictions of this type aren’t always needed. With today’s minimally invasive surgical techniques, some of these restrictions can be lifted. Your surgeon will give you your Dos and Don’ts based on the type of procedure done and type of implant used. Patients who follow what their surgeons tell them to do have the lowest rate of problems.

What is a cervical hip fracture?

admin — Wed, 14 Sep 2011 11:00:42 +0000

Have you ever heard of a cervical hip fracture? What is that? I thought the cervical bones were in the neck, not in the hip.

There are many types of hip fractures, usually named for their location. A basic understanding of the hip anatomy will help visualize where the fractures occur.

The hip joint is one of the true ball-and-socket joints of the body. The hip socket is called the acetabulum. It forms a deep cup that surrounds the ball of the upper thighbone, or femoral head. The femoral head is attached to the rest of the femur by a short section of bone called the femoral neck. A bony bump on the outside of the femur just below the femoral neck is called the greater trochanter. A smaller bony bump on the femur called the lesser trochanter is located on a diagonal from the greater trochanter.

These two bumps on the femur are where some of the hip muscles attach. A cervical hip fracture refers to the fact that the break is inside the joint itself. Either the top of the femur (called a subcapital fracture) or the acetabulum (hip socket) have a break. Another term for the location of these fractures is intracapsular or cervical.

When the break affects the hip, but is not right inside the hip, the fracture is referred to as an extracapsular hip fracture. The fracture may occur in the neck of the femur (femoral neck fracture), between the two trochanters (intertrochanteric fracture), or in the main shaft of the femur just below the lesser trochanter and may extend down the shaft of the femur. This last type of hip fracture is called a subtrochanteric fracture.

Dislocate hip to fix it?

admin — Mon, 12 Sep 2011 11:00:06 +0000

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.

Even loose-jointed yoga instructor has hip pain

admin — Thu, 08 Sep 2011 11:00:25 +0000

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.

Why Mom won’t get her hip replaced

admin — Tue, 06 Sep 2011 11:00:12 +0000

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.