Is getting a hip replacement a wise choice?

May 17th — admin

It seems like all my friends are getting hip or knee replacements. I’ve been told I need one, but I’m just not ready to jump in. Am I the only one holding out on this?

Joint replacement is an accepted treatment for arthritis. It has been shown to be safe and effective for the majority of patients. Even so, research shows that only 10 percent of patients with arthritis are willing to do it. The patients had all been evaluated as needing a joint replacement.

There are many reasons why patients hold off on this decision. Some do not have accurate information to rely on. They depend on their friends and peers’ results to make decisions for themselves. They may have been told paralysis is likely or that the pain doesn’t go away with the new implant. These fears keep them from taking advantage of this treatment.

Talk to your doctor about the risks and benefits of joint replacement for yourself. Make sure you are a good candidate. Then use accurate medical information to make an informed decision. Don’t rush into it until you are “ready to jump in.”

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 osteolysis?

May 10th — admin

Can you tell me what osteolysis means? My husband’s knee replacement went bad because of this problem. Now he has to have another operation to replace the replacement.

Osteolysis is a term used to describe a problem common to artificial joint replacements. It refers to an active process of bone breaking down and dissolving. Particles called debris wear off the implant. This starts a process of bone degeneration.

As the body tries to clean up the loose particles of plastic or metal, the bone grows away from the implant, causing it to loosen. A second or revision surgery may be needed. The surgeon will remove the damaged implant, smooth the bone, and reinsert another (new) implant.

Osteolysis caused by wear debris occurs for a variety of reasons. Patient activity is probably the most important one. Increased activity puts greater load over time on the joint replacement.

The implant itself is part of the problem. Manufacturers are working to improve implant materials and design. And finally, the surgery is a factor. Balancing the ligaments and restoring normal joint alignment are important in the long-term wear and tear on the joint.

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 baja of the kneecap?

May 2nd — admin

What is baja of the kneecap? My surgeon has identified this as the main reason my total knee replacement is so stiff.

Patellar baja refers to the position of the patella or kneecap. In patellar baja, the kneecap rides down low over the femur (thigh bone).

This can just be the way you were born. More often it occurs as a result of the patellar tendon shortening after surgery or injury. Either way, a patellar tendon that is too-short can pull the patella downwards.

A recent study of stiff knees after total knee replacement (TKR) identified patellar baja as a possible cause. Women were at higher risk of patellar baja. Younger age was also a factor but age was linked with joint stiffness after TKR, not the patellar baja.

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 much work will I miss having a partial knee replacement?

April 20th — admin

I’m trying to save up enough vacation time to have a knee replacement done. I’m opting for the unicompartmental design to help speed up recovery. How much time should I expect to be out of work for this operation?

You didn’t mention your age but since you are still working, we will assume you are younger than the average adult having a knee replacement. The peak age range for patients having total knee replacement (TKR) is 75 to 84 years old. Many patients having the unicompartmental knee arthroplasty (UKA) are younger than that.

Time in the operating room for a UKA is about an hour shorter than for a TKR. Recovery time is less for UKA, both in the immediate post-operative period and for rehab afterwards.

A recent study of outcomes suggests that patients experience about five weeks of disutility after a UKA. Disutility is defined as less than perfect health. This time period may vary depending on the age of the patient and general condition or fitness before the operation. Any complications such as infection or implant loosening can alter this estimate.

The demands of your job may make a difference as to how soon you can return to work. For example, manual laborers may need more time to rehab and build up enough strength for the required tasks compared to someone with a sedentary job at a desk. You may be able to return to your job before attaining perfect health.

Check with your surgeon for a more accurate idea. He or she may have some additional information to offer based on the type of implant being used and clinical examination of your condition.

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 an older adult get a partial or complete knee replacement?

April 18th — admin

Please help me out. We are trying to advise my father about knee replacement surgery. He’s 78-years old and not very active. The doctor has advised just replacing the side of the joint that’s worn out. At his age, wouldn’t it make more sense to replace the whole joint and be done with it?

Replacing one compartment of the knee joint is called a unicompartmental knee arthroplasty (UKA). Most often it’s the inside (medial) half of the joint that wears down first and becomes arthritic.

There are several pros and cons to this operation. Operative and recovery time are less. The cost is less, too. But there are some concerns, too. Studies show the UKA doesn’t last as long as the TKR. Other studies show function is improved more with the UKA compared with the TKR.

There may be an increased need for revision if the one-sided implant comes loose or the other compartment wears out. Then the patient would need a total knee replacement (TKR) after all. Overall, the UKA has become more popular as surgical implants and techniques improve.

A recent analysis of the cost versus benefit of UKA and TKR for low-demand patients confirmed the usefulness of the UKA. Low-demand means the person is fairly inactive and unlikely to put much stress on the new implant. Your father may fall into this category.

If the UKA gets him back on his feet sooner he may become more active. Many older adults find that pain relief from the implant makes their daily activities so much easier. They weren’t looking for a game of tennis or to take up jogging again, anyway. Many elderly patients die of unrelated causes before the UKA ever wears out or needs revision.

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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Would a knee replacement help my tightened muscles?

April 6th — admin

I’m 77-years old and have pretty bad knee arthritis. I can’t straighten my left knee all the way anymore. It means I have to walk with a limp all the time. Would a knee replacement help get my motion back if the loss of motion is caused by muscle tightness?

When a surgeon replaces a joint, the condition of the soft tissues around the joint is always evaluated carefully. Muscles, ligaments, and joint capsule may all be contributing to the problem and can be corrected.

The surgeon will carefully take steps to restore full motion during the operation. Removing any and all bone spurs called osteophytes is important. Osteophytes can act as a bony block to the joint, preventing it from moving all the way. These bone spurs can also keep the soft tissues from moving smoothly and freely with the same result.

If removing the osteophytes still doesn’t restore your motion while in the operating room, then the surgeon can remove some of the bone at the bottom of the femur (thighbone). If this doesn’t gain the needed motion, then one of several other steps can be taken.

First, the joint capsule may be cut or released. Then the gastrocnemius (calf muscle) may be released. Finally, a hamstring tenotomy can be performed. A tenotomy is the surgical cutting or division of a tendon.

Most often these last steps aren’t needed. Just removing the osteophytes and balancing the soft tissues around the knee is enough to restore your motion. It may take awhile, but with rehab you should be able to resume walking normally after your knee 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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Can knee replacements set off airport security detectors?

March 23rd — admin

I have a brand new knee replacement (this year). When I travel, I notice some airport detectors go off and others don’t. Why is that?

Many people have reported differences not only from airport to airport but even from time to time through the same security detector. To solve this puzzle, Dr. Robert F. Ostrum, Chief Orthopaedic Surgeon at Cooper University Hospital in Camden, New Jersey did a little research on the topic.

He found that airport metal detectors generate a brief magnetic field. When a metal object passes through the detector, the magnetic field is reversed and a sharp electrical spike sets off the alarm. Many other factors come into play as well.

For example, the more metal you have (say from multiple implants) or the larger the pieces (mass), the more likely it is that the detector will sound the alarm. The type of metal can also make a difference. Anything with iron in it or other type of metal that can be magnetized increases your chances of detection.

Detection units can also be set for higher sensitivity. So on high alert days, you are more likely to set off the alarm when you walk through the archway compared to a low-alert status.

Some of the walk-through archways only have a detection device on one side. If your implant is on the opposite side, you are less likely to set off the alarm. The handheld wand detectors are more likely to detect metal implants but these are not used routinely.

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 common are knee replacements in younger adults?

March 15th — admin

I’ve met more and more younger adults who have a knee replacement. I thought you had to be older before anyone would consider giving you a joint replacement. Is this changing?

Improved implant design and survivorship (how long it lasts) have made it possible for younger adults to have a joint replacement. There’s also a unicompartmental replacement that only replaces half of the joint.

The unicompartmental knee arthroplasty (UKA) is gaining in popularity for younger, more active adults with knee osteoarthritis.

Surgeons who prefer the UKA say that results are similar to results for a total knee replacement (TKR). The advantages of the UKA include faster recovery with a shorter hospital stay. This means lower costs.

Studies also show better range of motion with a UKA. Improved motion with less pain makes it possible for these patients to resume sports and recreational activities.

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 total knee joint replacement problem is over-stuffing. What is it?

March 1st — admin

For months after my new total knee joint it just seemed like something wasn’t right. I finally got a second (and a third) opinion. Both consulting orthopedic surgeons called my problem “over-stuffing.” What does this mean really?

Creating the perfect total knee replacement requires a very delicate balance between bone, implant, muscles, and ligaments. The surgeon may be working with osteoporotic bone or a joint with a natural extra rotation in one direction or another.

Once the arthritic or damaged bone is removed to make room for the implant, the surgeon must choose the right size and type of prosthesis for each patient. Replacing the anterior or front portion of the femoral bone (thighbone) with an implant that is larger than the bone removed is called over-stuffing. Too much over-stuffing can cause pain and loss of motion (flexion).

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 health care 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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I had a total knee replacement about three months ago. Why don’t I have my full motion back?

February 22nd — admin

I had a total knee replacement about three months ago. I never did get my full motion back. The doctor mentioned manipulating the joint and sending me back to PT for an intense rehab program. How soon should I do this?

Your surgeon may have a time frame in mind so be sure to ask for his or her best recommendation. For some patients manipulation is enough. The patient is anesthetized and the surgeon moves the joint through its full range of motion while the body is completely relaxed. Tiny adhesions and fibrotic tissue tear during this process.

Manipulation is best done in the first 90 days after the joint replacement. If the surgeon waits too long, the risk of fracture goes up.

Some patients need a more aggressive treatment. An operation called arthrotomy is done to clean the joint of any scar tissue. Many surgeons debate the timing of this treatment. Some experts suggest this type of surgery only after four to six months of intense physical therapy first.

With either type of procedure, intense rehab for weeks to months is needed afterwards. Exercise may be aided by stretching, bracing, and electrical therapy. The patient should show steady improvement in range of motion over the first two to three weeks in PT. Communication between the patient, therapist, and surgeon is also extremely important for the best outcome possible.

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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