My family has a history of hip problems. Is there value in having my hips X-rayed to see if they are okay?

My family seems to have a history of hip problems. We don’t all have the same condition but quite a few have arthritis. Is there any value in going in and having X-rays taken to see if my hips are okay? I don’t have any pain but I’m getting up there in age.

Research shows that about eight per cent of the general population develops arthritis. This is probably an under estimate as it is based on X-rays and many people don’t have routine X-rays that reveal this diagnosis. In an effort to prevent arthritis, there are some experts who suggest routine screening for problems that might result in arthritis. But the cost of performing X-rays and/or MRIs on everyone may not be cost-effective.One condition that can lead to early degenerative changes is called femoroacetabular impingement (FAI). Perhaps one or more of your family members has had this diagnosed as the predisposing factor for their arthritis.Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.A recent study was done to see how many people in the general population have this problem. They took MRIs of the hips of 200 adult volunteers (ages 21 to 50) for a total of 400 hips. By examining the MRIs against other tests performed, they were able to see that 14 per cent of the people had femoroacetabular impingement and didn’t know it.In this study, they specifically looked at age, gender (male versus female), body-mass index (a measure of obesity), and ethnicity. These potential factors may put people at increased risk for impingement and then for going on to develop arthritis later.There were some significant findings from the measurements taken of each volunteer when compared with their MRI results. The elevated angle measured on X-ray (called the alpha angle) wasn’t diagnostic of femoroacetabular impingement by itself. (Though it was a predictor of hip pain and joint cartilage damage). When combined with restricted hip internal rotation, the alpha angle could be used to predict impingement. A positive impingement sign was a reliable indicator of a problem with the labrum (rim of cartilage around the hip socket).What this tells us is that your orthopedic physician can examine you and offer some direction as to whether or not an X-ray or MRI is even needed. If you are painfree and there are no clinical signs of impingement or arthritis, then it may be appropriate to just monitor your situation. This will avoid unnecessary costs and exposure to X-rays while still keeping an eye out for any signs of developing problems.

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.

Too fat for knee surgery?

I’m about 100 pounds overweight and need a total knee replacement. The doctor won’t touch me until I lose at least 50 pounds. Does it really make a difference?

Yes. Obesity has been linked to heart and lung complications from surgery. Surgeons like to do surgery. A patient should sit up and take notice when a doctor refuses to operate. Losing weight would be in your best interest for a good operative result.

Whether or not you need to lose weight for a good result with the knee replacement is still uncertain. It makes sense that less weight and less stress on the implant will mean it lasts longer.

But there’s really no data to show that being overweight means a worse result. This may not hold true for patients who are extremely overweight. Studies have not reported results for patients in this group.

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 Aunt Luella is afraid her diabetes and obesity will kill her on the operating table. How can I calm her fears?

My Aunt Luella is a very large, but very active woman. She could really use a total hip replacement, but she’s afraid her diabetes and obesity will kill her on the operating table. What can I tell her to calm her fears?

It may be best if she had a medical exam along with an evaluation by an orthopedic surgeon. The doctors can assess her level of risk based on several factors. They will look at her age and general health (both mental and physical).

Any other conditions present such as high blood pressure, diabetes, and obesity will be reviewed carefully. Other problems that can interfere with anesthesia such as sleep apnea or asthma do put the patient at increased risk of complications during surgery.

Studies show there is a trend toward a higher rate of wound infection among obese patients after THR. The rate of dislocation and blood clots does not appear to be any higher than in the average adult group.

Long-term results to show the effects of obesity on wear and tear of the implant are underway. Results for large numbers of patients aren’t available yet. When dislocation or loosening of the implant does occur, revision surgery is often needed. Results are less than ideal in obese individuals under these circumstances.

Your aunt may need a longer hospital stay and more rehab services. It may be necessary for her to go to a transition or long-term care facility before going home. All of these steps can add to the total cost of the procedure. This is an important, but often neglected, factor to consider.

Many obese adults who elect to have a THR despite these concerns report a very satisfactory outcome. The pain relief they get is often enough to help them increase their activity level. They can have improved function and remain independent 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.

Obesity a factor in failed knee replacements

My brother-in-law is very overweight. His knees are bad but he refuses to lose weight. He says he’ll just have them replaced when they wear out. Is it really that simple?

The rising cost of health care has taken “simple” out of almost every picture today. Obesity is linked with degenerative disease of the hips and knees. A high body weight is also linked to a poor result after the joints are replaced.

A recent study at The Good Samaritan Hospital in Baltimore, Maryland compared total knee replacements (TKRs) in obese and nonobese adults. The patients all got the same joint implant (one that has been used successfully for many years).

Results were reviewed after five years. Being overweight had a negative impact on the success rate of TKRs. More implants failed in the obese group than in the nonobese group. Obese patients with failed implants had lower satisfaction rates.

There are improved medical treatments for obesity today. Encourage your brother-in-law to see his doctor and find out what are his options. He may be able to at least improve his health before his knees wear out and he faces the risks of surgery.

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.

Obesity a factor in total hip replacement surgery

I have been overweight all my life and now my hips are so bad with arthritis I need replacements. The doctor has told me to lose weight, but how much is enough?

A recent report on 851 cases of total hip replacement included information on patient demographics. This refers to data about the patients’ ages, gender, diagnosis, and body mass index (BMI).

BMI is calculated based on height and weight. It helps show how much body fat you have. Health risks from carrying too much weight include heart disease, diabetes, and arthritis.

A BMI in the “healthy” range does not always mean the person is fit and healthy. Poor diet and genetics can put an average person at risk for health concerns. Keep in mind the BMI does not take into account body frame. A muscular, large-framed person’s BMI could indicate obesity, but this may not be the case.

The Centers for Disease Control and Prevention (CDC) offer a website with easy calculations of your BMI. You can do this by going to:

http://www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm

Once you’ve found your BMI ask your doctor about a reasonable weight loss plan. Studies show results after a hip replacement are best in patients with a BMI of 30 or less.

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.

Obesity may be a factor in hip replacement surgery technique

I saw a videotape in my doctor’s office showing two ways to do a total hip replacement. One had a much smaller incision than the other. How do they decide which method to use?

 

The small incision is a fairly new method for hip joint replacement. It’s called a mini-incision. Many studies are being done to compare the mini-incision method with the standard way to replace the hip joint.

Right now doctors choose patients who aren’t overweight. Compared to the standard-incision group the mini-incision group is more likely to be male, taller, and thinner. In fact, the standard-incision group is six times more likely to be obese than the mini-incision patients. The mini-group also has fewer problems in general after surgery.

Researchers are working to find out what type of patients is best suited for each method. That information will help doctors guide their patients in choosing the right operation for each one.

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.