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

If you have femoroacetabular impingement, is it inevitable that arthritis will eventually set into that hip?

admin — Wed, 01 Feb 2012 11:00:30 +0000

Is it always the case that if you have femoroacetabular impingement (which I have) that arthritis will eventually set into that hip?

Not necessarily though many individuals with femoroacetabular impingement (FAI) do indeed eventually develop degenerative changes that lead to arthritis. This is most likely to happen in cases of untreated FAI.Let’s define femoroacetabular impingement and talk about how it can lead to osteoarthritis of the hip joint. 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.The cam-type of impingement is the most likely to set up conditions ripe for joint wear and tear. This type occurs when the round head of the femur isn’t as round as it should be. It’s more of a pistol grip shape. It’s even referred to as a tilt or pistol grip deformity. The femoral head isn’t round enough on one side (and it’s too round on the other side) to move properly inside the socket.The result is a shearing force on the labrum and the articular cartilage, which is located next to the labrum. The labrum is a dense ring of fibrocartilage firmly attached around the acetabulum (socket). It provides depth and stability to the hip socket. The articular cartilage is the protective covering over the hip joint surface. This abnormal contact between the femur and acetabulum is the leading cause of labral tears and degenerative hip arthritis.Treatment is advised when impingement is painful, limits function, and/or X-rays show potential for joint changes. You may be able to follow a conservative path by modifying activities and carrying out a program of strengthening and stretching exercises. In some cases, surgery is indicated to correct the problem.No one knows for sure who will develop arthritis. Studies are underway to determine how common is the problem and what factors might increase the likelihood of developing arthritis. Your orthopedic surgeon will follow your case and advise you if and when treatment (and what treatment) is appropriate.

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.

Early treatment of hip disorders can prevent later complications

admin — Wed, 18 Jan 2012 11:00:34 +0000

Ever since I was a young teenager (maybe around 13 or 14), I’ve had a snapping hip problem. The general consensus at that time was to just ignore it. Now I’m in my late 30s and it is still bothering me. Should I see someone about this before another 20 years go by — or is it still considered a benign problem (don’t worry about it)?

It might depend on the cause of the problem. If you have a femoroacetabular impingement, then early osteoarthritis is possible, even probable. Just the slightest change in the morphology (shape and structure) of the hip joint can cause problems like this. Femoroacetabular 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. The first type of femoroacetabular impingement (FAI) is called pincer impingement. This type occurs when the rim of the acetabulum (hip socket) sticks out farther than normal. There are several causes of this problem. There can be an overgrowth of cartilage forming the rim or even extra bone that forms in the area. Sometimes the hip socket is tilted backward slightly. In either case, every time the athlete flexes the hip, the rim that’s sticking out too far pinches the labrum against the neck of the femur. The labrum is a fibrous rim of cartilage around the socket to help give it some depth. It is a normal part of the hip biology.

The second type of femoroacetabular impingement is called CAM impingement. Normally, the head of the femur is a smooth, round shape. It is even all around so it can rotate inside the socket evenly. But any change in the shape can cause it to hit one point of the socket more than the others as the head of the femur moves inside the socket. The asymmetrical rotation of the pistol-shaped femoral head is called the cam effect. Anytime something repeatedly rubs against something unevenly, there is uneven wear, tear, and damage. In this case, when the hip is flexed or bent, the unevenly shaped femoral head doesn’t glide over the labrum as it should. Instead, it bumps up against the edge of the cartilage. Over time, the labrum gets worn down to the bone.

And finally, the third type of femoroacetabular impingement is a combination of the two just described (pincer and cam). Cam impingement is more common in males and brings on symptoms earlier than the pincer type. The combination of both types together causes problems sooner than if only one type was present. The best thing to do is see an orthopedic surgeon for an examination and diagnosis. It may be good to do this before any more time passes by. Early recognition and treatment of most hip disorders involving the soft tissue structures help prevent serious complications later.

I’m too young and too heavy for a knee joint replacement. Are there other options for people like me?

admin — Wed, 28 Dec 2011 11:00:08 +0000

I saw my own knee X-rays and know I have bad arthritis on one side of the joint. I’m too young (45 years old) for a joint replacement. I’m too heavy (100 pounds overweight) for an osteotomy. Aren’t there any other options for people like me (besides losing weight)?

Unicompartmental arthritis is not uncommon in some younger patients. Many have had the meniscus removed from a previous injury and now years later, arthritis has badly damaged the joint. Pain, stiffness, and loss of motion and function are common.

Joint replacement isn’t a good option yet for young adults. Too much bone loss and an implant that only lasts 10 to 15 years makes another replacement difficult. It is possible to have a unicompartmental replacement.

This is an attractive option for middle-aged patients. It only removes and replaces the portion of the joint that’s arthritic. Most of the bone is spared making it possible to have a total joint replacement later.

Ask your surgeon if you might be a good candidate for this procedure. You may also want to consider looking into gastric bypass surgery. If weight loss isn’t possible, it may be a way to lose weight and protect your joints from future deterioration. Talk to your doctor about your total health picture and find out what all your options are.

What’s a simple hip dislocation? That’s a term being used for my hip fracture and it seems like anything but simple.

admin — Wed, 21 Dec 2011 11:00:05 +0000

What’s a simple hip dislocation? That’s a term being used for my hip fracture and to me it seems like anything but simple.

A simple hip dislocation refers to dislocation without a fracture. Complex fracture-dislocations involve popping the round head of the femur (thigh bone) out of the acetabulum (socket) with a fracture of the acetabulum at the same time. Acetabular fractures affect the joint surface where the head of the femur moves against the joint surface to provide joint motion.If you can look at it this way, a simple dislocation has some long-term benefits, too. Only one out of every four patients with a simple dislocation results in hip arthritis later. It’s the dislocations accompanied by an acetabular fracture that present later with problems including arthritis. About 88 per cent of those complex fracture-dislocations damage the joint resulting in death of the bone (osteonecrosis) and osteoarthritis.Simple dislocations are often easier to reduce (set back in place) without major surgery. The patient is still sedated to achieve deep relaxation of the surrounding muscles. But with a few quick and easy techniques, closed reduction is possible. The more complex dislocations with fractures or other injuries often require arthroscopic or even open-incision surgery. There is a greater risk of complications with loss of blood flow, osteonecrosis (death of bone), infection, and poor outcomes with complex dislocations.

I need an injection for my hip arthritis. My previous injection required an X-ray. Can they use the old X-ray to do this injection?

admin — Thu, 01 Dec 2011 11:00:56 +0000

I need an injection for my hip arthritis. The last one I had required the use of X-rays. I also have a history of cancer and received radiation treatments. I’d like to avoid any more radiation if possible. Can they use the old X-rays to just do this injection without taking new ones?

Intra-articular (into the joint) injections of the hip can be helpful in alleviating painful symptoms from osteoarthritis. Careful technique is required on the part of the physician performing the injection. Blind injections (guided only by vision and touch) are less expensive than injections performed with imaging. Blind injections can be done right in the physician’s office. And the patient isn’t exposed to radiation. But blind injections are not advised. For complete accuracy, imaging and arthrography are required. Arthrography is the use of a contrast dye injected into the joint to show that the injected agent actually made it into the joint.Studies show that with blind injections you have a 50-50 chance of success. Using the blind technique with any success is like tossing a coin and shouting heads or tails and then being right (or wrong). Using previous X-rays isn’t helpful because arthritis changes the shape and structure of the joint. In other words, it could be a different looking joint even from the last time it was X-rayed.And most of the X-ray techniques are real-time, which means the surgeon sees in 3-D, the joint, the soft tissue structures in and around the joint, and the needle placement as it advances forward through the soft tissues into the joint space. Talk to your orthopedic surgeon about your concerns. Find out how much radiation you would be exposed to and what other options you may have. Some physicians are using ultrasound now instead of X-ray imaging. There’s no exposure to radiation and it can be followed up with arthrography to ensure 100% accuracy.

Biggest Success Factor in Total Knee Replacement is Pain

admin — Mon, 01 Aug 2011 22:46:40 +0000

I’m trying to get up enough courage to have one of my knees replaced. Are there any studies to show who should really have this operation? Maybe I’m not a good candidate.

Lots of studies have been done on the results of total knee replacements (TKRs). Unfortunately, most surgeons focus on which operation works best and which implant has the fewest problems.

Very few studies look at the characteristics of patients. Does age make a difference? Do patients with rheumatoid arthritis do better or worse than patients with osteoarthritis? Does it matter if you’re overweight when you have the operation?

These are just a few of the questions patients raise when thinking about having a TKR. A recent review conducted by the University of Minnesota reported no evidence that age or type of arthritis was linked to results.

The biggest factor in success was how much pain the patient had before the operation. Those with the greatest pain had the best improvement in function.

Accurate diagnosis of hip pain can be elusive

admin — Thu, 28 Jul 2011 11:25:30 +0000

I saw my primary care physician for hip pain that just won’t go away. Despite a huge amount of time testing me every which way, there’s no known cause for the problem. Should I insist on X-rays or an MRI?

There are many, many possible causes of hip pain. An accurate diagnosis is needed to direct treatment. But this can be elusive and take a long time to make. The physician’s examination takes into account the possible etiology or cause of the problem. Was there some trauma? The mechanism of acute hip pain caused by injury is often a twisting motion. Overuse, repetitive motion, and diseases or degenerative conditions are other potential causes of hip pain. Pain patterns associated with hip problems start with a deep aching and stiffness in the hip. True hip pain is experienced in the front of the body down into the groin area. Hip pain along the pelvic rim, down the side of the leg, or down the back of the leg is usually a sign that the cause of the pain is extraarticular (outside the hip joint). This could be coming from pinching of the soft tissues, nerve entrapment, or other extraarticular lesions. Loss of motion and/or function can help point to the specific soft tissue structures affected.

It sounds like your physician has been very thorough. Evaluation of hip pain may require imaging studies such as X-rays or MRIs. But unnecessary X-rays and other imaging studies should be avoided. Results are viewed cautiously as many changes in and around the hip may be observed but may not be the cause of the painful symptoms. The most obvious pathologies that must be treated include tumors, fractures, hematoma from bleeding after a fall, and infections.

Often in the face of an unknown cause of joint pain, a short course of physical therapy can be a diagnostic aid for the physician and helpful to the patient. As experts in human movement dysfunction, the therapist can evaluate and treat the soft tissues and postural issues that could be the underlying cause of the problem.

Change in hip flexibility is a warning sign for postmenpausal women

admin — Fri, 15 Jul 2011 11:45:51 +0000

I’m 56, postmenopausal, and noticing a sudden change in my hip flexibility. My older sister has pretty bad hip arthritis. She started having this same change when she was around my age. Does it sound like I’m going to get arthritis too?

Arthritis is a very common problem for adults 55 and older. In fact, it’s estimated that up to one in four (25 per cent) of older adults will be diagnosed with this condition. Early and accurate diagnosis is the number one key to stay as functional and independent as possible for as long as possible.

For women who are postmenopausal, declining estrogen levels are linked with changes in soft tissue. Decreased blood circulation of estrogen contributes to reduced elasticity of ligaments and joint capsules. In the hip, ligaments surround the joint forming a capsule to support and stabilize the joint. With less estrogen available, these structures tighten up and become less supple or flexible and inflexible. The change in your flexibility could also be caused by a sedentary (inactive) lifestyle. But before you assign blame or cause to your problem, it might be a good idea to see your primary care physician for an accurate diagnosis.

If it turns out that you do have osteoarthritis, in order to prevent disability pay attention to good nutrition, getting enough fluids, and exercise. These four steps in self-care are all equally important. With or without early signs of arthritis, if you are overweight, weight loss is always advised. See a physical therapist for help with an exercise program designed to help you maintain flexibility, joint motion, strength, and endurance.

Joint pain vs. postoperative pain – which is worse?

admin — Fri, 01 Jul 2011 10:43:26 +0000

My adult children are pushing me to have a hip replacement. I don’t really want to have surgery. I think I can put up with the pain. But the kids are worried that I’m not active enough. Would a new hip really make that much difference? Doesn’t having surgery cause pain, too?

Pain can be a big stumbling block to activity and quality of life. Hip replacements have become very common and very successful. Patients are able to perform daily activities, sleep better, and get around better. The implants and techniques for putting them in have improved so they last longer with fewer problems. Relieving pain improves physical function and activity level. This is important in promoting general health and preventing specific diseases such as heart disease and diabetes.

The positive benefit of movement and activity on bone structure is very important for the older adult. Good bone health helps prevent fractures and falls, which can cause serious disability and even death.You may want to just make an appointment with an orthopedic surgeon and find out what are your options. Knowledge and understanding of the process and expectations can help calm your anxious thoughts. Then you’ll be making a decision based on facts, not fears.

You can expect a period of some postoperative pain during recovery. The postoperative plan provides medications to help with the pain. The physical therapist will help you get up and get moving. That always helps alleviate pain and aching from stiffness. Most patients report the postoperative pain is different from the joint pain they had before surgery. They say the new pain is much more tolerable and goes away with time and exercise.

Do more people have cancer than have arthritis?

admin — Fri, 27 May 2011 11:00:52 +0000

I see the news focused on cancer all the time. None of my friends have cancer but we all have arthritis. Do more people really have cancer than arthritis?

You and your friends are in the majority. Osteoarthritis (OA) is two and a half times more common than heart disease and six times more common than cancer. The incidence of both OA and cancer increase with age.

Since Americans are living longer with more active lifestyles, OA is expected to affect many more adults in the years ahead. An active lifestyle may be preventative for cancer. The odds are that cases of OA will continue to outnumber cancer in the near future.

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.