I had one knee replaced. Can I use the mininally invasive (MIS) method if I get the other knee replaced?

January 9th — admin

I have rheumatoid arthritis that has bothered my knees for years. Two years ago I had the right knee replaced. I see now there’s an even better operation with a small incision that doesn’t cut through the muscle. If I have my other knee replaced, could I have it done with this new method?

You may be talking about the minimally invasive (MIS) quadriceps-sparing total knee replacement (TKR). In the standard TKR operation the quadriceps muscle in front of the knee and thigh is either split open or cut and moved out of the way while replacing the joint.

Problems can occur when the muscle is disrupted this way. Blood vessels and nerves can be cut causing swelling and weakness after the operation. Quadriceps sparing doesn’t avoid the muscle completely, but it reduces the amount of trauma by quite a bit.

Patients with rheumatoid arthritis who do not have osteoporosis can have this operation. Younger patients with normal weight and no knee deformity have the best chances of a good result from 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 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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I am a hospital prevention specialist. What do other hospitals do to reduce complications after hip fracture repairs?

November 16th — admin

I am a designated prevention specialist in a small hospital setting. We see our fair share of broken bones and other emergencies involving senior citizens. We are focusing this month on hip fractures. I’m looking for any information about what other hospitals do to reduce complications after hip fracture repairs.

Older adults with hip fractures often have an underlying diagnosis of osteoporosis (brittle bones). As you have indicated, we know that complications associated with hip fractures in this age group are common — and can be deadly.Pneumonia, heart failure, infections, and pressure ulcers (bed sores) head the list of problems that some seniors face when a hip fracture occurs. And according to a recent report from the Washington University School of Medicine, a delay in surgery increases the risk of complications even in healthy patients.What can be done to reduce the number and severity of complications related to surgery for hip fracture? First, it’s clear from studies that a delay in surgery can make things worse. Even a 24-hour delay increases the risk of death. The longer the delay, the greater the risk of pressure ulcers. What’s causing the delays? One of the significant factors contributing to delays in surgery is the insistence on cardiac testing before surgery. In an effort to prevent heart attacks and other cardiac complications, this practice may increase the risk of such problems. Treating the heart conditions before having surgery seems like it makes good sense. But, in fact, studies show that testing doesn’t really change how these patients are treated — it just delays the surgery they were admitted for in the first place. A second, important risk factor for poor outcome after surgery for hip fracture is malnutrition. Decreased bone mass is often linked with poor nutrition. And with an inadequate diet comes weight loss and no fat to protect the bones when a fall occurs. Not only that, but malnutrition also leads to poor wound healing and an increased risk of those pressure ulcers already mentioned. What can be done when the patient comes in to the hospital with osteoporosis and a hip fracture? Isn’t it already too late to make a difference? Evidently not, according to several studies that showed using intravenous nutritional supplementation followed by vitamins taken by mouth can really make a difference. Nutritional consultation with a specialist is also advised. A nutritional expert can help with the immediate concerns about malnutrition as a risk factor for complications but also set up a plan for home once the patient is discharged. This step is essential in preventing future health problems of all kinds.Another important risk factor for complications associated with hip fracture surgery is low hemoglobin. Hemoglobin helps carry the oxygen you need in every cell of the body. Without enough hemoglobin, anemia develops. This particular risk factor has many causes to watch out for. Besides the obvious loss of blood from the surgery, there can be internal bleeding from the GI tract. Many older adults have bleeding ulcers from taking antiinflammatory drugs for their arthritis. Smoking adds to the risk of GI bleeding. One-third of all patients having hip fracture surgery end up needing a blood transfusion. What can be done to prevent bleeding problems? The research supports using a drug called proton pump inhibitor (PPI) right after surgery for anyone with risk factors for GI bleeding. Surgeons are also advised to do everything possible to avoid/reduce bleeding during the operation. This is possible now more than ever before with today’s minimally invasive surgical techniques.There are other measures that can be taken to decrease postoperative problems after hip fracture repair. These include protective padding over bony prominences to prevent pressure ulcers, antibiotics to prevent infections, and proper pain management to prevent stress-induced heart problems. Preventing blood clots through the use of medications, compression stockings, and pneumatic pumps applied to the lower legs for at least the first 24 hours is standard practice.You can take a look at these suggestions and compare them with standard operating procedures already in place within your facility. Any areas that are lacking can be reviewed by staff and administration for consideration and implementation. Gathering evidence from research and identifying best practice is a great way to get started when evaluating your own policies.

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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The difference between osteoporosis and osteonecrosis

October 19th — admin

What’s the difference between osteoporosis and osteonecrosis? I have both conditions in my hip, but I can’t keep them straight in my mind.

The first part of both terms (osteo) refers to bone. In the first word (osteonecrosis), necrosis means death — so, osteonecrosis is the death of bone. In the second word (osteoporosis), porosis refers to how porous the bone has become. Loss of bone density creates larger spaces between bone cells. As a result of these changes, the bone is more brittle.The differential diagnosis is made using advanced imaging. X-rays may not show osteoporosis clearly. Doctors rely on MRIs to see patterns in the signals that indicate the presence of osteoporosis. For example, low-signal lines in the subchondral bone called crescent lines are seen with osteoporosis. Subchondral refers to the first layer of bone just under the joint cartilage.

When osteoporosis is present, MRIs can show fluid called bone edema. Bone edema can be present with stress fractures and bone tumors, so the presence of bone edema doesn’t necessarily confirm that the person has transient osteoporosis. Further tests may be required such as DEXA bone scans. DEXA stands for dual-energy X-ray absorptiometry. A more up-to-date abbreviation for that term is DXA. DXA provides means of measuring bone mineral density that can be compared to the expected norm.

Osteonecrosis shows up on MRIs without the defects in bone seen with osteoporosis. Instead, there are clear changes in the subchondral bone of the femoral head. Subchondral refers to the first layer of bone just under the joint cartilage. The distinction between these two conditions (osteonecrosis and osteoporosis) is important because these are separate problems requiring individual treatment.

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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Cancer survivor fears breaking hip

May 30th — admin

I am a 10-year breast cancer survivor. As I get older, I’m aware that my chances of falling and breaking a hip go up every year. Is there any direct link between having cancer and having a hip fracture?

There may be a link between cancer and hip fracture in the early years after having cancer. Metabolic changes after chemotherapy and radiation therapy increase the risk of fracture. But after five years, the risk of hip fracture in cancer patients actually drops below adults the same age who have never had cancer. The reasons for this aren’t clear yet. Some experts think that whatever made it possible for the person to be a cancer survivor is also working in their favor in the case of hip fracture. Some of the risk of bone fracture in cancer patients may be linked to the type of cancer, presence of bone metastases, and effect of treatment on the bones.

If you are concerned about your bone health and risk of fracture from osteoporosis, falls, or secondary to metabolic changes associated with cancer, see your physician for an evaluation. If you are osteoporotic, there are medications that can help prevent bone fracture.

Take a look at some of the other risk factors and modify anything you can. For example, patients who remain independent ambulators (walkers) without an assistive device of any kind do the best in the long run. Staying fit and active is the best medicine for many health problems including fracture prevention.

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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Could intraoperative fracture during total shoulder replacement have been prevented?

May 26th — admin

We are really bummed as a family. We all encouraged Mom to have a shoulder replacement and then her upper arm broke during the surgery. Is this a fluke? Could it have been prevented?

There are many possible reasons why a bone fracture occurs intraoperatively. Sometimes it’s completely unavoidable. There are some known risk factors such as decreased bone mass (osteopenia or osteoporosis). Shoulder instability from a previous rotator cuff tear can make a difference.

Fractures of this type occur most often during a total shoulder replacement (versus a hemiarthroplasty where only one side of the shoulder joint is removed and replaced). Sometimes the surgeon has trouble getting to the shoulder socket. The angle and force needed may be too much for the brittle bones.

Older women seem to be at increased risk for humeral (upper arm) fractures. They are especially at risk if they also have rheumatoid arthritis or other health issues such as diabetes contributing to delayed or poor healing.

Surgeons must be aware of potential risk factors for fracture. Surgical approach and techniques must be chosen carefully with these risks in mind. Patient position during the operation is important. The elbow should never be used as a lever to get increased shoulder motion when under anesthesia.

Soft tissue release around the shoulder may be needed before moving the arm through its full range of motion. Special care must be taken when reaming out the humeral bone to place the stem of the implant inside. Hand reaming instead of power reaming is advised. The bone should be compressed, rather than removed, in patients who have low bone density.

These are just a few of the many considerations surgeons must include in the surgical process. When many risk factors present at the same time, then the risk of fracture goes up. Even being aware of all the risks doesn’t guarantee complications won’t occur. The surgeon can’t always predict who might develop intraoperative fractures.

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 wife and I both broke our hips. We both had surgery to repair the damage. My wife received a pate and sliding compression screw. My surgeon used a screw through a short nail. What’s the difference and why didn’t they do the surgery in the same way?

May 4th — admin

My wife and I are snowbirds. We winter in Florida and summer in Idaho. She broke her hip while we were in Idaho. The next year I broke my hip while in Florida. We both had surgery to repair the damage. Her surgeon put in a plate and sliding compression screw (so he tells us). My surgeon used a screw through a short nail. What’s the difference and why didn’t they do the surgery in the same way?

As you’ve discovered, there are different ways to repair a broken hip. This is based on a number of different factors. The location and type of fracture are two of the first and most important deciding factors.

Surgeon training, experience, and preference are also considerations. For example, younger orthopedic surgeons are more likely to use the nail and interlocking screw system. Older surgeons stick with the sliding compression hip screws.

The patient’s health and condition of the bones are two more variables. The presence of osteoporosis can make a difference in which type of fixation method is used. Some types of fixation implants are more likely to cause fracture as a complication. The surgeon does everything possible to avoid this additional problem.

And finally, there’s even a difference in how things are done from geographic area to area in the U.S. A review by the American Board of Orthopaedic Surgery showed that newer methods of practice tend to show up first in the southeast, south, and southwest regions. The northwest is often the last place to adopt new practice patterns.

No one is quite sure why surgeons in the South convert to new technologies faster than in the North and Midwest. It may be based on age of patients and/or the age of the surgeon. Research is ongoing to compare different approaches and find out which method works the best regardless of where a patient lives when the procedure 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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My 72-year old mother,who has a history of alcohol abuse, fell and now has knee pain. Will an X-ray show anything if it’s not broken?

April 4th — admin

My 72-year old mother has a long history of alcohol use and now has osteoporosis. She’s been complaining of knee pain for the last two weeks. We think she fell on her knee but she won’t admit it. Would an X-ray show anything if it’s not broken?

In this age group with a history of alcohol use as described, an X-ray would certainly be a good place to start. If nothing unusual shows up, an MRI, CT scan, or even a bone scan may be needed.

Doctors are finding more and more cases of a condition called insufficiency fractures in this age group. Postmenopausal women seem to be at greatest risk, probably because of osteoporosis. The weakened bone just can’t stand up to normal, everyday stresses. Early diagnosis and treatment are important to avoid a full fracture.

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 has knee pain that’s being called an insufficiency fracture. What is it?

March 30th — admin

What is an insufficiency fracture? My mother was told that’s what’s causing her new knee pain.

Insufficiency fracture is a small subset of a larger group of fractures called stress fractures. Insufficiency fractures are caused by the effect of normal stress on weakened bone. Osteoporosis is the most common cause of bone loss leading to insufficiency fractures.

Loss of bone density from osteoporosis decreases the bone’s ability to “give” slightlyand resist everyday loads. The loss of this “elasticity” seems to affect the spine, tibiaand fibular (lower leg bones) and calcaneus (heel) most often.

These fractures seem to be on the rise in older adults, especially postmenopausal women.

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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Having gotten off a bus for 10 years, my mother’s hurt knee was diagnosed as an insufficiency fracture. Why was this time different?

March 25th — admin

My mother was getting off the bus when she had severe, sharp knee pain. The MRI showed a stress fracture. The doctors are calling it an insufficiency fracture. She’s gotten off that bus everyday for the last 10 years. Why was yesterday any different?

You didn’t say your mother’s age but age may be a factor. Older women are at increased risk for this problem. There’s an increased number of these fractures in women who are postmenopausal. Osteoporosis (decreased bone density) in this age group is another important factor.

Without its normal resiliency, the simplest, everyday stress can cause damage to the bone. Anyone who has arthritis is also at increased risk. Often, the osteoporosis added to any slight knee deformity can be enough to cause this problem.

Other factors include alcohol use, Crohn’s (intestinal) disease, and the use of steroids for arthritis. Low calcium absorption, vitamin D deficiency, and hormonal changes are also factors.

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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