Size matters in reducing hip dislocations

October 11th — admin

I was raised by my grandparents and now find myself helping to take care of them as they get older. Grandad had a hip replacement two months ago that just won’t stay in the socket. The surgeon wants to take it out and put one in with a larger femoral head. It seems to me that a larger head in the small socket would make the problem worse instead of better. Can you explain this to me?

A larger femoral head size has been shown to reduce hip dislocations and minimize instability. There are several reasons why they work.

First, they provide a larger surface area in contact with the acetabular cup (socket).

Second, a larger head gives a better ratio of size from the head of the femur to the neck. That’s important in allowing a larger arc of motion and preventing impingement or pinching of the femoral neck against the rim of the cup.

The surgeon usually puts a polyethylene (plastic) liner inside the cup (between the cup and the femoral head). With this liner in place, the larger head can sit deeper inside the cup, making it more difficult for the head to jump out of the cup and dislocate. Studies have verified that a thinner liner can hold up while still accommodating the larger femoral head. And improved materials have extended the wear on these heads. That’s important because larger heads do tend to wear more potentially reducing their long-term survival.

Finally, larger heads can potentially eliminate the risk of early dislocation with implants of all kinds (e.g., ceramic, metal-on-metal, polyethylene). That makes them useful for a large variety of patients who need a hip replacement or revision surgery such as your grandfather requires.

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 revision surgery for a total hip replacement?

August 26th — admin

What does it mean to have revision surgery for a total hip replacement? My twin sister is having this operation next week. I’m wondering if she needs me to come help take care of her.

Revision tells us that your sister had a primary or index (first) hip replacement procedure already. Revision suggests the need to remove and/or replace one or all of the implant parts. The most common reason for implant revision is loosening of the stem on the femoral (thigh bone) or acetabular (cup or socket) side. This can occur with or without infection. The surgeon removes the old implant and replaces it with a new one. In the case of implants with a polyethylene (plastic) liner, excessive wear can cause tiny flecks of the liner to slough off and enter into the joint. Sometimes the bone around the liner starts to disintegrate.

If the whole implant is removed and exchanged or replaced, it’s like having the surgery all over again. Your sister will have to go through a shortened version of the original rehab program. Having had the surgery already one time, she will be more prepared for the postoperative recovery than she was the first time. She will be able to tell you if she needs extra help for a day or two. There’s always the chance that complications will occur, which could mean a longer recovery time and the need for more help.

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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Does high-risk patient require intervention?

August 5th — admin

Well, I hate to admit it, but Mother is a bit of a drinker. We didn’t tell the doctor, and now she has fallen and dislocated her new hip replacement. Should we say something? Or is it already too late?

Most surgeons perform a screening exam to look for high-risk patients. Patients who are considered high-risk don’t just have problems with alcohol use and abuse. They may have other significant health problems. Dementia, Alzheimer’s, diabetes, and heart disease are common in older adults who need a hip replacement. The presence of a drinking problem doesn’t mean the patient can’t be treated.

First of all, even older adults can get help for an addiction problem with alcohol or other drugs. A psychologist or social worker in the community who specializes in this type of problem can be very helpful.

Second, precautions can be taken to prevent falls and hip trauma. A physical therapist is the best one to assess both the patient and his or her home for ways to reduce the risk of falls and fractures or dislocations.

Third, if revision surgery is needed, the surgeon may want to put the patient in a brace or cast to slow him or her down and give the soft tissues a chance to heal. Sometimes, for the older adult (and especially someone with weak muscles or lax (loose) soft tissues), a specific type of implant is used that is less likely to dislocate. The surgeon may choose an implant with a larger femoral head and then cement the socket portion in place. Both of these steps help stabilize the joint.

So, it’s never too late to offer information that can help direct and guide treatment as well as prevent further complications. It may be best if the patient (in this case, your mother) disclose this type of information to the physician. Encourage your mother to confide in her surgeon. Having them work together to solve the problem is usually more helpful than family members stepping in without the patient’s permission.

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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Will Mom outlive her hip implant?

August 18th — admin

My mother is thinking about having a total hip replacement. She’s 72-years old. The doctor says the new implants last about 15 to 20 years. Does anyone have an implant that lasts longer than that? As she gets older, a second hip replacement may not work so well. We’d like to avoid that if possible.

Long-term studies over 15, 20, and even 25 years are being reported more and more. The revision rate of the earlier implants may turn out to be higher than rates for implants used today. The materials, design, and even the surgery are much improved over even 10 years ago.

One study from the University of Iowa Hospitals and Clinics reported on 357 cases of total hip replacement (THR) done by one surgeon. All patients got the same kind of implant called the Charnley THR. This type of implant was put in using hand-packed cement. Today many implants are cementless or cemented in place with a cement gun for a better fit.

All of the patients still living had the implant at least 25 years. Many of the patients who had died still had the original Charnley implant at the time of their death. About 10 per cent of the patients had to have an implant revision because of infection, dislocation, or implant loosening.

At age 72, your mother’s implant has a good chance of outliving her. Revision or replacement of the first THR may not be needed. The new implant methods reduce pain, increase function, and improve quality of life for most patients.

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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More hip replacements means more hip fractures

August 5th — admin

I’ve been a nurse on the med-surg floor for over 20 years. I think we are seeing more and more hip fractures in patients with a hip replacement. What’s causing this increase in numbers?

Several studies have confirmed your observations: the number of femoral (thigh bone) fractures after total hip replacement (THR) is on the rise. There may be several reasons for this change.

First of all, more people are having THRs. Good results from the surgery has also increased the number of people and types of problems that can be helped by THR.

Third, with more people having THRs, the number of revision operations is increasing, too. Patients who have had a THR 20 years ago are still alive and going strong. Increased physical activity decreases the life of the implant. Many of these patients have revision surgery to replace the first implant. Fractures are more likely and more common after revision surgery.

Finally, implant design may be a factor. A recent study from Sweden pointed out the fact that implants with a straight and short stem are more likely to loosen causing dislocation and/or fracture. Complications such as fracture and implant loosening may be further reduced with continued research and improved implant design features.

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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How common is revision hip replacement surgery?

August 2nd — admin

Both my parents have had total hip replacements. Both have had to have a second operation on the same hip. Is this a common thing or just a coincidence?

Reoperations after total hip replacement (THR) are not uncommon. The most common reasons for reoperation are loosening of the implant, repeated dislocation, or bone fracture around the implant.

Most patients report minor trauma before bone fracture. Spontaneous fracture (no known cause) is more likely after revision surgery. Revisions are done to repair or replace the primary (first) THR.

Other reasons for reoperation can include nonunion of the fracture or refracture. Sometimes infection or fracture of the implant can occur.

Researchers are collecting data to help sort out who is at risk for implant failure or reoperation. One way to do this is to create a national patient registry. For example in Sweden, anytime someone has a total hip replacement, the surgeon must report information about the case to the Swedish National Hip Arthroplasty Register.

This registry has three separate databases. Each one collects slightly different bits of information. This allows researchers to group data together for easier analysis. Information can be used to identify who has a reoperation, fracture or refracture, or other complications.

Patient selection, implant choice, and experience of the surgeon all seem to be important factors in THR surgery. Your parents’ situation could be the result of one of these factors — or it could indeed be just a coincidence. We still don’t always know how to tell exactly what caused the problem in order to prevent it.

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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