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

February 3rd — admin

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.

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Does femoroacetabular impingement (FAI) surgery work? What are my chances for a successful FAI operation?

January 30th — admin

My question for you today is: does surgical treatment for femoroacetabular impingement (FAI) work? I’m facing the decision whether or not to have this surgery, and I want to know what my chances are for a successful operation.

We may find some helpful information to answer this question from a recent systematic review of studies done regarding surgery for femoroacetabular impingement (FAI). The statistical significance of any conclusions from a systematic review is worth noting. That’s because such a review combines the results of many smaller studies to give an overall view of the results of treatment like surgery for FAI of the hip.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.Most studies on this condition are case studies. That’s because no one surgeon sees 100s or 1000s of patients with this problem. Case studies are good because surgeons have to start somewhere when trying to see the effects of treatment. The problem with published case studies is that this is considered a low level of evidence. A surgeon wouldn’t want to treat any patient with methods considered “successful” based on low levels of evidence. Conducting a systematic review like this one allowed the authors to examine the data on 970 different patients (collected from 23 reports of case studies). Now surgeons can see what the latest findings are and evaluate their own practices based on what is statistically significant.One of the questions specifically addressed in this review is the very same one you raise. Does surgical treatment for femoroacetabular impingement (FAI) work? The answer to this question may depend on how “success” is defined.If pain relief is the measured outcome, we know that the majority of the 970 patients included did have relief of painful symptoms. A second outcome was improved function. That was also a benefit of surgical repair for femoroacetabular impingement (FAI). Levels of patient satisfaction as an outcome measure were not so high. For those patients whose pain didn’t improve and especially those patients who ended up having a hip replacement, reported patient satisfaction was low. In some studies, the rate of dissatisfaction and/or conversion to hip replacement was as high as 30 per cent.The obvious next question is: can we predict who will have a poor result? That’s a simple question that doesn’t have a simple answer yet. One risk factor for worse outcomes with femoroacetabular impingement surgery is advanced joint arthritis at the time of the diagnosis. But there are two problems with relying solely on this factor.First, not everyone with severe damage has a poor outcome with surgery. Just as many patients with severe damage had good outcomes as those who had a failed treatment. The reasons for those differences remain unknown and will require further study. Second, even with X-rays and MRIs, it isn’t always possible for the surgeon to know the full extent of the damage. Sometimes, it isn’t until getting inside the joint that the surgeon can see what’s really going on. These tests are still important and the results should be discussed with you by your surgeon when making the final decision about the best treatment choice for you.

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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Early treatment of hip disorders can prevent later complications

January 18th — admin

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.

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 have a labral tear of the hip. What kind of surgery can they do for this problem?

January 16th — admin

I’ve been diagnosed with a labral tear of the hip. I’m scheduled to see a specialist next week but thought I’d do a little research of my own on the Internet before my appointment. What kind of surgery can they do for this problem?

The labrum is a thin but helpful extra layer of cartilage around the hip and shoulder joints. In the hip, it helps extend the edges of the joint socket to form a deeper cup for the round head of the femur (thigh bone). This helps keep the joint in the socket while still allowing a wide range of movements needed by the leg.Damage to the labrum can result in painful symptoms. Sometimes there is a clicking sensation and the hip can even get locked up if the torn labrum gets caught between two structures of the hip. Loss of hip motion is the outcome of either of these symptoms. There is a chance that the labrum can heal itself but most of the time, surgery to remove the ragged edges of the torn labrum is required. This procedure is called debridement. The surgeon shaves off the ragged edges of the labrum and smoothing the remaining edges.A more extensive surgery called a partial labrectomy may be needed. This involves removing the unstable part of the labrum. Studies show that partial labrectomies have better outcomes when there isn’t damage to the underlying layer of cartilage attached to bone. The success rate drops from 90 per cent without chondral lesions down to 21 per cent for those patients with chondral defects.A newer approach to labral tears is now in use: labral repair. During a labral repair, the surgeon uses stitches and surgical anchors to reattach the torn labrum. Results of labral repairs have not been published yet in English-language medical journals. Most of the research that has been done has been published in European or Spanish-language journals. When valid and reliable tools are available, the results of debridement, partial labrectomy, and labral repair can be compared.Your surgeon will probably go over the various surgical options available to you and recommend the one that will work the best for the type of injury and damage you have.

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 it make a difference in recovery for patients based on the type of hip fracture they have?

April 26th — admin

Does it make a difference in recovery for patients based on the type of hip fracture they have? My aging aunt has what’s called an intertrochanteric hip fracture. I got the impression from the hospital staff that this is the worst kind. Why is that?

There are many different types of fractures classified by location and specific type. For example, in the hip, the most common fractures in older adults affect the femur (thigh bone). These fractures include: ty

  • femoral neck
  • femoral head
  • subtrochanteric
  • intertrochantericFemoral neck fracture is a fracture in the femur (thighbone). The break is between the (long part of the femur) and the round round head at the top of the femur. This is where the femoral neck attaches the shaft to the head. These fractures often damage the blood supply to the femoral head. Loss of blood to the top of the bone can lead to death of the bone cells. This condition is called avascular necrosis.

    Femoral head fracture is a break in the femoral head. This is usually the result of high-energy trauma. Dislocation of the hip joint often occurs with this fracture. Subtrochanteric fracture involves the shaft. The break is right below the lesser trochanter (bony knob on the femur). Subtrochanteric fractures may also go down the shaft of the femur.

    When the break is between the greater and lesser trochanter, it’s considered an intertrochanteric fracture. This is the most common type of hip fracture. The prognosis for bony healing is usually pretty positive if the patient is in good health.

    But older age, poor nutrition, and poor health (especially combined together) puts a patient at risk for a poor prognosis. Immobilization after a hip fracture increases the risk of infections that can be life-threatening. A simple urinary tract infection or pneumonia can compromise the health of an older adult hospitalized with hip fracture. Deep vein thrombosis (blood clot) is also a risk in these cases.

    Many people beat the odds. So just having the risk factors doesn’t guarantee that your aunt will have a poor outcome. There may be other health issues or concerns that caused the hospital staff to react this way. You may need more information before coming to any firm conclusions.

    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 considering have a hip joint resurfacing operation. What kind of problems are likely?

    March 31st — admin

    I’m thinking about having an operation called hip joint resurfacing. But I’ve heard the metal used can cause problems. What kind of problems are likely?

    Early attempt to use hip resurfacing were done with titanium alloy, cobalt chrome, alumina or ceramic components. Over time, new developments have led to the use of metal components made from cobalt chromium.

    As you’ve discovered, there were some concerns about heat build-up between the bone and the metal. If the temperature of this interface gets too high, bone necrosis (death) can occur. But surgeons have overcome this problem with modified techniques to dissipate the heat.

    There were also some questions about maintaining an adequate blood supply from the shaft of the femur (thigh bone) up into the femoral head. But studies using nuclear imaging show that an even mount of blood flow is preserved.

    Metal-on-metal hip resurfacing (MOMHR) has not been approved for use in woman of childbearing age. There is concern that debris from the metal can cross the placenta and affect the growing fetus. Cobalt and chromium ions have been found in umbilical cord blood to prove this can happen.

    So far, there’s been no negative effect seen in children who have been exposed to ion particles. But we don’t know if long-term studies would show the same benign effect. More study is needed before MOMHR will be approved for this group of 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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    Is it possible that a doctor would want to do a partial replacement on one hip and a total replacement on the other?

    March 18th — admin

    Is it possible that a doctor would want to do a partial replacement on one hip and a total replacement on the other?

    The type of replacement a doctor chooses to do depends on the damage, the patient’s health and condition, and the state of the femur, or thigh bone. It is possible that a doctor would prefer to do a partial replacement on both hips but one is not a good candidate for it – that could be one reason. This is the type of question that a patient should ask the surgeon beforehand.
     
    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 under 55 and my doctor says I should have a partial hip replacement. Can you explain what that is?

    March 10th — admin

    My hip is going to be replaced but I am under 55. My doctor says that people my age who are active should have something called a partial hip replacement. Can you explain what that is?

    A total hip replacement, called a total hip arthroplasty (THA) literally replaces the hip joint. The implant is attached to the bones and is set into place.

    A partial replacement, called total hip resurfacing, replaces only part of the hip, which provides an advantage for many people.

    With hip resurfacing, the surgeon reshapes the head (top) of the femur (thigh bone) and fits a lining over it, as opposed to the total replacement that will remove that part of the bone and replace it with an implant. With the resurfacing, the bones need to be strong and able to withstand the force of the procedure, so people who have weakened bones are not able to have this type of surgery.

    The benefits to the resurfacing are that it appears to have a lower dislocation rate, the healing time is faster, and because the head of the femur is preserved, there is enough bone left for further surgery if it 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 son, in his earyly 20′s, was diagnosed with osteonecrosis. What is this?

    March 7th — admin

    My son, who is only in his early 20s, has been diagnosed with something called osteonecrosis of the hip. The doctor told him that part of his bone had died. What does that mean?

    Osteonecrosis of the hip is a condition where part of the bone does not get the blood it needs for nourishment and the bone cells die. When this happens in the hip, it is the top or the head of the femur, or thigh bone, that is affected.

    It is generally a disease that affects young people, but doctors don’t understand yet what causes it. They do believe that it can be caused by previous hip dislocations or injuries, alcohol consumption, high doses of corticosteroids, or a genetic history of similar diseases.

    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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    Tear in ligament often revealed only through arthroscopic surgery

    September 30th — admin
    I was in a car accident and broke my pelvis in two places. After the injury finally healed, I still had deep groin pain and my hip kept giving out on me. I had MRIs, X-rays, and CT scans done for my pelvis, and nothing ever showed up. Finally, I had arthroscopic surgery and the doctor found a tear in the ligamentum teres. Where is this and why doesn’t it show up on all these tests?

     
    If you pull a chicken leg out of its socket, you’ll see a fibrous white ligament. That’s the equivalent of the ligamentum teres in the human. It helps hold the head of the femur (thigh bone) in the hip socket.

    Traumatic or twisting injuries can cause this ligament to tear. Hip dislocation can stretch it to the tearing point, too.

    Doctors don’t have a test to help them find this type of tear. In fact, it wasn’t until arthroscopic surgery came along that they even knew it occurs as often as it does. Now that we know it’s a problem, more studies will be done to find easier ways to diagnose it.

    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. 

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