What to do about noisy, dislocating hip replacement

November 4th — admin

I have an unusual situation. I’m only 23 years old, but because of severe hip dysplasia, I had to have a hip replacement. Because of my age, the ceramic-on-ceramic type implant was recommended. I’m nine months post-op and have two problems. First, the hip squeaks and clicks. Second, it also dislocates. I’m going to be seeking advice from several orthopedic surgeons in my area, but I wanted to also ask your group what to do.

Hip dysplasia is a condition in which there is a disruption in the normal relationship between the head of the femur (thigh bone) and the acetabulum (hip socket). Usually, the acetabulum is too shallow or sloping rather than a normal cup shape. It cannot hold the femoral head in place. Hip subluxation (partial dislocation) and even full dislocation can occur.The condition can be present at birth or develop in the early months to years of life. Conservative (nonoperative) care is possible when this condition is identified early in life. But sometimes, it’s not possible to keep the femoral head in good contact with the acetabulum. Then surgery may be required.

Hip replacement is usually not the first procedure used for this problem. An open reduction is a surgical procedure used most often in children two years old or older when hip dysplasia has not been corrected. During this operation, the surgeon removes any abnormal tissues that are keeping the femoral head from fitting inside the acetabulum and cuts any tight ligaments in the joint capsule around the hip joint. The surgeon may perform a tenotomy during the surgery to cut the tightly contracted tendons or muscles in the hip area. This relaxes the tight structures around the hip joint and allows the hip to be placed in the socket.

Other more advanced procedures may be required. An operation called derotational osteotomy may be needed. In this surgical procedure, the femur is cut and rotated to make it easier to keep the femoral head inside the acetabulum. When this procedure is done, the soft tissues loosen up and the forces of the muscles tend to keep the femoral head reduced. But when all else fails, a hip replacement may be the only way to correct the problem. Ceramic-on-ceramic bearings are used most often on young, active patients but complications such as squeaking or other noises are possible. For a while, it was thought that the ceramic implants had a very low rate of noise-making (less than one per cent). But a recent study showed that when specifically asked about this problem, up to 10 per cent of the patients who were surveyed reported noises. Squeaking was the most common, but there were reports of grinding, popping, and snapping.

Some patients aren’t bothered by the noises — or at least not enough to have a second (revision) operation. But with chronic dislocations, it may be necessary to swap out the ceramic-on-ceramic implant for one that has metal-on-polyethylene (plastic) or even a ceramic-on-polyethylene interface. The surgeon who has been following you will probably be the best one to advise you. Given your age and the diagnosis of hip dysplasia, there are likely other complicating factors to be considered.

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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How soon can I swim after a hip replacement?

November 2nd — admin

I was always a swimmer through grade school, high school, and college. I probably should have kept it up because now I need a hip replacement. The exercise would have been good for me. Oh well. What do the experts say about swimming after a hip replacement? How soon can I start?

With the recent effort to reduce the length of hospital stays, physical therapists are exploring the most effective ways to treat orthopedic patients. The standard rehab program after hip or knee joint replacement includes a mix of exercises to improve circulation and to prevent blood clots and other complications. Other goals include improving motion, strength, and function (especially walking).

Aquatic therapy after hip replacement may fill the bill nicely. Aquatic (pool) therapy is defined as physical therapy that is performed in the water. There are good reasons to consider using aquatic therapy after joint replacement. Aquatic therapy uses the resistance of water instead of weights. With the reduced load provided by the buoyancy of the water, certain exercises (e.g., squats, step ups, walking without a cane or walker) can be started sooner in water than on land. Circulation is also improved leading to faster tissue healing and reduced swelling.

A recent study from Australia looked at the benefit of aquatic therapy in the early days after joint replacement. Physical therapists randomly placed patients getting a hip or knee replacement into one of three different treatment groups. The goal was to find out what kind of treatment is best in the early days after orthopedic surgery. Everyone in the study either had a hip or knee replacement. They each received the standard postoperative hospital care by a physical therapist for the first three days after the operation. After that, the patients were randomly assigned to one of three groups. Group one continued with the standard care. This included circulation and deep breathing exercises, transfer practice, gait (walking) training, and practice going up and down stairs. Stretching and strengthening exercises were also done daily. Group two received a nonspecific water therapy session each day they were in the hospital. Group three had one standard physical therapy treatment each day and attended aquatic therapy everyday while in the hospital. The only reported difference among groups in this study was hip abductor muscle strength. Hip abductor strength is important for trunk and hip stability and normal a gait (walking) pattern. Patients in the specific aquatic therapy program had the greatest improvement in strength. When all other variables were compared among the groups, the aquatic group had the best short-term improvements. At the end of six months, there was no difference in outcomes from one group to the next. There were overall trends that seemed to support the idea that aquatic therapy was slightly more beneficial than either land-based or nonspecific water-based exercises.

You may be able to start swimming early on after your surgery. But you’ll need to check with your surgeon. Some rehab programs have an aquatic program specifically geared toward postoperative orthopedic patients. Keying into specific muscle groups needing strengthening after each type of surgery may be to the patient’s advantage. It might be best to go through a rehab-specific program before just resuming swimming laps. That way you’ll get the best of both worlds — the pleasure of getting back in the pool while performing exercises just for your new situation.

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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Standard vs. rapid recovery for hip replacement surgery

October 31st — admin

My mother is going to have a total hip replacement next month. My sisters and brothers are trying to figure out how much time each one of us can go and help her out after surgery. Can you give me any kind of time frame to plan on? How long should we plan on staying?

You’ll probably want to ask the orthopedic surgeon this question. He or she may have a general idea given the condition of your mother before surgery, the type of surgery being done, and the philosophy behind their rehab program.

Studies show that if things go smoothly, there are no complications or problems to delay recovery. The wound heals nicely, there are no infections, no blood clots, and no need for readmission to the hospital. When readmissions do occur, they tend to take place within the first month after the operation.

Some surgeons follow a standard rehab protocol but others have now adopted a more accelerated (faster) approach. Patients move through rehab with an aggressive program of mobility and exercises. They tend to do things with a group of patients having the same surgery rather than following a single or solitary path. By doing so, they regain motion, strength, and function much faster.

If your mother is in good health and moves through rehab quickly, she could be discharged early. She can go home and continue her exercises and navigate her daily self-care and household activities with less and less help. Expect at least a one to two week period of time providing assistance at home. With any complications or set backs, this time period could be extended up to a month or more.

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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Can metal implant hip replacement increase cancer risk?

October 25th — admin

I’ve heard that having a hip replacement with a metal implant can increase my chances for cancer. Is that really true?

Hip replacements are made from a variety of materials such as ceramic, polyethylene (plastic) and metals such as titanium, high-carbide cobalt, and chrome. A popular implant has a metal-on-metal (MOM) design. It gives the hip smooth action. But with repeated motions, flecks of metal ions are released into the joint and into the blood stream. Metal ion release may be a factor in implant loosening. Some patients are hypersensitive to these particles and develop hip pain as a result. And there’s been some question about the possibility of an immune system response to the foreign debris being linked with cancer.

Particles of both cobalt and chromium have been found in urine, blood, and organs of the immune system (e.g., spleen, lymph nodes) and in red blood cells and the liver. There are no reported cases of cancer linked with debris from hip replacements. For now, it’s just a theoretical possibility. This will bear warching in future studies. 

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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How long should it take to recover from total hip replacement?

October 17th — admin

I had a total hip replacement about 9 months ago. I had it in my head that I’d be back to normal after about six months. But that isn’t the case at all. What went wrong?

Studies do show that the average patient makes rapid gains in recovery after a hip replacement in the first three to six months following the procedure. Patients are encouraged to keep up their exercise program after that for at least another six months (if not longer).

It appears that it takes some people as long as two years to fully regain strength, motion, and function. It’s not entirely clear why there are such differences. Many factors may come into play. For example, the type of procedure performed has something to do with it. More invasive procedures that require the surgeon to cut through major hip muscles can delay restoration of normal movement patterns.

Implant placement is an important key. The implant must be put in place with the correct angle and rotation. If the center of rotation is off, the muscles can’t function normally. Hip stability, load on the hip, and biomechanics are all affected in different ways by these variables. Sometimes the patient ends up with a leg length difference. The implant may sink down into the bone too much making the operated leg shorter than the other leg. In other cases, the component parts make the leg longer than the other side. Either of these situations can impact recovery.

There’s also some question about how long the rehab program should extend. The standard time is two to three months. There’s some evidence that this just isn’t long enough. But it’s not clear yet what the ideal time frame may be. Some experts who study human movement and posture have also suggested that a different rehab protocol may be needed. It’s clear that the hip abductor muscles are key here. These muscles move the leg away from the body. They also stabilize the hip when you stand on one leg. Both functions are equally

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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Should soccer player get hip joint resurfacing?

October 13th — admin

I’m a 45-year-old avid soccer player. But my right hip is wearing out. If I go for the newer hip joint resurfacing, how soon could I get back on the field?

Hip joint resurfacing was introduced several years ago to help younger patients who are more active and who would likely dislocate or wear out a total hip replacement. Surgeons found a way to replace the surface of the joint without removing the bone and replacing the entire joint. Bone is saved because the femoral head (round ball at the top of the thighbone) isn’t cut off. And it isn’t necessary to put a long stem down into the canal of the femur since the head isn’t replaced. All of these features of joint resurfacing make it possible for patients to extend the life of their own joint before a full joint replacement is needed.

There is also some thought that joint resurfacing may preserve a more normal load transfer during gait (walking and running). If that is true, gait recovery could be added to the list of advantages for joint resurfacing over total hip replacement.

These are just a few of the many reasons why joint resurfacing has advantages over a total hip replacement for younger, more active adults. Research is underway to find ways to further maximize these benefits. Scientists are studying all aspects of the implant design, surgical technique, and rehab protocols.

Each surgeon has his or her own way to perform the operation. The approach, type of implant, incisions made, and fine-points of surgical technique can vary. So, it’s the surgeon who ultimately must answer your question. You don’t want to do anything to compromise what would otherwise be a perfect result.

You can expect at least a 12 week postoperative recovery time. Six months of concentrated rehab is not unreasonable for someone who wants to participate in competitive sports such as soccer. Ask your surgeon for a timeline to guide you. Make sure you understand what (if any) motions or activities are not advised and how long these restrictions should last. Participation in high-impact activities may be always restricted in order to protect and preserve the joint for as long as possible. Find out what your particular restrictions may be when making your final decision about this procedure.

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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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 happens if a hip replacement dislocates?

October 6th — admin

My mother fell and dislocated her new hip replacement. They took her back into surgery and put the joint back in place. She’ll be going to a step-down transition unit. What should we expect for a prognosis? Will it hold? What happens if it doesn’t?

Dislocation is every patient’s fear after getting a new hip replacement. The surgeons call it instability. No matter what name you give it, the problem is troublesome for the patient and a complex challenge for the surgeon. Conservative (nonoperative) care is usually tried first. Once the hip is back in the socket, a brace may be applied and the patient is sent to physical therapy.

Not all surgeons use bracing in these situations. If they do, the brace used is called an abduction brace. It holds the hips apart and in a neutral position (not turned in or rotated out). The physical therapist will help your mother learn how to move safely while strengthening the muscles around the hip.

A special focus of treatment is to restore normal joint proprioception (sense of joint position) and kinesthesia (awareness of movement). Balance training is also very important. Before discharging her to home, the therapist will interview the family to find out what kind of changes need to be made at home. For example, throw rugs will have to be removed, additional lighting (especially for at night) may be needed, grab bars installed in and around the bathroom, and so on.

If a conservative approach doesn’t work and the hip dislocates again and again, then surgery may be needed. The surgeon may have to tighten up loose tissue and restore a balance to soft-tissue tension on all sides of the hip joint. If the implant is improperly positioned, it must be removed and realigned. The surgeon may need to replace the femoral head with a larger one. The goal is to prevent a recurrent (second) hip dislocation.

The good news is that only 10 per cent of patients who dislocate the hip after receiving a total hip replacement will dislocate it a second time. Your surgeon and the rehab team will help you navigate through this difficult time. Don’t hesitate to bring up your concerns and questions. They have knowledge of your mother’s health and hip condition that they can draw on to provide you with answers.

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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Hip resurfacing vs. hip replacement

October 4th — admin

I’m looking into the possibility of having a hip joint resurfacing procedure done instead of a total hip replacement. I’ve heard all about the positives of this operation from my surgeon. Could you fill me in on any down sides there might be?

Hip resurfacing arthroplasty is a type of hip replacement that replaces the arthritic surface of the joint but removes far less bone than the traditional total hip replacement. Because the hip resurfacing removes less bone, it may be preferable for younger patients that are expected to need a second, or revision, hip replacement surgery as they grow older and wear out the original artificial hip replacement.

You are asking, how well do they work? And what are the potential problems or complications? Using data from the 1000s of hips done outside of the United States along with studies done in the states, it’s clear that the overall revision rate is still higher for resurfacing than for standard total hip replacements. But the rate is still small enough to make it worth having the procedure for the many patients who aren’t ready yet for a complete total hip replacement.

The most common complications are femoral neck fracture, implant dislocation, and metal ion hypersensitivity. Because the component parts of the implant are metal, tiny pieces of metal ions flake off and get trapped inside the joint forming a tumor-like cyst or entering the blood stream. This could become a problem for anyone with metal hypersensitivity.

Studies show that women are more likely to have a failed resurfacing procedure. So are patients who’ve had a previous hip surgery or anyone who has osteonecrosis (loss of blood supply to the top of the femur or thighbone causing death of bone cells). And anyone with inflammatory arthritis or developmental dysplasia of the hip is at increased risk for implant failure.

Joint resurfacing is a stop-gap measure for patients with painful arthritic conditions. By preserving as much bone as possible, it buys them some time before converting to a total hip replacement. This plan allows younger patients to remain active and put off the inevitable hip replacement.

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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Fast-track program for hip replacement

September 30th — admin

Have you ever heard of a fast-track program for total hip replacements? That’s what my father is on, and we are just wondering what it means.

Patients and surgeons are both interested in a speedy, painless recovery from surgery after a total hip replacement. To reach that goal, surgeons have introduced something called a minimally-invasive surgery (MIS). Minimally invasive surgery refers to any operation where the surgeon changes how long or how deep the cut is made into the tissue. With some minimally invasive approaches, the surgeon can avoid cutting into most of the muscles around the hip that are normally removed from the bone during the standard hip replacement surgery. The hope is that with less trauma to the soft tissues (especially the muscles around the hip), the patient will be able to recover that much faster.

There are also some efforts to speed up the rehab or postoperative recovery process. A program called the fast-track has been designed to accomplish this. Several studies have shown that patients who are on the fast-track after surgery get better faster. The fast-track means they get a patient-controlled pump to manage their pain. They start rehab sooner, and the therapist provides a more aggressive program. In studies so far, patients in the fast-track groups are discharged sooner, can walk better, and are more satisfied than patients following the standard rehab protocol. This is true no matter what type of incision or approach was used to do the surgery.

Not everyone can participate in a fast-track program. Patients are selected based on general health, motivation, and compliance level. Complications after surgery such as infection, dislocation, or fracture can put an end to someone’s fast-track status. But for those who are able to complete the program, the results have been very impressive.

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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