Is Postoperative Delirium More Common in Women?

June 17th — admin

Both my parents and my mother-in-law have had total hip or total knee replacements. The women were very confused and disoriented after surgery. Is this more common for women than men? If so, does anyone know why this happens?

Confusion or disorientation after surgery of any kind may be a neurological problem called postoperative delirium. Agitation and disorganized thoughts are part of this problem. Women are not necessarily at greater risk for delirium. The most significant risk factor is older age. Since women outlive men two to one, older adults are more often women than men.

Other factors that put patients at risk include poor mental health or decreased physical fitness. The use of alcohol or other drugs is a greater problem among older adults than often realized. Withdrawal from alcohol and other drugs can also bring on periods of confusion and/or delirium.

Certain medications such as narcotic pain relievers and antidepressants may be another risk factor. Dehydration, lack of oxygen, and immobility are common risk factors for delirium among older adults.

Doctors are being encouraged to prevent postoperative neurological symptoms like confusion and delirium. Assessing patients’ physical condition and mental status before surgery is an important part of reducing these 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.

Posted in Hips, Knees. Tags: , , , , . No Comments »

What is a Physical Function Test?

June 13th — admin

My father-in-law had hip replacement surgery. He’s going to have physical function tests today to see if he can go home. What does this mean really? What kind of physical function do they test? Is driving a car included in those tests?

Physical function is usually defined as your ability to move around and look after yourself. There are many standard tests of physical function used by rehabilitation specialists. The goal is to make sure patients are able to return home and complete their daily tasks safely.

Many patients overestimate their abilities when in fact, pain keeps them from moving as quickly or as smoothly as they think they can. After a joint replacement, pain is often better but movement is slower for many months. Various tests can be administered to measure pain, exertion, speed, distance, and time.

Some of these tests such as the 40-meter self-paced walk measure walking ability. Others such as the Stair Test assess stair climbing skills. More complete testing using something like the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is also possible.

And yes, there are specific driving tests that can be given. If you’re concerned about specific skills like driving, it may be a good idea to contact the person who is giving the test(s). Let them know your concerns and questions ahead of time so they can direct the testing to include as many of those areas as possible.

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.

Posted in Hips. Tags: , , , , . No Comments »

Is Minimally Invasive Hip Replacement for Everyone?

June 11th — admin

I’ve heard there’s a new way to put a total hip joint in with only two small incisions. Can anyone getting a total hip have this type of operation?

When two-small incisions are made for a total hip replacement (THR), the operative technique is called minimally invasive (MI).

There are a few conditions that may keep a patient from having a MI THR. The first is hip dysplasia. This is a deformity of the hip with a shallow acetabulum (hip socket). There’s a tendency for the head of the femur to slip up and out of the socket.

You may be excluded from having a MI THR if you already have plates, screws, or other hardware in the hip or pelvis. It may be necessary to remove these pieces before the THR can be done.

Otherwise the two-incision MI procedure can be done on most patients with degenerative hip disease needing a THR.

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.

Posted in Hips. Tags: , , , , , . No Comments »

After having a total hip replacement, can you break that hip?

May 24th — admin

My 90-year old grandma just broke her hip. She has a total hip replacement on that side, so how can she break a hip?

She may have what’s called a periprosthetic fracture of the femur. The femur is the thighbone. Periprosthetic means the fracture is in the bone next to the implant. The fracture is probably just below the implant and close enough to the hip to be generally referred to as a hip fracture.

Sometimes joint implants crack or fracture but these cases are usually referred to as implant failure rather than hip fracture. Fracture of the femur is not uncommon in patients with either a hip or a knee joint replacement.

Advancing age puts the older adult at risk for bone fracture. Many of the problems that come with aging are also risk factors for fracture. Other age-related risk factors include osteoporosis, diabetes, and arthritis. Anyone who is already experiencing problems with balance and falling is also at risk for bone fracture. Medications such as corticosteroids can weaken the muscles and bones putting patients at increased risk for falls as well.

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.

Posted in Hips. Tags: , , , , , , , , , , , , , , , , . No Comments »

After a hip replacement, can one become too active?

May 22nd — admin

My husband had a total hip replacement about six months ago. He’s back to running and playing tennis as if nothing ever happened. Is there any danger of being too active after with a joint replacement?

There isn’t a simple yes/no answer to this question. Many doctors caution their patients to avoid high-impact activities such as running and tennis. There’s some concern that the implant won’t last more than 10 to 15 years. That could mean another surgery on the same hip.

On the other hand, it’s clear that weight-bearing activities are important to maintain good bone strength and density. Studies show that patients who are less active and more sedentary actually lose bone. Bone loss around the implant can cause it to loosen and require revision surgery.

Your husband’s surgeon is probably the best one to ask this question. Knowing the type of implant and surgical procedure used can make a difference, too. When patients are educated and informed about their joint replacements, then they can make the best decisions about activity and lifestyle.

For active, healthy adults, being more active than is advised may improve their quality of life enough to make it worth the risk.

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.

Posted in Hips. Tags: , , , , , , , , , , , , , . No Comments »

After hip replacement, is it bad to not be active?

May 20th — admin

My mother had a total hip replacement for her very bad arthritis. The pain seems much better but she’s really not any more active. She just seems to sit a lot. Is that bad for her hip?

Activity, especially weight bearing is needed to maintain bone strength with or without a joint replacement. But after a total hip, the load and compression from activity becomes even more important.

This is because the implant itself changes the force and direction of load through the bone. The effect is called stress shielding. Studies show that the shape and density of the bone can even change as a result of stress shielding. Bone loss can occur, which would be a problem if your mother ever needed further surgery on that hip.

In general, there are so many health benefits from activity your mother should be encouraged to resume former activities and regain more function. She may need some help in this area. Perhaps there is an exercise group she could attend. Or maybe a membership at a local health club or YMCA would get her going in the right direction.

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.

Posted in Hips. Tags: , , , , , , , , , , , . No Comments »

Is it common for a partial hip replacement to cause a hip fracture?

May 8th — admin

My mother just had a partial hip replacement. I guess it was like having a tooth capped. Just the top of her femur was replaced. She ended up with a hip fracture afterwards. Is this common?

It sounds like your mother had an operation called joint resurfacing. This type of operation has been around since the 1930s. It has come and gone based on problems afterwards and materials available. Most recently, new metals have made it possible to resurface the head of the femur (thigh bone) with good results.

Fracture (usually of the femoral neck) is the most likely complication of hip joint resurfacing. It happens in up to four per cent of the cases. Studies show fracture occurs most often in the first 100 cases done by a surgeon. Fracture rates go down as the surgeon becomes more familiar with this technique.

Causes of fracture are both patient and technique-related. Obesity, decreased bone mass, and arthritis make a difference on the patient side. Anyone with a femoral neck cyst should get a total hip replacement instead of resurfacing. Putting the implant in with too much of a tilt or twist can also result in fracture.

Women seem to have a higher risk of fracture after hip joint resurfacing. The reason for this remains unknown at this time. Short-term results of hip joint resurfacing are good to excellent. Long-term studies aren’t available yet. Total hip replacement may be needed by patient who have a fracture after resurfacing.

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.

Posted in Hips. Tags: , , , , , , , , , , , , , , , , , , . No Comments »

Are second hip replacements a common occurrence?

April 26th — 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?

Re-operations after total hip replacement (THR) are not uncommon. The most common reasons for re-operation 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 re-operation can include nonunion of the fracture or re-fracture. 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 re-operation. 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 re-operation, fracture or re-fracture, 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 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.

Posted in Hips. Tags: , , , , , , , , , , , , , , , . No Comments »

Isn’t saving the bone, if possible, better than a hip replacement?

April 12th — admin

My father-in-law is just going into surgery for a broken hip. We won’t know until he comes out if they can repair it or if it has to be replaced. Isn’t it better to save the natural bone if possible? How do they decide these things?

Many surgeons agree that it’s best to try and save the patient’s hip when at all possible. What they don’t want to see happen is a failed fracture repair that has to be operated on again.

In order to reduce costs and save stress on the patient, they try to pick the best operation to fit the patient’s needs at the time. This isn’t always easy to do. If a plate and screws are used to repair the hip (an operation called internal fixation), the fracture might not heal. The blood supply to the hip can get cut off leading to death of the bone called osteonecrosis. If that happens, the bone has to be removed and a hip replacement put in.

The surgeon will take all factors of the patient’s health and living situation into consideration. Will he be going home alone or is there someone who can help take care of him? What is his mental state? Is he at risk for falls and injury because of Alzheimer’s or some other form of dementia?

How old is the patient? How active is he? What is the condition of his bone? Younger, more active patients with good bone quality do better with internal fixation. Older, more brittle-boned patients may do better with a total hip replacement (THR). Studies show that in the long run, THR is more cost effective than internal fixation or a partial 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.

Posted in Hips. Tags: , , , , , , , , , , , , , , . No Comments »

Which is best hip repair or replacement?

April 2nd — admin

My 78-year old mother was very active until she fell and broke her hip. In fact, she was leading daily exercise classes for Senior Citizens. She decided to go ahead and have the hip replaced instead of just pinning it together. Would she be better off in the long-run with a shorter rehab and less surgery with a simple repair? Hip replacement seems like much more trouble.

Both short-term (two years) and long-term (four years) studies show better results with total hip replacement (THR) for older adults who are healthy and active. They have less pain and return to a higher level of function compared to patients who have the hip repaired with internal fixation devices (screws, pins, plates).

Many elderly patients who have internal fixation for hip fracture end up with so many problems, they eventually have the hip replaced anyway. By the time they have two or more operations, their walking ability and quality of life have declined quite a bit.

Decreased activity puts them at increased risk for even more health problems. And they are even at risk for new fractures of the lower extremities. So although it seems like more trouble than it’s worth, hip replacement is advised over internal fixation for patients like your mother.

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.

Posted in Hips. Tags: , , , , , , , , , , , , , , , . No Comments »
« Older posts «
»