Playing tennis after a total hip replacement

September 3rd — 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  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 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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Partial hip replacement may result in fracture

August 26th — admin

My mother just had a partial hip replacement. I guess it was like having a tooth capped. Just the top of his femur was replaced. She ended up with a hip fracture afterward. 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 afterward 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 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 a total hip replacement necessary for just one part?

August 23rd — admin

I just got the results of my hip X-rays. One hip has arthritis but just at the top of the thigh bone. The round ball in the socket is all broken down. It’s not really round anymore. Do I have to have a whole hip replacement just for one part?

Maybe not! You may have a couple choices. The first is called a hemiarthroplasty. The surgeon removes the round top of the femur (thighbone) and drills out some of the bone down inside the shaft. Then a replacement top and stem are inserted down into the bone.

Or if you are younger than 60 and have good bone stock, you may be able to have a hip resurfacing arthroplasty (HRA). In this operation, just the top or cap of the femoral head is removed and replaced. It’s a lot like having a tooth capped by the dentist.

Your surgeon will be able to tell you both what is possible and what he or she can do. Not all surgeons perform all types of joint implants. Experience is important so it’s a good idea to go with what your surgeon is skilled at doing. If you are a good candidate for a HRA, then you may want to go to a center where this operation is done routinely.

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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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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What’s the age of the average patient who gets a hip replacement?

August 13th — admin

What’s the age of the average patient who gets a hip replacement?

It used to be the average age of a total hip recipient was mid-60s or older. Because the typical implant lasts around 15 to 20 years, surgeons waited until patients were older before giving them a total hip replacement (THR).

That policy is slowly changing based on several factors. First is demand. As adults remain active longer, the need for joint replacement earlier is increasing. Second, the materials and methods used with THR have improved dramatically over the last two decades. Better and better long-term results are being reported. The age and type of patients eligible for THR is expanding every year.

According to a large 25-year prospective (looking back) study, the average age of patients getting their first THR has been around 69 years old. The age range was from 24 to 88 and older. If there are no complications, today’s THRs can last 25 years or more.

Some patients report pain, stiffness, and loss of physical function as time goes by. Most aging adults slow down their activity level anyway so the decline in function doesn’t impair their life style. Researchers hope that with improved implants, better long-term results will make it possible to stay active longer.

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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MRA or arthroscopy needed to diagnose hip pain

July 2nd — admin

How can I find out what’s wrong with my hip? I’ve had an X-ray and an MRI. Both were “normal”. But I can tell you that hip is not “normal”. I have pain and can’t bend it all the way or turn it in. Sometimes I have trouble turning my hip out, too. Where do I go from here?

If you’ve had some imaging studies it sounds like a physician has started the diagnostic process. The next step is to go back to the doctor. You may need an MRA or magnetic resonance arthrography. A liquid dye is injected into the joint space. This allows the radiologist to see the outlines of the joint capsule that don’t show up otherwise.

One other step is to look inside the joint with an arthroscope. A long, thin needle is inserted into the joint. A tiny TV camera on the end of the tool allows the physician to view the joint.

This doesn’t always work without manipulating the joint first. Manipulation is done while the patient is sedated. The doctor moves the joint through its full range of motion. Some pressure may be needed to break loose any adhesions or bits of scar tissue holding the joint back.

Ask your doctor what your options are given your symptoms, history, and results of early imaging 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 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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One leg shorter than other as a result of hip replacement?

June 28th — admin

A year ago I had a total hip replacement. I did all my exercises and I’m almost back to normal. There is one problem. It feels like that leg is longer than my other leg. Is this possible or am I just imagining it?

You may be quite right. In a small number of patients after total hip replacement the leg either is longer or seems longer. An X-ray and exam are needed to find out for sure.

If the leg is truly longer than the other one, the doctor will see this on X-ray. Sometimes this can happen because of the implant. Usually the patient has pain along the outside of the hip or around the incision. The pelvis drops on the short side to make up the difference. A shoe lift may be all that’s needed.

If the legs are truly equal in length on X-ray then the problem is considered called a functional leg length difference. This means the soft tissues around the hip are tight or off-balance pulling the leg up or down. In these cases physical therapy may be helpful. An aggressive program of stretching and/or strengthening may restore limb length and function.

Make an appointment today with your orthopedic surgeon for a follow-up visit. This kind of problem should be addressed sooner than 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 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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MRA more accurate than MRI for ddetermining cause of hip pain

June 18th — admin

What is magnetic resonance arthrography (MRA)? I’ve heard of MRI but not MRA. My doctor wants me to have an MRA to help figure out what’s wrong with my hip.

Magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) are very similar tools. MRA is basically MRI for the joints. It is more accurate in detecting joint problems. MRI can confirm there’s a problem in the joint. MRA shows exactly what is the abnormality.

CT scans work well for bone lesions around the hip. CT scan shows places where the bone might have a tumor, abnormal anatomy, or necrosis (dead cells).

If you ever need surgery on the hip, advanced imaging studies of this type are very important. The more details the surgeon can see ahead of time, the better the surgical plan with no (or very few) last minute surprises.

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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