Uneven wear in hip joint replacement result of third-body wear.

March 5, 2010 — admin

I had a joint hip replacement for severe arthritis three years ago. The doctor tells me that “third-body wear” is likely the cause of some uneven wear in the joint. What does this mean?

When patients with hip joint replacements are compared, there are very different results in wear patterns of the new joint. This is true even when the same replacement parts are used from patient to patient.

In fact, one study looked at patients with both hips replaced using the same implant. The researchers compared one side to the other and found that the wear pattern was different from side to side. One of the reasons for this is third-body wear.

This is the presence of tiny particles in the joint. These pieces may be bits of bone or fragments of glue or cement used to hold the new joint in place. Even metal debris from the coating around the joint implant can cause the joint liner to be scratched and roughed up. Joint wear and tear is increased when the surfaces are roughened.

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 position is best for sleeping after a total hip replacement?

March 3, 2010 — admin

What position is best for sleeping after a hip replacement?

It depends how long ago you had the operation. During the first weeks-to-months, patients are restricted to lying on the back. Many doctors request they use a special abduction pillow between the legs with another pillow under to knees to keep the hips slightly bent.

When the doctor gives you the go ahead you can sleep on the “good” side. This means the hip replacement is up facing the ceiling. You’ll still need a firm pillow that goes between the legs from the hips down to the ankles.

Lying on your stomach is not advised. If your doctor approves this position, you may need a pillow under the hips to keep them in a slightly flexed or bent position. It’s usually many months (if ever) that stomach sleeping is comfortable or safe.

Sleeping on the operated side is also delayed by many months if it is resumed at all. Most patients find this position too uncomfortable to rest well at night.

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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I had total hip replacement surgery, how long will I limp?

February 26, 2010 — admin

I’m very self-conscious that I still limp after a total hip replacement I had five months ago. Will this ever go away?

Muscle weakness is the usual cause of a limp while walking. Three to six months after a total hip replacement, the muscles around the hip are still only at 50 percent of normal. Limping is not unusual up until six months after the replacement.

Limping may even go on up to one year later. This is because joint strength and function are still only at 80 percent of normal. It’s important to keep doing your rehab exercises. By five months you should be able to move past the basic program and continue to improve your strength.

Try to get back to your favorite physical activities. Any nonimpact sports you enjoy will help keep you on track for full recovery. If you aren’t seeing some gradual improvement over time, ask your doctor if there are any special or unusual reasons why you are still limping. Perhaps you’re a good candidate for an updated rehab program.

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 Grandma too old for total hip replacement?

February 5, 2010 — admin

My 83-year old grandma is going to have a total hip replacement. We’re all worried that she’s too old for this. What do you think?

Americans are living longer and in better health. This means they are more likely to need a major joint replacement as they reach their 80s. Joint replacements are available for the shoulder, hip, or knee.

These operations do put older adults at increased risk of problems.

Studies of 80-year old (and older) adults compared to younger adults show there is an increase in the number of serious problems that occur. But the overall rate is low, and it’s more likely to happen in elderly patients with other health problems.

Results should be good if your grandmother is in good health and the doctor has approved the surgery.

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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Taking gingko biloba and planning hip surgery? Tell your surgeon!

January 11, 2010 — admin

Have you ever heard of this? My aunt had hip surgery and then developed a weeping, oozing wound. The doctor said it was from taking ginkgo biloba.

There have been a few cases of persistent bleeding after surgery caused by herbal self-medication. Usually the patient forgets to tell the doctor that he or she is taking a supplement such as St. John’s wort, ginseng, or ginkgo biloba.

Gingko biloba has an anticoagulant property much like aspirin. This means it prevents the blood from forming clots. That’s important for patients at risk for heart attack or stroke, but it’s a risk factor for anyone who’s just had surgery or who has a bleeding disorder.

The most recent report of gingko biloba causing oozing from a wound after surgery comes from Wales. A 77-year old woman had a hip replacement without problems. Afterwards, the wound site drained blood and a clear fluid for three weeks. When it was finally discovered she was taking gingko biloba and she stopped taking it, the problem cleared up within 10 days.

Visit The Zehr Center online for more information on total hip replacement surgery.

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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Pinning vs. total hip replacement

December 22, 2009 — admin

I’m writing to you from a hospital bed after tripping over a shoe lace and breaking my hip (a femoral neck fracture). I don’t have much time before the nurses come in and scold me for being on the computer. Please tell me the pros and cons of having the bone pinned together versus having the joint replaced.

You didn’t mention your age or bone status, two important points in making these choices. Older patients (65 years old and older) with poor bone density may not be able to grow enough new bone to heal a fracture that’s pinned. The hip replacement may be the best option.

Is the fracture stable (fracture line hasn’t moved), separated (bone has drifted apart) or impacted (one side of the fracture is pushed into the other side)? A stable fracture that hasn’t moved or shifted is often treated by internal fixation. This means screws are used to hold the bone together until it heals.

If the fracture can’t be pinned together or if there are serious arthritic changes in and around the bone and joint, then a joint replacement may be needed. According to the results of a recent study, older adults have better results with a total hip replacement.

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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Specialists undecided on treatment for displaced femoral fracture

December 17, 2009 — admin

My 82-year old father is in an assisted living center. He was hospitalized two days ago for a broken hip bone. I guess it’s what’s called a displaced femoral fracture. He’s had three specialists consult on the case. They can’t seem to decide what’s the best way to treat the problem. Is this unusual? Should we move him to a different hospital?

A displaced fracture of the femur (thigh bone) means the bone broke and the two ends either separated or shifted. In other words, the broken pieces of the bone don’t line up anymore.

Femoral fractures are very common in the United States, especially with the aging of America. The type of fracture you’re describing can cause quite a bit of disability for the patient. Some patients are unable to get back to their former level of function. They may have to give up independent living. They may go from being able to walk to being confined to a wheelchair.

The goal of treatment is always to get the patient back to a prefracture level of function. Treatment is usually an operation to repair or replace the bone. Repair may be done using screws to hold the two ends of bone together until healing takes place. This is called internal fixation. It may be necessary to replace part or all of the hip joint.

There are many factors to consider when choosing the right treatment. The patient’s age, bone density, mental status, and other health issues are important. Most likely the doctors are meeting to confer on which treatment would give your father the best chance for recovery based on his individual factors.

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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Muscle testing may be necessary years after total hip replacement

December 9, 2009 — admin

I had a hip replacement about two years ago. I notice I’m having more trouble now doing simple things like putting on my socks and shoes than even right after the surgery. What can I do about this?

You may be experiencing some loss of strength. This happens in many patients one to two years after recovery from a total hip replacement (THR). Sometimes an exercise program is all you need.

Your muscles can be tested and a specific program of exercises given for any weakness. A regular program of walking 30 minutes at your own pace each day has also been shown to help. Patients do best when they combine an exercise program with daily walking.

It’s a good idea to have your doctor check you over for any medical causes of this change in your function. If you get the all-clear signal make an appointment with a physical therapist for muscle testing and an exercise program. Most programs of this type can be done on your own at home.

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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Mini-incision hip surgery study biased?

November 12, 2009 — admin
My doctor is going to include me in a study they are doing at their orthopedic center. I had a total hip replacement done with a mini-incision. They are going to compare patients with a mini-incision to patients with the standard cut. Maybe I’m a bit off in my thinking, but don’t they just see what they want to find in studies like this?
You’re wondering about the bias in such a study. It’s a valid and fair question. And one that researchers must ask themselves when setting up the study. There are ways to avoid this kind of problem.

For example, your study is being done after the operation is over. This is called a cohort or retrospective study. This type of study helps limit patient bias. The study takes place after you’ve finished your treatment. The results aren’t biased by what you expect to happen.

The doctor may choose to compare your results with the final X-rays of the hip joint. In these cases, the X-rays are read by a doctor who didn’t do the operation. The radiologist doesn’t know by looking at the X-ray which patients had a small incision and which ones had the mini-incision.

Finally, scientists think that independent researchers reduce bias. These are studies done by people who weren’t the first ones to try something. They aren’t trying to prove something works. They are just looking at the results of using the method developed by someone else.

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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Get your hip replacement surgery done at a high-volume hospital!

October 22, 2009 — admin
My son-in-law is a doctor. He told me to get my hip replacement done at a high-volume hospital. What does this mean?

 
Generally it means the hospital does more than just a few total hip replacements (THRs) each year. Researchers often set 100 as the point at which a hospital is called high-volume.

A recent study of Medicare patients getting THRs in a high volume hospital reported a death rate of less than one percent. This was compared to a 1.3 percent rate in hospitals doing less than 10 joint replacements each year.

The research supports finding both a high-volume facility and an experienced doctor. Doctors who do more THRs also have lower rates of complications. Be aware that increased experience and volume can lower complications but not to zero. Problems still occur even with the most skilled surgeons. This may have to do with the age and overall health of the patient.

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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