Naples Orthopedic Surgeon - Dr. Robert J. Zehr » total hip replacement

MRA or arthroscopy needed to diagnose hip pain

admin — Fri, 02 Jul 2010 14:36:13 +0000

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.

One leg shorter than other as a result of hip replacement?

admin — Mon, 28 Jun 2010 12:45:37 +0000

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.

MRA more accurate than MRI for ddetermining cause of hip pain

admin — Fri, 18 Jun 2010 16:32:59 +0000

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.

Pain control after total hip replacement surgery – what helps?

admin — Tue, 15 Jun 2010 23:51:18 +0000

Two months ago I had a total hip replacement. I wasn’t prepared for how painful it was afterwards — worse than my arthritis. Now I’m glad I had it done but I can’t help but wonder why they can’t do more for patients to reduce the pain.

Pain control after major orthopedic surgery has really come a long way. General anesthesia (putting the patient to sleep) was the standard way to operate for years. But there were serious problems with blood loss and blood clots.

Over time doctors have been able to narrow the anesthesia down to the specific area being operated on. This is the use of nerve blocks called regional anesthesia. The risk of blood clots is much less. Patients are also less likely to have nausea, vomiting, fever, and breathing problems.

Postoperative pain is still a problem. The latest effort to control pain after a hip replacement is the continuous use of nerve blocks. The doctor keeps the leg from feeling any pain for hours to days after the surgery. The hope is to find a drug that will do the same thing but still allow the patient to go home.

For now, a combination of anesthesia and narcotics seems to work well. Each patient is different so it’s never clear what dose of each drug is ideal. Doctors and nurses must adjust both to find the optimal treatment for each person.

When is it time to replace a total hip replacement?

admin — Fri, 11 Jun 2010 13:15:57 +0000

My husband is having severe thigh pain from a total hip replacement. How do you know when a problem is bad enough to need more surgery?

Good question and of course, it probably varies from person to person. The first thing to find out is if the problem is something that can be fixed with another operation. Perhaps the surgeon has already told you the implant needs revision.

In some cases patients wait so long to have the hip replacement that they can’t recover fully. More surgery may not make a difference. In other cases, the problem isn’t with the new implant. The person may have spinal stenosis or some other low back problem causing referred pain to the hip.

When a patient’s quality of life or activity level is severely affected, then something needs to be done. Pain can disrupt daily activities and lead to further problems. If you haven’t seen the orthopedic surgeon who did the first operation, it would be a good idea to make an appointment now before things get worse.

Double hip replacement an option?

admin — Mon, 07 Jun 2010 12:01:38 +0000

I have pretty bad hip arthritis. The doctor is going to do a hip replacement on the worst side first. The other side isn’t really too good. How will I manage with one bum hip and the other one just operated on?

You may want to ask your doctor about having both hips done at the same time. If you are in good health and qualify, this may be the best option for you. Without the stiffness and pain on the nonoperative side after a single replacement, you can move along faster in rehab, too!

There’s also a cost savings. Even though you’ll be in the hospital longer than if only one hip was done at a time, the overall number of days is less when both hips are done together.

You can have bilateral hip replacements in one of three ways. First, they can both be done in the same surgery. Second, you could do one and finish rehab before having the second one done. There’s usually at least six to eight weeks between operations. Some people wait longer. Third, you could have one hip done and wait five to seven days. If your health is stable and you’re up for it then have the second one done. With this third method, you don’t leave the hospital between operations.

If you still opt for one hip replacement at a time, then a physical therapist will help you. Your home may need to be adapted to make toileting, bathing, sleeping, and household chores easier. You will likely need a family member or live-in assistant for a few days to weeks, depending on the speed of your recovery.

Mini-incision hip replacement can mean shorter hospital stay

admin — Wed, 02 Jun 2010 16:37:30 +0000

I heard the new mini-surgery for hip replacement takes less time and fewer days in the hospital. How much less?

The answer to your questions really depends on the surgeon. If the mini-incision method is fairly new to the surgeon, the operation itself can take longer. If all things are equal (the doctor has done the same number of both operations: open and mini), then the time is about the same.

Length of hospital stay also varies. The hope is that the newer mini-incision method will mean a shorter hospital stay. But hospitalization may be longer if there are any complications during or after the operation. For example, fractures and dislocations may happen more often when a surgeon is learning a new technique.

A recent study from the University of Missouri reports on this. An experienced surgeon had an overall rate of 42 percent for problems after a two-incision mini-invasive hip replacement. That was compared with six percent for the single-incision method. The surgeon also reported a 25 percent rate of nerve injuries. Any of these (or other) problems can extend a patient’s stay in the hospital.

Is a total hip replacement safe for patients with osteoporosis?

admin — Fri, 28 May 2010 10:31:40 +0000

I’ve had osteoporosis for the past 10 years. I’m doing my exercises and taking my medications. I also need a hip replacement. Is it safe to try for it? I’ve heard brittle bones can break during that operation.

Many people with osteoporosis have had total hip replacements. Often the hip breaks and it can’t be repaired because of the osteoporosis. Doctors have special ways of handling such cases.

They use cement to hold the implant in place. They can choose implants that don’t need the inside of the femur (thigh bone) to be drilled out. They are more likely to use an open method of surgery instead of the newer mini-incisions.

Ask your doctor for his or her opinion. A decision can be made based on your X-rays and bone mineral density studies. Your overall health is a factor and whether you smoke. Tobacco-use delays wound healing and increases your risk of a fracture. If everything checks out, you could be a good candidate for a hip replacement.

Total hip replacement invasive no matter how it’s done

admin — Tue, 25 May 2010 19:02:08 +0000

My orthopedic surgeon has explained to me that my hip replacement will be done with the new minimally invasive method. I don’t get it. How is this any less “invasive” than a regular hip replacement? They’re still going to cut me open, saw the bone in half, and take the old hip out. I understand there’s a lot of cutting, drilling, and reaming of the bone. What’s not invasive about that?

You ask a very good question. Perhaps only a surgeon can really appreciate the difference between the two operations. A total hip replacement is invasive no matter how it’s done. A better way to look at it is to say it “minimizes the invasiveness”. From a patient’s point of view, it certainly does sound invasive.

The first difference and reason why it’s called “minimally invasive” (MI) is the length of the scar. MI means the incision is about two inches long. A full incision can be up to eight or 10 inches long.

During the operation fewer muscles are cut. New tools allow the surgeon to gently move structures out of the way to get to the hip. Anything that is cut is carefully repaired and put back in place.

More and more surgeons are getting trained in this new technique. We can expect it to improve even more over the next few years.

Is your weight going to affect your hip replacement?

admin — Thu, 20 May 2010 20:15:10 +0000

I’m slightly overweight and worried about the effect of that on my new hip replacement. How much overweight is “too much”?

First of all, the new hip joint is likely to reduce your pain and improve your function. It’s up to you to now increase your activity level.

If you can keep your intake of calories the same while increasing your activity, then you might be able to lose some weight. At the very least, you should work toward not gaining any more weight.

Studies do show that obese patients put increased loads on their joints. Grossly obese people may reduce their activity enough to balance out load on the joint.

A recent study was done looking at body mass index (BMI) and hip motion and function after hip replacement. Hip function was less as body weight increased but overall the change was minimal.