Posts Tagged ‘Hip Pain’

Hip Replacement Surgery 101

hip replacementThe hip is one of the body’s largest and most important joints. It allows us to walk, run and jump, and bears our body’s weight and the force of the muscles of the hip and leg. If your hip has been severely damaged—by a fracture, arthritis, osteonecrosis or other conditions–common activities such as walking or getting in and out of a chair may be painful and difficult. You may even feel uncomfortable while resting.

If other alternatives such as medications, the use of walking supports, or changes to daily activities do not effectively help your symptoms, hip replacement may be a viable solution and you should consult with your physician to learn more. Generally, hip replacement surgery is a safe and effective procedure that can help you get back to enjoying everyday activities.

Takeaways from Dr. Bradbury’s Hip and Knee Replacements Chat

Thank you for participating in the online chat on Hip and Knee Replacements.  We had a lot of really great questions.  We received a few questions a couple times so we will highlight the answers to those questions here!

What is the longevity of knee replacements?

The lifespan of a knee replacement is related to the body weight and activity level of the individual who receives the replacement.  Individuals who are very active often reduce the longevity of their knee replacement because high activity can put extra stress on the implant leading to loosening of the implants from the bone or “wearing” of the parts used to replace the joint.  Being overweight increases the forces on implant and can also lead to early failure.  In general, 15 year survivorship of modern knee replacement designs used in  good candidate is around 90 percent.

Typically for younger patients,  if x-rays do not show complete loss of cartilage, “bone on bone”, I recommend waiting as long as possible to have the knee replacement surgery.  However, if there is “bone on bone” arthritis, knee replacement is the most effective treatment, but the risks of early failure are increased.

What exercises can I do for a total knee replacement?

Low impact aerobic conditioning 4-5 times per week for 4-6 weeks prior to surgery is best.  Low impact activities include swimming, elliptical, or stationary  bike.

“Prehabilitation” is rehabilitation to get your body ready for the surgery so you can recovery as quickly as possible after surgery.  Instruction during this period should be focused on strengthening the muscles around the joint.  The prehabilitation period should last for several weeks before surgery.

How long is recovery after hip/knee replacement?

It is best to think of how long it takes to reach recovery milestones -

• For hip replacement, pain is typically better than what it was prior to surgery in 2-3 weeks, normal walking typically occurs by 6-8 weeks and full recovery typically occurs within 3-4 months.

• For knee replacement, pain is typically better than what it was prior to surgery by 4-6 weeks, normal walking typically occurs by 8-10 weeks and full recovery typically occurs within 4-5 months.

Thank you again for attending the chat. I hope you found the information useful!  If you have questions or would like to schedule an appointment with an Emory Orthopedic Surgeon about hip or knee replacements please call 404-778-7777.

>>Read the full transcript from the online chat here!<<

About Dr. Bradbury

Dr. Bradbury is an Assistant Professor of Orthopaedic Surgery at Emory. He specializes in hip and knee arthroplasty. He really enjoys this area of orthopaedic surgery because of the consistency of success in the properly selected patient. Dr. Bradbury’s professional goal is the improvement in quality of life for patients with pain secondary to hip and knee problems.

His research interests center around infections involving hip and knee replacements which are rare, but difficult problems. Dr. Bradbury is researching the success rate of current treatment methods for hip and knee replacement infections caused by resistant bacteria (MRSA). Through his research, he hopes to find better way to both prevent and treat periprosthetic hip and knee infections.

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Learn all about Hip or Knee Replacements

The decision to get a hip or knee replaced is a difficult one for many patients.  Hip and knee replacements are typically advised only when all other options have not worked for you.  If you are considering a hip or knee replacement or already have had one and want to speak to a physician, join Emory Orthopedic Surgeon, Thomas Bradbury, MD on Tuesday, June 11, 2013 at noon for an online web chat on Hip and Knee Replacements.  He will be available to answer questions such as:

• What are hip and knee replacements?
• Why have the surgery?
• Who are candidates for hip or knee replacements?
• What are the newest advances in Hip and Knee replacements?
• What is Emory’s approach on when to get knee or hip replacement surgery?
• What is the recovery after a hip or knee replacement?
• What types of exercise are suitable for someone with hip or knee replacements
• What kind of outcome can you expect?

Come prepared to ask your questions and learn more about your options!

CHAT TRANSCRIPT

About Dr. Bradbury

Thomas Bradbury, MD

Dr. Bradbury is an Assistant Professor of Orthopaedic Surgery at Emory.  He specializes in hip and knee arthroplasty.  He really enjoys this area of orthopaedic surgery because of the consistency of success in the properly selected patient. Dr. Bradbury’s professional goal is the improvement in quality of life for patients with pain secondary to hip and knee problems.

His research interests center around infections involving hip and knee replacements which are rare, but difficult problems. Dr. Bradbury is researching the success rate of current treatment methods for hip and knee replacement infections caused by resistant bacteria (MRSA). Through his research, he hopes to find better way to both prevent and treat periprosthetic hip and knee infections.

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Minimally Invasive Hip Surgery Gets Patients Active Faster – A Patient Story

Thomas Bradbury, MDWhen I first met Mark Putnam, he had chronic pain in his right groin and lower back caused by osteoarthritis of the hip. At 49, Mark felt twice his age. His local orthopedic surgeon was uncomfortable performing surgery because of the extent of the damage to the joint and instead referred Mark to the Emory Orthpaedics & Spine Center.

Mark needed a total hip replacement, and I knew he would be an excellent candidate for anterior total hip arthroplasty, an Emory-pioneered minimally invasive surgery that involved a new approach to the hip joint. Hip arthroplasty traditionally is performed through the posterior, or back, of the hip. This means the surgeon has to remove muscle and ligaments from the bone in order to reach the affected area. Because it takes a while for the tissues to heal after posterior total hip arthroplasty, the range of motion the hip can have for the first couple of months is restricted to prevent dislocation.

Anterior total hip arthroplasty has changed the way we perform hip replacement surgery at Emory. During the procedure, the orthopedic surgeon enters the front of the hip, as opposed to the back, via a single, very short incision to the patient’s leg. Because the surgeon can expose the hip without removing as much muscle and ligament from the bones around the hip joint, the patient retains a better range of motion in the hip and has greater hip stability following surgery.

While anterior total hip arthroplasty takes longer than traditional posterior surgery, the quick recovery time more than makes up for it. After surgery, Mark was pain free for the first time in years.

“It’s been terrific,” he said. “I was out the other day playing catch with my son, and I got down in a catcher’s squat and it didn’t even affect me.”

I encourage you to read up on the details of Mark’s total hip arthroplasty, and watch a video on Mark’s journey. Have you had anterior total hip arthroplasty? We’d like to hear about your experience. Please take a moment to give us feedback in the comments section below.

About Thomas Bradbury, MD

Thomas Bradbury, MD, is an assistant professor of orthopedic surgery. He holds clinic at Emory Orthopaedics & Spine Center at Executive Park and performs surgery at Emory University Orthopaedics & Spine Hospital (EUOSH). Dr. Bradbury’s professional goal is the improvement in quality of life for patients with pain secondary to hip and knee problems. He started practicing at Emory in 2007.

Got Hip Pain? Get Back in the Game Quickly with Hip Resurfacing

hip resurfacing procedureIn my practice at the Emory Orthopaedics & Spine Center, I see a lot of patients who suffer from hip pain as a result of osteoarthritis, or degenerative joint disease. In the past, when surgery was called for, hip replacement was often the best option—and in many cases, it still is. However, in 2006 the FDA approved the first total hip resurfacing implant in the United States, allowing patients suffering from serious hip pain another highly effective option.

Unlike total hip replacement, in which the diseased head ball of the hip (femoral head) is completely removed, total hip resurfacing preserves the femoral head and removes only the damaged surface of the bone.

Only a small number of surgeons in the Atlanta area have the training and expertise to perform this procedure properly. I have been performing total hip resurfacing procedures at Emory since 2007, with excellent patient outcomes. This specialized operation has a number of potential advantages for the right patient. Total hip resurfacing can:

  1. Preserve bone
  2. Restore the natural anatomy of the hip
  3. Provide the largest possible head size to improve hip stability
  4. Enable restoration of hip function to allow a multitude of activities
  5. Allow for an easier revision (re-do) in the future, if needed

So who’s the perfect hip resurfacing patient? Hip resurfacing is best suited for the young, active male (<55 years of age) with osteoarthritis of the hip and normal hip anatomy. Healthy and active at 45, Mark Gabriel was the ideal candidate. I met Mark last year, after he’d been suffering from pinching and pain in his hip for a year and was referred to me for surgery. Mark, a director for an Atlanta IT solutions and staffing company, was in great shape, save for his hip. His hip pain had resulted in large part from 40 years of playing tennis on hard-surface courts. As he put it, his hip was like a brake pad that had been used too much. Eventually it wore out. Resurfacing his hip was a great way to preserve the hip bone and allow Mark to get back to the active lifestyle he enjoyed.

In July of 2009, I performed Mark’s hip resurfacing surgery at Emory University Orthopedic & Spine Hospital (EUOSH), our state-of-the-art inpatient facility. Mark was put under general anesthesia for the procedure, which went smoothly and took about two hours. Because Mark is young and had stayed active by cycling up to his surgery date, he recovered from the surgery quickly. He stayed in the hospital just two nights and was off pain medication completely three days after surgery. After six days, he was down to one crutch and was back to walking around his neighborhood.

Mark says that he is 100% satisfied with the results of his hip resurfacing. In the year since the procedure, he’s played tennis five days a week, enjoyed golf, and gone skiing. He chooses clay courts over hard surface when he has the option, but Mark is back in the game and loving life after hip surgery.

Have you had hip surgery, or are you considering hip resurfacing? We welcome your questions and feedback in the comments section below.

About Greg Erens, MD:
Greg Erens, MD,  is assistant professor of orthopedic surgery and director of the Emory Adult Reconstruction Fellowship. Board certified in orthopedic surgery, he specializes in both uncomplicated and complex problems of the hip and knee. Dr. Erens started practicing at Emory in 2003.

Improved Joint Capsule Reconstruction Results in Fewer Dislocated Hips

James Roberson, MDDislocation of the ball from the joint has always been a possible complication following hip replacement surgery. However, at Emory Orthopaedics, a couple of developments have significantly reduced, if not eliminated, those concerns.

One of these developments is the use of alternative bearing surfaces such as highly cross-linked polyethylene—a super-wear-resistant plastic—which enables surgeons to use larger-diameter balls (femoral heads) in the hip joint. The new, thinner bearing surfaces allow for larger-diameter femoral heads, making the hip intrinsically more stable.

Another development that has significantly increased hip stability is recognition of the importance of reconstructing the ligamentous capsule of the hip joint to its appropriate anatomic position at the completion of the hip replacement. The hip is held in place by the soft tissue around the hip—the capsule, the ligaments, and the tendons. If these are not put back in an anatomic position (i.e., where they came from), the hip will have a greater chance of dislocation.

At Emory Orthopaedics, what these developments mean is that we have become more comfortable allowing our patients to resume natural activities earlier after surgery. Traditionally, patients were told they shouldn’t bend their hip more than 90 degrees, shouldn’t cross their legs, should use an elevated toilet seat, etc. for up to three months following surgery. Patients were apprehensive about dislocating their hip. But with these new materials and improved methods, for most patients we’ve stopped using those restrictions in the early post-op period. Now we feel confident telling patients that they can sit however they’d like to, bend their hips, and so on. They can go straight to enjoying their new and improved hip.

Have you had or are you going to have joint capsule reconstruction surgery? We’d like to hear about your experience. Please take a moment to give us feedback in the comments section below.

About Dr. Roberson

James R. Roberson, MD, chairman of the Department of Orthopaedics and professor of Orthopaedic Surgery, specializes in treating hip and knee arthritis and has performed more than 10,000 hip and knee replacements over the course of his career. Dr. Roberson has practiced at Emory since 1982.

How Do You Know if You Have a Hip Problem?

Thomas Bradbury, MDThink you’ve pulled a groin muscle? You may have a hip problem instead. Because hip pain often presents in the groin area, a lot of patients come to me thinking they’ve pulled a muscle, when in fact they have arthritis of the hip or a hip impingement.

Causes of hip pain may include arthritis, hip impingement, and labral tear.

Arthritis is the most common cause of hip pain, usually affecting older adults. Hip impingement, which generally affects younger folks, is caused by abnormalities in the shape of the ball in the socket, and it’s usually congenital, or a condition you’re born with. Impingement can lead to arthritis.

When you have hip impingement, you feel pain when the hip is at the extreme of its range of motion, such as when you’re sitting or walking up stairs. Because impingement pain is positional, it shouldn’t occur when you’re walking on level ground or at night, while you’re sleeping. Hip impingement also may cause a labral tear.  The labrum can be thought of as a cartilage “O-ring” that attaches to the rim of the hip socket. Rarely, trauma can result in a labral tear.

If you have pain in the buttock area, you may have a spine problem rather than a hip problem.

How do you know when to see a physiatrist or an orthopedist?

Pain that doesn’t resolve with several weeks of rest and avoidance of painful activities or with the use of Tylenol or anti-inflammatory drugs needs to be evaluated.  At the Emory Orthpaedics & Spine Center, we use x-rays and MRIs to help diagnose hip problems. Steroid injections into the joint also may help with both diagnosis and to ease the pain.

When hip problems are caused by arthritis, we start treatment with conservative methods, such as use of a cane, modification of activities, and taking Tylenol or anti-inflammatories. If these don’t sufficiently ease hip pain, hip replacement surgery offers the potential for dramatic improvement in pain, function, and quality of life.

When impingement causes hip pain, hip arthroscopy may be beneficial. During hip arthroscopy, your orthopedic surgeon uses a small camera to look inside the joint. If there’s an abnormal shape to the ball or socket, it can be corrected with special instruments. This treatment will often offer improvement in pain. Labral tears can be trimmed or repaired at the time of arthroscopy.

Have you experienced groin pain or hip pain? Have you tried conservative measures and not found relief? Or have you had a hip replacement or arthroscopy? We’d like to hear about your experience. Please take a moment to give us feedback in the comment section below.

About Thomas Bradbury, MD:

Dr. Bradbury is an assistant professor of orthopedic surgery. He holds clinic at Emory Orthopaedics & Spine Center at Executive Park and performs surgery at Emory University Orthopaedics & Spine Hospital (EUOSH). Dr. Bradbury’s professional goal is the improvement in quality of life for patients with pain secondary to hip and knee problems. He began practicing at Emory in 2007.