Managing Pain after Total Hip Replacement

People who undergo a hip replacement surgery often have problems with post-operative pain. For many, pain management is a matter of managing your expectations. Surgery on a hip requires a significant period of rest in order for the body to fully recover and regain strength. Post-operative pain after hip replacement is shorter for a hip replacement than for a knee replacement surgery.

Rest

In the first week of recovery, the patient should rest often and be active only in short spurts. The more rest the  body gets during this crucial time, the better for your recovery. Usually, after 10 days, hip joint pain has gone away and soft tissue pain lessens. Some people may use a cane for up to 4 weeks post-surgery. After 4-6 weeks, most patients can return to usual activities without pain.

Ice

Ice is used to provide pain relief and reduce swelling. For hip replacement patients, use gel packs and keep them in the freezer. During recovery, you will need to change these packs frequently. Remember that gel packs can burn the skin, so wrap them in a soft, thin cloth. Also, elevate your leg and rest during icing.

Medications

Patients are typically sent home with strong narcotic analgesics at first. The orthopedic surgeon will have you scheduled for a follow-up to remove staples/sutures and refill pain medicines as needed. Take the medication as needed, and follow post-operative instructions. If the medication is not effective for your pain, talk with your doctor about increasing the dosage or changing your medication.

Elevate Legs

Elevating your legs will help reduce pain and swelling. Put your feet higher than your hips to offset some of the physical discomfort in the legs. In bed, prop your legs up on pillows at the end of the bed. Regularly elevating the legs several times each day, along with icing and medication, will help manage post-operative pain.

Regional Pain Medication

Regional anesthesia is associated with fewer complications than general anesthesia. The regional method avoids central nervous depression, and has a different spectrum of effects on the heart and lungs. Regional anesthesia provides excellent pain relief, allows for painless weight-bearing and range of motion exercises, and enhances overall patient satisfaction.

Epidural Analgesia

Epidural analgesia can consist of an opioid, an anesthetic, or a combination of both. This method of administering pain medication allows the patient to have a continuous low-dose infusion that is effective for controlling post-operative pain. The continuous infusion allows the analgesia to be more precisely titrated to a level of pain Exercise-senior-couple-199x300stimulus, and to rapidly terminate should problems occur.

Oral and Injectable Agents

After a total hip replacement, some medications used include:

  • Oral or IV Toradol
  • Oral anti-inflammatory drugs (ibuprofen, naproxen, and ketoprofen)
  • COX-2 inhibitors – Mobic Celebrex
  • Oral and IV opioids (oxycodone, morphine)

Post-Operative Rehabilitation

Patients are mobilized out of bed on the day after surgery. The patient works with a physical therapist to learn how to get up and down from bed, how to use the walking device (walker, crutches, or cane), and performs exercises for strengthening and flexibility. The therapist teaches thee patient how to avoid pain with the new hip, and what activities to avoid.

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Resources

Maheshwari AV, Blum YC, Shekhar L, et al. (2009). Multimodal Pain Management after Total Hip and Knee Arthroplasty at the Ranawat Orthopaedic Center. Clin Orthop Relat Res, 467(6), 1418-1423.

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Why do I have to Undergo Hip Arthroscopy?

Hip arthroscopy is the new minimally invasive treatment option for patients suffering from hip pain, hip injuries and degenerative hip conditions.

If you have been recommended hip arthroscopy, read on to know more about the procedure.

Hip Arthroscopy

Hip arthroscopy involves making a small incision to insert a tiny camera in the joint. The images from the small camera or arthroscope enable the surgeon see examine the joint. This is done by transmitting the images to a large television screen. The orthopedic surgeon can visualize the inside of your joint and identify problems. Surgical tools are then inserted through other small incisions to repair the damage or treat your condition.

The advantage of hip arthroscopy is that repairs can be made with minimal trauma to surrounding tissue, less pain and less risk of complications. The recovery time is also significantly shortened and the patient can get back to normal activities faster than in traditional surgery.

Hip Arthroscopy is recommended in the following conditions.

Hip Injuries

The hip is a ball and socket joint in which the head of your upper leg bone fits into a hollow in your pelvic bones. Both are covered with a slippery cartilage to allow them to slide across each other, and the entrance to the socket has a thick ring of cushioning cartilage.

Damage to any of these tissues caused by various hip injuries, can be treated with hip arthroscopy.

Hip Dysplasia

In hip dysplasia, the ball and socket of the joint don’t fit together properly. This results in excessive wear and tear on the bones, cartilage, and other connective tissue.

Snapping Hip Syndrome

In the snapping hip syndrome, you can feel a snapping or popping when you move it. This is often caused by a muscle or tendon sliding over one of the bony protrusions of your hip or due to an injury to the cartilage in your hip.

Synovitis

An inflammation of the synovium or the lining of the hip joint can also be a reason to perform hip arthroscopy.

Loose Bodies in the Joint

Loose bodies can be bits of cartilage, bone chips, or even foreign objects, floating in the joint. These can occur due to osteoarthritis, fractures or injuries.

Hip Joint Infection

In case of an infection in your hip joint, arthroscopy can remove the infected tissue.

Consult leading East Valley orthopedic surgeons if you or a loved one is suffering from chronic pain. To schedule an appointment at the top orthopedic clinic, call OSPI (Orthopedic and Sports Performance Institute) in East Valley at 480-899-4333.

How Does a Knee Get Replaced?

How do they Replace a Knee?

Knee replacement surgery is performed due to chronic knee pain and loss of mobility. According to the Center for Disease Control and Prevention (CDC), in 2010 alone, almost 700,000 total knee replacements were performed on adults age 45 years and older. Total knee replacement (TKR) has nearly doubled in prevalence over the last couple of decades, especially for women (a 99% increase).

Steps in a Total Knee ReplacementKnee pain 3

Step 1: Administering anesthesia – Knee replacement surgery is usually performed with you under general anesthesia. The doctor will discuss this with you before the surgery. You will be given medications through an intravenous (IV) catheter, and an intubation tube will be placed in your airway.

Step 2: Prepping the knee – After all excessive hair over the knee is clipped or shaved, the skin over the knee is cleaned with an antiseptic solution.

Step 3: Making incision – The orthopedic surgeon will make a 4- to 6-inch incision in the knee area.

Step 4: Removing damaged surfaces – The damaged knee joint and surface will be removed. This involves specialized instruments used to remove cartilage and bone pieces from the joint.

Step 5: Insert prostheses – The artificial components are made of plastic and metal. Most artificial knee components are cemented into the joint. The prosthesis attaches to the bone using a special cement. The components include a tibial component (resurface top of tibia or shin bone), a femoral component (resurfaces end of femur or thighbone), and a patella component (resurfaces the patella or kneecap).

Step 6: Checking motion and implants – After the implants are in place, the surgeon checks range of motion and prostheses stability.

Step 7: Closing incision – The incision is closed using surgical staples or sutures. Depending on the situation, a tiny catheter with drain may be placed in the incision to remove fluid. A sterile, dry bandage dressing is applied over the knee.

How Long does a Total Knee Replacement Last?

A common reply to this question is that a total joint replacement typically lasts 15-20 years. Most current data suggest that both knee and hip replacements have an annual failure rate of around 0.5%. This means that if you have a total knee replacement today, you have a 95% chance of it lasting 10 years, and an 85% chance that it will last 20 years.

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Types of Implants

The orthopedic implant industry has continued to develop innovative technologies to improve the outcomes of total knee replacement. However, many studies show that there is no clear advantage of any of these designs in relation to improving clinical outcomes. Some designs are:

  • Gender specific – This refers to a modified implant design that accounts for the anatomic difference between women’s and men’s knees. Most companies have some modifications in these designs to allows for sizing options so the prosthesis will fit accurately in relation to the patient’s anatomy.
  • Rotating platform – This refers to a plastic component that independently rotates on a metal tray. The plastic bearing will lock into the tray, and was designed to reduce wear on the bearing. In addition, this device can reduce the rate of loosening of metal components and better replicate the normal knee function and movement.
  • Computer technology – There are studies that have evaluated the emerging technologies in knee replacement surgery along with the success of the procedure using computer technology. Computer, robot, and custom cutting guides are used for accuracy in implant placement, as well as a more efficient surgery.

Resources

Center for Disease Control and Prevention (2015). Hospitalization for Total Knee Replacement Among Inpatients Aged 45 and Over: United States, 2000–2010. Retrieved from: http://www.cdc.gov/nchs/data/databries/db210.htm

Intermediate and Long-Term Quality of Life after Hip Replacement

Hip osteoarthritis (OA) causes severe disability and pain. If hip OA is treated successfully with a total hip arthroplasty, patients will have significant improved quality of life.

Researchers conducted a follow-up study to assess the quality of life and functionality of 250 people an average of 16 years after total hip Hip painreplacement. The Harris Hip Score, WOMAC screening, Functional Comorbidity Index, and the SF-36 questionnaire were used to assess the participants. The questionnaire showed that the results compared positively with results from untreated persons with severe hip arthritis. In addition, patients reported a 96% post-operative satisfaction rate.

In this study, hip function and comorbidities were found to be the most important determinants of physical measures on the SF-36. Additionally, patients who had undergone total hip replacement had some long-term impaired quality of life and hip functionality, but they did perform significantly better than untreated patients.

What to Expect

During the recovery period, there are some things you can do to improve recovery outcomes and quality of life after the hip replacement. These include:

  • Wound care: During home recovery, you should keep the wound area dry and clean, and dress it according to doctor’s instructions.
  • Swelling: Mild to moderate swelling may occur up to 3 months post-surgery. To reduce selling, you must elevate your leg slightly and use ice packs. Wearing compression stockings can help to decrease leg swelling.
  • Medications: Take all medications as directed by your doctor. Use pain medicine before physical therapy sessions to improve participation during the exercises. In addition, avoid any over-the-counter drugs and supplements that could interfere with prescribed medicines.
  • Weight-bearing: Use a walker, crutches, or cane as recommended by your physical therapist. Full weight-bearing is often allowed right after surgery, but this depends on the doctor’s choice and your health status.
  • Driving: It is not safe to resume driving until you quit taking pain medication. In addition, you should wait until your strength and reflexes return to normal. Usually, you can resume driving after 3 weeks.
  • Sexual activity: Please consult your doctor about resuming sexual activities, as this varies for each patient. Depending on the type of surgery you have undergone, sexual activity is restricted for several weeks.
  • Return to work: If you have a sedentary job, you may be able to resume work activities within a few weeks. This decision will be made by the orthopedic surgeon depending on your progress in rehabilitation.

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The Longevity of a New Hip

Total hip replacement is one of the most successful orthopedic surgeries done today. However, people are having hip replacements at a younger age, and wearing of the new joint surface can become a problem after 15-20 years. Revision surgery is becoming more common to maintain quality of life. This involves repeating the surgery, only this time, the artificial components are replaced with new ones.

If medication and physical therapy does not relieve pain and disability, or if the new hip shows damaged around the artificial components, the surgeon may consider revision surgery for you. This is done when bone loss, wearing of joint surfaces, or joint loosing occurs. Hip revision may be required after infection, fracture, or injury to the joint.

Resources

Galasso O, Costa GG, Recano P, & Cerbasi S (2011). Quality of life and functionality after total hip arthroplasty: a long-term follow-up study. BMC Musculoskel Dis, 12, 222.

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Physical Therapy for Chronic Orthopedic Problems

Chronic pain affects millions of Americans. Many orthopedic conditions are chronic, and they cause serious pain. Physical therapy is a good way to alleviate pain and improve quality of life.

Manual Therapies

Physical therapy involves manual therapies for pain relief, as well as exercises for strengthening and flexibility. Manual physical therapy is a specialized kind of treatment delivered with the therapist’s hands as opposed to a machine or device. Many patients come to their first physical therapy appointment expecting to get ultrasound and hot packs. However, the therapist first assesses your condition before canstockphoto47029630devising a treatment plan.

The physical therapist is interested in why a muscle or structure is not functioning properly, and see back exercises as more than the driving mode of recovery. Exercise is viewed as a complement treatment to manual therapy. With manual therapy, the therapist uses his/her hands to apply pressure on muscle tissue and to manipulate joints, which is used to decrease back pain caused by tension, spasm, or joint dysfunction.

Many physical therapists have the option to use manual therapy, but many do not spend the time to become efficient in this area of practice. Patients should request manual therapy, which is used to relieve pain. However, because this treatment is not standard, insurance reimbursement may be limited.

Manual therapy is used for joint pain. Joints that do not have adequate mobility or range of motion can benefit from physical therapy. Certain musculoskeletal conditions cause limitations, which in turn, creates discomfort, pain, and altered function. Manual physical therapy involves restoring motion to stiff joints and reducing muscle tension so the patient can regain a natural movement without pain.

Types of Manual Physical Therapy Techniques

Manual physical therapy techniques are aimed at relaxing restricted joints and tense back muscles. The goal of therapy is to increase flexibility and decrease back pain. The types of movement include:

 

  • Soft tissue work – This involves application of pressure to the soft tissues, such as subcutaneous tissue and muscles. This massage maneuver and pressure relaxes the muscles, breaks up scar tissue, increases circulation, and eases soft tissue pain.

 

  • Mobilization and manipulation – This uses measured movements of varying speed (slow to fast), distances (called amplitude), and force (gentle to forceful) to pull, push, and/or twist bones and joints into position. This helps loosen tight tissues in and around the joint, helps with alignment and flexibility, and reduces pain in the joint and surrounding tissues.

Other Therapy Maneuvers

Some commonly used physical therapy maneuvers include:

 

  • Soft tissue mobilization – Muscle tension will decrease joint motion and cause muscle spasms. For these patients, the therapist will use soft tissue mobilization (STM), which breaks up inelastic or fibrous muscle tissue, such as scar tissue form a back injury, and moves tissue fluids. The therapist will localize the area with the most tissue restriction through assessment. Once this is identified, the restrictions are mobilized with STM.blog_shoulder-physical-therapy-hawkgrips-instrument-assisted-soft-tissue-mobilization-iastm

 

  • Strain-counterstrain – This technique focuses on correcting abnormal neuromuscular reflexes that cause postural and structural problems, resulting in tender points. The therapist finds these points and holds the muscle area down. Through mild stretching, this allows the body to reset its muscle to a normal tension level.

 

  • Joint mobilization – This involves loosening up a restricted joint and increasing the range of motion by providing speed (velocity) and increasing distance of movement (amplitude). These mobilizations move the bone surfaces on each other in ways the patient cannot move the joint himself.

 

  • Muscle energy techniques (METs) – These maneuvers are designed to mobilize restricted joints. METs utilize a voluntary contraction of the patient’s muscles against a controlled counterforce, which is applied by the therapist from a precise position and in a specific direction. The operator takes the joint to a new level where the patient them contracts the muscle.

OSPI offers top orthopedic services in the East Valley with Board Certified doctors. Physical Therapy is offered along with chiropractic and pain management too!

Basics of Hip Joint Replacement

Hip joint replacement, also called total hip arthroplasty, is a procedure used to replace a damaged or worn hip joint with artificial components (prostheses). This surgery is often performed following a hip fracture or for patients with severe and advanced arthritis.

What types of arthritis affect the hip joint?hip arthritis picture

Three main types of arthritis affect the hip joints. These include:

  • Osteoarthritis – Degenerative joint disease, or OA, affects older individuals. This type of arthritis may cause joint cartilage break down.
  • Rheumatoid arthritis – Severe, deforming type of arthritis that causes synovial lining inflammation and excessive synovial fluid.
  • Traumatic arthritis – This results from an injury or trauma, and it causes cartilage damage.

Will I have a big scar after the surgery?

The traditional approach to hip replacement involves a 6 to10 inch incision over the hip joint. Newer approaches, such as minimally invasive and the anterior approach, involve two smaller incisions. The doctor will tell you which approach is best for you.

How do I prepare for hip replacement surgery?

When you meet with the surgeon, he will discuss the procedure and review the risks and benefits. Because bleeding is a risk, you must hold all blood-thinners for a few days before the surgery. The doctor takes a detailed medical history, inquires about allergies, goes over your medications, and conducts a physical examination. If not available, routine hip x-rays are done. Because this is a major surgery, you will have some preliminary tests (urinalysis, bloodwork, and EKG).

canstockphoto38482995What happens the day of the surgery?

You must arrange to have someone drive you home from the hospital and help you for a few days. Because anesthesia is given, you must fast for 8 hours before the procedure. After you change into a gown, a nurse places an IV catheter in your arm to administer medications. You will be given a mild sedative before going to the surgical room.

What happens during hip replacement surgery?

When you are asleep from anesthesia, the medical workers will clean your hip region using an antiseptic. The surgeon makes incisions and uses special instruments to remove the diseased and damaged hip bones. The prosthesis is inserted into the thigh bone, and the cup is placed into the hip joint socket. After all changes are made, the incisions are closed using sutures. The doctor will place a small drain and bandage over the surgical site.

What happens after my hip surgery?

After your operation, you are taken to the recovery room. A nurse monitors your pulse, breathing, and blood pressure, and once you are alert, you are taken to the hospital room. A nurse helps you to bed and administers pain medication as necessary. The physical therapist will meet with you and discuss your exercise rehabilitation plan. Some patients are moved to a rehabilitation center for recovery, whereas others will go home.

What modifications will I need at home?

After your hip replacement surgery, you will need certain modifications. The physical therapist will do a home visit before you have surgery to ensure you have the right modifications. These include:

  • Safety handrails in the bath/shower
  • Proper handrails along the stairs
  • Raised toilet seat
  • Shower chair
  • Stable chair with firm back and knee rest
  • Sock aid
  • Dressing stick
  • Long-handled sponge
  • Shower hose
  • Reaching stick
  • Firm pillows
  • Removal of all loose carpets and cords

Orthopedic and Sports Performance Institute offers top hip replacement doctors in Gilbert AZ. Most insurance is accepted, call us today!

Life after a Total Hip Replacement

Hip osteoarthritis (OA) is a cause of disability and severe pain, but it can be successfully remedied with a total hip replacement (THR). Also called total hip arthroplasty (THA), many short- and long-term studies show substantial improvements in health-related quality of life using from THR to treat OA.

Around 20% of THR procedures are performed in people younger than 60 years of age. The general increase in life expectancy among the population further increases a need for hip replacement. Greater attention should be paid to long-term results of hip replacement surgery.

Activities to Avoid

Once you have completed the post-surgical rehabilitation process, you will have near normal range of motion in the new hip, as well as adequate strength to perform most activities of daily living. Because THA is a successful procedure, you will return to a high level of function. However, to avoid damaging the new hip, you should take certain precautions.canstockphoto38482995

Patients who have a total hip replacement can return to activities such as walking, swimming, golf, driving, stationary cycling, and gardening. Remember to listen to what your body is telling you during exercise. If you have pain or swelling that last for over 24 hours, you need to see a healthcare provider. You must avoid certain high-impact activities, including:

  • Running
  • Vigorous walking
  • Downhill skiing
  • Tennis

Longevity of the New Hip

It is difficult to predict the life of a total hip implant, and lifespan is related to many factors. With surgical complications, new injury, and severe wear, the new hip can only last a short time, but this only affects a small percentage of people. The vast majority of new hips last for many years (10-20), providing patients improved function, pain relief, and increased mobility.

Researchers and prosthesis manufacturers continue to work to improve the long-term outcomes of a total hip replacement. Oxinium technology from Smith & Nephew is a high-performance material shown to reduce acetabular component wear by 60%. With less implant wear, the life of a new implant will be extended, which reduces the need for future surgeries.

Quality of Life Studies

canstockphoto316893To evaluate long-term quality of life and functionality in 150 patients who had an average of 16-year longevity after a THA, researchers used a validated questionnaire. In addition, The Harris Hip Score, WOMAC score, and Functional Comorbidity Index was used. Researchers found that THR had a 96% patient satisfaction rate, and patients had positive results compared to untreated people with severe hip OA. It was concluded that patients who underwent THA have better quality of life and hip functionality and perform physically better than untreated persons with advanced OA of the hip.

In another study, age was evaluated as an impactor of health-related quality of life after total hip replacement. Researchers evaluated patients from the Swedish Hip Arthroplasty Register who had THRs due to osteoarthritis between 2008 and 2010. They used a questionnaire to evaluate pain scores, patient satisfaction, and other factors. After deriving data from over 27,000 patients, they found that patients’ outcomes were fairly unaffected by age unless the patient was in his/her late sixties or older. They concluded that health-related quality of life was affected by age, with improvement decreasing in the elderly.

Resources

Gordon M, Greene M, Frumento P, et al. (2014). Age- and health-related quality of life after total hip replacement: decreasing gains in patients above 70 years of age. Acta Orthop, 85(3), 244-249.

Mariconda M, Galasso O, Costa GG, et al. (2012). Quality of life and functionality after total hip arthroplasty: a long-term follow-up study. BMC Musculoskel Disord, 12, 222.

Anterior versus Posterior Total Hip Replacement

The surgical approach to total hip replacement (THR) may impact the surgical outcome. Total hip replacement is a common surgery, with more than 300,000 procedures performed in the United States each year. Traditionally, most total hip replacements have been done using the Hip painposterior approach, in which the surgeon accesses the hip joint through the buttocks or side. More recently, surgeons are using the anterior approach, which involves entering the hip joint through the front thigh region.

According to researchers, both direct anterior and posterior surgical approaches for THR yield excellent results as reported by patients. The surgical approach is not the singular variable that makes a difference in a 6-month post-operative outcome. Patients considering total hip replacement should ask the orthopedic surgeon about which approach is best for them. A decision will be made based on the risks and benefits of the surgical approach for the individual patient.

Clinical Studies

In a recent clinical study, involving 275 patients who had a total hip replacement between 2012 and 2014, the average age of patients was 65 years. Using certain outcomes for evaluation, researchers compared the two groups regarding pre- and post-surgical pain, function in recreation, function in daily living, and hip-related quality of life. According to results, there were no significant differences between the two groups.

In another study, researchers compared radiographic, clinical, and surgical outcomes among patients undergoing total hip arthroplasty performed via the posterior versus anterior approach. After evaluating 17 studies and 2,300 patients, researchers found that there was a significant difference in favor of the anterior approach regarding dislocations and length of stay after surgery.

canstockphoto38482995Researchers have found that the extent of muscle damage is different for each surgical approach as well. In a randomized clinical trial, researchers compared the two procedures. The main end point was the ability to walk unlimited distances and climb stairs at 6 weeks, 3 months, 6 months, and one year post-operative. At the 6-week follow-up, the direct anterior group had more patients walking limitlessly and climbing stairs compared to the direct posterior group. The differences were not as significant later on in the recovery process. However, the direct anterior approach was found to provide earlier restoration of function after total hip arthroplasty.

Another group of researchers evaluated 88 procedures (41 anterior and 47 posterior approaches for THA). The length of stay after surgery was shorter for the anterior group than the posterior group. The duration of surgery was longer, however, for the anterior approach group. Both groups performed similarly on questionnaires regarding pain and clinical outcome measures at the 6-month follow-up.

Before your surgery, the orthopedic surgeon will complete an extensive evaluation including a past medical history, physical examination, hip x-rays, and certain blood and diagnostic tests to establish fitness for surgery. Careful consideration will be given to how much pain the patient has and how often pain limits bending, walking, and resting. In addition, the surgeon will evaluate what measures have helped alleviate hip symptoms in the past.

How the Procedures Vary

During both anterior and posterior THR procedures, the head of the femur must be removed and replaced with a metal stem, as well as a ceramic or metal ball. The damaged cartilage and bone are removed from the hip socket and replaced with a metal prosthesis. Finally, a plastic spacer is placed between the new socket and ball to allow for a smooth gliding motion.

With the posterior approach, the hospital stay is usually 2-8 days, depending on the patient’s health condition, the severity of hip damage, and the surgeon’s recommendations. The incision will be 10-12 inches long, running from the outer buttock. Some muscles around the hip joint are cut and repaired, and recovery is 2-4 months. People who have this procedure have to follow specific precautions for 6-12 weeks, which include no internal rotation (turning leg inward), no crossing the leg, and no bending past 90 degrees.

With the anterior approach, the hospital stay is shorter (2-4 days), and the surgical incision is along the front aspect of the hip. The incision is shorter with this procedure (4-5 inches), and recover time is only 2-8 weeks. There are no specific precautions with the anterior approach, which makes it a more desirable procedure. With both procedures, patients must use an assistive device (walker or cane) while moving about, and physical therapy is required to improve strength, range of motion, and mobility.

Orthopedic and Sports Performance Institute in Gilbert AZ offers top hip replacement with surgeons performing both anterior and posterior procedures. Most insurance is accepted, with some of the procedures offered as an outpatient or a one day stay. Call us now!

Resources

Barrett WP, Turner S, Leopold J (2013). Prospective randomized study of direct anterior vs posterolateral approach for total hip arthroplasty. J Arthroplasty, 28:1634–8.

Higgins BT, Barlow DR, Heagerty NE, & Lin TJ (2015). Anterior vs. posterior approach for total hip arthroplasty, a systematic review and meta-analysis. J Arthroplasty, 30(3), 419-434.

Martin CT, Pugely A, Gao Y, et al. (2013). A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty. J Arthroplasty, 28:849–54.

 

Cubital Tunnel Syndrome Treatment Opions

Cubital tunnel syndrome occurs when the ulnar nerve is pinched as it passes behind the elbow. If you have ever hit your funny bone, you understand what cubital tunnel syndrome is like.

Is cubital tunnel syndrome common?

According to experts, cubital tunnel syndrome is a common nerve entrapment condition with an incidence of 25 cases per 100,000 persons per canstockphoto4094506year. The condition is caused by injury or irritation to the inside aspect of the elbow. This syndrome is most common among persons who have jobs where their elbow is bent most of the day, where they could suffer repetitive injury to the elbow, or where they lean on the elbow much of the time. Also, persons who play golf, tennis, or guitar are at increased risk for ulnar nerve injury.

What are the symptoms of cubital tunnel syndrome?

Like other nerve compression syndromes, cubital tunnel syndrome causes numbness, pain, and weakness. Nerves become pinched for many reasons. The ulnar nerve is one of the nerves that supply the upper extremity. Irritation to this nerve produces elbow pain and arm weakness. When the elbow is struck, it causes a shooting sensation into the ring and small fingers. Weakness of the hand muscles is also common with this condition.

How is cubital tunnel syndrome diagnosed?

The diagnosis of cubital tunnel syndrome is made by a thorough history and physical examination. If there is a concern about structural injury or damage, x-rays and nerve conduction tests may be ordered.

What is the treatment for cubital tunnel syndrome?

Cubital tunnel syndrome treatment starts with simple steps. Most cases of cubital tunnel syndrome resolve after a short time. Treatment options are:

  • Avoidance of leaning on the elbow
  • Taking anti-inflammatory medicines (naproxen and ibuprofen)
  • Padding the elbow for leisure and work activities
  • Splinting the elbow at night

Will I need surgery?

When conservative treatment fails, the orthopedic specialist may recommend surgery. Because the nerve may be pinched at several locations behind the elbow, to release pressure from all areas of pressure, surgery is done. For many patients, treatment consists of moving the nerve to the front aspect of the elbow, so the nerve is under much less tension when the elbow is bent (called ulnar nerve transposition).

What types of surgeries are there for ulnar nerve syndrome?

Several approaches can be considered to treat cubital nerve syndrome. These include:

  • Local decompression of the nerve – This is achieved by simple decompression without medial epicondylectomy. It involves the release of canstockphoto25790214deep tissue that overlies the nerve. This procedure is recommended with symptoms are mild or intermittent, there is little or no pain, there is no instability of the ulnar nerve, and/or the osseous structure of the elbow is normal.
  • Medial epicondylectomy – This involves making a large incision over the elbow, and decompressing the cutaneous nerves. The flexor pronator is detached from the elbow bone, and the medial epicondyle, or a portion of it, is removed.
  • Anterior transposition – This involves decompression of the ulnar nerve, excision of the proximal end of the medial epicondyle, and transposition of the nerve into the subcutaneous tissue.
  • Endoscopic release – This procedure uses a tiny scope with camera to allow for local decompression of the nerve. The advantages of this procedure include reduced complication rates, faster rehabilitation, and limited invasiveness. In a recent study, 87% of patients reported good or excellent results with endoscopic release surgery.

Orthopedic and Sports Performance Institute offers both conservative and surgical options for cubital tunnel syndrome in Gilbert Arizona. The includes injections, bracing, medications and various options for surgery. Most insurance is accepted, call us today!

FAQs on Rotator Cuff Repair in Arizona

Rotator cuff repair surgery is used to repair a torn shoulder tendon or muscle, or to repair a group of tendons and muscles. This procedure is done with a large open incision, or through a buttonhole-sized incision via shoulder arthroscopy.

What is the rotator cuff?

The rotator cuff is a group of muscles and tendons that form a cup over the shoulder joint. These structures hold the arm bone (humerus) in the rotator cuffglenoid joint (shoulder area). One or more of the tendons and muscles can be torn from trauma or overuse.

How common is a rotator cuff tear?

In a recent study, researchers evaluated rotator cuff tendinopathy. They found that the annual prevalence was 1-7%, and some evidence suggested that the incidence increased with age.

Does the procedure hurt?

You will receive general anesthesia before the rotator cuff surgery. You will be asleep and have no pain. After surgery, you will be given pain medicine to alleviate discomfort.

What procedures are used to repair a torn rotator cuff tendon?

Three main types of surgeries are:

  • Open repair – With traditional surgery, a large incision is made over the shoulder. The deltoid (large muscle) is moved to the side so the tendon can be repair. This procedure is used for large or complex tears.
  • Arthroscopy – With this procedure, a small incision is made, and a scope is inserted into the joint. The camera projects images on to a TV monitor, so the doctor can use tiny instruments to make repairs.
  • Mini-open repair – This procedure involves using an arthroscope and a couple of small incisions to repair the rotator cuff.

How is the rotator cuff repaired?

Rotator Cuff TearTo repair the rotator cuff, the tendons are re-attached to the bone if possible. This is done using small rivets (suture anchors) that hold the tendon in place. These are made of metal, or they can be made with dissolvable materials. At the end of surgery, the incisions are closed and a dressing is applied.

What can I expect before the rotator cuff repair surgery?

After the Phoenix shoulder doctor diagnoses a rotator cuff tear, you meet with the orthopedic surgeon to discuss surgery. Two weeks before the procedure, you must stop taking any medicine that thins the blood (aspirin, ibuprofen, and naproxen). Be sure to discuss all allergies and medications with the doctor. You cannot eat or drink for 8 hours before your surgery, and should leave all valuables at home the day of surgery.

What can I expect after the rotator cuff repair procedure?

You will wake up from sedation or anesthesia with a bulking bandage on your shoulder, your arm in a sling, and an immobilizer on your arm. This is to protect the shoulder while it heals. Most patients are discharged home the day of surgery. Recovery may take up to six months, and you will wear the sling for 4-6 weeks. The doctor gives you medications for pain, and you will follow-up with a physical therapist who helps improve strength and function in the shoulder joint.

What is the prognosis after the rotator cuff repair surgery?

Surgery to repair a torn rotator cuff is successful for relieving shoulder pain. The procedure usually returns strength to the shoulder structure. Rotator cuff repair requires an extended recovery period, and not everyone heals the same. The doctor will advise you on which activities you can and cannot perform following recovery. Poorer results often are related to:

  • Advanced age
  • Large tears
  • Weak or previously torn rotator cuff
  • Not following aftercare instructions
  • Smoking

Orthopedic and Sports Performance Institute provides  rotator cuff repair procedures with expert shoulder surgeons in Arizona. Most insurance is accepted, with the procedures being offered in a minimally invasive fashion. Call us today!

Resources

Littlewood C, May S, & Walters S (2013). Epidemiology of rotator cuff tendinopathy: a systematic review. Shoulder & Elbow, DOI: 10.1111/sae.12028.

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