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4 Top Reasons you can’t straighten your Knee

Knee injuries are often a result of a twisting or a direct impact injury to your leg. The severity of the injury can vary but loss of bending in the knee is common after an injury. An inability to straighten and bend your knee is a sign you have been injured badly.

Here is a look at the top reasons why you are unable to straighten your knee after an injury.

Swelling

Swelling is common after injuries that cause bleeding, inflammation and pain, making it too painful to straighten the knee.

Tendon Injuries

Injuries to the quadriceps or patella tendon do not allow you to straighten the knee and also cause significant weakness. Such injuries are more common in professional sports.

Meniscus Tear

A tear in which the torn piece of meniscus flips into the center of the knee joint, can lock your knee and prevent it from straightening.

ACL Tear

ACL tear do not cause the knee to be locked but it hurts too much to straighten it. Within a few days, the swelling will reduce and you may be able to straighten your knee. But sometimes ACL tear is accompanied by a meniscus tear. In such cases, it will be hard to straighten the knee and you should see an orthopedic surgeon.

If you have suffered an injury to your knee and are not able to straighten or bend your knee, it could be due to a severe knee injury. Consult an orthopedic surgeon to find out the root cause and begin treatment.

To learn more or to consult the best orthopedic surgeons in Mesa, AZ, call OSPI (Orthopedic and Sports Performance Institute) at 480-899-4333.

Rehab Exercises after Total Knee Replacement

Once you return home after a total knee replacement (TKR), you will need to perform certain exercises to prevent complications, improve motion of the knee, and build strength. Most people have weak leg muscles before surgery because they were not used much due to knee problems. Now that surgery has corrected this knee problem, you will need to have a regular exercise regimen.

Exercise Program

A regular exercise program is used to strengthen weak leg muscles. Your success with rehabilitation relies on your willingness to follow the exercise program developed by your physical therapist. You should perform these exercises 2-3 times each day after surgery. Each exercise must be done 10 times, starting out, and you gradually increase the repetitions by 5 times each week until you reach 20 repetitions. Your schedule will be:

  • Week 1 – 10 repetitions
  • Week 2 – 15 repetitions
  • Week 3 – 20 repetitionsheel-slides

Ankle Pumps and Circles

  • Bend both ankles up, pulling toes toward you.
  • Bend both ankles down, pointing toes away from you.
  • Rotate each foot clockwise and then counterclockwise while keeping toes pointed to the ceiling.

Heel Slides (Knee and Hip Flexion)

  • Bend the hip and knee by sliding the heel up toward buttocks while keeping the heel on the bed.
  • Slide heel back down again while keeping kneecap pointed at the ceiling.
  • Repeat with opposite leg.

Thigh Squeezes (Quadriceps Sets)

  • Tighten muscles at the front of the thigh by pushing the back of your knee down on the bed.
  • Hold for 5 seconds, then relax.
  • Repeat with opposite leg.

Leg Slides (Abduction/Adduction)

  • Slide leg out to the side while keeping kneecap pointed toward ceiling.
  • Slide leg back to the starting position.
  • Repeat with opposite leg.

Lying Kicks (Short Arc Quadriceps)

  • Lie on back with a rolled blanket under your knee.
  • Straighten knee and hold for 5 seconds.
  • Lower leg down slowly and relax.
  • Keep back of knee in contact with blanket.
  • Repeat with opposite leg.

Straight Leg Raises

  • b7a636bc5a5da7a0eafbb497fb8cac4eBend leg with foot flat on the bed.
  • Raise opposite leg up 12 inches with knee straight.
  • Hold for 5 seconds.
  • Slowly lower leg and relax.
  • Repeat with other leg.

Knee Bending (Sitting Knee Flexion)

  • Sit on a chair.
  • Bend knee back as much as you can and hold for 10 seconds.
  • Return to starting position and relax.
  • Repeat with other leg.

Sitting Kicks (Long Arc Quads)

  • Sit on a chair.
  • Lift foot and straighten knee as much as possible.
  • Keep knee level as if you are holding a tray on your lap.
  • Hold for 5 seconds.
  • Lower leg down slowly and relax.
  • Repeat with other leg.

Prolonged Knee Stretch

  • Sit on a chair.
  • Bend knee back as much as possible.
  • Scoot your body forward to increase the stretch.
  • Hold for 30-60 seconds.

Knee Straightening Stretch

  • Sit on a chair with your heel up on a footstool or chair in front of you.
  • Hold this for 30-60 seconds.
  • Repeat with other leg.

Knee Dangling/Swinging

  • Sit on a high chair or bed so that feet don’t touch floor.IMG_5017
  • Bend knees and swing surgical leg back and forth.
  • Do this for 2-3 minutes.

Heel Digs (Hamstring Sets)

  • Bend surgical knee.
  • Tighten muscle at back of thigh by digging heel into the bed.
  • Hold for 5 seconds.
  • Repeat with other leg.

Buttock Squeezes (Gluteal Sets)

  • Tighten buttock muscles by squeezing.
  • Hold for 5 seconds and relax.

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Rehab After a Total Knee Replacement

Total Knee Replacement Rehabilitation

Having a total knee replacement surgery is usually the best option for patients with severe knee arthritis. At present, more than 4.5 million people in the U.S. are living with at least one total knee replacement, and around 1.5 million people with a replaced knee are 50-70 years of age. During the last couple of decades, total knee replacement increased by 84% in the U.S. population, with the current rate 22 per 10,000 persons. The most important part the knee replacement process is rehabilitation.

The greatest demand for total knee replacement is not coming from the elderly demographics. Rather, it is younger people who have weight issues. There is a strong relationship between knee osteoarthritis and having a high body mass index. More people ages 18 to 64 years are having severe knee pain and loss of mobility related to being overweight.

General Considerations

  • Patients are weight-bearing as tolerated with a walker, crutches, or cane until they can walk without assistance.
  • Early emphasis is on developing full extension equal to the opposite leg soon as possible.
  • No active or passive flexion motion greater than 90 degrees until stitches are removed.
  • Early exercise will focus on recruitment of proper quadriceps set.
  • Keep incision site clean and dry.b7a636bc5a5da7a0eafbb497fb8cac4e
  • Avoid submerging in a pool, tub, or sauna until wounds are healed.
  • Avoid jumping, twisting, pivoting, or rigorous activities.

Week 1

  • You will return to see the Arizona orthopedic surgeon to change the dressing and review health status.
  • Icing, leg elevation, and swelling control are implemented. Swelling control can be achieved using a compression wrap and circumferential massage.
  • Soft tissue treatments and gentle mobilization are implemented by physical therapist.
  • Exercises include gluteal sets, gait training, and balance/proprioception maneuvers. Straight leg raise exercises with quad sets are began, and passive/active range of motion exercises are started.
  • Goals of therapy are to increase range of motion < 90 degrees, and to decrease swelling and pain.

Weeks 2-4

  • You will return to the Gilbert orthopedic surgeon’s office to have staples/stitches removed and for a check-up.canstockphoto7424057
  • The therapist will continue with soft tissue treatments and gentle mobilization, avoiding flexion or patella contracture.
  • Exercises are continued, including progress flexion range of motion, functional exercises, gait training, and balance/proprioception maneuvers.
  • Aerobic exercise is began as tolerated (cycling, swimming).
  • Goals include decreasing swelling and edema and range of motion < 10 degrees extension to 100 degrees.

Weeks 4-6

  • You will follow-up with the orthopedic surgeon.
  • Gentle mobilization and soft tissue treatments continue.
  • Exercises continue, such as functional exercises (weight machines and walking outside), balance/proprioception maneuvers, and swimming after incisions are closed.
  • Goals include walking without a limp and range of motion < 5 degrees extension to 110 degrees.

Weeks 6-8

  • Continue soft tissue treatments, joint mobilizations, and patellar glides to increase range of motion.
  • Add lateral training exercises, and incorporate single leg exercises as tolerated.
  • Goals include patient walking without limp, and range of motion 0-115 degrees.

Weeks 8-12

  • Continue joint mobilizations, soft tissue treatments, and patellar glides to increase range of motion.
  • Begin activity specific training, such as gardening, sports, and household chores.
  • Low impact activities after week 11.
  • Patients are weaned into a home and gym program with emphasis on their particular sport/activities.
  • Goals include return to functional activities and range of motion within functional limits.

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Resources

Health Research Funding (2016). 23 Amazing Total Knee Replacement Statistics. Retrieved from: http://healthresearchfunding.org/23-amazing-total-knee-replacement-statistics/

Intermediate and Long-Term Quality of Life after Knee Replacement

Osteoarthritis (OA) is one of the main causes of functional disability and chronic pain in older people. OA is related to environmental factors, aging, lifestyle changes, and genetic predisposition. When the knee is affected canstockphoto10845760by arthritis, many people undergo knee replacement procedures.

The goal of total knee replacement is to improve overall quality of life and return patients to a higher level of functioning than before surgery. Most people will heal well without problems if they follow their rehabilitation program. Some activities are permitted and others are not:

  • Permitted: Swimming, golf, dancing, water aerobics, cross-country skiing, cycling, hiking, light labor (involves standing and walking), and sedentary occupations.
  • Not permitted: Jogging, running, impact exercises, contact sports, sports that require pivoting and twisting, and heavy labor.

Post-Operative Exercise

golf swingPost-operative exercise may be detrimental to the success in recovery after a total knee arthroplasty (TKA). You will begin to receive physical therapy in the hospital, and will continue at home, outpatient, or in a skilled nursing facility. A home exercise program is provided before hospital discharge.

Weeks 1-2: Anticipate discharge from the hospital after 3-5 days. Continue using walker with instructions from the therapist. At this time, you will start walking 300 feet, begin to straighten the knee, dress independently, and perform simple homemaking tasks. Home exercises will be advanced with your therapist.

Weeks 2-4: During this time, you will gradually increase independence. The home exercise program involves progressive ambulation using the cane, resuming driving if you had a left knee replacement, independent showering, and walking around ¼ mile.

Weeks 4-6: During this time, your physical therapist will have you bending the knee to 90 degrees, using a cane as needed, walking up stairs, and straightening the knee completely.

Weeks 6-12: You will continue home exercises. During this time, you will progress to walking one mile, climb stairs, and resume usual activities, such as swimming and bowling.

Clinical Studies

Many clinical studies regarding total knee replacement have studied quality of life after surgery. Considered a highly successful operation, technical outcomes from total knee replacement are excellent. In a recent study evaluating intermediate and long-term quality of life following surgery, researchers conducted a large review of studies. They found that both intermediate and long-term post-operative quality of life were superior to the pre-Hiking2operative level in analyses.

In the review of clinical reports, researchers found that most patients were satisfied with the knee replacement surgery and reported substantial improvement in daily functional activities. In addition, the benefits were related to health-related quality of life as well as disease-specific quality of life. Four validated measurement tools were used to assess quality of life: the Western Ontario and McMaster’s Universities Osteoarthritis Index, the Knee Society Score, the Center for Epidemiological Studies Depression Scale, and the visual analogue scale for pain.

Another study evaluated self-reported outcomes in the first year after total knee replacement and attempted to determine which factors influenced patient quality of life. The results showed that after 6 weeks, all patients reported significant improvement for all measured parameters in relation to quality of life.

To examine health-related quality of life after total knee arthroplasty, researchers in a Singapore hospital interviewed patients. Data were collected from almost 5,000 patients. The patients who had total knee replacement all had improved pain scores. In addition, two years after surgery, the majority of patients showed improved physical functioning scores.

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Resources

Ko Y, Narayanasamy S, Wee HL, et al. (2011). Health-related quality of life after total knee replacement or unicompartmental knee arthroplasty in an urban asian population. Value Health, 14(2), 322-328.

Papakostidou I, Dailiana ZH, Papalychroniou T, et al. (2012). Factors affecting the quality of life after total knee arthroplasties: a prospective study. BMC Musculoskel Dis, 13, 116.

Shan L, Shan B, Suzuki A, et al. (2015). Intermediate and long-term quality of life after total knee replacement: a systematic review and meta-analysis. J Bone Joint Surg Am, 97(2), 156-168.

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.

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.

canstockphoto4842007

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!

How does Surgical Approach to Hip Replacement affect Recovery?

Anterior hip replacement is an approach to surgery used to improved patient outcomes. Thousands of hip replacement surgeries are performed each year, but only 20% of surgeries in the United States are done using the anterior approach. The other 80% of surgeries are performed using the posterior or lateral approach.

Advantages of the Anterior Hip Replacement

Supporters of the anterior hip replacement approach believe it offers the following canstockphoto10503438advantages:

  • Less damage to major muscles – The orthopedic surgeon avoids cutting and manipulating major muscles during the anterior hip replacement. The surgeon works between the front muscles rather than severing muscle fibers or detaching muscle from bone.

 

  • Less post-operative pain – Because anterior approach does not require manipulation and cutting of muscles, the patient has less post-surgical pain and requires less medication.

 

  • Faster recovery – After surgery, the patient can bend at the hip and bear weight sooner. Most anterior hip replacement patients use walker or crutches soon after surgery. In a recent study researchers found that anterior hip patients walked unaided 6 days earlier than those who had the posterior surgery.

 

  • Decreased risk for dislocation – With the anterior surgery, the hip is not at risk for dislocation because soft tissue structures are not moved.

 

  • Improved range of motion – Patients can bend over, sit with legs crossed, and perform other movements without risking hip dislocation.

 

  • Shorter hospital stay – A patient who undergoes anterior surgery will not stay in the hospital as long as with the traditional approach.

 

Advantages of the Posterior-Lateral Hip Replacement

In a recent study comparing posterior and anterior approaches to hip replacement, researchers found that both groups had improvements in pain and range of motion, with no observable differences in gait or dislocation. Advantages to the posterior approach can include:

 

  • Less technically demanding – The posterior approach to hip replacement is easier to canstockphoto24182699perform. Anterior approach requires considerable training, skill, and experience by the orthopedic surgeon.

 

  • Simpler and easier – Many Gilbert orthopedic surgeons believe the posterior approach is the simplest and easiest, therefore providing the greatest safety margin for patients.

 

  • Minimal risk of femoral fracture or implant problems – Due to ease of this surgery, there is less risk to the patient for femoral fracture or poor positioning of the prosthetic component.

 

  • No special surgical equipment required – This procedure does not require the use of high-tech, specialized surgical equipment.

 

Disadvantages of the Anterior Hip Replacement

There are a few limitations associated with anterior hip replacement. These include:

  • Not suitable for obese or large patients – Muscular, overweight, or obese people are not good candidates for the anterior procedure.

 

  • More technically demanding – The Arizona orthopedic surgeon must be very experienced in performing the anterior hip replacement. This surgery is known to be quite technically demanding.

 

  • Potential for nerve damage – The lateral cutaneous femoral nerve runs down the front of the pelvis and past the hip to supply the thigh. There is more potential for damage to this nerve with the anterior approach.

 

  • Delayed wound healing – Some studies show that wound healing is delayed using the anterior approach, with 1.4% of patients having a wound complication compared to 0.2% with the posterior approach.

 

Disadvantages of the Posterior-Lateral Hip Replacement

  • Higher post-operative dislocation rates – Some studies show higher rates of dislocation with the posterior approach. However, with improved technology, these rates have declined.
  • Longer recovery – The posterior approach to hip replacement is associated with longer hospital stays and recovery. However, with full participation in physical therapy and rehabilitation, the recovery time has shortened.

OSPI offers state of the art approaches for hip replacement which minimize hospital stay and complications, while improving outcomes. Most insurance is accepted by the Gilbert and Mesa orthopedic surgeons, call today!

Resources

Kennon RE, Keggi JM, et al. (2013). Total hip arthroplasty through a minimally invasive anterior surgical approach. Journal of Bone and Joint Surgery, 85-A:39-48.

Petis S, Howard JL, Lanting BL, & Vasarhelyi EM (2015). Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes. Can J Surg, 58(2), 128-139.

Post, ZD, Orozco F, Diaz-Ledezma C, Hozack WJ, & Ong A (2014). Direct anterior approach for total hip arthroplasty: indications, technique, and results. Journal of the American Academy of Orthopaedic Surgeons, 22:595-603.

Taunton MJ, Mason JB, Odum SM, & Springer BD (2014). Direct Anterior Total Hip Arthroplasty Yields More Rapid Voluntary Cessation of All Walking Aids: A Prospective, Randomized Clinical Trial. J Arthroplasty. pii: S0883-5403(14)00340-4. doi: 10.1016/j.arth.2014.03.051.

 

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