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Physical Therapy After Total Hip Replacement

One of the most commonly performed orthopedic surgeries is a total hip replacement (THR). The surgical techniques and prosthesis used for a THR have improved over the years, allowing the patient to now achieve optimal recovery and less pain. Physical therapy is an important aspect in a successful, full recovery after hip replacement.

In the Hospital

Right after your total hip replacement, a physical therapist begins working with you to restore joint motion and strength. Initially, therapy begins in physical therapy1the hospital the day after surgery. A therapist shows you how to get in and out of bed, ways to get into the shower and car, and how to walk using a walker or crutches. In addition, the therapist has you perform simple exercises in bed to prevent blood clots, such as gluteal squeezes and tightening the thighs.

After a hip replacement, some patients received additional physical therapy in a rehabilitation facility before going home. This will depend on the age of the patient, what the home environment is like, and functioning when discharged from the hospital. The physical therapist works with the patient using exercise equipment for strengthening and mobility. Balance exercises are used to decrease risk of falling. In addition, the physical therapist uses heat to warm up tight muscles and ice to reduce soreness and swelling.

Avoiding Dislocation

After a total hip replacement, there are some considerations the physical therapist follows to help you decrease risk of dislocating the new hip. With the posterior approach hip replacement, you cannot bend the hip past 90 degrees, must avoid crossing your legs, and cannot rotate the hip inward. Maneuvers to assist with avoiding these activities include use of a raised toilet seat and shower chair, use of a pillow between the knees, and using an orthopedic device to put on shoes and socks.

Home Physical Therapy

Once you go home, the physical therapist will visit you 3-4 times each week to improve hip strength, mobility, and flexibility. Common therapy exercises include:

  • Buttock contractions – Tighten muscles and hold to a count of 5.
  • Abduction exercise – Slide leg out to the side as far as possible and then back.
  • Quadriceps set – Tighten thigh muscles and try to straighten knee. Hold for 5-10 seconds.
  • Straight leg raises – Tighten thigh muscles with knee straight. As muscles tighten, lift leg sever inches from bed and hold for 5-10 seconds.
  • Standing exercises – These include standing knee raises, hip abduction, and hip extensions.
  • Walking and full weight-bearing – These exercises are used to help you perform light everyday activities.

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Recovery at Home

Don’t be surprised if you feel fatigued right after surgery. This will improve over the next few weeks, however. You should arrange to have someone help you out for 1-2 weeks after your total hip replacement. The exercises given to you by your physical therapist are an essential part of recovery.

You should be able to stop using crutches or a walker, and resume normal leisure activities within 6 weeks of the surgery. However, it could take up to 12 weeks for pain to completely resolve. Your new hip is continuing to recover for up to 2 years after the operation, which involves scar tissue healing and restoration of muscles.

Orthopedic and Sports Performance Institute in Gilbert AZ offers top surgeons specializing in joint replacement (hip and knee), along with sports medicine too. Most insurance is accepted with patients being seen from all over the Valley including Mesa, Chandler, Queen Creek and Scottsdale too! Call us today.

Recovery after Anterior Approach Total Hip Replacement

Anterior hip replacement is a less invasive approach to hip joint surgery. With the anterior approach to total hip replacement, the orthopedic  surgeon in Gilbert AZ accesses the joint from the anterior (front) of the hip as opposed to the lateral (side) or posterior (back). The anterior approach allows the Arizona hip surgeon to make repairs and replacements without detaching tendons, muscles, or soft tissue.

Small Incision

The anterior approach to hip replacement was first described in the 1940s. This approach is gaining in popularity, and advocates for anterior approach total hip replacement consider its advantages to be earlier restoration of walking, low dislocation rates, and muscle-sparing ability. The ModularEndoprosthesisprocedure begins with the patient lying on his/her back. The surgical incision is slightly lateral to the front superior iliac spine of the pelvis. The 4- to 5-inch incision runs toward the lateral aspect of the ipsilateral knee. After moving soft tissue and muscle, replacement is made.

Because the anterior total hip replacement surgery uses a small incision, and muscles are moved rather than cut, the result is less trauma and damage to the hip soft tissues. Recovery time is usually faster with the anterior approach than traditional surgery, and patients report less post-operative pain. After only 2-3 weeks, patients begin walking without assistance, which is compared to 5-6 weeks with posterior hip replacement surgery.

Length of Hospital Stay

After the minimally invasive hip replacement, you will stay 1-4 days in the hospital. You may stay longer if you have serious health conditions, severe hip arthritis, and complications during the procedure. The length of stay varies from patient-to-patient, but the anterior approach to hip replacement is usually related to a shorter length of hospital stay than the posterior or lateral approaches.

Physical Therapy

Physical therapy begins the day of surgery. To strengthen the hip joint, you must do small exercises, such as contracting buttock and leg muscles and ankle pumps. The therapist works with you to learn exercises that help regain full hip movement. You will work with the therapist two times each day. Once you return home, the physical therapist will see you 3-4 times each week.

 

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Home Recovery

After you leave the hospital, you should have family or friends stay with you for a few days. You will need help with errands and household activities. In addition, you cannot drive for 2-4 weeks, so you will need transportation home from the hospital, to follow-up appointments, and to the pharmacy. It is also important to stock up on easy to prepare foods, such as frozen, canned, and premade meals.

Incision Care

Your anterior incision will be closed with staples or sutures, which are removed around 10-14 days after surgery. The surgical site will be numb, sore, bruised, and/or swollen for a few days. You may experience itching or pulling of the incision site as well. We recommend using an icepack for 10-20 minutes several times a day to relieve discomfort. In addition, avoid using any lotions or creams on the hip area. To keep the incision clean and dry, avoid showering until your wounds are healed. You can bathe, however.

Physical Activity

Being physically active is an important aspect for recovery. Within 2-4 weeks, you will be able to resume your daily routine and normal activities. During the first week, you will start walking with a walker and advance to using a cane. To avoid falls and injuries, you should only walk in areas where there are handrails, no loose rugs, and no cords. You may begin driving after 2-3 weeks, depending on how you progress.

 

OSPI offers the top hip specialists in Arizona, specifically the East Valley. Hip replacements done by the anterior approach need an expert to be done well. Call OSPI today, most insurance is accepted!

What You Need to Know About Rotator Cuff Tears

A rotator cuff tear is a common cause of disability and pain among adults. According to 2008 statistics, around 2 million people in the United States visited a doctor with a rotator cuff problem. A rotator cuff tear can weaken the shoulder, and it limits ability to perform simple daily activities, such as brushing teeth or dressing.

What structures are affected by a rotator cuff tear?

The shoulder is made of three bones: the humerus (upper arm bone), the scapula (shoulder rotator cuffblade), and the clavicle (collarbone). The shoulder is a ball-and-socket joint that is kept stable by the rotator cuff. The rotator cuff is composed of four muscles that come together with tendons to cover the head of the humerus (ball of the joint). The rotator cuff helps you lift and rotate your arm. Between the rotator cuff and the shoulder bone (acromion) is a lubricating sac known as a bursa. This structure allows the arm bone to move freely in the socket.

What are the different types of rotator cuff tears?

When one or more rotator cuff tendons are torn, the structures no longer attach to the ball (head of the humerus). Tears can begin as partial frayed areas that progress to complete tears as the damage worsens. The types of rotator cuff tears are:

  • Partial tear – A slight tearing of the soft tissue, but it is not severed into two pieces.
  • Full-thickness tear – Also called a complete tear, this is where the structure is torn into two separate pieces.

What causes a rotator cuff tear?

There are two primary causes for tearing of the rotator cuff: acute injury and degeneration.

  • Acute injury – This occurs if you fall onto an outstretched arm, or when you lift something that is too heavy. An acute tear often occurs along with other shoulder injuries, such as a Rotator Cuff Teardislocated shoulder or broken collarbone.
  • Degeneration – A tear related to degeneration occurs from wearing down of the tendon over time. This type of tear occurs more in older adults. Rotator cuff tears are more common in the dominant arm, and you have an increased risk for tearing the opposite shoulder structure when you have a tear in the dominant arm rotator cuff.

What are the risk factors for a rotator cuff tear?

Several factors can contribute to chronic rotator cuff tears. These are:

  • Repetitive stress – Repeating the same shoulder movements over and over can put stress on your rotator cuff tendons and muscles. This occurs with certain sporting activities like baseball (throwing) rowing, tennis, and weight lifting.
  • Lack of adequate blood supply – As you age, the blood flow to the rotator cuff lessens. Without an adequate blood supply, the body’s ability to heal and repair damaged tendon and muscle decreases.
  • Bone spurs – Bony overgrowths develop on the lower aspect of the acromion bone. When you lift your arms, the spurs rub on the rotator cuff structures, which are called shoulder impingement. Over time, this rubbing weakens the tendon are makes it tear.
  • Being older – Because most rotator cuff tears are caused by wear-and-tear, aging and being over age 40 years is a risk factor.

How common are rotator cuff tears?

The frequency of full-thickness rotator cuff tears is 5-30%, with increasing incidence with advanced age.

What are the symptoms of a rotator cuff tear?

The most common symptoms of a rotator cuff tear are:Shoulder pain

  • Intense pain after an injury
  • Snapping sensation and immediate upper arm weakness
  • Pain when lifting or lowering the arm
  • Pain at rest, particularly when lying on the injured shoulder
  • Weakness when rotating the arm or lifting
  • Cracking sensation (crepitus) when moving the shoulder

How is a rotator cuff diagnosed?

The orthopedic doctor in Chandler and Gilbert will ask you questions about your injury, inquire about your usual activates, ask about your symptoms, and take a medical history. In addition, a thorough examination is done. The doctor will measure range of shoulder motion and test your arm strength.

X-rays are often done to assess for a dislocation, fracture, or bony deformity. X-rays do not show the soft tissue structures, so a magnetic resonance imaging (MRI) scan is done. This test confirms the tear and alerts the doctor to the significance of the injury.

How are rotator cuff tears treated?

The goal of treatment is to reduce pain and to restore full function. Treatment options vary, depending on the severity of the tear, the age of the patient, and the level of activities. Around 50% of people will not need surgery. Nonsurgical treatment options include:

  • Rest – The East Valley orthopedic doctor may suggest you rest the shoulder and limit Shoulder Arthroscopyoverhead activities. A sling can be worn to protect your shoulder while you rest it.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – This includes drugs such as naproxen and ibuprofen, which decrease pain and swelling.
  • Physical therapy – Specific exercises will improve strength and restore movement of the shoulder. Your exercise program involves stretches for range of motion and flexibility, as well as strengthening the muscles that support the shoulder. This will prevent future injury and relieve pain. The therapist can also use various pain relief measures, such as heat therapy, ultrasound, electrical stimulation, and massage.
  • Corticosteroid injection – If rest, NSAIDs, and physical therapy do not reduce pain and improve mobility, the doctor may recommend a corticosteroid injection. This medication is instilled into the joint to decrease inflammation.

How will the Gilbert orthopedic doctor determine if I need surgery?

Some patients with rotator cuff tears require surgery for repair. The East Valley shoulder specialist may suggest surgery if:

  • You are active and use your arms for sports and overhead work.
  • You have continued pain after conservative measures.
  • You have a large tear (greater than 3 cm).
  • You have symptoms that persist for more than 6 months.
  • You have significant loss of function and weakness in the shoulder.
  • Your tear was caused by a recent injury.

How is rotator cuff tear surgery done?

Repair of a torn rotator cuff with a Gilbert or Chandler shoulder specialist involves reattaching the torn tendon to the humeral head. If the tendon is destroyed, a graft may be used to make the repair. The arthroscopic surgery involves making a few incisions around the shoulder capsule and using a camera and small instruments to make the repair.

OSPI offers the top sports medicine treatment in the Valley, including nonoperative and operative therapies. This may include NSAIDS, PT, injections or surgical repair. Call today!

Resources

Baker CL, ed. Shoulder impingement and rotator cuff lesions. The Hughston Clinic Sports Medicine Book. Baltimore, Md: Lippincott Williams and Wilkins; 1995. 272-9.

Ligament Reconstruction of the Ankle in Arizona

Strains and sprains of the ankle can result in stretching and tearing of the ligaments. Many patients with ankle injuries make a full recovery, but on occasion, the ligaments do not heal fully, which causes a feeling of “giving way.” This instability can lead to future ankle sprains and strains. Ligament reconstruction involves tightening these tissues to help the ankle regain stability and mobility.

What are the ligaments most often affected by trauma?

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Some people are more predisposed to ankle strains and sprains than others. These ankle injuries are more common in people with a hindfoot varus, which means the heel is turned toward the inside. In addition, people with weak muscles (run along the outside of the ankle) are more at risk for ligament injury. The ligaments most often affected are:

  • Anterior talofibular ligament (ATFL) – Connects the lower fibula to the ankle bones.
  • Calcaneal fibular ligament (CFL) – Connects the fibula to the calcaneus (heel) bone.

How do I prepare for surgery?

Two weeks before your scheduled procedure, you should notify the surgeon of all your medications, and give him a copy of your medical records. The doctor may schedule some laboratory and diagnostic tests to assure you are able to have surgery. You need to have someone available to drive you home after the procedure. To prepare your home for discharge, you need to have necessary items where you can easily get to them.

How is the procedure performed?

The surgeon will first make an incisions on the ankle, near the damaged ligament. Using a lighted camera (arthroscope) and small tools, the surgeon makes necessary repairs. The ligament is tightened by first cutting it, then repairing it using sutures. After all ligaments are reconstructed, the incisions are closed with sutures, and a bandage is applied.

What can I expect after the ligament reconstruction procedure?

Immediately after surgery, your foot will be placed in a plaster cast, which runs from the knee to the toes. You will be sent home following brief monitoring in the recovery room. The doctor will give you a follow-up appointment, home-care instructions, and a pain medication prescription. You must elevate your foot as often as possible to reduce swelling. We encourage movement, just avoid weight bearing on the ankle.

What does rehabilitation involve?

Healing of tightened ligaments usually takes around six weeks. During this time, no weight should be put on the ankle. To protect the ankle, an ankle lacer or brace can be used. After the first six weeks, the patient will begin a physical therapy program that focuses on:

  • Improving ankle mobility
  • Strengthening of the ankleospi_small
  • Regaining flexibility of the joint

When can I start to walk?

Healing varies, depending on the severity of the ligament injury, the health of the patient, and the type of surgery. Walking is not permitted for several weeks. A typical guide for patients is:

  • 0-2 weeks: Use crutches.
  • 2-4 weeks: Use a walking immobilizing boot cast with partial weight bearing and use of crutches.
  • 4-6 weeks: Use the boot and fully weight bearing wearing regular shoes.

When can I return to usual activities?

The rate of healing varies from patient to patient. Most patients are able to return to usual activities in 4-6 months. Returning to work depends on the type of work you do as well as how quickly you recover. If you have a sedentary job, you can return to work as soon as two weeks. For people whose work requires lifting, standing, and physical activity, you will be off for 4-8 weeks.

OSPI offers the top orthopedic and podiatry treatment in the entire East Valley, including Chandler, Mesa and Gilbert. Most insurance plans are accepted, with comprehensive nonoperative and operative treatments being offered. Call today!

Total Joint Replacement at OSPI – AZ Orthopedic Surgeons

Total Joint Arthroplasties

Joint replacement surgery, also called a total joint arthroplasty (TJA), is a common procedure used to relieve pain, improve mobility, and restore quality of life. There are many types of joint replacement procedures. Joint replacement surgery is used to replace damaged cartilage and any loss of bone structure.

The procedure is a resurfacing of the damaged joint, which relies on the ligaments and muscles for function and support. The replacement joint is called a prosthesis, which can be made of cobalt chrome, stainless steel, titanium, ceramic, or polyethylene.

Osteoarthritis and Joint Dysfunction

The most common conditions that cause joint dysfunction are osteoarthritis and rheumatoid arthritis. Many factors contribute to joint degeneration and damage, which leads to arthritis. Factors include:

  • Developmental abnormalities of the jointknee replacement
  • Heredity
  • Minor repetitive injuries
  • Abnormal cartilage metabolism
  • Severe trauma to the cartilage
  • Being overweight

Total Knee Replacement

The knee is the body’s largest joint, and it is necessary for walking, climbing stairs, and everyday activities. With age, excessive weight, and wear-and-tear from arthritis, the knee joint becomes damaged, making movement painful.

In a total knee replacement, the Gilbert orthopedic surgeon removes the degenerated cartilage surfaces at the ends of the shinbone (tibia) and thighbone (femur), and then replaces these areas with metal or plastic components. A spacer is inserted between the components so the joint will glide in a smooth fashion.

Patients who are candidates for a knee replacement are those with a knee deformity, people with chronic knee inflammation, persons who do not respond to conservative treatment, and anyone with limited movement of the knee. The Centers for Disease Control and Prevention (CDC) reports, in the U.S., more than 719,000 total knee replacements are performed each year.

Total Hip Replacement

The hip is a mobile joint, formed with a ball-and-socket. The ball and socket are both coveredcanstockphoto24680715(1) with articular cartilage, which can wear down from injury, trauma, or arthritis. This causes pain and limited mobility.

A total hip replacement involves removing the ball of the joint (femur head) and replacing it with a metal stem that attaches to the thigh bone. The damaged area of the socket is also replaced with a metal socket, and between these implants, the surgeon places a spacer that helps the joint glide easily. Candidates for a total hip replacement are patients who experience significant hip pain and stiffness, as well as people who have not responded to non-surgical methods. According to the CDC, there are more than 330,000 total hip replacements performed each year in the U.S.

Shoulder Joint Replacement

The shoulder joint consists of three bones: the humerus (upper arm bone), the clavicle (collarbone), and the scapula (shoulder blade). The shoulder is a ball-and-socket joint with cartilage on the ends of the structures to help them glide smoothly against one another. This cartilage breaks down due to arthritis and trauma, causing significant pain and loss of function. A total shoulder joint replacement involves use of prosthetic bone ends to replace the damaged areas. This surgical procedure is used for patients who do not respond to medications and those who have symptoms at rest.

Success Rates of Joint Replacement

The success rate of total joint replacement surgery is quite high. The need for repeat operation in the first ten years is less than 5%. Most replaced joints last from 10-20 years.

The Board Certified hip, knee and shoulder joint replacement surgeons at OSPI are highly skilled in the procedures. The Gilbert orthopedic surgeons offer contemporary, minimally invasive procedures that decrease postoperative pain, bleeding and speed recovery.

Most insurance is accepted at OSPI, call (480) 899-4333 today!

Are Orthopedic Knee Braces Helpful In Preventing Or Treating Injuries?

This has been a controversial topic for a very long time. On one hand, knee braces can be used and are suggested by most orthopedic surgeons to help in a variety of conditions and problems, but there’s still the question of “Do they really help?”; which needs to be answered.

There are two types of basic knee braces that your orthopedic surgeon might suggest depending on the situation; Functional and Prophylactic knee braces.knee brace

Functional Knee Braces

Patients who are already suffering from a ligament injury are the ones concerned about the effectiveness of knee braces. In such cases, they are usually interested in the functional knee brace type, because they are specially designed to support a torn knee ligament. This means the knee braces can prove beneficial if the patient’s already suffering from a ligament injury, as further confirmed by a number of studies done on the subject.

In summary; functional knee braces are fully able to provide at least some protection to the knee, particularly when force is applied. The studies done, further examined that the knee with the brace is more stable as compared to without it.

Prophylactic Knee Braces

Specifically designed to prevent knee injuries from happening in healthy athletes, these knee braces were first made available and highly popularized in the late 1970s when they were tried and tested by NFL players. Since then, use of prophylactic knee braces has only increased with the positive results shown by several studies, regarding the injury rate of athletes wearing the braces as compared those who don’t.

Although the difference isn’t questionably large, they do show that athletes of certain sports such as football; have a much lower rate of contraKnee Bracecting an MCL injury, when wearing the brace. Some important factors however, should be taken into account as well when determining the likelihood of injury, such as;

  • The sport played
  • The position of the player
  • The conditioning of the player
  • The size and weight of the player

At first; there was a huge concern with regard to usage of prophylactic knee braces. It was said that they could potentially alter the force on the knee which could very well become problematic. This isn’t the case at all, because when fitted and worn properly, they have shown to decrease the rate of ankle injuries.

OSPI offers bracing for clients for both types. This includes braces that are either custom made or potentially “off the shelf”. Insurance often covers them. Call OSPI today at (480) 899-4333.

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