People with hip joint damage that causes pain and interferes with daily activities despite treatment may be candidates for hip replacement surgery. Osteoarthritis is the most common cause of this damage. However, other conditions, such as rheumatoid arthritis (a chronic inflammatory disease that causes joint pain, stiffness, and swelling), osteonecrosis (or avascular necrosis, which is the death of bone caused by insufficient blood supply), injury, fracture, and bone tumors also may lead to breakdown of the hip joint and the need for hip replacement surgery.
For most people who have hip replacement surgery, the procedure results in:
With an anterior hip replacement, the surgeon uses a small incision to reach the hip joint from the front of the hip joint (anterior) rather than the side (lateral) or back (posterior). This allows the hip implant to be placed without detaching the muscle from the hip or thigh bone – potentially causing less tissue disruption, reduced pain and faster recovery.
You are place on a special table. The carbon-fiber arms support and manipulate the leg during surgery. Sterile robotic attachments reach inside the wound and lift the femur so that the surgeon can access it easier.
The hip is exposed by following a natural line between muscles so that the surgeon does not have to detach muscles or tendons from the bone. The femoral neck is cut and the arthritic femoral head and neck are removed.
With special tools called reamers, the surgeon scraps the burrs of the arthritic acetabulum so that it is smooth and can accept the new acetabular prosthesis.
Activity is important. It can reduce stiffness and increase flexibility and muscle strength. We will talk with you about developing an appropriate exercise program. Most programs begin with safe range-of-motion activities and muscle-strengthening exercises. Activities such as walking, stationary bicycling, swimming, and cross-country skiing can increase muscle strength and cardiovascular fitness without injuring the new hip.
Labrum is a ring of cartilage found on the rim of the shoulder or hip joint’s socket. A labral tear occurs when this cartilage somehow gets torn. It can take several forms.
Signs and symptoms include pain or a “catching” sensation in the joint.
The treatment depends upon which kind of tear there is in the labrum.
Many athletes experience knee-ligament injuries. Of the four major ligaments found in the knee, the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) are often injured in sports. The posterior cruciate ligament (PCL) may also be injured.
ACL injury — Changing direction rapidly, slowing down when running, and landing from a jump may cause tears in the ACL. Athletes who participate in skiing and basketball, and athletes who wear cleats, such as football players, are susceptible to ACL injuries.
MCL injury — Injuries to the MCL are usually caused by a direct blow to the outside of the knee. These injuries often occur in contact sports, such as football or soccer.
PCL injury — The PCL is often injured when an athlete receives a blow to the front of the knee or makes a simple misstep on the playing field.
Torn cartilage — When people talk about torn knee cartilage, they are usually referring to a torn meniscus. The meniscus is a tough, rubbery cartilage that acts like a shock absorber. In athletic activities, tears in the meniscus can occur when twisting, cutting, pivoting, decelerating, or being tackled. Direct contact is often involved.
Treatment will vary depending upon the patient’s individual needs. Most ACL, MCL and PCL tears cannot be stitched back together. To surgically repair the ligaments and restore knee stability, the ligaments must be reconstructed. We will replace your torn ligament with a tissue graft. This graft acts as a scaffolding on which a new ligament can grow.
Because the regrowth takes time, it may be six months or more before you can return to sports.
The surgery to rebuild an anterior cruciate ligament is done with an arthroscope using small incisions. Arthroscopic surgery is less invasive. The benefits of less invasive techniques include less pain from surgery, less time spent in the hospital, and quicker recovery times.
Meniscal tears are among the most common knee injuries. Athletes, particularly those who play contact sports, are at risk for meniscal tears. However, anyone at any age can tear a meniscus. When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus.
You might feel a “pop” when you tear a meniscus. Most people can still walk, athletes keep playing with a tear. Over the next few days, your knee gradually becomes more stiff and swollen.
Common symptoms of meniscal tears are:
Without treatment, a piece of meniscus may come loose and drift into the joint. This can cause your knee to slip, pop or lock.
It depends on the type of tear, its size, and location. The outside one-third of the meniscus has a rich blood supply. A tear in this zone may heal on its own, or can often be repaired with surgery. The inner two-thirds of the meniscus lacks a blood supply. Without nutrients from blood, tears in this area cannot heal. Because the pieces cannot grow back together, tears in this area are usually surgically trimmed away.
Arthroscopy is the preferred technique for treating a torn meniscus. We insert a miniature camera through a small incision to give us a clear view of the inside of the knee. We will then insert miniature surgical instruments through other small incisions to trim or repair the tear.
Usually people with rotator cuff injuries feel pain over the deltoid muscle at the top and outer side of the shoulder. Motions like those involved in getting dressed can be painful. The shoulder may feel weak, especially when trying to lift the arm into a horizontal position. Individuals may also feel or hear a click or pop when they move their shoulder. Pain or weakness when rotating their arms outward or inward may indicate a tear in a rotator cuff tendon. Individuals also feel pain when lowering their arms to the side after they move their shoulders backward and raise their arms.
Patients with rotator cuff tendinitis or bursitis that does not include a complete tear of the tendon can usually be treated without surgery. Nonsurgical treatments include the use of anti-inflammatory medication and occasional steroid injections into the area of the inflamed rotator cuff, followed by rehabilitative rotator cuff strengthening exercises.
Surgical repair of rotator cuff tears is best for:
Impingement occurs when the rotator cuff tendons become compressed and/or worn. The rotator cuff is actually a series of four muscles connecting the scapula (shoulder blade) to the humeral head (upper part of the shoulder joint).
The rotator cuff is important in keeping the upper shoulder join within the socket during normal shoulder function and also contributes to shoulder strength during activity. Normally, the rotator cuff glides smoothly between the undersurface of the bone at the point of the shoulder and the upper part of the shoulder joint.
Any process that compromises this normal gliding function may lead to impingement. Common causes include weakening and degeneration within the tendon due to aging, the formation of bone spurs and/or inflammatory tissue within the space above the rotator cuff and overuse injuries. Overuse activities that can lead to impingement are most commonly seen in tennis players, pitchers and swimmers.
We can diagnosis shoulder impingement through a careful history and physical exam. Patients with impingement most commonly complain of pain in the shoulder, which is worse with overhead activity and sometimes severe enough to wake them during the night.
Manipulating the shoulder in a specific way during the exam will usually reproduce the symptoms and confirm the diagnosis. X-rays can also help in evaluating the presence of bone spurs and/or the narrowing of the subacromial space. MRI (magnetic resonance imaging), a test that allows us to see the rotator cuff, is usually not necessary in cases of shoulder impingement, but may be used to rule more serious problems.
Surgery is not necessary in most cases of shoulder impingement. But if symptoms persist despite nonsurgical treatment, surgery may help. Surgery involves removing tissue that is irritating the rotator cuff. This can typically be done using arthroscopic techniques.