Hip & Knee

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Common Hip Injuries

Without the hip, many of the movements we take for granted each day would not be possible. Hips are important in bearing our weight, walking, running, and giving our body stability. However, hips can be injured. Below are five of the most common hip injuries and their symptoms.

Dislocation

Normally, the head of the femur, or thigh bone, rests in a socket in the pelvis, or hip bone. When the head of the femur slips out of this socket, it is called a dislocation. This can happen as a result of trauma or accident, such as a car wreck or a fall. Symptoms of hip dislocation include pain and mobility issues. If nerve damage occurs, there may also be numbness or lack of sensation in the ankle or foot.

Fracture

If a break occurs in the upper quarter of the thigh bone, or femur, it is called a hip fracture. This often occurs due to a fall or from an impact to the hip, but it can also be the result of degenerative conditions, like osteoporosis. Symptoms of a hip fracture include pain in the groin or the outer and upper thigh area, as well as issues with the movement of the hip.

Strains

Hip strains occur when one of the muscles in the hip is stretched or torn. This often occurs due to overuse, stretching the muscle beyond its capability, receiving a fall or sudden impact, or suddenly forcing the muscle to bear an unexpected weight. Symptoms include pain, swelling, and sometimes loss of strength.

Bursitis

Bursitis occurs when the bursa, a small fluid-filled sac that cushions bones in joints throughout the body, becomes inflamed. Hip bursitis refers especially to inflammation of one of the bursae in the hip. This can be caused by overuse injuries, trauma, injury, or degenerative conditions. Bursitis can also be caused by bone spurs, arthritis, and other conditions. Symptoms of hip bursitis include sharp and intense initial pain in the hip that often turns into an aching pain. The symptoms are usually worse at night or with use of the hip.

Osteoarthritis

Osteoarthritis is one of the most common forms of arthritis or joint inflammation. Normally, the bones that make up the joints in the body are covered with articular cartilage, a smooth material that allows the bones to easily glide against each other. Osteoarthritis is what occurs when natural wear-and-tear damages that cartilage. This condition is very common, usually caused by aging, being overweight, or suffering an injury that adds stress to your hip joint. Symptoms include discomfort, stiffness, bone spurs, inflammation, and painful mobility.

Common Knee Injuries

The knee is one of the most commonly injured joints. The knee joint is made up of the femur (leg bone), tibia (shin bone), and patella (knee cap). Any of the bones and their tissues attachments can be injured during weight bearing activities such as walking and running. One of the most important steps patients can take to prevent knee injuries is to simply be aware of what the most common ones are and how they occur.

Cruciate Ligament Injuries

The anterior and posterior cruciate ligaments are commonly referred to as the ACL and PCL. The ligaments cross each other in the knee joint to form an “X”. Together, they control back and forth motion of the knee and provide rotational stability. The ACL is more commonly injured than the PCL. Typically, injuries occur during athletics or high impact physical activities.

Collateral Ligament Injuries

The medial and lateral collateral ligaments are commonly referred to as the MCL and LCL. They are responsible for bracing the knee and controlling sideways motion. The LCL is rarely injured. The MCL is commonly injured due to the knee being pushed sideways by a force or blow.

Meniscus Injuries

The menisci are the shock absorbers of the knee. They sit between the tibia and the femur and act as pillows that cushion the joint. Overuse of the knee, sudden athletic movements, or arthritis can all damage the menisci. A meniscal tear is a serious knee injury that may require surgical intervention to repair.

Tendon Injuries

The patella and quadriceps tendons attach the patella bone to the tibia and quadriceps muscles. Both tendons are large and strong. They play an important role in running and jumping. When coming down while running or jumping, either tendon can partially or completely tear. Both are serious injuries that should be seen as soon as possible.

Treatment

Nonsurgical and surgical treatment options are available to treat knee injuries. Patients who are interested in learning more about them are encouraged to make an appointment with an orthopaedic knee specialize who can diagnose their injury and give the treatment advice they are searching for.

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Conditions We Treat

ACL Injuries

Anterior Cruciate Ligament (ACL) injuries are one of the most common types of knee injuries. They are typically sustained by athletes and active individuals who participate in high-impact sports that involving running, jumping, cutting, pivoting, and turning. ACL injuries can vary in severity. Low-level sprains generally heal quickly and does not sideline athletes. Complete tears are serious injuries that usually require surgical intervention and typically sideline athletes for a minimum of 6-8-months.

Causes

The ACL is one of the cruciate ligaments of the knee. The other cruciate ligament is the posterior cruciate ligament (PCL). The two cross one each other in the knee joint to form an “X”. Both have the important responsibilities of providing back and forth motion of the knee and rotational stability. The PCL is less commonly injured than the ACL. Common causes of ACL injuries include the following:

  • Forcefully changing direction
  • Suddenly slowing down
  • Landing awkwardly while falling
  • Direct contact (i.e. a tackle, fall, or blow to the knee)

Symptoms can range in severity depending on the seriousness of the injury. Males are more likely than females to sustain an ACL injury. Athletes who are not in good physical condition are also more likely to sustain ACL injuries.

Symptoms

ACL injuries commonly present with the following symptoms:

  • Pain
  • Instability
  • Decreased range of motion
  • Tenderness

Following an ACL injury, patients may have trouble bearing weight on the injured knee. For this reason, crutches are often used after an injury occurs.

Diagnosis

A physical examination, x-ray, and MRI are used to diagnose ACL injuries.

Treatment

Nonsurgical treatment

ACL injuries that do not involve a tear can be treated using the following nonsurgical treatment options:

  • Rest, Ice, Compression, Elevation (RICE)
  • Immobilization (bracing)
  • Activity modification
  • Anti-inflammatory medications
  • Physical therapy

In most cases, a nonsurgical treatment plan will include all these treatment options.

Surgical Treatment

Torn ACLs generally require surgical intervention. An arthroscopic ACL reconstruction is performed. During the procedure, an orthopaedic surgeon replaces the torn ACL with a new one made from an autograft (the patient’s tissue) or an allograft (tissue taken from a cadaver). The procedure takes 1-2-hours. In most cases, patients fully heal 6-8-months after surgery and are allowed to return to competition or activity.

Meniscal Tears

The knee joint is formed by the femur (leg bone), tibia (shin bone), and patella (knee cap). In-between the femur and the tibia lie pieces of cartilage known as menisci. The menisci are important in that they cushion the joint by distributing the load experienced during weight-bearing activities like walking and running. One of the most common knee injuries is a meniscal tear. Athletes and active individuals and patients who have osteoarthritis are most at risk to tear their meniscus.

Causes

Athletes typically sustain meniscal tears while squatting and twisting. They can also sustain them due to direct contact. Patients with severe arthritis can sustain a tear in many ways. If arthritis is severe enough, a tear can occur while sitting or standing.

Symptoms

Often times, patients hear a popping sound when they tear their meniscus. Typically, pain and swelling occur immediately after the injury. If athletes continue to bear weight on a knee with a torn meniscus, it is very likely that swelling will get worse and eventually the knee will become stiff. For this reason, patients who sustain a meniscus tear are advised to rest and elevate their leg. Other symptoms that typically present with a meniscus tear include:

  • A catching or locking sensation of the knee
  • Knee instability
  • Decreased range of motion

A torn meniscus is serious enough to be seen by an orthopaedic specialist. “Toughing it out” is not a good idea.

Diagnosis

A medical history, physical examination, and medical imaging studies (x-ray and MRI) are used to diagnose meniscal tears.

Treatment

Rest, ice, compression, and elevation (RICE) and anti-inflammatory medications can be used to reduce pain and inflammation associated with a meniscus tear. A brace can also be worn to stabilize and protect the injured knee.

Badly torn menisci may need to be surgically repaired, especially if they limit a patients ability to perform athletic or day-to-day activities. During surgery, an orthopaedic surgeon removes or repairs the meniscus. Meniscus tears are common orthopaedic injuries. Patients with meniscus tears do well when their injury is treated properly.

Osgood-Schlatter Disease (Knee Pain)

Osgood-Schlatter Disease is a condition characterized by the inflammation of the area where the patella tendon inserts on the tibia or shin bone. The condition is typically experienced by maturing children and young adults as their bones and muscles grow larger and stronger. Active children who are in the middle of a growth spurt are the patients that are most at risk to develop Osgood-Schlatter disease. Parents should be aware of the condition and its symptoms, so they can help their children if they need it.

Symptoms

Symptoms of Osgood-Schlatter disease include the following:

  • Knee pain
  • Tenderness
  • Swelling
  • Muscle tightness

The just below the knee cap and near the shin bone is where symptoms will typically be experienced. Physical activity tends to makes symptoms worse and rest tends to improve them.

Diagnosis

A medical history and thorough physical examination are used to diagnose Osgood-Schlatter disease. During a physical exam, an orthopaedic specialist examines the knee to make sure that there a no fractures or soft tissue injuries that might be producing the symptoms the child is experiencing. In many cases, x-rays will be also be ordered to rule out these injuries.

Treatment

The symptoms of Osgood-Schlatter will decrease on their own if the patient limits his or her physical activity levels. For this reason, a short period of rest and a slow, gradual return to activity are recommended. Stretching exercises and anti-inflammatory medications can be used to manage discomfort and pain.

Unstable Kneecap

The femur (leg bone), tibia (shin bone), and patella (knee cap) are the three bones that form the knee joint. Often overlooked because it is not easily injured, the patella is an important bone. Its job is to connect the muscles of the thigh to the tibia. Without the patella, the knee would not stable and movement would be awkward and limited.

A condition known as an unstable kneecap develops when the patella does not run in its designated groove on the side of the femur. This can occur because the groove is shallow and/or uneven. Patients with an unstable kneecap are at an increased risk to experience a knee dislocation.

Symptoms

Many symptoms may be associated with an unstable kneecap, including the following:

  • Anterior knee pain
  • Knee stiffness
  • Knee buckling
  • Knee catching
  • Pain when squatting
  • Pain that gets worse with exercise
  • Crepitus sounds in the knee

The presentation of these symptoms is enough to warrant an appointment with an orthopaedic specialist, as an unstable kneecap can lead to more serious injuries.

Diagnosis

An orthopaedic specialist uses a medical history, physical examination, and medical imaging studies (x-rays and MRIs) to diagnose an unstable knee cap.

Treatment

Nonsurgical treatment of an unstable kneecap is geared towards managing symptoms, improving stability, and preventing a dislocation. Anti-inflammatories may be taken to decrease pain, a brace may be worn to stabilize and protect the knee, and exercises can be done to ensure the knee muscles and ligaments are strong.

If an unstable kneecap dislocates, it may go back into place on its own. If it does not, a reduction may need to be performed. A physician should always be the one to perform a reduction.

An unstable kneecap that causes chronic knee dislocations may require surgical intervention. The goal of surgery is to tighten the tendons and deepen the femoral groove where the patella moves through. After a successful surgery and subsequent physical therapy program, patients no longer have to worry about their kneecap being unstable.

Procedures We Perform

Minimally Invasive Total Hip Replacement

Total Hip Replacement surgery has helped countless patients experience less pain and live functional lives. Thanks to the new minimally invasive surgical techniques, hip replacement surgery is more advanced than ever. This is advantageous to patients because they experience less post-surgical pain, recover faster, and have a smaller, less noticeable scar.

The Procedure

Minimally invasive total hip replacement may be performed using one or two incisions. One incision surgery uses a 3-6-inch incision on the outside of the hip. Two-incision surgery uses a 2-3-inch incision over the groin and a 1-2-inch incision over the buttocks.

The following steps occur after the incision(s) is made and the joint is visualized:

  • Muscles and tendons are retracted
  • The hip is dislocated
  • Arthritic tissue and bone spurs are removed
  • The head and neck of the femur (leg bone) are cut and replaced using a metal femoral stem
  • A metal or ceramic ball is placed over the femoral stem and serves as the new femoral head
  • The acetabulum (hip socket) is smoothed out and deepened
  • A new, metal socket is inserted
  • A plastic spacer is placed and secured into the socket so the femoral head ball component can move properly and smoothly

The surgeon takes x-rays to make sure the components are perfectly in place. The range of motion is checked. The incision is then closed. Typical surgical time is approximately two hours.

Recovery and Rehabilitation

Minimally invasive hip surgery is an inpatient procedure. During a 1-4-night stay in a comfortable hospital room, pain is controlled and antibiotics are given to prevent infection. Physical therapy starts during the hospital stay and continues throughout recovery. Physical therapy is an important part of a successful recovery because it helps patients learn how to stand, balance, and walk. It also helps patients regain strength and range of motion. Patients typically fully recover from surgery in 6-12-months.

Outcomes

Minimally invasive total hip replacement is one of the most successful orthopaedic surgeries. Following surgery, patients are able to walk better and perform day-to-day activities without experiencing pain. Patients interested in minimally invasive total hip replacement are encouraged to make an appointment with an orthopaedic surgeon who specializes in the procedure.

Minimally Invasive Total Knee Replacement

Over half a million total knee replacement surgeries are performed in the United States every year. Quality of life improves for patients who undergo a successful knee replacement because they are able to perform everyday movements and activities easily and without pain. Advancements in surgery have led to total knee replacements being performed minimally invasively. Patients can now recover faster, experience less post-surgical pain, and have a less noticeable scar.

The Procedure

A minimally invasive approach uses a 4-6-inch incision (rather than an 8-10-inch one) that allows surgeons to avoid the quadriceps muscle and tendon. Once an incision is made, the joint is visualized and the procedure is performed through the following steps:

  • Damaged bone and cartilage are removed
  • The femur (leg bone), tibia (shin bone), and patella (knee cap) are cut and smoothed
  • Metal and plastic components are perfectly placed over the bone and fixated
  • The surgeon examines the knee to make sure it moves properly
  • The incision is closed

The procedure typically takes 1-2-hours.

Recovery and Rehabilitation

Minimally invasive total knee replacement is an inpatient procedure. Patients typically spend 1-4-nights in the hospital while their pain is controlled. Antibiotics are taken to prevent infection. Physical therapy is started the day of surgery. After patients are discharged from the hospital, they return home with instructions from their surgeon and the hospital staff. The first postoperative appointment occurs around the two-week mark. Physical therapy continues throughout recovery to improve balance, coordination, strength, and flexibility. A full recovery typically takes 6-12-months.

Candidates

Not all patients are candidates for a minimally invasive knee replacement. The following are evaluated to determine if a patient is a candidate:

  • Age
  • Weight
  • Health
  • Surgical history

Generally, patients who are overweight, unhealthy, and have had previous knee surgeries are not candidates.

Seeking Treatment

Patients who are interested in having a minimally invasive total knee replacement are encouraged to make an appointment with an orthopaedic surgeon who specializes in the procedure. They have the experience, knowledge, and skills needed to diagnose knee conditions and determine is minimally invasive total knee replacement is a viable treatment option.

Knee Replacement Implants

A Total Knee Replacement is a procedure used to treat severe arthritis. During the procedure, an orthopaedic surgeon removes arthritic bone and replaces it with artificial components known as implants. Following surgery, properly positioned and secured implants allow the knee joint to function properly without producing pain.

Implant Components

Three implants components are used.

  • A distal femur component. The distal femur or end of the leg bone is shaved during surgery. A smooth, metal component is placed over the shaved bone. The component curves around the bone to restore distal femur anatomy.
  • A proximal tibial component. The proximal tibia or top of the shinbone is cut during surgery. A flat metal platform is placed over the area and secured. A plastic insert made of polyethylene attaches to the platform and serves as a cushion between the femur and tibia.
  • A patellar component. The patella is shaved and smoothened during surgery. Small holes are drilled in the bone and a plastic, dome-shaped component is placed into them and secured. This component serves as the new patella or kneecap.

The implants work in harmony to move the knee. Metal always moves against plastic to ensure smooth movement and reduce wear and tear of the implant.

Implant Fixation

Implants can be fixated using the following:

  • Biological cement. A special type of fast-acting cement.
  • Press-fit fixation. Press-fit components are made out of a special material that promotes bone growth. Implants are fixated as new bone grows around them.
  • Hybrid fixation. Cement is used on the tibia and patella components but not the femur.

The type of fixation used depends on the preference of the orthopaedic surgeon and the patient’s condition.

Learning More

There are many manufacturers of total knee implants. The choice of which one to use depends on a variety of factors, including but not limited to: the cost of the implant, the preference of the surgeon, and the age and weight of the patient. Patients who are thinking of having a total knee operation and would like to learn more about knee implants should talk to their orthopaedic surgeon. Most will gladly discuss the topic and answer any questions and address any concerns interested patients have.

Revision Total Knee Replacement

In rare cases, a total knee replacement may cause patients to experience pain, swelling, stiffness, and instability. A revision total knee replacement is a procedure used to remove and replace total knee implants that do not work properly. The procedure generally takes longer than a total knee replacement because it is more complicated.

The Procedure

A revision total knee replacement is usually performed by a revision specialist. Careful planning and preparation measures are taken to ensure the revision surgery is a success. During the procedure, the surgeon removes failed components and replaces them with special revision ones. Bone loss may be treating using metal or bone graft augmentation. In some cases, not all components need to be replaced and bone loss is not present.

Causes

A revision total knee replacement may be indicated for the following reasons:

  • The implants become loose. Several factors may contribute to the loosening of implants. Being overweight or overactive can lead to excessive force and pressure being placed on the implant and it loosening as a result. Other factors include the implant not being placed or fixated properly.
  • The implants become worn. Implants can outlast a patient. When the spacer between components is worn out, it can easily slide out of place and alter joint anatomy. Careful precaution is taken to ensure this does not happen and total knees are never performed on patients before the time is right.
  • Infection. Infection is a risk with any surgery. Although rare, a replaced knee may become infected at anytime—even years after surgery. An infected knee needs to irrigated and debrided and the implants need to be replaced.
  • Knee instability develops. Some knee ligaments are kept intact to stabilize and move the knee. When these ligaments are damaged or torn due to injury or aging, knee instability can result. Revision surgery may be needed if nonsurgical treatment does not improve instability.
  • Scar tissue builds up. Excessive scar tissue formed after surgery can cause the knee to become stiff. If the knee does not loosen up on its own, an orthopaedic surgeon can perform a manipulation under anesthesia. If this does not work, a revision may be necessary.

Revisions may also be needed when a fracture occurs near the knee. Causes of this type of fracture include motor vehicle accidents and high-impact trauma.

Conclusion

There are risks associated with any type of surgery. The fact that some total knee replacements may need to be revised should not scare patients. To alleviate concern and get answers to any questions they may have, patients are encouraged to have a discussion with their orthopaedic surgeon.