To learn more about a condition or treatment, make a selection from the list below:
Definition
A hip fracture occurs near the top of the thighbone (femur) where it angles into your hip socket. Hip fractures are painful and may cause your leg to turn outward or shorten. Most are one of two types: femoral neck fractures (1-2 inches from the joint) and intertrochanteric fractures 3-4 inches from the joint. Hip fractures are common among mature men and women, and most require surgery.
Diagnosis
A physician will perform an X-ray to determine the extent of the fracture. In addition, he may request an MRI (Magnetic Resonance Imaging) scan.
Treatment
Although treatment for the elderly with hip fractures may vary, most fractures are treated in two ways: 1) In a femoral neck fracture, pins are used to stabilize the break. This procedure is usually performed on younger or more active patients. In older patients, a metal device may be implanted into your hip socket, replacing the head of your femur. This is also called hemiarthroplasty. 2) In an intertrochanteric fracture, a metallic device is implanted to hold the broken bone in place while the head of your femur moves normally in your hip socket.
What to Expect After Surgery
Your physician will advise you as to when you should stand or walk again after surgery. You will probably need an assistive device such as crutches, a walker or a cane. You will need to have physical therapy after surgery in order to resume daily activities. Complete healing usually takes about 12 weeks, but many patients are walking well before that time.
Definition
Hip replacement, also called arthroplasty, is a surgery performed to replace part or all of the hip joint with an artificial device (prostheses), usually made of metal, plastic, ceramic, or a combination.
The hip is a ball and socket joint; the ball being at the head of the thighbone, or femur, and the cup-shaped socket in the pelvic bone. The place where the two parts of the hip glide together during motion is called the bearing surface. A hip replacement involves surgically implanting a prosthesis to replace the damaged bearing surface within the hip joint.
Why It's Done
The most common reason for having hip replacement surgery is due to a wearing down of the hip joint, which is most often caused by osteoarthritis but can also be caused by rheumatoid arthritis. This is the reason that most hip replacement surgeries are performed on patients over 60 years of age. Other reasons include avascular necrosis (loss of bone caused by insufficient blood supply), a fracture or a hip joint tumor. Your physician will perform an extensive evaluation to determine if you are a candidate for hip replacement surgery.
How It's Done
A total hip prosthesis is comprised of three parts:
A cup that replaces your hip socket. Options include plastic, metal or ceramic.
A ball, made out of metal or ceramic, that replaces the fractured head of the femur.
A metal stem attached to the shaft of the bone that adds stability to the prosthesis.
During hip replacement surgery, the surgeon removes the diseased bone tissue and cartilage from the hip joint, leaving the healthy part of the hip intact. After the socket is cleaned out and all cartilage and arthritic bone removed, the surgeon replaces the head of the femur (the ball) and the acetabulum (the socket) with new, artificial parts. Finally, the muscles and tendons are replaced against the bone and the incision closed.
What to Expect After Surgery
Any pain or discomfort after surgery will be managed with patient controlled analgesia (PCA), IV analgesics or an epidural. By the second day of surgery, oral analgesic medications should be sufficient to control pain. You may have a catheter to monitor function of your kidneys and hydration level. A respiratory therapist will ask you to breathe deeply, cough, or blow into a device called a spirometer, which measures lung capacity. These exercises are necessary to avoid collection of fluid in the lungs after surgery.
To reduce the risk of blood clots, you may wear anti-embolism stockings or inflatable pneumatic compression stockings. Although you are allowed only limited movement immediately after surgery, a physical therapist will show you exercises to contract and relax the muscles. These exercises will also help to prevent blood clots, common in leg surgery. After one to two days, bending, standing and walking with assistance is highly encouraged. Patients usually do not spend more than 10 days in the hospital after hip replacement surgery, but full recovery takes from three to six months.
Definition
The Anterior Cruciate Ligament (ACL) is the major stabilizing ligament of the knee. Located in the center of the knee joint, it runs from the femur (thigh bone) to the tibia (shin bone) through the center of the knee. If the ACL is torn, you may feel a popping sensation followed by rapid swelling of the knee.
Why It’s Done
ACL surgery involves an arthroscopic surgical reconstruction of the injured ligament, and is done only after initial treatments for the injury have failed. These include ice, anti-inflammatory medication and physical therapy.
How It’s Done
Many surgeons use arthroscopic surgery rather than open surgery for ACL injuries for many reasons, primarily because the procedure uses a smaller incision, it has fewer risks, and the rehabilitation is often faster. Arthroscopic ACL surgery involves making two to three incisions around the knee. An arthroscope is inserted into one of the incisions, and a camera at the end of it transmits pictures of the knee to a TV monitor.
The surgeon drills small holes into the upper and lower leg bones to form tunnels through which replacement tissues, or grafts, will be anchored. He secures the graft with screws or staples and closes the incision. A tube may be inserted into the wound to drain fluid. Also during ACL surgery, the surgeon may repair other parts of the knee such as ligaments, cartilage and broken bones.
What to Expect After Surgery
Rehabilitation is key after ACL surgery in order to rebuild your strength and get range of motion back in your knee. While in the hospital, you may start partial weight bearing exercises to re-establish knee joint mobility. You may be required to wear a brace or use crutches for the first six weeks.
You will begin a physical therapy program starting with range-of-motion and resistive exercises, then move to power, aerobic and muscular endurance, flexibility and coordination drills. Usually a patient returns to normal activities within a few weeks of surgery, and sports between six and twelve months after surgery.
Definition
In the past, a total knee replacement involved making a large (8 to 12 inch) incision on the knee. Once the incision was made, the kneecap was dislocated and a long incision made in the quadriceps muscle. Today, quad-sparing total knee replacement involves a much smaller incision (3 to 5 inches) on the side of the knee, kneecap dislocation is no longer necessary, and the tendon and quad muscle are separated rather than cut.
Who Is a Candidate
Not all patients are suitable candidates for quad-sparing total knee replacements. In some cases, more traditional knee replacement techniques must be used to provide the patient with the best possible outcome.
Why It’s Done
The knee is composed of bone, muscle, cartilage and ligaments. The cartilage is the “shock absorber” that lies between the femur (thigh bone) and the tibia (shin bone). Over time, the cartilage can break down, and the bony surfaces begin rubbing together, causing pain, stiffness, and sometimes swelling. As this condition progresses, pain increases and mobility is compromised. Knee replacement surgery is the most common option after other treatments, such as physical therapy and pain medication, have failed.
How It’s Done
First and foremost, you need to be examined by an orthopedic surgeon, who will test your range of motion as well as look for deformities such as bowlegs or knock-knees. A detailed medical history will be taken, and you will undergo X-rays to determine the structural condition of the knee joint. Total knee replacement is a major surgical procedure and should be considered only if all other treatments have been attempted and have failed.
In quad-sparing total knee replacement, an incision is made along the top of the knee to expose the joint. Special instruments and guides are used to remove the damaged surfaces and shape the end of the bones. The implants are secured to the bones and the ligaments adjusted if necessary.
What to Expect After Surgery
Your knee will be swollen and tender for a few weeks after surgery. Almost immediately after surgery, you will need to start flexing your knee. Shortly after that, you will stand, and within 24 hours, begin walking with the help of a walker or cane. An occupational therapist may meet with you to advise you on how to perform your daily routine at home. Once your physician has determined you are able, you will be discharged or possibly transferred to a rehabilitation facility. Regardless, you will begin some type of physical therapy regimen, and will follow up with your physician within one to two weeks to check your progress. Some patients are able to walk without assistance within weeks after surgery. Regardless of your recovery rate, you will have some restrictions.
Definition
The Achilles tendon is the largest tendon in the body. It connects the calf muscle to the heel bone, and allows you to push off while walking or running.
Problems and Symptoms
There are two main problems that can occur with the Achilles tendon:
Achilles tendinopathy is either an inflammation of the Achilles tendon (tendonitis) or a series of small tears in the tissue in or around the Achilles tendon. Symptoms of Achilles tendinopothy are swelling, tenderness and pain, which may come on gradually or may only occur when you are walking or running. You may also find you have less strength and range of movement in the ankle area. Tears or ruptures in the actual Achilles tendon can range from mild to severe, depending on whether it is partial or complete. While a partial tear may cause mild discomfort or no symptoms at all, a rupture may include a sudden, sharp pain often accompanied by a popping noise. In addition, swelling and bruising may occur and you may be unable to point your foot in a downward position.
Diagnosis
Your physician will review your medical history and perform a physical exam, checking for swelling and tenderness. He will also ask you questions about your symptoms and when they began.
Treatment
The best treatment for Achilles tendinopathy is rest of the Achilles tendon. Stretching exercises and a change in footwear can reduce stress in the tendon. Over-the-counter medication may be taken for pain. It may take weeks or months to for the tendon to fully recover. Treatment for a rupture may include surgery to repair the tendon. You may have a cast, splint, brace or walking boot to keep your lower leg immobile. An Achilles tendon generally takes six to 12 weeks to heal.
Definition
A sprain, or strain, occurs when a ligament or tendon is stretched beyond its normal range. Types of sprains include: 1) a partial tear, where some of the fibers of the overstretched ligaments are torn; 2) a full tear, a more serious injury where the ligaments are completely torn; and 3) a joint dislocation, which involves a stretching of the joint capsule to where movement is impossible.
Symptoms
Symptoms of sprains include pain, swelling and bruising around the joint, as well as limited mobility. In a severe strain, you may hear or feel a tearing sensation and a snap or pop.
Diagnosis
Your physician will perform an exam and evaluate the injury. In a more severe strain, X-rays may be necessary to rule out a broken bone.
Treatment
Treatment for an ankle sprain utilizes the PRINCE approach:
Protection: For the first 24-36 hours, a protective brace and/or a compression wrap, like an elastic bandage, is applied to the sprain.
Rest: Stay off the strain, or use crutches until walking is no longer painful.
Ice: Apply an ice pack 10-20 minutes a day, every one to two hours for the first 24-72 hours. After 48 hours, alternating ice with heat is recommended.
NSAIDs or acetaminophen: NSAIDs are non-steroidal anti-inflammatory drugs such as Advil or Motrin that will help reduce pain and swelling. Acetaminophen, such as Tylenol, will help alleviate pain.
Compression: An ACE bandage will help decrease swelling for the first 24-36 hours. Note that a compression wrap doesn’t offer protection and that a protective brace should be worn at the same time.
Elevation: To decrease swelling and bruising, elevate the ankle above your heart for two to three hours a day.
As the sprain heals, rehabilitation exercises are encouraged to regain range of motion and mobility. PRINCE and rehabilitation are both important, because if a sprain doesn’t heal correctly, the joint can become weakened and prone to re-injury.
The content provided on this page is to be used for information purposes only, and is not meant to be a substitute for professional examination, diagnosis or treatment. Please see your physician with any symptoms you may experience or questions you may have regarding a medical condition or procedure.
