Hip Pain Your Treatment Options. Daniel Hoard, M.D. Joint Plus Excel, Sinai-Grace Hospital
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1 Hip Pain Your Treatment Options Daniel Hoard, M.D. Joint Plus Excel, Sinai-Grace Hospital
2 Does this sound familiar? It would be embarrassing to get out of a car because everybody had to help me. Somebody would have to pull me up. I felt like this old woman. My life got progressively less active, less fun, and less participative. Just a day on my feet was exhausting. The pain became greater and greater until Advil and ibuprofen couldn't numb it out. It just got worse and worse.
3 You re Not Alone Hip pain is very common. There are many causes of hip pain. Bursitis Sciatic pain Arthritis Source: CDC
4 Bursitis Pain is lateral (outside of hip ) Sometimes associated with painful snapping Worsens during or after activity Source: CDC
5 Bursitis Treatment Physical Therapy Stretching of IT Band NSAIDS Cortisone Injection Source: CDC
6 Sciatica Presents as pain in buttock region Sometimes radiates down thigh to knee or calf Can be associated with: Numbness Weakness Bowel or Bladder Symptoms Low Back Pain (not always) Source: CDC
7 Sciatica Treatment: Physical Therapy Stretching Traction Exercises Modalities NSAIDS Epidural cortisone injection Surgery Source: CDC
8 Arthritis More than 43 million people have some form of arthritis. It is estimated that the number of people affected by arthritis will increase to 60 million by Source: CDC
9 The Hip Joint
10 Your Hip Joint The hip joint bears the full force of your weight and consists of two main parts: A ball (femoral head) at the top of your thigh bone (femur) A rounded socket (acetabulum) in your pelvis Normal hip joint, showing healthy articular cartilage
11 What Causes Hip Joint Pain? One of the most common causes of joint pain is arthritis. The most common types of arthritis are: Osteoarthritis (OA) Rheumatoid Arthritis (RA) Post-traumatic Arthritis Diseased hip joint, showing worn cartilage
12 Osteoarthritis
13 Did you know? Nearly 21 million Americans suffer from osteoarthritis, a degenerative joint disease that is a leading cause of joint replacement surgery. Source:
14 OA Symptoms May present suddenly or develop very slowly Arthritis can cause pain and stiffness Some types of arthritis may cause swelling Simple tasks may be difficult to do
15 Joint Degeneration Pain from arthritis and joint degeneration can: Be constant or come and go Occur with movement Occur after a period of motionlessness Be located in one spot or in many areas Be worse during certain times of the day Be worse after certain activities
16 The Orthopaedic Evaluation X-Rays X-ray Evaluation help show how much joint damage or deformity exists An abnormal X-ray may reveal: Narrowing of the joint space Cysts in the bone Spurs on the edge of the bone Deformity or incorrect alignment
17 The Orthopaedic Evaluation Additional Diagnostic Tests Occasionally, additional tests may be needed to confirm the diagnosis. These may include: Blood tests Urine analysis Analysis of joint fluid Magnetic Resonance Imaging (MRI) Bone scan
18 Treatment Options Medication Physical therapy Arthroscopy (cleaning the joint) Joint fluid supplements (injections that provide temporary pain relief) Partial joint replacement Total joint replacement
19 Medications Aspirin-free pain relievers acetaminophen Nonsteroidal anti-inflammatories (NSAIDs) Corticosteroids injection/pill form
20 Injections Hyaluronic acid (Synvisc, Supartz, Hyalgan) Corticosteroids
21 Physical Therapy Passive range-of-motion exercises may help: Reduce stiffness Keep joints flexible Isometric exercises help build muscle strength
22 Arthroscopy What is arthroscopy? Arthroscopy is a surgical procedure used to visualize, diagnose and treat problems inside a joint. In an arthroscopic examination, a pencilsized camera and instruments are inserted through small incisions. The camera contains a small lens and lighting system to magnify and illuminate the structures inside the joint.
23 Total Hip Replacement Total hip replacement is a surgical procedure in which certain parts of an arthritic or damaged hip are removed and replaced with a ceramic or metal devic. The artificial joint is designed to move just like a healthy joint.
24 Hip Joint Replacement You're Not Alone! Today, more than 300,000 Americans a year have hip replacement surgery First performed in 1960, this procedure is considered one of the most important surgical advances of the past 100 years
25 Hip Replacement Hip replacement is a treatment option when pain: Is severe Interferes with daily activities Interferes with work
26 Hip Replacement: Anatomical Description
27 Hip Replacement Hip replacement is a decision that should include: You Your Family Your primary care provider Your orthopaedic surgeon
28 Did you know? Total joint replacements of the hip and knee have been performed since the 1960s. Today, these procedures have been found to result in significant restoration of function and reduction of pain in 90% to 95% of patients. Source: National Development Conference, National Institutes of Health, December 2003
29 What is Minimally Invasive Surgery? MIS is a term used to describe a surgical procedure that often utilizes a smaller incision(s) than conventional surgery. MIS procedures reduce the amount of soft tissue (muscles and tendons, etc) that are disrupted during surgery.
30 What are the potential benefits of MIS Hip Surgery? Less soft tissue disruption Faster discharge from the hospital Quicker rehab and recovery Less blood loss Reduced pain Smaller scar Source: Keggi, Kristaps J., Total Hip Arthroplasty Through A Minimally Invasive Anterior Surgical Approach JBJS Vol. 85-A
31 Hip Implant Options Conventional Hip Implants Ceramic Hip Implants Acetabular shell Acetabular shell Plastic insert Ceramic insert Metal femoral head Ceramic femoral head Femoral stem
32 What is Computer-Assisted Surgery? It functions like a surveyor s tool that helps the surgeon align and orient knee and hip implants with the patient s anatomy It provides the surgeon with an interactive display of lines, angles and measurements needed to give the patient s new joint the best strength, stability and range of movement It is a rapidly expanding area of medical technology for orthopedic surgery
33 A Giant Step Forward in Joint Replacement Computer Assisted Navigation Advanced computerassisted surgical monitoring helps your surgeon more precisely align your hip or knee implant with computer imaging.
34 Recovery
35 Recovery Estimated Recovery Schedule: In-hospital Recovery: 2 3 days Significant Functional Improvement: 2 weeks 3 months Maximal Improvement: 3 12 months
36 Recovery Rehabilitation Following hip replacement the physical therapist begins an exercise program. The physical therapist works to help the patient: Regain muscle strength Increase range of motion Regain the ability to walk
37 After Surgery For Limitations approximately 12 weeks after surgery certain limitations are placed on your activities. When fully recovered, most patients can return to work.
38 Realistic Expectations Physical Activities After hip replacement, acceptable physical activities should: Not cause pain including pain felt later Not jar the joint running and jumping should be avoided Not place the joint in the extremes of its range of motion
39 Realistic Expectations Longevity of Hip Replacement It is impossible to predict in individual cases how long a hip replacement will last. Many factors determine the outcome including: Age Weight Activity level Bone strength
40 Lifestyle Realistic Expectations
41 Shoulder Replacement minimally-invasive or conventional? Ralph B Blasier, MD Sinai-Grace Hospital
42 Resurfacing (hemi) arthroplasty: Preserves bone Duplicates angles and offsets easily Accommodates deformity in the humeral shaft
43 Two balls
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45 Evans pre R lat
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49 Evans post R Ax
50 Evans pre L AP 1 + 2
51 Evans clin
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54 Two balls
55 What benefits? Spares bone Pretty good satisfaction Rapid recovery Deformity of the shaft irrelevant Easy to duplicate heights and angles Theoretically easier to revise
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87 Total Knee Arthroplasty Minimally Invasive Surgery (MIS) Robert J. Ference, MD Melissa R. Bacyinski, Senior PA-C
88 Minimally Invasive Surgery (MIS) Total Knee Arthroplasty
89 MIS Definition Minimally invasive surgery is performed not just through a smaller incision, but more importantly spares the muscle (quadriceps) from being injured or cut during surgery. It should not be confused with limited incision surgery in which a smaller incision is made, but the surgeon still cuts or disrupts the integrity of the quadricep muscle. We perform a pure quadricep sparing knee replacement and great care is taken to be delicate to all tissues surrounding the knee.
90 Approaches to the Knee Standard Approach Mini-Quadricep Approach Allows for extension to standard incision Mid Vastus Approach Excellent for post-op pain relief and early function Pure Quadricep Sparing Dr. Ference s approach Ference Technique
91 Average MIS incision 4 INCHES
92 No Limits Here at Sinai-Grace Hospital, we are the only institution in the country that does not select out patients We perform MIS surgery regardless of: Age Weight/BMI Amount of deformity (varus/valgus)
93 Normal vs. Abnormal Joint Surface
94 Joint Space Narrowing Sinai- Grace Hospital
95 Joint Replacement
96 Range of Motion 2 weeks post-operative
97 Computer Navigation New innovation in joint replacement surgery Allows computer to recheck accuracy of proper cuts and alignment during surgery Offers MIS to patients who would ordinarily require much larger surgeries Patients with existing hardware surrounding the knee Severe deformities such as in post-traumatic arthritis
98 Post-traumatic Arthritis
99 Computer Navigation
100 Before and After with Computer Navigation MIS
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