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Updated: Jan 4, 2020

Hip Surgery/replacement overview, Pro's vs Con's:

Hip Surgery is becoming more and more common these days.  In fact, now days.. we are seeing hip surgery performed on younger people than in the past.  This could be due to a few different factors such as a higher BMI amongst the general population now days than in the past. (People now days are generally 5-10 pounds heavier than generations before us thus adding weight and therefore stress to the hip joints).  And people now days tend to be more active than in generations before and therefore expect to do things like run marathons, hike, bike and or at least hit the gym daily without hip pain. This being said, it makes perfect sense as to why we are seeing hip surgeries amongst younger people than in previous years.

However, as with anything, there are always pro's and con's to everything and hip surgery certainly has both.  One pro to having hip surgery and the main reason anyone has this surgery, is obviously to move better with reduced pain for many years to come following surgery recovery and most patience do in deed achieve this outcome and can expect to move pain free for a good 10 years or more after surgery before needing a revision to their older surgery to keep them pain free. The main Con to early hip surgery is that sense the life of the hip surgery/replacement is about 10 years, the younger a person is when they get it, the more active they typically are and for longer... therefore, they will most likely need revisions to their surgery sooner and perhaps even more often than a person who has the surgery later in life.

I guess the real message here is that hip surgery/replacement has a relatively short life span of about 10 years.. and revisions to the original surgery will become necessary sooner with more use.  Therefore, It is highly recommended to really weigh out all of your options carefully prior to having the surgery AND... be sure to look deeply into holistic and more natural remedies first.  There are many things you can do all by yourself to help alleviate the pain and help your hips to move better and with less pain before resorting to surgery.  

Some conservative treatment strategies to try before resorting to surgery:

Try things such as...

1. changing your diet to include more anti-inflammatory foods and beverages... less inflammatory foods such as sugars, loosing even just a few pounds  and simply walking and stretching daily can help a lot.  You can seek the advice from a nutritionist for more information about your diet and how changing it can help you lose weight and lighten the load your joints have to carry thus, reducing pain in your joints.

2. Try exercises designed specifically to strengthen and or stretch and loosen tight joints.  You can seek out a personal trainer to teach you both strengthening and stretching exercises and a yoga instructor to really help to deeply stretch and strengthen your muscles and joints helping to alleviate the pain even more.

3. You can take it even further and seek out a physical or physiotherapist who will help you with everything you need to know regarding the natural and most conservative methods of managing your hip pain from anti- inflammatory drugs to diet and exercise therapy to physiotherapy. It is important to exhaust all natural or conservative treatment strategies of weight loss, non-steroidal anti-inflammatories and physiotherapy first. Research shows that physiotherapist working as first points of contact in primary care have actually reduced referrals for hip and knee replacements by 20%. As long as the physiotherapist has the support and experience to make the judgement, they should know which person is a good candidate for physiotherapy and which ones are best surgical candidates.

If surgery is your last resort:

If you find yourself still facing surgery after exhausting the natural and conservative approach, do not despair, Hip Replacement Surgery, also called Total Hip Arthroplasty, is helping many people to live active, pain free lives. With this surgery, The hip joint is replaced with an artificial one, this surgery is performed for reasons such as a hip fracture, break or even due to certain types and degrees of arthritis.

There are a number of types of arthritis that affect the hip joint such as Osteoarthritis,

Rheumatoid arthritis or Traumatic arthritis.

The hip replacement surgery is done in order to replace the damaged parts of the hip joint and thus, the patient is relieved of the hip pain.

Two types of surgeries:

Accounting for about 95% of all cases and dating all the way back to several decades ago, the most common and traditional method of surgery is called the posterior hip replacement

where the incision is usually done on the back and is several inches long. This method is a little more painful, not as exact and a little longer recovery time taking up to eight weeks. However, the newer approach, called Anterior hip replacement involves smaller incisions through the front side of the body, is the minimally invasive hip replacement method resulting in less pain, faster recovery time (about 4 weeks vs 8 weeks), reduced risk of complications and a more accurate positioning of the new hip components.

Although the (posterior or back) method is currently still used for about 95% of all surgery cases, the new (anterior or front) method is quickly becoming the most commonly used method as this newer technique is now considered more desirable for it proves to have more benefits and is a far superior method for its faster recovery time and more accurate position ability.

Goal of Hip Replacement Surgery:

The reason for hip replacement surgery is to relieve the patient from pain and disability of the hip area, to give them back their strength, flexibility, range of motion and ultimately to increase their mobility allowing them to enjoy a fuller, healthier, more active life. Thus prolonging their life by allowing them to stay active longer and pain free.

Most common reason for hip surgery:

As mentioned earlier, the most common reason for hip replacement surgery is arthritis.  

In particularly...Osteoarthritis. This type of arthritis causes wear and tear of the joint cartilage of the hip to such a degree which actually then results in the total loss of it. Without our joint cartilage, there is nothing between our bones to cushion the joints and bones as they move past one another this causes a great deal of friction and bone on bone movement and as you can imagine, this would definitely make the movement of the bones and joints extremely difficult and cause mush pain.

If a patient is suffering from this type of degenerative joint disease then, as you can imagine, it is not possible for them to perform even the most basic and normal activities such as bending, sitting, walking or even just standing. Any movement, or anything in which the patient may have to bend the hip will cause tremendous pain.

Other kinds of arthritis like rheumatoid arthritis which is usually caused due to hip injury can also damage the hip joint and cause pain.

Hip replacement surgery can also be performed in order to treat hip fractures caused mostly due to a fall. A fracture can disable a person and can cause severe pain.

Patients are usually given strong pain medicines in order to control arthritis/fracture pain.  However, if their pain continues the physician may recommend hip replacement surgery. Some medicines that are used for degenerative joint disease and fractures include Anti-inflammatory medicines, Glucosamine, physical therapy and other pain medicines/remedies.

Risks of Hip Replacement Surgery:

As with any and all surgical procedures, there may be complications such as bleeding, infection, dislocation, nerve injury and sometimes the need for revision of the initial surgery. There can also be other risks factors depending of on the severity of your hip injury and your current health condition. It is a good idea to consult your primary care doctor or your surgeon to understand all of the risks associated with your particular situation.

Preparations for Hip Replacement Surgery:

Before the surgery, is a very good time to ask any questions that you may have regarding your hip replacement surgery. Most hospitals, will require your to complete a consent form allowing the doctor to perform the planned procedure. You should have had plenty of opportunity to discuss the surgery in full detail with your doctor or surgeon prior to being asked to sign the consent form.  It is very important that you read the form in it's entirety and understand it prior to signing it. Should you not understand something or have general questions about what is contained on the form, please be sure to ask all questions and understand it prior to signing.  Once the form is signed, you have now given your consent for the procedure to begin. Your doctor will schedule your appointment and notify you of the date.  It is important to let your doctor know about any 

allergies you may have, have all blood tests or other diagnostic tests done and let your healthcare provider know about any sort of medication that you may be taking.

You will be advised not to eat anything 8 hours prior to the surgery as food on your stomach is not a good mix with the Anesthesia and could cause nausea. Before the surgery starts, you will be given sedatives that will help to relax you. If you are a smoker, it is best to not smoke before the surgery since smoking can delay the healing process. Be sure that there is someone to drive you home and to look after you at home after you are discharged from the hospital.

The process of Hip Replacement Surgery:

Hip replacement will require you to stay in the hospital for at least a night. It is performed after you are asleep while under general anesthesia or spinal anesthesia.

When you arrive at the hospital, you will be called back and asked to remove your clothes and put on a hospital gown. you will then lay on the hospital bed, warm blankets placed over you, An IV will be started in your arm supplying you with pain medicines, fluids and anesthesia. Once you start getting sleepy and numb you will be positioned on the operating table and surgery will soon begin. Your heart rate, blood pressure, breathing and blood oxygen level will be monitored by the anesthesiologist during the entire process of surgery.

The skin of the area of the incision will be cleaned with an antiseptic solution and the healthcare provider will make he appropriate incision in the cleaned area. The healthcare provider will remove the damaged parts of the hip joint and replace them with prosthetic parts. The prosthetic parts have a stem part that goes into the femur, a ball part that fits into the stem and a cup is installed in the socket for the ball to fit in. The stem and the cup are made of metal while the ball may be made of either metal or ceramic. The incision is then closed by stiches or surgical staples. In order to remove any fluids from the incision, a drain may be placed. The last step is dressing the incision site with a dressing.

After Hip Replacement Surgery:

After the surgery is done, you will be taken to the recovery room and monitored. Your blood pressure, pulse and breathing is monitored, when they are all back to normal, stable and you have come out of the anesthetic, then you will be moved to the hospital room where you ill stay comfortable for a number of days.

It is advised that you move your new hip joints very soon after the surgery. You will be introduced to a physical therapist right after the surgery and a plan of exercises and stretches will be created for you. Medication will be given to you to sooth the pain so that you can exercise and move more. You exercise according to the plan during your stay at the hospital and at home after your discharge.

After you are discharged, you will be either sent home or to a rehabilitation center, depending on your condition. You will attend physical therapy sessions weekly if not daily at least in the beginning to strengthen your muscles.

When you reach home, make sure that you keep the surgical area clean and dry at all times. Take showers according to the bathing instruction given by your healthcare provider. There will be a number of visits to the healthcare center for follow up care and eventually for the removal of stitches.

In closing:

Be sure not to skip any doses of medication that your healthcare provider has recommended to you to relieve you from soreness and pain. Make sure that you only take the prescribed medicines. Get plenty of rest but move as much as possible to get your muscles working and strong again. Take care of yourself and remove any obstacles from your house such as electrical cords or carpets that may cause any trip and falls.

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What is sports medicine?

Sports medicine is a branch of medicine which deals with physical fitness and the treatment and prevention of injuries which relate to sports and exercise.

Sports medicine doctors are specialists who deal with sports medicine and they are responsible for treating a wide range of physical conditions in patience young and old. Though sports medicine is not a medical specialty itself, most sports medicine doctors are certified in internal medicine, family medicine or another specialty first and then later receive additional education or certificate specializing them in sports medicine.

Some of these doctors specialize in treating children and teens whose growing bodies can be very different from an adult body and sometimes require even more knowledge. In fact, they are generally board-certified in pediatrics or family medicine and then have additional training in sports medicine. Other sports medicine doctors specialize in treating athletes who sometimes get injured while playing their professional sport. It is very important that the sports medicine doctor understand in detail just how the body works and the intricate details of all the working parts of a body and just how they all connect, relate and move together. Some sports medicine doctors specialize in everyday, regular adult persons who may only be active for fitness or fun. Even a regular person can experience body injuries that require the knowledge and help of a sports medicine doctor. It is important to note that some, but not all sports medicine doctors have surgical training too, usually as orthopedic surgeons.

Some other professionals, that are not doctors may sometimes also work in conjunction with a sports medicine doctor to provide care. They might include some of the following other professionals.

Physical therapist: They help people who have been injured rehabilitate and recover.

Certified athletic trainers: Trainers provide rehabilitative exercise routines to help patients regain strength and flexibility and also develop certain conditioning programs to prevent future injury.

Nutritionalist: Are professionals trained.... well..... basically... in... food! Or at least, the nutritional values of it! :) They know all about food and nutritional values and how they effect your body. They know what makes you fat, what makes you lean and what makes you heal or get sick. They are amazing because they can teach you how to make food your friend... your healer and medication. Food can be healing or it can be deadly. Eating for health is what a nutritionalist can teach you about. They can help put you on a diet that promotes whatever it is you are trying to accomplish. For example, if you are over weight it is very important that you lose some weight in order to be at your optimal health or perhaps your coach requires you to lose or maybe even gain weight to make the team... a nutritionalist can help you. Maybe you have diabetes or another illness which stems from an unhealthy diet or inactive lifestyle... if so, then your nutritionalist can put you on a diet that helps you get your blood sugar in check. The same goes for other important health related numbers such as your blood pressure and blood cholesterol. A nutritionalist is who you would turn to for help with all of it as they are the ones who know all about food and how it pertains to the body. They will write you "a prescription" sort-a-speak, of the appropriate foods for you to accomplish whatever it is you need to accomplish health wise.

Why you should check with a sports medicine doctor?

Here are a few reasons why seeing the sport medicine specialist/doctor is important.

First of all, while injuries may occur while performing any type of physical activity, the chances of being injured increase with incorrect form, too heavy of weight or improper stretching and/or warming up. Also, anyone can sustain injuries weather an expert or novice. believe it or not, even something as small as a little twist of the

knee can affect your physical activities and this is why no matter how small the strain, pull or injury seems... it is always best to seek medical observation by a trained doctor to be sure you are not ignoring the small symptoms that are there to warn you of perhaps something larger. Listen to your body. If something hurts, its better safe than sorry. Your doctor could be the one who catches something small before it has a chance to turn into something big. In this case and as the saying goes... "an ounce of prevention is definitely worth a punt of cure!"

Some examples of injuries that may happen as a result of physical activities and that may require examination by a sports medicine doctor are as follows:

· Ankle and wrist sprains

· Minor to major fractures

· Injuries like pulls, twist and tears to your knee or shoulder

· Tendonitis (inflammation of a tendon)

. Bursitis (inflammation of the fluid-filled sacs that cushion the joints)

. Achilles tendon injuries

. Shin splints

· Back injuries

. Neck injuries

· Illness due to heat exposure

· Concussions

· Pulled hamstring and or dislocated shoulder 

· Cartilage tears

. Knee injuries including ACL tears

. Fractures and dislocations

. Lacerations and dislocations (Cuts and Scrapes)

End Note:

Sports medicine involves not only treating injuries, but prevention, physical therapy/rehabilitation, and (for some) Performance training.

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Updated: Jan 4, 2020

Knee pain is a common complaint, can effect people of all ages and can result from injuries such as torn cartilage or a ruptured ligament or from medical conditions including arthritis, gout or certain infections. If your knee has been injured, you will certainly want to relieve the pain fast. Minor knee pain may respond well to some self-care measures. Self-care methods to relieve you of the pain from structural damage to your knee can range from braces, ice packs and heat therapy to strength training, physical therapy and anti-inflammatory medications. If you have been unsuccessful at relieving your knee pain caused from the above mentioned conditions or other conditions such as a torn ACL, Torn Meniscus or even osteoarthritis, you may require surgery. It is important to check with your physician if your pain is long lasting. Your doctor will most likely take some X-ray's to determine exactly whats wrong and then figure out which remedy is best for you. If you and your doctor decide that surgery is your best option, then he will schedule your surgery date and explain everything you need to know pertaining to your upcoming surgery. The day of surgery you will meet your surgical team, one of whom will be your anesthesiologist. Your anesthesiologist will be the one who makes sure you are numb and keeps you most comfortable during the procedure.

After surgery... It is of the most importance that you get plenty of rest and stay off of your leg for a few good weeks. You will also most likely work with a trained physical therapist who will help you to heal. Though some of the movements and exercises they will ask you to do may seem impossible and perhaps even be a little painful at first, it is very important to do all of the exercises he recommends for you each day as this is the only way you will regain the strength and flexibility in that area. The physical therapist will stretch you and put you through a series of movements all designed to help you regain use of that area after surgery. The more you move the faster you will get strong again. Some people report physical therapy as being painful at first but then getting better and better with each and every visit until eventually, they are back to "like new" again. One last thing to note is to be sure to take your prescribed pain medications prior to your physical therapy sessions for the most comfort during your movements.

Types of Knee Surgeries:

There are currently a few different types of most common knee surgeries.Below are two most popular. 

Arthroscopic surgery:

One of the most common kinds of knee surgery is arthroscopy, this is a minimally invasive "keyhole" surgery used to diagnose and treat a wide range of knee problems.  where long, thin instruments are inserted into the patient's body through small incisions. This technique uses a small camera called an arthroscope, on the end of that long, thin instrument to see the area being repaired. The scope displays pictures on a monitor to help guide the surgeon's work.  Surgical devices are then inserted into the joint via a second incision. This procedure is used to repair different types of knee problems and usually leaves minimal scaring.  

Arthroscopy surgery is a good choice for the following conditions:

  • The surgery is done to remove or repair a meniscus that has been torn. The meniscus is a cartilage and its function is to cushion and stabilize the joint.

  • This surgery can also be done if reconstruction of a torn ACL is needed, ACL is Anterior Cruciate Ligament, the function of this ligament is also to help in stability of the knee joint.

  • For removing the inflamed synovial (connective) tissue.

  • To trim the damaged articular cartilage.

  • For the removal of loose fragments of bone or cartilage.

  • To treat the problems of the patella or kneecap.

  • For the treatment of knee sepsis or infection.

Knee replacement:

In case of a knee replacement operation, the damaged parts of the knee joints are removed and replaced with new parts which are mostly made of metal, ceramic or plastic. After the knee replacement surgery is complete, there are chances that the patient might feel paint in the new joint. If the patient starts therapy and executes physical activities then that can help a lot with the pain.

The knee replacement can last at least 20 years or maybe longer. Since the knee replacements do not last forever, it really depends on the age of the patient, whether to replace the knee or just manage the pain by other methods.

Types of Anesthesia:

The type of anesthesia you and your doctor choose depends on a number of factors, like what kind of surgery is being performed or if you have any allergic or adverse reactions to any medications or not. Your choice of anesthesia can affect the complications, cost and time spent during and after the surgery in the medical facility, affecting the time you have to wait to begin physical therapy.

Before choosing a type of anesthesia, it is recommended to consult your physician and your anesthesiologist.

  • One type of anesthesia is Regional Anesthesia, it is commonly used for arthroscopic surgeries. It numbs only the area of the patient’s body involved in the surgery. During the operation, you will be awake and aware of the process of surgery but won't feel anything. Regional anesthesia also includes spinal anesthesia and epidural anesthesia. Regional anesthesia can control pain very well with fewer complications compared to general anesthesia which is used to render you completely unconscious during the operation which means that you will have no knowledge of the process going on at all nor will you feel anything.  This is used during the process of a full knee replacement.

  • Another option for arthroscopic surgeries is Local anesthesia. A one-time injection is given to the patient that numbs the area around the area that is involved in the surgery. It has advantages i.e. the risk of complications are lower and it costs less too.  Also, the patient can be released from the medical facility much sooner.

Pain Management:

The pain from surgery can be made a bit more bearable if you consider a number of options that are common for the relief of pain after knee surgery. Each option has certain pros and cons to it and there can even be combination of options to choose from. Your physician and  anesthesiologist can help you with the management of pain and can work together on a plan that is best suited according to your condition, medical history and preferences. The following are some options that you may want to choose from.

  • Analgesics act solely to relive local pain.

  • Anti-inflammatory act to relive pain and reduce inflammation.

  • Peripheral nerve blocks are options that involve an injection that contains an anesthetic that is injected into certain nerves that block the pain signals between the brain and the knee.

  • Opioids are drugs that block pain signals to the brain. This drug is only given if there is severe or persistent pain and should be taken only as needed and in as low a dosage as possible as they can be very addictive.

  • Multimodal therapy is a therapy that is used for pain management right after the knee replacement surgery and usually involves opioids and one or more additional pain relief methods, in this method pain can be controlled while the dosage of opioids is limited.

The patient must consider all options in consultation with the pain management specialist. If the right method or combination of medication is used then it is possible for the patient to be discharged from the medial facility sooner, with less pain.

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