Wednesday, 22 of November of 2017

Category » Hip Replacement

Update on the DePuy Hip Replacement Lawsuit

 

 

DePuy ASR

An Articular Surface Replacement, removed from a patient.
Photo Credit: The New York Times

Metal on metal implants for hip replacement surgery have been the subject of intense scrutiny and media attention for some time now. Bloomberg Business News and the New York Times recently reported that Johnson & Johnson has “tentatively agreed” to an estimated $4 billion settlement to settle some 7,500 lawsuits against its DePuy Articular Surface Replacement (ASR) hip implant device.

Metal-on-metal implants were initially thought to be a breakthrough product that would last longer, offer greater stability and improve bone conservation, but unfortunately that is not turned out to be the case. In January of this year, the FDA issued a safety bulletin, citing growing clinical evidence that shows a failure rate two to three times that of non-metal-on-metal devices.

In addition, the impact of metal rubbing on metal can cause tiny metal particles to flake off, causing damage to muscle and bone, as well as a high level of metal ions in the blood. Many patients have been forced to undergo hip revision surgery to remove the flawed implant and replace it with a different design.

Thousands of patients have filed lawsuits against DePuy and other manufacturers of metal implants, claiming the devices were defective and have harmed their health. When formal announcement in the DePuy ASR case is released some time this week, it is expected to be one of the largest product liability claims to be paid involving a medical device. The New York Times reports that only patients who have undergone revision surgery to replace the defective ASR implant will be included in the current settlement.

If you are dealing with chronic hip pain from osteoarthritis or are concerned about a hip replacement that you had in the past, please feel free to call our office at 239-936-6778 to schedule a consolation. For more information about joint replacement or other orthopedic-related conditions, go to www.kaganortho.com.


Don’t Let Hip Pain Slow You Down

 

 

Hip pain is a common orthopedic complaint

What do former Olympic gymnast Mary Lou Retton, singer Billy Joel, former president George Bush and golfer Jack Nicklaus have in common?  Each suffered from years of chronic hip pain until they decided to undergo successful hip replacements surgery.

At age 37, Retton was younger than most hip replacement patients when she had surgery.  But years of rigorous training, plus a congenital hip deformity, made it almost impossible for her to be active without surgery. Nicklaus was in his late 50s by the time he decided to have the procedure done. The pain from osteoarthritis had become severe enough to prevent him from enjoying golf and playing with his grandchildren.

While hip pain can be debilitating and disabling, there are many surgical and nonsurgical treatment options to take away the pain and return patients to an active lifestyle.

Hip Anatomy

The first step is to understand how the hip joint works.  One of the body’s largest and strongest joints, the hip joint is designed as a ball and socket, with the rounded end of the thighbone fitting into a socket formed in the pelvis bone.

Cartilage covers the surface of the bones and acts as a cushion to reduce friction during movement.  Muscles, tendons and ligaments connect the bones and keep the hip joint stable, allowing us to run, walk, jump, climb, turn and sit.

While the hip joint is built to handle a significant amount of pressure, accidents, degenerative conditions like osteoarthritis, and activities that repeatedly overstress the joint can lead to problems.

The most common complaint is sharp or lingering pain that may begin in the hip area and radiate to the lower back, thigh, buttocks or groin.  Many people find the hip joint feels stiff.  Others experience swelling, redness or tenderness to the touch.  All of these symptoms are signs of an underlying problem that will need to be evaluated by a specialist so appropriate treatment can be prescribed.

Nonsurgical Treatment for Hip Pain

Not all hip pain requires surgery.  It all depends on the reason for the discomfort. Runners, cyclists, tennis players and soccer players are often prone to “overuse” injuries, leading to inflammation and irritation of the hip tendons, or tendonitis. Pain occurs when the swollen tendon rubs against the pelvic bone. Rest, ice, anti-inflammatory medication, injections and physical therapy can be helpful in treating tendonitis.

Tight muscles or muscle imbalance can also cause hip pain.  Both athletes and people who sit for long periods of time, especially at a computer, are prone to tight hip flexors, hamstrings and abductors.   Stretching exercises that promote flexibility in this area can help reduce discomfort and correct imbalances.

Bursitis is another common cause of hip pain.  The bursa are fluid-filled sacs located near the joints in the body.  Like cartilage, the bursa serve as a lubricating cushion, but rather than covering ends of the bone, the bursa are located between the bone and muscles or tendons.

Bursitis occurs when the bursa becomes inflamed and irritated, making walking, climbing stairs and even crossing the legs painful.  Treatment usually includes rest, ice, anti-inflammatory medication and injections.

When Surgical Intervention is Required

Surgery is indicated for more serious causes of hip pain, including fractures, dislocation and osteoarthritis.

According to the American Academy of Orthopedic Surgeons, about 10 million men and women in the U.S. have osteoarthritis, a common degenerative condition of the joints that causes stiffness, pain and disability.

Osteoarthritis is often called the “wear and tear” arthritis.  In its advanced stage, there is chronic inflammation of the joint, the development of bone spurs around the edges of the joint and the wearing away of the cartilage that cushions the bones. Osteoarthritis of the hip makes it difficult to rotate or flex your hip. Walking, sitting, climbing or any activity can be a challenge.

There isn’t a “cure” for osteoarthritis, but the discomfort and disability can be alleviated with treatment.  When nonsurgical interventions fail to provide relief, arthroscopic surgery, which can include hip resurfacing, total hip replacement or minimally invasive hip replacement, is the answer.  An estimated 230,000 hip replacement surgeries are performed in the U.S. every year.

For more information hip pain and treatment options, go to KaganOrtho.com or call the office for a consultation at 239-936-6778.       


What Is MIS Joint Replacement?

The trend toward bigger is better may apply in some areas of popular culture, but definitely not in the field of medicine, especially for joint replacement surgery.

MIS joint replacement is a minimally invasive surgical technique in which the surgical incision used to open the body is very tiny, just 2.5- to 3.5 inches. In contrast, traditional joint replacement surgery calls for a much larger incision – typically 12- to 14-inches.

But here’s the interesting twist. Whether the surgeon uses traditional surgery or a minimally invasive technique, the device used to replace the arthritic hip, knee or shoulder is always a full-size, traditional plastic or metal implant.

How is that possible? Technology.

Standard operating procedure calls for the surgeon to make a large incision and then retract the tissue, giving him a large surgical field in which to operate and insert the new artificial implant.

The new MIS technique uses a completely different approach. First, miniature specialized surgical instruments have been developed that are small enough to inset through a tiny incision.

Then, to overcome the restriction of a dramatically reduced surgical field, the specialized surgical instruments are equipped with a light source and video capability. Video images of the interior structure are sent in real-time to a monitor, giving the surgeon highly magnified 3D images of the operating field.

Performing minimally invasive surgery not only requires the right surgical instruments, it also takes training and certification to learn the surgical skills and manual dexterity required to become proficient in minimally invasive techniques.

In addition, the surgeon has to have a successful practice and track record that allows him to consistently perform the technique to keep his skills up to date and his surgical outcomes good.

Not everyone is a good candidate for MIS joint replacement. But the advantages of this new advance are extensive. The benefits include less blood loss, reduced trauma to the body, fewer days of hospitalization and faster overall recovery. Minimally invasive techniques are definitely a positive trend for the future of orthopedic care.

Want to find out more about minimally invasive techniques to treat joint pain? Go to www.kaganortho.com/learn-more. If you have chronic osteoarthritis that doesn’t respond to nonsurgical treatment, ask your doctor if you a good candidate for MIS joint replacement.

The trend toward bigger is better may apply in some areas of popular culture, but definitely not in the field of medicine, especially for joint replacement surgery.

MIS joint replacement is a minimally invasive surgical technique in which the surgical incision used to open the body is very tiny, just 2.5- to 3.5 inches. In contrast, traditional joint replacement surgery calls for a much larger incision – typically 12- to 14-inches.

But here’s the interesting twist. Whether the surgeon uses traditional surgery or a minimally invasive technique, the device used to replace the arthritic hip, knee or shoulder is always a full-size, traditional plastic or metal implant.

How is that possible? Technology.

Standard operating procedure calls for the surgeon to make a large incision and then retract the tissue, giving him a large surgical field in which to operate and insert the new artificial implant.

The new MIS technique uses a completely different approach. First, miniature specialized surgical instruments have been developed that are small enough to inset through a tiny incision.

Then, to overcome the restriction of a dramatically reduced surgical field, the specialized surgical instruments are equipped with a light source and video capability. Video images of the interior structure are sent in real-time to a monitor, giving the surgeon highly magnified 3D images of the operating field.

Performing minimally invasive surgery not only requires the right surgical instruments, it also takes training and certification to learn the surgical skills and manual dexterity required to become proficient in minimally invasive techniques.

In addition, the surgeon has to have a successful practice and track record that allows him to consistently perform the technique to keep his skills up to date and his surgical outcomes good.

Not everyone is a good candidate for MIS joint replacement. But the advantages of this new advance are extensive. The benefits include less blood loss, reduced trauma to the body, fewer days of hospitalization and faster overall recovery. Minimally invasive techniques are definitely a positive trend for the future of orthopedic care.

Want to find out more about minimally invasive techniques to treat joint pain? Go to www.kaganortho.com/learn-more. If you have chronic osteoarthritis that doesn’t respond to nonsurgical treatment, ask your doctor if you a good candidate for MIS joint replacement.

 


Hip Dislocation

What does remodeling the house, falling off a ladder, a car accident or hurting yourself in a very physical sport like football, snow skiing, wrestling or basketball have in common? You have a greater risk of dislocating your hip joint.

It takes a lot of force to dislocate the hip, which is structured as a ball and socket joint to give you maximum range of motion and flexibility for walking, turning, jumping and sitting. The bottom of the thighbone has a ball-like shape, which fits into a cup-shaped socket in the pelvic bone. Dislocation occurs when a severe blow to the hip forces the thighbone out of the socket. A car accident is the most common cause of hip dislocation.

The American Academy of Orthopedic Surgeons calls a hip dislocation an orthopedic emergency that requires immediate assessment and treatment. The injury is very painful and temporarily immobilizes the joint. The joint may swell and look visibly deformed or out of place.

X-rays will allow the doctor to determine the extent of damage to the hip joint and to see whether there are other related injuries to the ligaments, bone or cartilage. Depending on the diagnosis, treatment can include reduction and immobilization, or for more severe injuries, surgery. Rehabilitation is required for best recovery.

What is a reduction? During this procedure the physician gently manipulates the thighbone back into place in the socket. It’s usually done under anesthetic in the operating room. After the reduction, then joint may be immobilized for a while until it is safe to begin rehabilitation. It can take several months for a dislocated hip joint to heal completely.

For more information about hip injuries, go to www.kaganortho.com/learn-more.


Treating Hip Fractures

Hip fractures are a serious concern for older Americans, especially if poor eyesight, medications, osteoporosis or loss of balance places them at risk for tripping and falling. But hip fractures can occur at any age due to a serious car, bicycle or motorcycle accident, a sports-related injury, or an illness like cancer that causes the bones to be weak.

A hip fracture is a painful and potentially disabling break of the upper part of the thighbone, known medically as the femur. Almost always, surgery will be required to mend the bone, promote healing and stabilize the area.

The type of surgery will depend on the area of the hip that is broken, the severity of the fracture, the person’s age and level of activity. The surgeon may use a combination of surgical “hardware” to repair the fracture and “pin” the hip, or joint replacement surgery may be recommended.

If there is already existing damage to the cartilage and the ends of the bone, especially from arthritis, or the bones are not properly aligned after the fracture, the surgeon may be concerned that the blood supply to the hip joint will not be sufficient. In this situation, the surgeon may recommend replacing part or all of the hip joint with a metal replacement prosthesis.

When joint replacement is not needed, the surgeon may use surgical screws to repair the break. Sometimes the screw is attached to a metal plate that is positioned inside the body next to the bone. Or, the surgeon may place a metal rod, known as a surgical nail, inside the thighbone. The rod is attached to the ball of the hip joint with a screw.

Rehabilitation is an important part of recovery from hip fractures. Physical and occupational therapy in the hospital and at home will accelerate healing and return patients to normal activities faster.

For more information about treating hip fractures or other orthopedic-related conditions, visit www.kaganortho.com/learn-more.


Therapy After Hip Replacement Surgery

Physical therapy is essential for a successful recovery from hip replacement surgery. Physical therapists are trained to help people who have been injured or ill improve their ability to walk, handle daily activities and regain their independence.

Under the guidance of the therapist, you will perform specific exercises to help strengthen the joint and muscles. Participating in therapy will allow you to return to everyday activities faster and stronger.

Physical therapy begins while you are still in the hospital. Medication will reduce discomfort as you gradually learn to put more weight on the joint, balance without falling and walk with an assistive device such as a walker. You may also be asked to do simple exercises while you are in bed, such as tightening the muscles in your legs and pointing your feet.

When you are ready to leave the hospital, the therapist will give you certain exercises that are to be performed daily at home. The therapist will also teach you how to get in and out of the car, tie your shoes, sit in a chair and get in and out of the bathtub without damaging the new joint. For a while you will need to avoid putting too much stress on the joint. You will also attend therapy sessions at the doctor’s office or outpatient center until you have made sufficient progress and can resume an active lifestyle.

For more information about rehabilitation after orthopedic surgery, go to http://www.kaganortho.com/services/therapy


Hip Resurfacing, An Alternative to Total Hip Replacement Surgery

For people who lead an active, physical lifestyle and enjoy participating in vigorous recreational activities such as running, tennis and racquetball, hip resurfacing may be an alternative to traditional total hip replacement surgery.

There are several key advantages to hip resurfacing, including greater range of motion and less risk of dislocating the hip. In addition, should future hip revision surgery be needed, it may be easier to perform the procedure after hip resurfacing than if the patient has received a traditional total hip replacement.

What’s the difference between the two?

During a total hip replacement procedure, the entire joint is removed. This includes the head of the thighbone, called the femoral head, as well as any diseased or damaged bone and cartilage within the socket. The original disease joint is then replaced with an artificial implant.

In contrast, hip resurfacing is considered a bone-conserving procedure. The femoral head is not removed. Instead a few centimeters of bone are trimmed from the surface of the femoral head, which is then capped with a smooth metal covering. The implant fits into this covering.

According to the American Academy of Orthopedic Surgeons, the best candidates for hip resurfacing are people less than 60 years old who have a large frame and strong, healthy bones. The procedure may be less successful for people who are elderly or small-framed, and those who have weak or damaged bones.

For more information on both hip resurfacing and total hip replacement, go to www.kaganortho.com

 


Metal-on-metal hip implants: What patients need to know

While surgery is not always the first or best option for every patient, hip replacement surgery to replace the diseased hip joint with an artificial joint may be advised to help relieve pain, increase motion, and get you back to enjoying many normal, everyday activities.

For patients contemplating hip replacement, there are several options for implants. Replacement joints are made of many different materials including plastic, ceramic and metal. Sometimes the ball and socket are made with the same materials and other times, the two are made of different materials. When I determine that hip replacement surgery is the next best step for my patients, I will select an implant based on the patient’s body structure, medical history, and lifestyle.

Recent recalls of metal-on-metal hip implants have prompted more discussions and concerns between surgeons and patients about the types of products available and materials used. About a year ago, the U.S. Food and Drug Administration (FDA) issued a public health communication about hip replacement components that have both a metal ball and a metal socket (metal-on-metal hip devices), due to the number of patients who required a second hip replacement procedure, called a revision surgery.

Symptoms of implant failure may include hip/groin pain, local swelling, numbness or changes in your ability to walk. However, there are many reasons a patient with a metal-on-metal hip implant may experience such symptoms and it does not mean your implant must be replaced but it is important that you contact your surgeon to help determine the cause.

There have also been cases where metal particles from the implant caused a reaction around the joint, leading to deterioration of the tissue surrounding it, loosening of the implant, and failure of the device. In addition, some metal ions from the implant may enter into the blood stream. There have been a few recent case reports of patients with metal-on-metal hip implants developing a reaction to these ions and experiencing medical problems that might have been related to their implants, including effects on the nervous system, heart, and thyroid gland.

Most recently, the FDA issued orders to hip manufacturers requiring post-market surveillance studies to monitor adverse events after a device has been approved by the FDA. Information for patients on the recall and a list of frequently asked questions can be found on the FDA website.

If you are uncertain about which type of implant you have or if you experience pain or other medical concerns following joint replacement surgery, you should contact the orthopaedic surgeon who performed your procedure.

When discussing your options for hip surgery with your surgeon, some questions you should ask include:

  • What are the risks and benefits of each type of hip implant system (metal-on-metal, metal-on-polyethylene, ceramic-on-polyethylene, and ceramic-on-ceramic devices)?
  • What is the surgeon’s personal experience and outcomes with metal-on-metal hip systems?

If you are not satisfied with the surgeon’s responses or have concerns about the surgery, consider seeking a second opinion. Ultimately, it is the “joint” decision of the surgeon and patient on which course of treatment and type of implant is best.

If I can be of assistance, please call my office at 239-936-6778 or visit www.kaganortho.com/.



Warning: Illegal string offset 'status_txt' in /home/content/53/6203553/html/Kaganorthoblog/wp-content/plugins/share-and-follow/share-and-follow.php on line 1938

Warning: Illegal string offset 'status_txt' in /home/content/53/6203553/html/Kaganorthoblog/wp-content/plugins/share-and-follow/share-and-follow.php on line 1938

Warning: Illegal string offset 'status_txt' in /home/content/53/6203553/html/Kaganorthoblog/wp-content/plugins/share-and-follow/share-and-follow.php on line 1938