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How to Make Your Hip Replacement Last Longer

August 10, 2022

Orthopedic surgeon in southern California examines imaging of a hip replacement for signs of ware

The number of hip replacements over the past ten years has increased dramatically. In fact, The Agency for Healthcare Research and Quality estimates that more than 450,000 of these procedures are performed yearly in the United States. Hip replacements can significantly benefit patients suffering from hip conditions such as degenerative arthritis by dramatically reducing pain, providing increased mobility, and promoting an active lifestyle. So, if you have had a total hip replacement, you may wonder what can make your new hip last longer. The following tips will help prevent the early degradation of your joint replacement.

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Improving Knee Stability After an Injury or Knee Replacement

July 13, 2022

Woman uses leg exercises at the gym to create balanced strength and flexibility for knee stability per instructions from experts at Premier Orthopaedic and Trauma Specialists

Like many joints throughout our bodies, the knee is a marvel. Even more impressive is that we use and abuse our knees constantly throughout the day, whether with high-impact exercise, injury, or simply placing too much weight on them through lifestyle choices. Yet, for decades our sensitive yet impressively tough cartilage maintains its structure and keeps us pain-free. However, whether due to age, lifestyle choices, or injury, our knees can become damaged and require us to place renewed emphasis on stability to ensure that the knee is not further damaged or that healing can occur properly. This article will discuss how to maintain or improve the knee’s stability. You should always follow these tips even if your knees don’t hurt; prevention is always better and more predictable than treatment.

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The Progression From Osteopenia to Osteoporosis: What You Need to Know

June 15, 2022

Orthopedic surgeon explains osteopenia and osteoporosis to a patient using a medical model of a spine

The human skeleton is at the literal core of our bodies. Its most straightforward purpose is infrastructure. Unlike any building, however, this interior scaffold provides support and protection for vital organs and structures, is essential to mobility, serves as a depot for blood cell formation and essential minerals, and even has a purpose as an endocrine organ. The vitality of bone is evidenced in its strength, measurable in density, which can degrade with age.

The Risk Factors

Osteopenia is the first measurable stage of lower bone density and identifying risk factors is important. Those risks include female gender, age over 35, smaller body frames, poor diet, a sedentary lifestyle, smoking, excessive drinking, Caucasian or Asian ancestry, low mineral stores or absorptive capability, thyroid dysfunction, and exposure (especially prolonged) to steroids or chemotherapy.

Diagnosing Bone Density Issues

A valuable diagnostic tool is the dual-energy X-Ray absorptiometry (DXA/DEXA) scan to quantify Bone Mineral Density (BMD). It uses low radiation levels and is painless – patients lie down, and a scanner passes over their bodies. A DEXA scan is recommended in men or women with health risks or evidence of bone density loss. A preventative or routine DEXA scan is recommended for women over age 65 and men over age 70. After the scan, a T score is calculated based on the patient’s bone density compared to average densities. Lower scores indicate a greater loss of density.

A T score below –2.5 on the DEXA scan is a marker of Osteoporosis, a more serious state of porousness in the bone. While not a guarantee, osteoporosis increases the risk of bone fracture. Fractures may even occur with very routine activity.

While the DEXA scan can measure density itself, a Fracture Risk Assessment Tool (FRAX Questionnaire) is another gauge developed to understand risk in low bone density patients. Bone Mineral Density is a consideration. Weight and height measures assess frailty or the burden of excess weight. Advanced age, female gender, a parent with a hip fracture, current smokers, and those drinking more than three alcoholic beverages per day, steroid medications, and rheumatoid arthritis will increase the FRAX score. Patients with Type 1 diabetes, hyperthyroidism, chronic liver disease, and premature menopause (either by hormone or surgery) may be at a higher risk of bone fracture.

Lifestyle Changes to Slow the March Toward Osteoporosis

When osteopenia is identified, lifestyle modification becomes essential to reduce the risk of advancing to osteoporosis. Stop all smoking and reduce alcohol. Increasing calcium and Vitamin D through diet and supplementation may help slow bone density loss. Foods such as green vegetables, dairy products, sardines with bones, salmon, and tofu are all rich in calcium. Naturally containing Vitamin D food sources include fish and fish liver oils, beef liver, cheese, and egg yolks. Foods fortified with Vitamin D include grains and cereal, and dairy. Supplements containing both calcium and Vitamin D are commonly recommended and should be taken only with your orthopedic specialist’s advice. Exposure to sunlight also triggers Vitamin D production in your body. Walking and climbing stairs, impact or step aerobics, dance, and weight or resistance exercises apply pressure to bones, increasing bone density.

More significant measures may prevent bone density loss in the advanced stages of osteopenia trending toward osteoporosis. Physical therapy may be appropriate, and medication regimens may be considered. Bisphosphonates, antibody therapy, and hormone therapy (procalcitonin) inhibit bone resorption, which is a normal step in ‘recycling’ and replenishing bone mineral stores. Hormone replacement (estrogen and testosterone) also normalizes the resorption and replenishment cycle. All medications have side effects, so a consultation with your orthopedic surgeon or primary care physician is essential.

How Bone Density Affects Fractures

If fractures related to osteopenia occur, there is a lower threshold for surgical repair due to underlying frailty. Intramedullary devices such as metal posts and securing screws become necessary to provide infrastructure for the hips and long bones. Joint replacement may be considered if bone healing is predicted to be complicated or prolonged. In these instances, the top of the femur and its socket within the hip may be replaced with artificial appliances, which may be screwed or cemented in place. Spine vertebra fractures (compression or burst fractures) may require fusion by either bone graft and/or implant with instrumentation or injection of bone cement.  Recent low bone density-related fractures predict fracture risk in other bones, especially adjacent bones. These risks are most significant within the first year or two.

Next Steps

When starting any medication or supplement regimen, all dosing recommendations are educated ‘guesses’ based on history and population averages.  Therefore, consultation with an orthopedic physician and nutritionist would be a great starting point to establish a baseline of your status. This can begin with a medical history and blood work to identify vitality, mineral, cellular, and metabolite status.  If these measures are not normal, discuss which supplement regimens work in their experience and for their other patients. Plan regular follow-ups, and reassess those measures regularly. Keeping a food and activity journal will provide your medical team data for detecting variables and helps track positive or negative changes.

The best strategy for osteopenia and the prevention of osteoporosis is an aggressively preventative approach. If you haven’t done so already, a good practice is establishing a relationship and regular visits with a knowledgeable Primary Care Physician before symptoms of any kind have even occurred.

Awareness, information, and education predict better general health, particularly in conditions to be prevented or identified for early intervention. Contact us to learn more about osteoporosis prevention or to evaluate your risk and start treatment for low bone mineral density.

Home Care For Sports-Related Knee Injuries

May 11, 2022

oung man holds cold pack on knee to treat a sports-injury at home with recommendations for the orthopedic surgeons at Premier Orthopaedic & Trauma Specialists

When we think of sports injuries, our minds typically go to children’s sports, especially those particularly hard on the knee, like soccer. However, you might be surprised to know how many adults visit our offices and ERs due to significant knee injuries. Of course, as we age, the combination of weakened musculature and the tendency to over-exert, whether to impress or make ourselves feel better, can create a genuinely problematic knee injury situation. The cutting, twisting, turning, and kicking motions can strain the knee. This is true in children and adults alike – especially those who aren’t adequately conditioned or have not warmed up appropriately. Many minor injuries can be treated at home, with an eye toward specific markers that would suggest urgent or even emergent intervention is necessary.

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The Right Way to Ride a Peloton or Other Spin Bike

March 21, 2022

Woman rides stationary bike to receive the benefits of cardio and resistance training for her overall and orthopedic health according to recommendations by experts at Premier Orthopaedics & Trauma Specialists

If pandemic-related shutdowns had one benefit to our collective health, it was in the form of introducing exercise equipment into the home. Millions of Americans barred from their gym could bring the gym to them. One of the most popular high-profile companies leading this charge is Peloton, a maker of stationary bikes and treadmills.

However, along with this newfound interest in home exercise, there has been a marked rise in exercise-related injuries, most commonly from overuse. This, of course, stands to reason. You’ve acquired a shiny, new, and typically expensive bike, and you want to use it! Further, the classes that you can take are engaging and fun, making you push ever harder. However, this push can also mean injury if taken too far. Continue reading

Making the Most of Your Downtime After a Joint Replacement

March 7, 2022

Man works with physical therapist to maximize his healing and recovery after a joint replacement surgery at Premier Orthopaedics & Trauma Specialists in Southern California

If you were particularly active but are now hobbled by joint issues, the several weeks you need to recover from a joint replacement may be frustrating and driving you out of your mind! Your orthopedic surgeon has already told you that this recovery time is significant for the long-term health of your new joint and longevity. Even so, you may want to accelerate the recovery process. A wrong move could end in further injury. While you should always follow your surgeon’s postoperative instructions, there are a few ways to speed up your recovery and get back to your regular activity faster.

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Exercises for Hip, Knee, and Back Pain

February 21, 2022

Man swims laps for healthy exercise that works with his hip, knee, and back pain as recommended by the team at Premier Orthopaedics and Trauma Specialists

Exercise is key to the proper functioning of muscles, bones, tendons, and joints. You may have heard the phrase “motion is lotion” in physical therapy. This is very true. Getting up and being active lubricates the joints, allowing them to function better and work harder for you.

However, chronic pain can keep us sidelined for days, weeks, or months. Even once the pain has subsided or been treated, patients may treat their body too gently with the worry that the pain will return, and they will require additional intervention. However, avoiding exercise only leads to more pain and dysfunction now and in the future.

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The Importance of Core Strength How to Get and Maintain It

February 7, 2022

Group fitness class works on side planks to improve core strength and stability as recommended by orthopedic surgeons at Premier Orthopaedics and Trauma Specialists in Southern California

Many fitness gurus talk about core strength as the key to getting into better shape. And while for some, this may conjure ideas of a flat stomach with washboard abs, the importance of a strong core is far greater than just the cosmetics. Your core involves the front, sides, and back of the central part of your body. The muscles in these areas work in unison to stabilize your spine, take pressure off the joints, and allow you to perform everything from intense activity to minor chores around the house.

However, when we go to the gym or work out at home, we often only focus on the muscles that everyone looks at first, our arms, legs, or chest.

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Stretching Before and After Physical Activity

January 17, 2022

It sounds like a broken record. Stretch before you exercise. However, stretching and warming up muscles prior to a workout of any kind is an incredibly important part of long-term muscle and even joint health. Much like a car’s engine, the muscles in our body work more efficiently when they are warmed up and primed for strenuous activity. Pushing the muscles hard before they’ve had a chance to warm up often leads to soft tissue injury, instability, and the potential for joint problems.

However, as science and medicine have learned more about the musculature of the body, we have also pivoted on when one should stretch. Stretching a cold muscle can be detrimental. If we launch directly into stretching a muscle that has been immobilized for a while – for example sitting at a desk for the day or just getting out of bed – we can create strain that leads to injury. Therefore, the first part of any exercise routine should be a quick warm-up. This can consist of a brisk walk for about 5 to 10 minutes that gets the muscles working but does not overwork them. From there, these warm muscles can be stretched more efficiently, and strenuous activity can begin.

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Compartment Syndrome

January 3, 2022

Compartment syndrome is a very serious cause of severe disability and even amputation if left untreated. To understand more about compartment syndrome, we need to briefly discuss the musculature in our bodies. Muscles in our legs and arms are surrounded by a layer of tissue known as fascia that you can equate to the casing of a sausage. There is very little flexibility or give in the facia, so when a muscle is injured, particularly due to a crushing blow, significant swelling of the muscle can occur. As the muscle pushed into the fascia, this can lead to a great deal of pressure which, in turn, eventually leads to reduced oxygen levels, tissue necrosis, nerve damage and death of the muscle.

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