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Ask The Expert Archive

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Total Joint Archive Questions

Below are Dr. Sterling’s answers to Total Joint questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 52.

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Q : 1

I need hardware removal from the failed ORIF which resulted in a femoral neck fx non-union followed by a total hip replacement. I need a hip specialist who has experience in this procedure. Can you recommend anyone?

Both myself and Dr Theodore Manson at the University of Maryland have extensive experience with the treatment of post-traumatic hip arthritis and we each perform a number of these each year. The complexity of the procedure depends on the hardware that was used for the fixation of the femoral neck (screws, plate and screws, or rod), but this is a common procedural combination at our institution.

Q : 2

I had a total hip replacement in 2009. I had a couple of follow ups and the following year my orthopaedic doctor moved his practice out of state. I also ended up moving last year. I haven't had any problems, but wondered if I should contact a new ortho in my new state and get my records transferred?

I think that this is a good idea for several reasons. I recommend routine follow every 4-5 years for all of my total joint patients to check the status of the implants and look for early signs of wear of the bearing surfaces. Having the implant log is important so that in the future if you ned to have something more done, the surgeon knows which implants you have in place. The rcords that I recommend you obtain are the operative rport and the implant log (this is usually a copy of stickers from the implant boxes listing the manufacturer, implant design, lot#, size). Best of luck

Q : 3

What do you think of the anterior approach to hip replacement?

I have been doing an anterolateral approach to the hip for nearly 30 years and am quite happy with it. It is my standard approach for nearly all of my primary total hip replacements.

Q : 4

I believe that I have CPPD of the knee. I have been to two orthopaedists who said nothing can be done for CPPD. What kind of doctor should I see?

CPPD is simply a crystalline deposition disease, a variant of arthritis, where crystals of calcium pyrophosphate are deposited in the cartilage, which wears it out quicker. The usual anti-inflammatory medicines are a good first start and indomethacin has a good track record in this condition. A rheumatologist may have more discussion to offer, but not much different in treatment.

Q : 5

Do you perform minimally invasive piriformis syndrome surgery?

This operation involves exploration and decompression of the sciatic nerve over a length of the nerve. It is imperative that we can clearly see the anatomy around the nerve, so there really is no such thing as "minimally invasive" surgery here. That said, while we do an open approach to the nerve, we do not use any extra length of the incision.

Q : 6

Do you do bilateral hip replacement?

I do not typically do both procedures under the same anesthetic, but will do them close together, usually separated by a few weeks.

Q : 7

I have been told that I would benefit from total knee replacement on both knees. My job requires that I frequently work from a kneeling position for as much as 30 minutes at a time. Will I still be able to do this after surgery?

Kneeling is certainly allowed after knee replacement operation. The details of your job would be best discussed with your surgeon after an examination of your knees.

Q : 8

At 27 years old, it was discovered that I had had Legg-Calve-Perthes disease that had gone undiagnosed and untreated. Recently my hip and knee pain has become much worse. I'm not big on taking pain pills all the time and visited my orthopaedic surgeon for options. After x-rays, he stated that hip replacement was my only option. He has some concerns such as dislocation of a replacement due to my activity level, the need for future replacements, my age and further degeneration of the joints. Do you have any other suggestions?

Total hip replacement may be a very reasonable option, but should be embarked upon only after a candid discussion with an experienced orthopaedic surgeon about all of your options and a realistic appraisal of expectations for success and longevity.

Q : 9

My husband has an infection following knee replacement surgery. His doctor has recommended the two step process. Is this the appropriate treatment method?

The two step surgery, removal and then reimplantation, is the accepted treatment approach.

Q : 10

I am taking Arava and Fosomax and am worried that this will cause problems after my reversal shoulder surgery. My RA doctor doesn't seem concerned, but it was after I started this that I lost a lot of the graft from my previous surgery.

Wound healing can be delayed with some of these newer drugs, but since they are relatively new on the market, no one has a great deal of experience with them and their side effects around the time of surgery. It is best to be cautious and consult with your surgeon.

Q : 11

Does any doctor on your staff do anterior hip replacement surgery?

Yes, I perform anterior hip replacements and have performed this procedure for 25 years.

Q : 12

I am an adult with genu valgum, commonly called knock-knees. Is there a way to correct this and have straight legs?

This can be corrected, but it is only worth the risk if you are experiencing symptoms or limitations in activity.

Q : 13

Can you have more than two surgeries on the same elbow?

Yes, there is no limit to the number of surgeries. However, the results tend to be less good with each successive operation.

Q : 14

My wife is allergic to nickel. She needs a total knee replacement in both knees. Is there a product that doesn't use nickel?

Yes. There are titanium implants treated with a coating, plus polyethylene plastic inserts.

Q : 15

I am a 50-year-old male and have totally destroyed my left elbow. Recently I was diagnosed with Pseudogout and a non union. Is a total elbow replacement an option for me? If I can have a replacement, how long should I expect it to last?

Elbow replacements are less durable than hips and knees as far as replacements go. Nonetheless, you may be a candidate depending upon your activity level and the status of the bone around your elbow.

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