Iowa Ortho, for your hip and knee orthopaedic care,
you can have confidence in our fellowship trained,
board certified orthopaedic surgeons.
Our surgeons have extensive knowledge and education
in diagnosing, treating and managing all conditions
of the hip and knee including congenital deformities,
degenerative diseases such as arthritis, and complete
fracture and trauma care. Iowa
Ortho ’s orthopaedic surgeons strive
to continually increase their knowledge of new advancements
in their field by attending special courses to learn
and train in the latest developments of hip and knee
replacement including minimally invasive procedures
and computer assisted muscle sparing techniques.
Iowa Ortho is proud to continue bringing additional
orthopaedic surgeons to this area of practice. [For
more information on welcoming John Nettrour, M.D.
go to the website Orthoscope link and click on the
September 2007 issue, Page 3].
offers an integrated and
comprehensive approach to hip and knee care by working
collaboratively in one clinic with other specialties
to provide pain management and rehabilitation services
as well as working with Mercy Medical Center to provide
Joint Camp for joint replacement patients [For
more information on Joint Camp go to the Orthoscope
link on the homepage and select the Winter 2007 issue].
gives patients a comprehensive approach to hip and
The hip is one of the most stable joints in the body.
Because of its function in bearing the body's weight,
however, it may be susceptible to arthritis due to
the excessive pressure. The hip joint is a ball and
socket joint. The socket area, which is inside the
pelvis, is called the acetabulum. The ball part of
this joint is the top of the leg bone. It joins with
the acetabulum to form the hip joint. These are actually
held together by ligaments, muscles, and the joint
capsule. This arrangement allows motion, yet provides
the stability needed to bear all the rest of your
body weight on your legs.
The structures in the hip joint are the capsule,
which is a tough, stretchy material; the ligaments,
which go all the way around and outside the capsule;
and the muscles, which are attached by tendons and
are all around the hip joint. Some of the muscles
that go around your hip are your hip flexors, which
flex your hips; your hip abductors, which bring your
leg out to the side; and the hip extensors, which
bring your leg back. The hip also rotates internally
and externally. Internal rotators such as abductors
turn the legs in, and external rotators turn the legs
out. These are tiny little muscles on the back part
of your hip. Because some of the muscles are tiny,
they become tighter more easily and can be overpowered
by the larger muscles. Therefore, it is important
to have a good range of motion that will allow the
hip to move freely without pains and strains.
Hip Injuries and Conditions
There are three kinds of arthritis that affect the
Osteoarthritis or "wear and
tear" arthritis generally occurs after the age
of 50 and can run in a family. In this form of arthritis,
the cartilage cushioning the bones of the hip simply
wears away. The bones then rub together, causing hip
pain and stiffness.
Rheumatoid Arthritis is a disease
where the synovial membrane becomes irritated for
unknown reasons, produces too much fluid and damages
the cartilage, leading to pain and stiffness.
Traumatic Arthritis results from
an injury or fracture. There are over 280,000 hip
fractures in the United States every year. These fractures
and their subsequent care are very costly in terms
of money and the emotional impact on the patient and
their family. About half of all patients suffering
from a hip fracture will lose their independence and
may require long term care.
As with most orthopaedic problems, there are many
different ways to treat each individual's symptoms.
Whenever you feel pain in your hip, slow down what
you are doing; cut the activity in half until the
pain subsides, and then increase your activity again
as you feel better. If the pain persists, you may
want to consider obtaining a more accurate diagnosis.
As always, conservative treatment is usually all that
is required. In the event that surgery is needed,
there are many different procedures that can get you
back on the road to independence.
Total Joint Replacement is just one of the surgeries
that is making a lifestyle difference in many people's
lives. Total joint replacement has been in widespread
use since the early 1970s for total hip and the late
1970s for total knee. Even though the technology is
recent, it has progressed rapidly so that long term
results are excellent.
In a total joint replacement, bony surfaces of the
joint are prepared to allow application of metal and
plastic devices to substitute for the destroyed cartilage
and/or bone. The ligaments and tendons are usually
preserved so that function of the joint is not compromised.
There are several methods currently utilized to provide
stable fixation of the implant to your bone, including
the use of bone cement, special coatings on the implant
and techniques involving a very tight fit of the implant
with your bone. Your surgeon will discuss with you
the type of implant that is appropriate for your particular
lifestyle and circumstances.
Knees & Joints
A joint is a meeting of two bones for the purpose
of allowing movement. It has the following six parts:
Cartilage-the end of each bone is covered with cartilage,
a tough material that cushions and protects the ends
of the bone.
Synovial membrane (synovial sac)-around each joint
is the synovial sac, which protects the joint and
also secretes the synovial fluid, which oils the joint.
Bursa-a bursa is a small sac that is not part of
the joint but is near the joint. It contains a fluid
that lubricates the movement of the muscles: muscle
across muscle and muscle across bone.
Muscle-muscles are elastic tissues that, by becoming
shorter and longer, move the bones and thus move you.
Tendon-tendons are fibrous cords that attach the
muscles to the bones.
Ligament-ligaments are much shorter fibrous cords
that attach bone to bone and make up the joint capsules.
The knee is essentially made up of four bones. The
femur, which is the large bone in your thigh, attaches
by ligaments in a capsule to your tibia. Just below
the tibia is the fibula, which runs parallel to the
tibia. The patella (kneecap) rides on the knee joint
as the knee bends.
When the knee moves, it does not just flex and extend.
There is also a slight rotation component in this
motion. The knee muscles that cross the knee joint
are the quadriceps and the hamstrings. Quadriceps
are on the front of the knee, and hamstrings are on
the back of the knee. The ligaments are equally important
in the knee joint because they hold the joint together.
Problems with ligaments are common. In review, the
bones support the knee and provide the rigid structure
of the joint, the muscles move the joint, and the
ligaments stabilize the joint.
The knee also has a structure made of cartilage,
which is called the meniscus. The cartilage protects
the joint and allows the bones to slide freely on
each other. There is also a bursa around the knee
To function well, a person needs to have strong and
flexible muscles; the cartilage, ligaments, and bursa
must be smooth and strong. Problems occur when any
of these parts of the knee joint is irritated.
Meniscus Cartilage Tears
A torn meniscus usually results from a sudden twist
or repeated squatting. This usually causes your knee
to swell and hurt. You may also feel a "catching"
or locking when you bend it.
The anterior cruciate ligament may tear from a fall,
twist, or direct blow to the knee. These tears usually
cause pain, swelling and instability which can make
your knee give away.
Articular Cartilage Wear
Aging or injury may wear articular cartilage. A piece
may even break off into the joint. Pain, stiffness,
or grinding may be some of the symptoms that you would
The cartilage under your kneecap can become damaged
due to aging, overuse, or a direct blow to the knee.
These structural problems can restrict joint motion
causing uneven wearing and pain.
Arthroscopy is a surgical technique that utilizes
a small instrument with a magnifying lens and a light
beam that allows the surgeon to diagnose and treat
many knee problems. A Meniscus tear can be repaired
or removed, depending on the severity of the injury.
The kneecap can be realigned or smoothed, cartilage
can be shaved or removed and ligaments may be reconstructed
using the arthroscope.
In cases of severe degenerative arthritis, total
knee reconstruction may be recommended.
All treatments are generally accompanied by a physical
therapy regimen specific to the injury.
Whether you’ve injured your hip or knee
over the week-end playing a round of golf or gardening,
or you suffer with doing daily activities due to hip
or knee pain from arthritis, Iowa
Ortho can offer help. Iowa
Ortho ’s board certified specialists are supported
by a highly skilled ancillary team to provide accurate
diagnoses and treatment plans focused on the individual
needs of our patients. Get moving again…come see the
experts at Iowa Ortho, call 515-247-8400, or toll