When selecting Iowa Orthopaedic Center, P.C., 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.  IOC’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.  IOC 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].

IOC 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].  IOC gives patients a comprehensive approach to hip and knee pain.

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

Common Injuries

There are three kinds of arthritis that affect the hip,

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.

Treatment
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 joint.

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.

Common Injuries

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.

Ligament Tears
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 experience.

Patella Problems
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.

Treatment
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. Meniscus 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.

Weather 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, IOC can offer help.  IOC’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 Orthopaedic Center, P.C., call 515-247-8400, or toll free 800-642-6381.