Frequently Asked Questions
What is orthopedics?
Orthopedics is a medical specialty concerned with the diagnosis, care and treatment of patients with musculoskeletal disorders. The musculoskeletal system consists of the body's bones, muscles, tendons, ligaments and nerves.
What does an orthopedist do?
Although orthopedists may perform surgery to restore function lost as a result of injury or disease of bones, joints, muscles, tendons, ligaments, nerves or skin, they are involved in all aspects of health care pertaining to the musculoskeletal system. They employ medical, physical and rehabilitative methods.
Where is The Institute for Orthopedic Science located?
Our services are provided at convenient locations throughout the North Shore-LIJ Health System.
What causes hip pain?
Pain in the hip may involve injury to muscles, tendons, or bursae (small fluid-filled sacs that cushion and lubricate joints).
Some of the most common hip problems are:
- arthritis - The most common cause of the breakdown of hip tissue. There are three kinds of arthritis that commonly affect the hip, including the following:
- osteoarthritis - Also referred to as "wear and tear" arthritis; this type of arthritis involves the cartilage that cushions the bones of the hip wearing away, letting the bones then rub together, causing hip pain and stiffness.
- rheumatoid arthritis - A disease in which, for unknown reasons, the synovial membrane becomes irritated and produces too much fluid. It damages the cartilage, leading to pain and stiffness.
- traumatic arthritis - Often the result of an injury or fracture, there are more than 320,000 hospitalizations for hip fractures in the United States every year.
- avascular necrosis - Involves the loss of bone caused by insufficient blood supply, injury, and bone tumors and may lead to breakdown of the hip joint.
- bursitis - In this condition, the bursa, a closed fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body, becomes inflamed. There are two major bursae of the hip, both of which can be associated with stiffness and pain around the hip joint, including the following:
- trochanteric bursa - The bursa located on the side of the hip and separated significantly from the actual hip joint by tissue and bone.
- ischial bursa - The bursa located in the upper buttock area.
- hip pointer - A bruise or tear in the muscle that connects to the top of the ileum (the crest of the pelvis, just below the waist). Causes of a hip pointer may include a blow, a fall, or a quick twist or turn of the body.
What treatment is available for hip pain?
There are a variety of treatment options available, ranging from rehabilitation to total knee replacement surgery. Specific treatment for knee problems will be determined by your physician based on:
- your age, overall health, and medical history
- extent of the disease, injury, or condition
- your tolerance for specific medications, procedures or therapies
- expectations for the course of the disease, injury, or condition
- your opinion or preference
If initial treatment methods do not provide relief and X-rays show destruction of the joint, your orthopedist may recommend total hip replacement surgery.
What is total hip replacement surgery?
In a total hip replacement surgery, the painful parts of the damaged hip are replaced with artificial hip parts called a prosthesis, a device that substitutes or supplements a joint.Total hip replacement offers:
- Elimination of pain
- Improved motion
- Minimized joint wear and tear
Who might be a candidate for artificial hip replacement?
The most common condition that results in the need for hip replacement surgery is arthritis. Osteoarthritis, a degenerative, joint disease that affects mostly middle-aged and older adults, causes the breakdown of joint cartilage and adjacent bone in the hips. Rheumatoid arthritis, which causes inflammation of the synovial membrane and results in excessive synovial fluid, can lead to pain and stiffness. Traumatic arthritis, arthritis due to injury, can cause damage to the articular cartilage of the hip.
The decision to replace the painful hip with an artificial one is a decision made by the patient and physician. Other, alternative treatments may first be used, including assistive walking devices and anti-inflammatory medications.
What happens before the surgery?
In addition to a complete medical history, your physician may perform a complete physical examination, including X-rays, to ensure you are in good health before undergoing surgery. In addition, you may also meet with a physical therapist to discuss rehabilitation after the surgery and undergo blood tests (or other tests).
How is a hip replaced with an artificial hip?
Although each procedure varies, generally, surgery to replace a hip usually lasts a few hours.
The two most common types of artificial hip prostheses used in replacement surgery are cemented prostheses or uncemented prostheses. Sometimes, a combination of the two types is used to replace a hip. A hip prosthesis is made up of metal and plastic. A cemented prosthesis is attached to the bone with a type of surgical cement. An uncemented prosthesis attaches to the bone with a fine mesh of holes on the surface, in order for the bone to grow into the mesh and attach naturally to the prosthesis.
The prosthesis (artificial hip) is comprised of the following two components:
- metal ball component
- plastic socket component (which may have a metal outer shell)
While undergoing surgery, the patient may be under general anesthesia or awake with spinal anesthesia.
What can I expect after surgery?
Hip replacement surgeries usually require an in-hospital stay of several days. Even while in the hospital, the patient usually begins physical therapy exercises to begin regaining range-of-motion in the hip. Physical therapy will continue at home. Pain medication also will be administered to keep the patient comfortable.
The incision will have stitches or staples that will be removed after a few weeks.
Making certain modifications to your home may help you during your recovery. These modifications include the following:
- proper handrails along all stairs
- safety handrails in the shower or bath
- shower bench or chair
- raised toilet seat
- stable chair with firm seat cushion and firm back withtwo arms, which will allow your knees to be positioned lower than your hips
- long-handled sponge and shower hose
- dressing stick
- sock aid
- long-handled shoe horn
- reaching stick to grab objects
- firm pillows to raise the hips above the knees whensitting
- removing loose carpets and electrical cords that may cause you to trip
What causes knee pain?
Many knee problems are a result of the aging process and continual wear and stress on the knee joint (i.e., arthritis). Other knee problems are a result of an injury or a sudden movement that strains the knee. Common knee problems include the following:
- sprained or strained knee ligaments and/or muscles - A sprained or strained knee ligament or muscle is usually caused by a blow to the knee or a sudden twist of the knee. Symptoms often include pain, swelling, and difficulty in walking.
- torn cartilage - Trauma to the knee can tear the menisci (pads of connective tissue that act as shock absorbers and also enhance stability). Cartilage tears can often occur with sprains. Treatment may involve wearing a brace during an activity to protect the knee from further injury. Surgery may be needed to repair the tear.
- tendonitis - Inflammation of the tendons may result from overuse of a tendon during certain activities such as running, jumping, or cycling. Tendonitis of the patellar tendon is called jumper's knee. This often occurs with sports such as basketball, where the force of hitting the ground after a jump strains the tendon.
- arthritis - Osteoarthritis is the most common type of arthritis that affects the knee. Osteoarthritis is a degenerative process where the cartilage in the joint gradually wears away, and often affects middle-age and older people. Osteoarthritis may be caused by excess stress on the joint such as repeated injury or being overweight. Rheumatoid arthritis can also affect the knees by causing the joint to become inflamed and by destroying the knee cartilage. Rheumatoid arthritis often affects persons at an earlier age than osteoarthritis.
What treatment is available for knee pain?
There are a variety of treatment options available, ranging from rehabilitation to total knee replacement surgery. Specific treatment for knee problems will be determined by your physician based on:
- your age, overall health, and medical history
- extent of the disease, injury, or condition
- your tolerance for specific medications, procedures or therapies
- expectations for the course of the disease, injury, or condition
- your opinion or preference
If initial treatment methods do not provide relief and X-rays show destruction of the joint, your orthopedist may recommend artificial knee replacement.
Who might be a candidate for artificial knee replacement?
The most common condition that results in the need for knee replacement surgery is osteoarthritis, a degenerative joint disease that affects mostly middle-aged and older adults. Osteoarthritis is characterized by the breakdown of joint cartilage and adjacent bone in the knees. Other forms of arthritis, such as rheumatoid arthritis and arthritis that results from a knee injury can also lead to degeneration of the knee joint. In addition, fractures, torn cartilage, and/or torn ligaments also can lead to irreversible damage to the knee joint over the years.
The decision to replace the painful knee with an artificial one is a joint decision between you and your physician. Other, alternative treatments may first be used, including assistive walking devices and anti-inflammatory medications.
What happens before the surgery?
In addition to a complete medical history, your physician may perform a complete physical examination, including X-rays, to ensure you are in good health before undergoing surgery. In addition, you may also meet with a physical therapist to discuss rehabilitation after the surgery and undergo blood tests (or other tests).
How is a knee replaced with an artificial knee?
Although each procedure varies, generally, surgery to replace a knee usually lasts about two hours. After the damaged bone and cartilage of the knee is removed, the orthopedic surgeon will place the new, artificial knee in its place.
The two most common types of artificial knee prosthesis used in replacement surgeries are cemented prosthesis and uncemented prosthesis. Sometime, a combination of the two types is used to replace a knee. A knee prosthesis is made up of metal and plastic. A cemented prosthesis is attached to the bone with a type of epoxy. An uncemented prosthesis attaches to the bone with a fine mesh of holes on the surface, in order for the bone to grow into the mesh and attach naturally to the prosthesis.
The prosthesis (artificial knee) is comprised of the following three components:
- tibial component (to replace the top of the tibia, or shin bone)
- femoral component (to replace the two femoral [thighbone] condyles and the patella groove)
- patellar component (to replace the bottom surface of the kneecap that rubs against the thighbone)
While undergoing surgery, the patient may be under general anesthesia or awake with spinal or epidural anesthesia.
What can I expect after surgery?
Knee replacement surgeries usually require an in-hospital stay of several days. Even while in the hospital, the patient usually begins physical therapy exercises to begin regaining range of motion in the knee. Physical therapy will continue at home. Pain medication also will be administered to keep the patient comfortable. The incision will have stitches or staples that will be removed after a few weeks.
If you have any further questions, please contact us at ios@nshs.edu
