The Orthopaedic Connection

The American Academy of Orthopaedic Surgeons (AAOS) offers a comprehensive library of information related to the care and treatment of orthopaedic problems. Each item is reviewed for medical accuracy.

Orthopaedic Associates is pleased to offer this link to our patients. The Orthopaedic Connection, developed by the AAOS, contains the most thorough and accurate information on orthopaedics available on the Internet. Please click here to review the list of topics offered.

Back Pain WHAT IS THE REASON FOR MOST CASES OF BACK PAIN? DOES SEVERE BACK PAIN MEAN THAT SOMETHING IS DRAMATICALLY WRONG? I AM HAVING SEVERE BACK AND LEG PAIN. DO I NEED AN X-RAY AND MRI? I'VE BEEN TOLD I HAVE A DISC HERNIATION. IS THAT THE SAME AS A SLIPPED OR RUPTURED DISC? DO I NEED SURGERY TO CORRECT THIS? WHAT DOES CONSERVATIVE AND AGGRESIVE CONSERVATIVE CARE MEAN? IF I NEED SURGERY FOR A LUMBAR HERNIATED DISC WHAT SHOULD I EXPECT? WHAT IS SPINAL STENOSIS? Hip Replacement I HAVE PAIN IN MY HIP - HOW DO I KNOW IF I HAVE HIP ARTHRITIS? I HAVE ARTHRITIS IN MY HIP - HOW DO I KNOW I AM READY FOR A HIP REPLACEMENT? WHAT "SIMPLE MEASURES" MIGHT WORK? WHAT IS AN ARTIFICIAL HIP? SHOULD MY HIP REPLACEMENT BE "CEMENTED" OR NOT? WHAT ARE THE RESULTS? WHAT COMPLICATIONS MIGHT OCCUR? HOW LONG WILL MY HIP REPLACEMENT LAST? DO I HAVE TO BE A CERTAIN AGE TO HAVE A HIP REPLACEMENT? WHAT CAN I DO AFTER MY HIP REPLACEMENT? HOW LONG DOES IT TAKE TO RECOVER? WHAT IS THE RECOVERY LIKE? HOW OFTEN DO I COME BACK TO SEE MY SURGEON?

Next to the common cold, back pain is probably the most common reason patients give for visiting the doctor's office. Understanding back pain can be the first step to recovery. Dr. Ira Fedder, orthopaedic spine surgeon at Orthopaedic Associates, answers some frequently asked questions about back pain. WHAT IS THE REASON FOR MOST CASES OF BACK PAIN? Most people have back pain without any identifiable cause. There is frequently no history of a specific injury or trauma. If there is an identifiable event, it is not unusual for the pain to begin 24 hours later. There are many structures in your neck and back which at times can be painful; these include the muscles, ligaments, discs, and joints. Because of the location of those structures, it is hard to tell which structure actually hurts. DOES SEVERE BACK PAIN MEAN THAT SOMETHING IS DRAMATICALLY WRONG? This is a logical assumption, however it doesn't have to be true in the case of back pain. A patient can have severe back pain and even leg pain and have a normal physical examination and nearly normal MRI. More importantly; this severe pain can be resolved without any specific treatment. I AM HAVING SEVERE BACK AND LEG PAIN. DO I NEED AN X-RAY AND MRI? A person who sees a back specialist may get an x-ray on the first visit. However, if the pain has only been present for a short period of time (less than 2- 4 weeks), and your doctor has no reason to believe you have a fracture (for example, osteoporosis, trauma, history of cancer, etc) then even an x-ray may be postponed until a later time. In the event of neurological problems such as weakness, paralysis or loss of bladder control, an x-ray as well and an MRI or myelogram may be ordered. I'VE BEEN TOLD I HAVE A DISC HERNIATION. IS THAT THE SAME AS A SLIPPED OR RUPTURED DISC? YES. Don't be confused by your doctor's jargon! A disc is a large structure made of cartilage. Most people think of the disc as a shock absorber, shaped like a jelly doughnut. The disc functions more like a universal joint. It is a cartilage structure that is attached to two bones (vertebra) that holds the bones together, but allows controlled motion in all directions. The disc plays a large role in spinal stability and shares this mechanical load with the facet joints and the surrounding soft tissues. DO I NEED SURGERY TO CORRECT THIS? Possibly. If you have a disc herniation in your neck or your back, you may have neck and/or back pain as well as pain in your arms or legs. People who have pain in their extremities may improve with conservative or aggressive conservative care. The vast majority of people with a disc herniation will improve with time and will not need surgery. Anyone with a worsening set of symptoms, i.e. increasing pain, weakness, paralysis, loss of bladder or bowel control, poor coordination of the hands, or an unsteady gait, need urgent, if not emergent, evaluation by a spine surgeon. WHAT DOES CONSERVATIVE AND AGGRESIVE CONSERVATIVE CARE MEAN? Most people want to be treated in the least invasive manner possible. These terms describe the use of medications, exercise, and physical therapy, as well as more aggressive interventions such as epidural injections. These techniques allow you to be more comfortable during the early phase of a painful spine problem. They are not curative, rather they are designed to give you relief while waiting for the symptoms to settle down. In the long run, I believe that a consistent, but not necessarily aggressive aerobic exercise program will help people decrease the frequency of the spine symptoms. In addition, it is important to understand the basic rules needed to protect your back while staying active. This may help prevent recurrences. IF I NEED SURGERY FOR A LUMBAR HERNIATED DISC WHAT SHOULD I EXPECT? Most disc surgery involves a small incision in the back, a 45-90 minute surgery and usually a one day hospitalization. WHAT IS SPINAL STENOSIS? This is another confusing subject. Spinal stenosis usually occurs in people over 50 but can occur in younger persons. Spinal stenosis is usually caused by degenerative arthritis or wear and tear arthritis. This type of arthritis is also called osteoarthritis and is NOT related to osteoporosis. The joints in this condition get larger and sometimes change shape. Just look at a person's hands as they age, the same thing happens in the spine. As the joints get larger they begin to squeeze the nerves in your spine. This happens very slowly, over many years. Eventually, a person develops symptoms that frequently include heaviness in the legs, fatigue, leg pain, numbness, and weakness. Most of these symptoms get worse with walking and get better with a short period of rest. Surgery is frequently needed to treat spinal stenosis. For more information about neck and back problems, contact your physician or one of our spine specialists at the Orthopaedic Associates Scoliosis and Spine Center at 410.337.8888 Back to Top

Commonly Asked Questions about Hip Replacement Surgery By Brian D. Mulliken, M.D. Orthopaedic Associates Do you have hip pain? If you answered yes, you might be wondering: I HAVE PAIN IN MY HIP - HOW DO I KNOW IF I HAVE HIP ARTHRITIS? Pain around the hip can come from a variety of sources, including hip arthritis. The only way to truly know if you have this degenerative condition is by taking an x-ray of the hip. However, if you suffer from pain in the hip, groin or thigh, and the pain is made worse by walking and other activities, there is a good chance that you do have arthritis or degenerative joint disease of the hip. I HAVE ARTHRITIS IN MY HIP - HOW DO I KNOW I AM READY FOR A HIP REPLACEMENT? Each person has to make that decision for him/herself. I usually recommend basing this decision on the amount of pain that is present and how that pain interferes with everyday living, or prevents you from doing activities that you desire. For example, if the pain prevents you from working around the house, going up and down steps or going outside to shop, that is a significant hindrance on everyday living. Also, if you cannot play golf or recreational tennis as you used to, this again is a reason to consider hip replacement surgery. However, it is often helpful to attempt to control the pain with simple measures, before you make your decision about a hip replacement. WHAT "SIMPLE MEASURES" MIGHT WORK? Many patients get some relief from a variety of medications, rest or the use of a cane for walking. Unfortunately, despite the recent hype about new or alternative forms of treatment, there are no "magic bullets" to cure arthritis, and hip replacement surgery is the only truly effective treatment for severe arthritis of the hip. WHAT IS AN ARTIFICIAL HIP? An artificial hip is just another term for a hip replacement, signifying that the arthritic "ball and socket" are replaced by a prosthetic or artificial "ball and socket". The prosthesis is made of a type of metal and a very hard plastic called polyethylene. SHOULD MY HIP REPLACEMENT BE "CEMENTED" OR NOT? Many patients are aware of the two methods of fixing the prosthesis to bone, that is, bone "cement" or a porous ingrowth surface. This decision is made by the surgeon, and is usually based on his or her preference, the patient's age, activity level and bone quality. If you wish to discuss it, your surgeon should be more than happy to do so. WHAT ARE THE RESULTS? The results of hip replacement are truly outstanding in the great majority of cases. The pain is relieved, walking is greatly improved with less or no limp, and patients can participate in many more activities. In fact, hip replacement surgery provides the greatest improvement in quality of life of any medical or surgical treatment available today for any condition. You really will feel much better and be able to do much more. WHAT COMPLICATIONS MIGHT OCCUR? Major complications from hip replacement surgery have become rare, but include such problems as infection, blood clots and a dislocation of the new hip joint. The biggest long-term problem with hip replacement is "wearing out" and "loosening" of the prosthesis, over time. HOW LONG WILL MY HIP REPLACEMENT LAST? Despite a common misbelief that they only last a few years, hip replacements should last at least 10 to 15 years in most patients, and some studies have shown them to last well beyond 20 to 25 years. However, in a patient who is very young, heavy or active, a hip replacement may "wear out" or "loosen" prematurely. DO I HAVE TO BE A CERTAIN AGE TO HAVE A HIP REPLACEMENT? Most hip replacements are done in people between the ages of 55 and 75, as this is the most common age to develop degenerative arthritis of the hip. Most surgeons are leery of performing hip replacements in patients under the age of 50, because of the possibility of failure over time and the need for a repeat or revision surgery. Revision surgery is always possible, but is more difficult and has a lower success rate than the first hip replacement. WHAT CAN I DO AFTER MY HIP REPLACEMENT? The real answer to this question is - pretty much anything you want. However, I recommend patients maintain a reasonable level of activity, including walking, swimming, bicycling, golf or doubles tennis. What is not reasonable, and will probably be harmful to the longevity of a replaced hip, are activities like jogging, competitive tennis, basketball, volleyball, etc. HOW LONG DOES IT TAKE TO RECOVER? WHAT IS THE RECOVERY LIKE? The average time for full recovery is approximately two to three months and varies with the individual. This is when there is no pain or limp, and full activities can be resumed. Physical therapy is begun while in the hospital for the first three days. Therapy is then continued either at home or in a specifically designated rehab unit for the next few days. Outpatient therapy is generally recommended thereafter for a period of up to six to eight weeks from the time of surgery. By that time, most patients have been advanced off of a walker or crutches, and can do the exercises on their own. HOW OFTEN DO I COME BACK TO SEE MY SURGEON? I prefer to see my patients five to six weeks after surgery and again one month later. At this pint, most patients are usually discharged until a year from the date of surgery. It is recommended that you continue to see your orthopaedic surgeon on a regular basis (every one to two years) for a lifetime. It is very important to catch any problems that might be developing in an early stage, and x-rays are the only way to know if there is a problem for sure. Therefore, if you have had a hip replacement already, and have not seen an orthopaedic surgeon within the last year, you should come in for routine follow-up. In summary, I would state that hip replacement surgery is a wonderfully successful operation for treating the painful, arthritic hip. It is a very safe and reliable procedure that not only relieves pain and restores function, but also can greatly improve your quality of life. And, although it is a major surgery with a fairly lengthy recovery time, the results are generally excellent and longstanding. Dr. Mulliken is an orthopaedic surgeon who specializes in joint replacement surgery. If you would like more information, you can reach him at 410-337-7900. He sees patients at the Orthopaedic Associates' offices in BelAir, Havre de Grace and Towson. Back to Top

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