Physician Presentation: Dr. Rogers's Anterior Hip Seminar

by TOI Admin February 3, 2014

Dr. RogersIs pain in your hip taking away the life you love? Is playing golf, working in the garden and chasing grandkids impossible because it just hurts too much? If you are among the millions who live with hip pain, it may be time for a decision. TOI's Dr. Marc Rogers will be presenting the Anterior Approach to Hip Replacement.

Monday, February 10th
The Villages Comfort Suites
2 p.m. to 3 p.m
To register, please call 1-800-530-1188.

 

 

 

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Community Involvement | Hip

Keeping You Bodywise: Outpatient Treatment For Osteoporotic Pelvic Fractures

by TOI Admin December 16, 2013


By Richard E. Kinard, M.D.

Pelvic fractures, also known as insufficiency fractures, are common osteoporotic fractures of the pelvis and are often overlooked or misdiagnosed. The most common of these pelvic fractures involves the sacrum, known as a sacral insufficiency fracture. Although other parts of the pelvis may suffer similar fractures, this article describes the symptoms, diagnosis, and available treatments for sacral insufficiency fractures.

The Problem

In a sacral insufficiency fracture, the bone is weakened, usually from osteoporosis, to the extent that it gives way with only body weight or minimal trauma. Sacral insufficiency fractures have existed as long as osteoporosis but have received less attention than back and hip fractures. In fact, this condition was only first described in literature in 1982.(1) One reason this diagnosis was not recognized is the nonspecific, but sometimes severe, symptoms. The symptoms overlap with that of other low back problems, such as disc herniation, facet arthritis, and compression fractures.For example: When an elderly patient presents to the emergency room, the first test usually ordered by an ER physician is an X-ray. When testing for a sacral insufficiency fracture, an X-ray will almost always be normal. Since the X-ray result is "negative," the patient is often sent home or even kept in the hospital with continued pain and no diagnosis.

Another reason for recent recognition of sacral insufficiency fractures as a diagnosis is that sophisticated imaging studies such as MRIs, CTs, and bone scans were not introduced until the 1970s and 1980s. One of these three sophisticated imaging studies is needed to accurately make the diagnosis.

Diagnosis

Sacral insufficiency fractures are difficult to diagnose. When a previously active elderly patient, more commonly a female, presents with severe new pain in one or both buttocks and is unable to move about, the patient should be considered to have a sacral insufficiency fracture until proven otherwise. Symptoms are often insidious with no known event. Other times, symptoms start after a minor fall on the buttocks, a misstep off a curb, or sitting down too hard. The pain may radiate to the groin or down the back of the leg.

An MRI is the best test to diagnose a sacral insufficiency fracture. Often, however, a routine lumbar MRI is ordered, which includes only a small upper portion of the sacrum. If a patient is not able to have an MRI, a CT is the second best test to diagnose the fracture. Even with a CT test, a sacral insufficiency fracture can be very subtle and often missed, unless there is a high index of suspicion by the radiologist. Another test to diagnose a sacral insufficiency fracture is the radionuclide bone scan. Radionuclide bone imaging is sensitive for these fractures but unfortunately does not show the actual fracture, just the abnormal bony activity or "hot spot."

Conservative Treatment

Conservative treatment, which is usually started when the initial diagnosis is made, was the only treatment until 10 years ago. However, it is not without risk. Because this involves bed rest, partial weightbearing, and pain medication, there are risks of deep venous thrombosis (the formation of a blood

clot in a deep vein), pulmonary embolism (blockage in one or more arteries of your lungs), decrease in muscle strength, pneumonia, and depression. Pain medication can cause significant constipation in this patient population. Elderly patients lose 10 percent of their muscle mass for every week of bed rest. Mental depression can be significant if immobilization is prolonged in a previously independent person.

Enter Sacroplasty

Sacroplasty as a treatment for sacral insufficiency fractures was first described in 2002.(2) The procedure is an extension of vertebroplasty and kyphoplasty, which have gained acceptance as treatments for vertebral compression fractures. Injection of bone cement into a vertebral compression fracture originated in France in 1987, but was not popularized until the 1990s in the United States.

 Sacroplasty lagged behind in popularity for several reasons. One of these reasons is that sacral insufficiency fractures were less likely to be recognized and were thought to be shear fractures as opposed to compression fractures. A second reason is the technique of sacroplasty is more technically challenging due to the complex shape of the sacrum.

Sacroplasty is performed as an outpatient procedure with minimal to no sedation. Using local anesthesia, a needle is placed into the largest part of the sacrum called the sacral ala. This can be performed with fluoroscopic or CT guidance; both methods have advantages. Once the needle is in the proper location, polymethylmethacrylate (PMMA - bone cement) is mixed and slowly injected into the fractured area. The cement hardens within an hour. The patient lies prone or supine for the hour after the procedure. Once the hour passes, the patient may ambulate, usually with much less pain than before the procedure.

Complications, which are very unlikely, include the chance of bleeding or infection, like any other invasive procedure. There is also a very slight chance that the cement may leak out of the proper fractured area into a vein or nerve canal.

Post-procedure care is minimal. Driving on the day of the procedure is not allowed due to the possible use of sedatives. Normal activity with routine osteoporotic precautions can be resumed the next day. If there has been a delay of treatment or diagnosis for more than a couple of weeks, or if the patient has been debilitated, physical therapy and/or rehabilitation may be needed to build strength and regain mobility.

 

References:
1. Lourie H. Spontaneous osteoporotic fracture of the sacrum: An unrecognized syndrome of the elderly. JAMA. 1982;1982(248(6)):715-7.
2. Garant M. Sacroplasty: a new treatment for sacral insufficiency fracture. Journal of vascular and interventional radiology : JVIR. 2002;13(12):1265-
3. Galibert PD, H.; Rosat, P.; Le Gars, D. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie. 1987;1987(33(2)):166-8.
4. Peters KR, Guiot BH, Martin PA, Fessler RG. Vertebroplasty for osteoporotic compression fractures: current practice and evolving techniques. Neurosurgery. 2002;51(5 Suppl):S96-103. Epub 2002/09/18. PubMed PMID: 12234436.
5. Jensen ME, Evans AJ, Mathis JM, Kallmes DF, Cloft HJ, Dion JE. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR American journal of neuroradiology. 1997;18(10):1897-904. Epub 1997/12/24. PubMed PMID: 9403451.

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Hip

Physician Presentation: Dr. Marc Rogers's Anterior Approach to Hip Replacement

by TOI Admin December 9, 2013


Is pain in your hip taking away the life you love? Is playing golf, working in the garden and chasing grandkids impossible because it just hurts too much? If you are among the millions who live with hip pain, it may be time for a decision. TOI's Dr. Marc Rogers will explain the benefits of the anterior approach to hip replacement at The Villages Comfort Suites on December 16th from 2 p.m. to 3 p.m.


December 16th, 2013
The Villages Comfort Suites (1202 Avenida Central)
To register, please call 1-800-530-1188.



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Community Involvement | Hip | Pain

Keeping You Bodywise: Do I Have Osteoarthritis or Osteoporosis?

by TOI Admin December 2, 2013


By Rizwan Mansoor, M.D.

In my practice, I often come across the question “Do I Have Osteoarthritis or Osteoporosis?” It is an obvious answer to some but may be very confusing for many.  Despite the fact that osteoporosis and osteoarthritis are completely  different conditions, they are frequently confused because both names start with “osteo.”  The following article describes the key differences between osteoarthritis and osteoporosis.

When one takes a look at the words “osteoporosis” and “osteoarthritis” it is easy enough to think that these conditions are closely related. Despite the “osteo” portion of each word, osteoporosis and osteoarthritis are like apples and oranges. The root word, osteo, means bone. While both conditions impact the bones, osteoarthritis “-arthritis” effects the joints between the bones while osteoporosis “-porosis,” meaning porous bone, effects the bones directly.

Osteoarthritis

There are over one hundred types of arthritis, but the most common is osteoarthritis. Osteoarthritis, also known as degenerative joint disease, is a form of arthritis caused by inflammation, breakdown, and the eventual loss of cartilage in the joints. According to The Arthritis Foundation, about 27 million Americans are affected by osteoarthritis.

Risk factors associated with osteoarthritis include obesity, genetics and previous trauma to a joint. Osteoarthritis is more common among females than males, especially after the age of 45 years. Although osteoarthritis is more common in older people, younger people can develop it - usually as the result of a joint injury, a joint malformation, or a genetic defect in joint cartilage.

Osteoarthritis can be a very painful, debilitating and mobility-restricting condition. Many seek treatement because of the associated pain. Osteoarthritis can be diagnosed and managed with the help of a Rheumatologist. Rheumatologists offer a full evaluation of the patient’s osteoarthritis to confirm the diagnosis and make sure the patient does not have a different type of joint problem, such as gout or rheumatoid arthritis.

There are many types of treatments for osteoarthritis that are designed to reduce joint pain, increase flexibility and improve joint function. Treatments for osteoarthritis include decreasing the amount of work the joint has to do, exercise, pain relief medication, heat and ice treatments, and weight control. Severe arthritis may be treated with joint replacement surgery.

Osteoporosis

While osteoarthritis is a degeneration of a joint, osteoporosis is the loss of bone mass which increases the risk of fractures, even spontaneously. Osteoporosis is a painless condition, which only becomes painful if one experiences its consequences, i.e. a fracture or a broken bone.

It is important to remember that pain is not always a symptom of a disease process. For example, pain symptoms are not present in diabetes, high blood pressure or thyroid disease. Since osteoporosis is an asymptomatic condition and prevalent and progressive in the aging population, it has to be actively looked for. Early intervention and management is important to significantly reduce the sickness consquent to bone fractures of the spine and hips. According to the American Academy of Orthopaedic Surgeons (AAOS), patients who suffer hip fractures are at higher risk for preamature death or loss of indepenence after the fracture.  In fact, those who experience the trauma of an osteoporotic hip fracture have a 24 percent increased risk of dying within one year following the fracture.

Rheumatologists are experts in diagnosing osteoporosis and can provide and monitor the best treatments for this condition. The risk of osteoporosis may also be reduced by being aware of risk factors and taking action to slow down bone loss. Low bone mineral density is a major risk factor for fracture, the main consequence of osteoporosis. Osteoporosis is more common in women over the age of 50 and after menopause. Other key risk factors include advanced age, petite size, prior low-trauma fractures, smoking, increased alcohol consumption, rheumatoid arthritis, dietary deficiencies, a history of falls and use of certain medications, such as steroids. Family history of a fragility fracture is often a contributing factor.

Osteoporosis can be treated with lifestyle changes and use of prescription medication. Paying attention to diet (adequate calcium and vitamin D intake) and regular physical activity are important lifestyle changes. Weight-bearing and strength training exercises can help to manage pain and improve the strength of bones and muscles, which helps prevent falls. Broken hips caused by osteoporosis usually need to be repaired surgically. This can include the use of specialized “pins and plates,” but can also involve hip replacement surgery. This is determined by the orthopaedic surgeon based on the exact type of hip fracture that occurred. If you have osteoporosis, there are effective medications which can reduce your risk of fracture.

The take-home message of this article is to be aware of the facts and to be proactive in seeking expert advice from your rheumatologist for appropriate screenings and treatments. Both osteoarthritis and osteoporosis can effect the quality of life, each in different ways. Since both are a part of the aging process, preventative measures should always be taken. As the saying goes, “a stitch in time saves nine.”

Dr. Rizwan Mansoor is Board Certified in Rheumatology by the American Board of Internal Medicine. His clinical interests include the diagnosis and treatment of arthritis, osteoporosis, fibromyalgia and autoimmune diseases. Dr. Mansoor attended medical school at Dow Medical College and completed his residency at the Bergen Regional Medical Center in Paramus, NJ.  Additionally, he obtained his fellowship training at the University of Florida. Dr. Mansoor practices at The Orthopaedic Institute’s Lake City, Gainesville and Ocala facilities.

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General Information | Hip | Knees

Physician Presentation – Dr. Marc Rogers's Anterior Approach to Hip Replacement

by TOI Admin September 9, 2013

 

Did you know that with the anterior approach to hip replacement, the hip is accessed from the front of the joint and may allow an accelerated recovery? TOI's Dr. Marc Rogers will be presenting the Anterior Approach to Hip Replacement.

 

September 16th, 2013

1 pm to 2 pm

Comfort Suites - The Villages

To register, please call 1-800-530-1188.

 

 

Welcome to TOI's Blog!

TOI's Blog is dedicated to patient education with topics addressing current issues in health and medicine. We will also blog about some of our other favorite things, like community events, our wonderful employees, helping the environment and whatever else comes to our minds! We hope the information contained in our blog is fun to read, assists you in making educated decisions regarding your health, and supports your decision to select TOI when you are in need of quality musculoskeletal care.

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