Live Chat "Ask the Experts" Transcript

The following is the live transcript from Kaweah Delta Health Care District's “Ask the Experts” Live Chat with Orthopedic Surgeon Andre Edmonds on May 20, 2014.

Kaweah Delta Health Care District: Our first question is from Lacy Blaszak: I continuously have right hip pain deep in the crease where my torso meets my leg and all along the outside high up on my waist.. sometimes pins and needles and other times dull.... my pain specialist explained that it's because of my back pain but after a couple of epidural injections my back pain has subsided... but my hips continue to feel the same... I have scoliosis and my left hip sits visibly higher than my right.... I have heard that there is a way to surgically re-align my hips.. is this true? What is the procedure? Recovery time? Physicians practicing this?

Andre Peter Edmonds Lacy Blaszak: What you were told is false. Your pain has nothing to do with your hip joint. You have mainly a back problem due to your scoliosis; your hip is not the source of your problem. Numbness tingling is all nerve pain and that is from your back. In terms of leveling your hips, I need to know if you are talking about your pelvis. Your pelvis is likely higher on one side compared to the other. The hip joint is actually in the groin. And the level of your hip joint will not be affected by a spinal problem. The correction of your scoliosis may improve things, but major surgery will have blood loss and no guarantees. You need to see a spinal surgeon at a major medical center such as Stanford or UCLA or Cedar Sinaii.This is major league surgery.  

Kaweah Delta Health Care District Our second question was submitted by Robert. I had a full knee replacement in Nov. 2012. I received PT for 5 months, 2 times per week. I also had a manipulation and scar tissue removed in June 2013 with Pt for 4 weeks following. I continue to have pain in the area surrounding the replacement and do not have complete flexing on the joint. I am taking Tramadol 50 mg 3 times a day for pain and using a Lidocaine patch at night. I continue to exercise at Lifestyles and ride a stationary bike 3 times a week for up to 20 minutes. My question is: Why do I continue to have pain, what can I do for the pain?  

Andre Peter Edmonds Robert: Not every knee replacement can be guaranteed to be successful. Scaring is often related to the patient’s tendency for forming lots of scar tissue. Also, if there is a delay in getting your knee moving, one can get scar tissue or adhesions. This sometimes very difficult to get over. I recommend a good aqua physical therapy program and deep massage. Surgery is definitely not the answer. There is an excellent aqua therapy program through Kaweah Delta Rehabilitation Hospital. An intensive home physical therapy program is always beneficial. If you wish you may get another opinion by a board certified orthopedic surgeon with experience in total joint replacement. Kaweah Delta was rated No. 1 in the state of California for total joint replacement recently by HealthGrades and one of their orthopedic surgeons was rated one of the top orthopedic surgeons in America for total joint replacment in 2012 and 2013.  

Kaweah Delta Health Care District Great, Thanks Dr.Andre Peter Edmonds. Now, let's move to some of the questions you are most frequently asked.  

Kaweah Delta Health Care District One of the questions I get a lot is, “Doctor when can I drive?” The answer is a legal question and not a medical question in terms of getting permission to drive. You have to decide when you feel you are safe to drive. The physician can give you some recommendations. I personally like to use the recommendations of the American Academy of Orthopedic Surgeons which are as follows…for total joint replacement the recommendation is about six weeks for the affected joint. If it is only your left leg then basically you can drive earlier because you have control over the brakes and accelerator with your right leg which is what most people do. In terms of arthroscopic surgery the recommendation is minimum four weeks for the affected driving leg. For a nasty ankle fracture, it can sometimes be up to 2 months. Good judgment on your part is important since you are liable for any mishaps when driving. In terms of upper extremity surgery, you have to use your common sense. You need to have control of the steering wheel with your arms.  

Kaweah Delta Health Care District We were just asked a question from Savannah. Here it is: Hello. Ever since I had my first child in 2007 ive had severe knee pain havr had xrays done but was told they found NOTHING wrong with my knees it has been to the point when ive been carried into an er and still get bo result just pain medication...what could possibly be wrong with my knees?

Andre Peter Edmonds Savannah, first of all you need to be examined by a board certified orthopedic surgeon to make sure your pain is indeed from your knee and not referred pain from your back or hips. In young ladies it is not uncommon for them to have a maltracking knee cap. This is can also be further aggravated by flat feet. Typically this gives more pain walking up stairs than downstairs also getting up from low chairs and squatting. If you have had an injury then you may also have a meniscus problem. Plain xrays will not show any soft tissue problems. Therefore you should definitely be seen by a board certified orthopedic surgeon. At Kaweah Delta we have excellent, well respected, board certified orthopedic surgeons. Weight gain with pregnancy is also a major aggrevating factor for knee cap problems.

Andre Peter Edmonds Another frequently asked question I get is: How does obesity affect my joints? In general, obesity in a person with normal joints should not really have any major problems unless it is due to a loose and very mobile knee cap. However, if a person has a damaged joint, obesity will really worsen the problem. This will increase the wear and tear in the cushion layer called the articular cartilage edge. Note that the articular cartilage is not the meniscus which is fibro cartilage. For this reason people with arthritis I do recommend them taking over the counter Glucosamine.Glucosamine strengthens the damaged articular cartilage slows down the further break down.

Andre Peter Edmonds In summary, obesity does not cause arthritis but if you have arthritis in the joints then obesity will aggravate it a lot and lead to further wear and tear.Obesity will put an enormous amount of stress on the supporting ligaments and muscle and this will cause pain. Like · 18 hours ago

Andre Peter Edmonds Here is another frequently asked question: After my Total Knee Replacement, do I have to use a CPM (Continuous Passage Motion machine)? Here is my response: The CPM machine was invented by my professor Dr. Salter. It was initially designed for treating infected joints and damaged articular surfaces. It was subsequently used in total joint rehabilitation to allow effortless motion of the knee joint. I personally, and many other orthopedic surgeons, have extensively have prescribed this post operatively for a total knee. I personally feel it makes a difference. However, recent data suggests that there is no difference at 4 weeks comparing those that used a CPM machine and those who did not. Nowadays with the cost factor in renting a CPM machine, many insurance companies will balk at paying for the CPM machine rental. Most knee replacement surgeons I know still use them, and most of us feel that it is beneficial in getting the patient moving and walking early on.

Kaweah Delta Health Care District It looks like we are all out of questions for tonight. We would like to thank everyone who asked questions tonight and thanks again to Dr. Andre Peter Edmonds for taking time to answer them. Andre Peter Edmonds It was great to be here with all of you tonight. I hope this helped answer a lot of questions for people with hip and knee pain. If you need anything further, you can find the contact information for all the orthopedic surgeons practicing at Kaweah Delta at www.kaweahdelta.org.    
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