Home Community Chat Transcripts-2/19/01

Orthopedic Surgery with Dr. Ken Merriman

InsightHostKJ> OK.....let's get started! Dr Merriman is here to answer our questions about orthopedic surgery. If you have a question type a ? and wait until i call on you. DO NOT ask your question until you are called on

mitsy714> I need to have ankle fusion surgery. Please give me details what to expect for surgery and recovery.

DrMerriman> you should expect an anesthetic either spinal or general or possible a more peripheral block

mitsy714> Please tell me what to expect after surgery and about recovery

DrMerriman> surgery would usually use screws to fix the joint in place the place in a splint

DrMerriman> might be in hosp a day or so or evenlonger if and problems, non weight bearing X 6 wks, crutches or walker

mitsy714> how long before it can bear weight

DrMerriman> after 6 weeks if xrays look good start to full weight bear

Nubby> i had a synovectomy and arthroscope on my right wrist can the problem come back?

DrMerriman> any problem can come back unfortunately

Melanie> I need a good ortho doc, but each time I am referred to ortho doc on one particular body part - hands, feet, etc. Is this necessary for evaluation only?

DrMerriman> yes a problem of the fragmentation of care

DrMerriman> hard to solve in this high tech world

DrMerriman> maybe use a general orhtopod that you like as the team captian

swimmer> I had an ankle fusion. Was casted and non weight bearing for 3 MONTHS. I know my Doc is conservative, but does it have to be that long for good results? Am having left ankle fused in May

DrMerriman> plans for post op care vary depending on the situation. i perfer when possible to return to normal what ever that is as soon as possible

swimmer> so he is just not doing it to torture me? LOL

DrMerriman> torture is of course part of it

swimmer> LOL

DrMerriman> I try to intreanlly fix things so that we can be in a removeable cast within a couple of weeks if the paitent is reasonable

swimmer> meaning doesn't overdo?

DrMerriman> so a cast is not needed only to protect leg

DrMerriman> yes meaning listens and trys to gradually advance activity as we work together on

TEXAS> What is the recovery time from foot surgery, please? Fragmentation of patient! will change tortures from shoes to surgeons!

DrMerriman> also elevation post op is very very important to prevent swelling

DrMerriman> depends on what is done to the foot

TEXAS> Large owies on right foot and hammer toe

DrMerriman> could be as little as 2 wks or up to >3 mo

DrMerriman> ~6wsk

Giggles> I am having a synovectomy on both knees and partall re-build of the right in arouond 5 weeks time...what can I expect?

DrMerriman> doing both at once ??

Giggles> from what I have told yes

DrMerriman> if so that's a bit to go through

Giggles> I have to go to a hosp 800 kms away from home so they want to get it over and done with together

Giggles> 550 miles

DrMerriman> each case is unique

DrMerriman> so maybe in your case it is gbetter to do both

DrMerriman> what is your diagnosis?

Giggles> how long in hosp and than post op care...what would I have to do?

Giggles> RA....no cartlidge in the knees, and the bone ends are grating femur and tib

DrMerriman> well it is hard to say how long in hosp and it will be a bit of therapy getting things going again but it's doable

Giggles> I was told anything up to 6 months? would that be correct

DrMerriman> ask the ins co how long you can stay lol

Giggles> lol we dont need insurance here ( i'm in australia )

DrMerriman> 6mo of rehab not 6mo in hosp

Lucy> I have a right wrist that has been swollen for over a year and feel it may be from a car accident rathter then the RA, and the hand sugeon says it looks like it may have a broken bone? but wasn't sure, he says he could either fuse or take a piece of bone.

DrMerriman> ok what to do- well each casre is so different

DrMerriman> but hard to say what is right here without much more info

Lucy> alright then I am just gonna live with it till no more

DrMerriman> certainly you can hurt a wrist with RA

DrMerriman> living with it is a good option esp if you can-surgery is for those who can't live with it

Melanie> Dr. M, can you describe what a "fusion" involves. Neurosurgeon mentioned this regarding my spine, but wrist is also needing eval.

DrMerriman> fusion is to make a joint or disc space become solid bone

DrMerriman> do this by fixing them together some way and adding some bone graft or other stufft to make it heal esp if they smoke as that retards healing

DrMerriman> use screws and other devices to do the fixing and various types of bone grafts to stimulate healing

tigger> about 10 years ago i had shoulder reconstruction. capsular shift, no my shoulder is subluxing posteriorly and i wake up with an numb arm. is this common?

DrMerriman> not common but it certainly can happen

tigger> does leaving it as is cause more damage?

DrMerriman> maybe it a bit too tight in fornt therefore slips out back -numbness is a reaction to the subluxation

DrMerriman> maybe

DrMerriman> go see a good shoulder specialist

tigger> does that mean the strengthening exercises internal rotation etc are bad for it?

DrMerriman> maybe they are not so good

Harriette> 4 &5 disc's are bulging, what can be done to help them?

DrMerriman> do exercises lose weight

DrMerriman> use a lumbar roll

Harriette> I am not that heavy

DrMerriman> sorry I am

DrMerriman> still the lumbar roll

DrMerriman> there are some new treatments but the efficacy is open to queastion

InsightHostKJ> what is a lumbar roll?

DrMerriman> roll up a couple of hand towels or what ever and tape it up in a roll ~ 2.5-3in across & ~ 7-8 in long place behind back while sitting it helps

Pstar> Dr Merriman, would you recommend a hip revision on a 37 year old? I had my first hip replacement 14 years ago, but now , prostesis is loose and very painful

DrMerriman> if it is lose & hurts & there is progressive bone loss then it must be done or bigger problems ahead

DrMerriman> you do not have much of a choice

Pstar> how successful is the 2nd surgery?

DrMerriman> usually quite good but it is a bigger surgery

Pstar> what are the risks and complications

DrMerriman> infection, dvt, blood clots, dislocation, leg length discrepency etc etc

Pstar> so basically like the first surgery

DrMerriman> a bigger surgery is a bigger risk

Katie> my momwho Has arthritis had hip replaced about 15 years ago...

Katie> over teh weekend it right leg flew ot to the side and now it feels like she is sitting on a golf ball. x-rays showed nothing...could she still have some dislocaiton. x-rays showed a lot of calcificaiton

DrMerriman> get it checked out by an orthoprdic surgeon

Katie> her internist will not refer her

DrMerriman> OK this may be heterotopic bone formation

DrMerriman> bone formed in the muscle

DrMerriman> if it caused enough problems you could excise it but I wouldn't be in a rush to do so, maybe it will calm down

Katie> she is almost 80 and has heart problems , polio in her other leg and polymyalgia rheumatic too.

DrMerriman> sounds as though surgery is not such a good idea here

DrMerriman> that leaves symptomatic treatment- a gel seating pad might help

Giggles> ( question from Panda ) she wishes to know if a arthroscope of an elbow showed joint overuse could this also be arthritis. The synovium looked like spaghetti..... ( she will read the answer later..thanks Dr M)

DrMerriman> they are kind of the same thing really overuse can cause arthritis

DrMerriman> like extreme overuse such as pro football

swimmer> What is your opinion of the ankle replacements vs ankle fusion

DrMerriman> I hear tell that the new ankle arthroplasty is working better but I do not do the at least not yet

DrMerriman> ?? how long will it last-you hope of min 10 yrs

DrMerriman> a good fusion lasts but may get arthritis in surounding joints

swimmer> can they put those in already fused ankles

DrMerriman> no- at least i highly doubt it

DrMerriman> god knows what they will try next

Melanie> I've had different interpretations of my x-rays by two different physicians. What is the best way to make sure I get a true interpretation of joint condition?

DrMerriman> learn how to read you own xrays

InsightHostKJ> LOL

DrMerriman> really that might not be a bad idea

Katie> LOL...i transcribed radiology and it is amazing how two different rads can read the same film totally different

Melanie> I'm still learning the lab technology. lol

DrMerriman> any way there is a certain difference in how they look at them

DrMerriman> I agree

DrMerriman> I always look at may own xrays & with the patient

Melanie> My ortho doc and rheumy disagree. I tend to believe the ortho doc.

DrMerriman> well really xrays are useful but only part of the whole picture

DrMerriman> of course always believe the ortho doc always

DrMerriman> truly we fight over those sutpid xrays ourselves so there are differences of opinion

Katie> LOL

Katie> could you please explain frozen shoulder?

DrMerriman> frozen shoulder means srar tissue or adhesions in the joint sticking it togeather

DrMerriman> many treatments-all work some times

Katie> my shoulder was frozen once, then reduced and now I have impingement syndrome

DrMerriman> sure that can happen

DrMerriman> for shoulder gentle pendulum exercises 7 exrecise in pool, heat shoulder with heating pad then do exercises, stretch shoulder as tolerated, sometimes a cortisone shot helps

TEXAS> when achilles tendon is seeming to shorten...will exercise lengthen it?

DrMerriman> long term static stretch is best

DrMerriman> for achiles I like a dorsiflexion night splint

gwyn> i just had a total hip replace ment 5 weeks ago can you tell me why they said i could not have a bath or go swimming for 3 months?

DrMerriman> seems a bit srtingent, but it is re the risk of dislocation, also some fear of infection

gwyn> i thought swimming would be gental enough on the hip

gwyn> ahh yeah they are worried bout that

DrMerriman> sure infection will give yo a very bad day and or life

DrMerriman> actually i will get some patients in the pool pretty early 4 wks or so if the wound is well healed

gwyn> it seems to be heald ok is very itchy!

DrMerriman> use an aloe cream that seems to help some, also vit e

InsightHostKJ> does vit e really helps the scars shrink?

DrMerriman> it helps a bit along with a- a&e help with skin integrity

InsightHostKJ> Dr Merriman...thanks so much for coming! Any closing thoughts for us?

DrMerriman> hope you got some answers

Lucy> Thank you very much Dr

gwyn> thx dr M

swimmer> Thanks

Katie> Thank you Dr Merriman