Does an ACL Injury Require Surgery

Does an ACL Injury Require Surgery

The following article provides in-depth information about treatment for anterior cruciate ligament injuries. The general article, Anterior Cruciate Ligament (ACL) Injuries, provides a good introduction to the topic and is recommended reading prior to this article.

The information that follows includes the details of anterior cruciate ligament (ACL) anatomy and the pathophysiology of an ACL tear, treatment options for ACL injuries along with a description of ACL surgical techniques and rehabilitation, potential complications, and outcomes. The information is intended to assist the patient in making the best-informed decision possible regarding the management of ACL injury.

Anatomy

normal knee anatomy

Normal knee anatomy.  The knee is made up of four main things: bones, cartilage, ligaments, and tendons.

The bone structure of the knee joint is formed by the femur, the tibia, and the patella. The ACL is one of the four main ligaments within the knee that connect the femur to the tibia.

The knee is essentially a hinged joint that is held together by the medial collateral (MCL), lateral collateral (LCL), anterior cruciate (ACL) and posterior cruciate (PCL) ligaments. The ACL runs diagonally in the middle of the knee, preventing the tibia from sliding out in front of the femur, as well as providing rotational stability to the knee.

The weight-bearing surface of the knee is covered by a layer of articular cartilage. On either side of the joint, between the cartilage surfaces of the femur and tibia, are the medial meniscus and lateral meniscus. The menisci act as shock absorbers and work with the cartilage to reduce the stresses between the tibia and the femur.

Description

ACL tear

The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments of the knee.  In general, the incidence of ACL injury is higher in people who participate in high-risk sports, such as basketball, football, skiing, and soccer.

Approximately half of ACL injuries occur in combination with damage to the meniscus, articular cartilage, or other ligaments. Additionally, patients may have bruises of the bone beneath the cartilage surface. These may be seen on a magnetic resonance imaging (MRI) scan and may indicate injury to the overlying articular cartilage.

arthroscopic images of normal ACL and ACL tear

(Left) Arthroscopic picture of the normal ACL. (Right) Arthroscopic picture of torn ACL [yellow star].

Cause

It is estimated that the majority of  ACL injuries occur through non-contact mechanisms, while a smaller percent result from direct contact with another player or object.

The mechanism of injury is often associated with deceleration coupled with cutting, pivoting or sidestepping maneuvers, awkward landings or “out of control” play.

Several studies have shown that female athletes have a higher incidence of ACL injury than male athletes in certain sports. It has been proposed that this is due to differences in physical conditioning, muscular strength, and neuromuscular control. Other hypothesized causes of this gender-related difference in ACL injury rates include pelvis and lower extremity (leg) alignment, increased ligamentous laxity, and the effects of estrogen on ligament properties.

Doctor Examination

Immediately after the injury, patients usually experience pain and swelling and the knee feels unstable. Within a few hours after a new ACL injury, patients often have a large amount of knee swelling, a loss of full range of motion, pain or tenderness along the joint line and discomfort while walking.

When a patient with an ACL injury is initially seen for evaluation in the clinic, the doctor may order x-rays to look for any possible fractures. He or she may also order a magnetic resonance imaging (MRI) scan to evaluate the ACL and to check for evidence of injury to other knee ligaments, meniscus cartilage, or articular cartilage.

MRI of ACL tear

An MRI of a complete ACL tear. The ACL fibers have been disrupted and the ACL appears wavy in appearance [yellow arrow].

In addition to performing special tests for identifying meniscus tears and injury to other ligaments of the knee, the physician will often perform the Lachman’s test to see if the ACL is intact.

If the ACL is torn, the examiner will feel increased forward (upward or anterior) movement of the tibia in relation to the femur (especially when compared to the normal leg) and a soft, mushy endpoint (because the ACL is torn) when this movement ends.

Natural History

What happens naturally with an ACL injury without surgical intervention varies from patient to patient and depends on the patient’s activity level, degree of injury and instability symptoms.

The prognosis for a partially torn ACL is often favorable, with the recovery and rehabilitation period usually at least 3 months. However, some patients with partial ACL tears may still have instability symptoms. Close clinical follow-up and a complete course of physical therapy helps identify those patients with unstable knees due to partial ACL tears.

Complete ACL ruptures have a much less favorable outcome without surgical intervention. After a complete ACL tear, some patients are unable to participate in cutting or pivoting-type sports, while others have instability during even normal activities, such as walking. There are some rare individuals who can participate in sports without any symptoms of instability. This variability is related to the severity of the original knee injury, as well as the physical demands of the patient.

About half of ACL injuries occur in combination with damage to the meniscus, articular cartilage or other ligaments. Secondary damage may occur in patients who have repeated episodes of instability due to ACL injury. With chronic instability, a large majority of patients will have meniscus damage when reassessed 10 or more years after the initial injury. Similarly, the prevalence of articular cartilage lesions increases in patients who have a 10-year-old ACL deficiency.

Nonsurgical Treatment

In nonsurgical treatment, progressive physical therapy and rehabilitation can restore the knee to a condition close to its pre-injury state and educate the patient on how to prevent instability. This may be supplemented with the use of a hinged knee brace. However, many people who choose not to have surgery may experience secondary injury to the knee due to repetitive instability episodes.

Surgical treatment is usually advised in dealing with combined injuries (ACL tears in combination with other injuries in the knee). However, deciding against surgery is reasonable for select patients. Nonsurgical management of isolated ACL tears is likely to be successful or may be indicated in patients:

  • With partial tears and no instability symptoms
  • With complete tears and no symptoms of knee instability during low-demand sports who are willing to give up high-demand sports
  • Who do light manual work or live sedentary lifestyles
  • Whose growth plates are still open (children)

Surgical Treatment

ACL tears are not usually repaired using suture to sew it back together, because repaired ACLs have generally been shown to fail over time. Therefore, the torn ACL is generally replaced by a substitute graft made of tendon.

  • Patellar tendon autograft (autograft comes from the patient)
  • Hamstring tendon autograft
  • Quadriceps tendon autograft
  • Allograft (taken from a cadaver) patellar tendon, Achilles tendon, semitendinosus, gracilis, or posterior tibialis tendon

Patient Considerations

Active adult patients involved in sports or jobs that require pivoting, turning or hard-cutting as well as heavy manual work are encouraged to consider surgical treatment. This includes older patients who have previously been excluded from consideration for ACL surgery. Activity, not age, should determine if surgical intervention should be considered.

In young children or adolescents with ACL tears, early ACL reconstruction creates a possible risk of growth plate injury, leading to bone growth problems. The surgeon can delay ACL surgery until the child is closer to skeletal maturity or the surgeon may modify the ACL surgery technique to decrease the risk of growth plate injury.

A patient with a torn ACL and significant functional instability has a high risk of developing secondary knee damage and should therefore consider ACL reconstruction.

It is common to see ACL injuries combined with damage to the menisci, articular cartilage, collateral ligaments, joint capsule, or a combination of the above. The “unhappy triad,” frequently seen in football players and skiers, consists of injuries to the ACL, the MCL, and the medial meniscus.

In cases of combined injuries, surgical treatment may be warranted and generally produces better outcomes. As many as half of meniscus tears may be repairable and may heal better if the repair is done in combination with the ACL reconstruction.

Surgical Choices

Patellar tendon autograft prepared for ACL reconstruction

Patellar tendon autograft prepared for ACL reconstruction.

Patellar tendon autograft. The middle third of the patellar tendon of the patient, along with a bone plug from the shin and the kneecap is used in the patellar tendon autograft. Occasionally referred to by some surgeons as the “gold standard” for ACL reconstruction, it is often recommended for high-demand athletes and patients whose jobs do not require a significant amount of kneeling.

In studies comparing outcomes of patellar tendon and hamstring autograft ACL reconstruction, the rate of graft failure was lower in the patellar tendon group. In addition, most studies show equal or better outcomes in terms of postoperative tests for knee laxity (Lachman’s, anterior drawer and instrumented tests) when this graft is compared to others. However, patellar tendon autografts have a greater incidence of postoperative patellofemoral pain (pain behind the kneecap) complaints and other problems.

The pitfalls of the patellar tendon autograft are:

  • Postoperative pain behind the kneecap
  • Pain with kneeling
  • Slightly increased risk of postoperative stiffness
  • Low risk of patella fracture

Hamstring tendon autograft. The semitendinosus hamstring tendon on the inner side of the knee is used in creating the hamstring tendon autograft for ACL reconstruction. Some surgeons use an additional tendon, the gracilis, which is attached below the knee in the same area. This creates a two- or four-strand tendon graft. Hamstring graft proponents claim there are fewer problems associated with harvesting of the graft compared to the patellar tendon autograft including:

  • Fewer problems with anterior knee pain or kneecap pain after surgery
  • Less postoperative stiffness problems
  • Smaller incision
  • Faster recovery

Hamstring tendon autograft prepared for ACL reconstruction

Hamstring tendon autograft prepared for ACL reconstruction.

The graft function may be limited by the strength and type of fixation in the bone tunnels, as the graft does not have bone plugs. There have been conflicting results in research studies as to whether hamstring grafts are slightly more susceptible to graft elongation (stretching), which may lead to increased laxity during objective testing. Recently, some studies have demonstrated decreased hamstring strength in patients after surgery.

There are some indications that patients who have intrinsic ligamentous laxity and knee hyperextension of 10 degrees or more may have increased risk of postoperative hamstring graft laxity on clinical exam. Therefore, some clinicians recommend the use of patellar tendon autografts in these hypermobile patients.

Additionally, since the medial hamstrings often provide dynamic support against valgus stress and instability, some surgeons feel that chronic or residual medial collateral ligament laxity (grade 2 or more) at the time of ACL reconstruction may be a contraindication for use of the patient’s own semitendinosus and gracilis tendons as an ACL graft.

Quadriceps tendon autograft. The quadriceps tendon autograft is often used for patients who have already failed ACL reconstruction. The middle third of the patient’s quadriceps tendon and a bone plug from the upper end of the knee cap are used. This yields a larger graft for taller and heavier patients. Because there is a bone plug on one side only, the fixation is not as solid as for the patellar tendon graft. There is a high association with postoperative anterior knee pain and a low risk of patella fracture. Patients may find the incision is not cosmetically appealing.

Allografts. Allografts are grafts taken from cadavers and are becoming increasingly popular. These grafts are also used for patients who have failed ACL reconstruction before and in surgery to repair or reconstruct more than one knee ligament. Advantages of using allograft tissue include elimination of pain caused by obtaining the graft from the patient, decreased surgery time and smaller incisions. The patellar tendon allograft allows for strong bony fixation in the tibial and femoral bone tunnels with screws.

However, allografts are associated with a risk of infection, including viral transmission (HIV and Hepatitis C), despite careful screening and processing. Several deaths linked to bacterial infection from allograft tissue (due to improper procurement and sterilization techniques) have led to improvements in allograft tissue testing and processing techniques. There have also been conflicting results in research studies as to whether allografts are slightly more susceptible to graft elongation (stretching), which may lead to increased laxity during testing.

Some published literature may point to a higher failure rate with the use of allografts for ACL reconstruction. Higher failure rates for allografts have been reported in young, active patients returning to high-demand sporting activities after ACL reconstruction, compared with autografts.

The reason for this higher failure rate is unclear. It could be due to graft material properties (sterilization processes used, graft donor age, storage of the graft). It could possibly be due to an ill-advised earlier return to sport by the athlete because of a faster perceived physiologic recovery, when the graft is not biologically ready to be loaded and stressed during sporting activities. Further research in this area is indicated and is ongoing.

Surgical Procedure

Before any surgical treatment, the patient is usually sent to physical therapy. Patients who have a stiff, swollen knee lacking full range of motion at the time of ACL surgery may have significant problems regaining motion after surgery. It usually takes three or more weeks from the time of injury to achieve full range of motion. It is also recommended that some ligament injuries be braced and allowed to heal prior to ACL surgery.

The patient, the surgeon, and the anesthesiologist select the anesthesia used for surgery. Patients may benefit from an anesthetic block of the nerves of the leg to decrease postoperative pain.

The surgery usually begins with an examination of the patient’s knee while the patient is relaxed due the effects of anesthesia. This final examination is used to verify that the ACL is torn and also to check for looseness of other knee ligaments that may need to be repaired during surgery or addressed postoperatively.

If the physical exam strongly suggests the ACL is torn, the selected tendon is harvested (for an autograft) or thawed (for an allograft) and the graft is prepared to the correct size for the patient.

Passage of patellar tendon graft during ACL reconstruction

Passage of patellar tendon graft into tibial tunnel of knee.

After the graft has been prepared, the surgeon places an arthroscope into the joint. Small (one-centimeter) incisions called portals are made in the front of the knee to insert the arthroscope and instruments and the surgeon examines the condition of the knee. Meniscus and cartilage injuries are trimmed or repaired and the torn ACL stump is then removed.

post-operative x-ray of ACL reconstruction

Post-operative X-ray after ACL patellar tendon reconstruction (with picture of graft superimposed) shows graft position and bone plugs fixation with metal interference screws.

In the most common ACL reconstruction technique, bone tunnels are drilled into the tibia and the femur to place the ACL graft in almost the same position as the torn ACL. A long needle is then passed through the tunnel of the tibia, up through the femoral tunnel, and then out through the skin of the thigh. The sutures of the graft are placed through the eye of the needle and the graft is pulled into position up through the tibial tunnel and then up into the femoral tunnel. The graft is held under tension as it is fixed in place using interference screws, spiked washers, posts, or staples. The devices used to hold the graft in place are generally not removed.

Variations on this surgical technique include the “two-incision,” “over-the-top,” and “double-bundle” types of ACL reconstructions, which may be used because of the preference of the surgeon or special circumstances (revision ACL reconstruction, open growth plates).

Before the surgery is complete, the surgeon will probe the graft to make sure it has good tension, verify that the knee has full range of motion and perform tests such as the Lachman’s test to assess graft stability. The skin is closed and dressings (and perhaps a postoperative brace and cold therapy device, depending on surgeon preference) are applied. The patient will usually go home on the same day of the surgery.

Pain Management

After surgery, you will feel some pain. This is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster.

Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.

Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose has become a critical public health issue in the U.S. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.

Rehabilitation

Physical therapy is a crucial part of successful ACL surgery, with exercises beginning immediately after the surgery. Much of the success of ACL reconstructive surgery depends on the patient’s dedication to rigorous physical therapy. With new surgical techniques and stronger graft fixation, current physical therapy uses an accelerated course of rehabilitation.

Postoperative Course. In the first 10 to 14 days after surgery, the wound is kept clean and dry, and early emphasis is placed on regaining the ability to fully straighten the knee and restore quadriceps control.

The knee is iced regularly to reduce swelling and pain. The surgeon may dictate the use of a postoperative brace and the use of a machine to move the knee through its range of motion. Weight-bearing status (use of crutches to keep some or all of the patient’s weight off of the surgical leg) is also determined by physician preference, as well as other injuries addressed at the time of surgery.

Rehabilitation. The goals for rehabilitation of ACL reconstruction include reducing knee swelling, maintaining mobility of the kneecap to prevent anterior knee pain problems, regaining full range of motion of the knee, as well as strengthening the quadriceps and hamstring muscles.

The patient may return to sports when there is no longer pain or swelling, when full knee range of motion has been achieved, and when muscle strength, endurance and functional use of the leg have been fully restored.

The patient’s sense of balance and control of the leg must also be restored through exercises designed to improve neuromuscular control. This usually takes 4 to 6 months. The use of a functional brace when returning to sports is ideally not needed after a successful ACL reconstruction, but some patients may feel a greater sense of security by wearing one.

Surgical Complications

Infection. The incidence of infection after arthroscopic ACL reconstruction is very low.  There have also been reported deaths linked to bacterial infection from allograft tissue due to improper procurement and sterilization techniques.

Viral transmission. Allografts specifically are associated with risk of viral transmission, including HIV and Hepatitis C, despite careful screening and processing. The chance of obtaining a bone allograft from an HIV-infected donor is calculated to be less than 1 in a million.

Bleeding, numbness. Rare risks include bleeding from acute injury to the popliteal artery, and weakness or paralysis of the leg or foot. It is not uncommon to have numbness of the outer part of the upper leg next to the incision, which may be temporary or permanent.

Blood clot. Although rare, blood clot in the veins of the calf or thigh is a potentially life-threatening complication. A blood clot may break off in the bloodstream and travel to the lungs, causing pulmonary embolism or to the brain, causing stroke.

Instability. Recurrent instability due to rupture or stretching of the reconstructed ligament or poor surgical technique is possible.

Stiffness. Knee stiffness or loss of motion has been reported by some patients after surgery.

Extensor mechanism failure. Rupture of the patellar tendon (patellar tendon autograft) or patella fracture (patellar tendon or quadriceps tendon autografts) may occur due to weakening at the site of graft harvest.

Growth plate injury. In young children or adolescents with ACL tears, early ACL reconstruction creates a possible risk of growth plate injury, leading to bone growth problems. The ACL surgery can be delayed until the child is closer to reaching skeletal maturity. Alternatively, the surgeon may be able to modify the technique of ACL reconstruction to decrease the risk of growth plate injury.

Kneecap pain. Postoperative anterior knee pain is especially common after patellar tendon autograft ACL reconstruction. The incidence of pain behind the kneecap varies greatly  in studies, whereas the incidence of kneeling pain is often higher after patellar tendon autograft ACL reconstruction.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Common Knee Injuries

What to do if you think your joint replacement is infected

Article Featured on AAOS

Knee and hip replacements are two of the most commonly performed elective operations. For the majority of patients, joint replacement surgery relieves pain and helps them to live fuller, more active lives.No surgical procedure is without risks, however. A small percentage of patients undergoing hip or knee replacement (roughly about 1 in 100) may develop an infection after the operation.Joint replacement infections may occur in the wound or deep around the artificial implants. An infection may develop during your hospital stay or after you go home. Joint replacement infections can even occur years after your surgery.

This article discusses why joint replacements may become infected, the signs and symptoms of infection, treatment for infections, and preventing infections.

Description

Any infection in your body can spread to your joint replacement.

Infections are caused by bacteria. Although bacteria are abundant in our gastrointestinal tract and on our skin, they are usually kept in check by our immune system. For example, if bacteria make it into our bloodstream, our immune system rapidly responds and kills the invading bacteria.

However, because joint replacements are made of metal and plastic, it is difficult for the immune system to attack bacteria that make it to these implants. If bacteria gain access to the implants, they may multiply and cause an infection.

Despite antibiotics and preventive treatments, patients with infected joint replacements often require surgery to cure the infection.

Total knee implants

Examples of total knee implants. Joint replacement implants are typically made of metal alloys and strong, durable plastic called polyethylene.

Cause

A total joint may become infected during the time of surgery, or anywhere from weeks to years after the surgery.

The most common ways bacteria enter the body include:

  • Through breaks or cuts in the skin
  • During major dental procedures (such as a tooth extraction or root canal)
  • Through wounds from other surgical procedures

Some people are at a higher risk for developing infections after a joint replacement procedure. Factors that increase the risk for infection include:

  • Immune deficiencies (such as HIV or lymphoma)
  • Diabetes mellitus
  • Peripheral vascular disease (poor circulation to the hands and feet)
  • Immunosuppressive treatments (such as chemotherapy or corticosteroids)
  • Obesity

Symptoms

Signs and symptoms of an infected joint replacement include:

  • Increased pain or stiffness in a previously well-functioning joint
  • Swelling
  • Warmth and redness around the wound
  • Wound drainage
  • Fevers, chills and night sweats
  • Fatigue

Doctor Examination

When total joint infection is suspected, early diagnosis and proper treatment increase the chances that the implants can be retained. Your doctor will discuss your medical history and conduct a detailed physical examination.

Tests

Imaging tests. X-rays and bone scans can help your doctor determine whether there is an infection in the implants.

Laboratory tests. Specific blood tests can help identify an infection. For example, in addition to routine blood tests like a complete blood count (CBC), your surgeon will likely order two blood tests that measure inflammation in your body. These are the C-reactive Protein (CRP) and the Erythrocyte Sedimentation Rate (ESR). Although neither test will confirm the presence of infection, if either or both of them are elevated, it raises the suspicion that an infection may be present. If the results of these tests are normal, it is unlikely that your joint is infected.

Additionally, your doctor will analyze fluid from your joint to help identify an infection. To do this, he or she uses a needle to draw fluid from your hip or knee. The fluid is examined under a microscope for the presence of bacteria and is sent to a laboratory. There, it is monitored to see if bacteria or fungus grow from the fluid.

The fluid is also analyzed for the presence of white blood cells. In normal hip or knee fluid, there are a low number of white blood cells. The presence of a large number of white blood cells (particularly cells called neutrophils) indicates that the joint may be infected. The fluid may also be tested for specific proteins that are known to be present in the setting of an infection.

Treatment

Nonsurgical Treatment

In some cases, just the skin and soft tissues around the joint are infected, and the infection has not spread deep into the artificial joint itself. This is called a “superficial infection.” If the infection is caught early, your doctor may prescribe intravenous (IV) or oral antibiotics.

This treatment has a good success rate for early superficial infections.

Surgical Treatment

Infections that go beyond the superficial tissues and gain deep access to the artificial joint almost always require surgical treatment.

Debridement. Deep infections that are caught early (within several days of their onset), and those that occur within weeks of the original surgery, may sometimes be cured with a surgical washout of the joint. During this procedure, called debridement, the surgeon removes all contaminated soft tissues. The implant is thoroughly cleaned, and plastic liners or spacers are replaced. After the procedure, intravenous (IV) antibiotics will be prescribed for approximately 6 weeks.

Staged surgery. In general, the longer the infection has been present, the harder it is to cure without removing the implant.

Late infections (those that occur months to years after the joint replacement surgery) and those infections that have been present for longer periods of time almost always require a staged surgery.

The first stage of this treatment includes:

  • Removal of the implant
  • Washout of the joint and soft tissues
  • Placement of an antibiotic spacer
  • Intravenous (IV) antibiotics

An antibiotic spacer is a device placed into the joint to maintain normal joint space and alignment. It also provides patient comfort and mobility while the infection is being treated.

Knee Implant Compressors

(Top) These x-rays show an original knee replacement from the front and from the side. (Bottom) An antibiotic spacer has been placed in the joint during the first stage of treatment for joint replacement infection.

Spacers are made with bone cement that is loaded with antibiotics. The antibiotics flow into the joint and surrounding tissues and, over time, help to eliminate the infection.

Patients who undergo staged surgery typically need at least 6 weeks of IV antibiotics, or possibly more, before a new joint replacement can be implanted. Orthopaedic surgeons work closely with other doctors who specialize in infectious disease. These infectious disease doctors help determine which antibiotic(s) you will be on, whether they will be intravenous (IV) or oral, and the duration of therapy. They will also obtain periodic blood work to evaluate the effectiveness of the antibiotic treatment.

Once your orthopaedic surgeon and the infectious disease doctor determine that the infection has been cured (this usually takes at least 6 weeks), you will be a candidate for a new total hip or knee implant (called a revision surgery). This second procedure is stage 2 of treatment for joint replacement infection.

During revision surgery, your surgeon will remove the antibiotic spacer, repeat the washout of the joint, and implant new total knee or hip components.

An antibiotic spacer in a hip joint.

This x-ray shows knee components used in a revision surgery (stage 2). Note that the stems of the implants are longer to help support bone that has been compromised due to infection and removal of the previous implants.

Single-stage surgery. In this procedure, the implants are removed, the joint is washed out (debrided), and new implants are placed all in one stage.  Single-stage surgery is not as popular as two-stage surgery, but is gaining wider acceptance as a method for treating infected total joints. Doctors continue to study the outcomes of single-stage surgery.

Prevention

At the time of original joint replacement surgery, there are several measures taken to minimize the risk of infection. Some of the steps have been proven to lower the risk of infection, and some are thought to help but have not been scientifically proven. The most important known measures to lower the risk of infection after total joint replacement include:

  • Antibiotics before and after surgery. Antibiotics are given within one hour of the start of surgery (usually once in the operating room) and continued at intervals for 24 hours following the procedure.
  • Short operating time and minimal operating room traffic. Efficiency in the operation by your surgeon helps to lower the risk of infection by limiting the time the joint is exposed. Limiting the number of operating room personnel entering and leaving the room is thought to the decrease risk of infection.
  • Use of strict sterile technique and sterilization instruments. Care is taken to ensure the operating site is sterile, the instruments have been autoclaved (sterilized) and not exposed to any contamination, and the implants are packaged to ensure their sterility.
  • Preoperative nasal screening for bacterial colonization. There is some evidence that testing for the presence of bacteria (particularly the Staphylococcus species) in the nasal passages several weeks prior to surgery may help prevent joint infection. In institutions where this is performed, those patients that are found to have Staphylococcus in their nasal passages are given an intranasal antibacterial ointment prior to surgery. The type of bacteria that is found in the nasal passages may help your doctors determine which antibiotic you are given at the time of your surgery.
  • Preoperative chlorhexidine wash. There is also evidence that home washing with a chlorhexidine solution (often in the form of soaked cloths) in the days leading up to surgery may help prevent infection. This may be particularly important if patients are known to have certain types of antibiotic-resistant bacteria on their skin or in their nasal passages (see above). Your surgeon will talk with you about this option.
  • Long-term prophylaxis. Surgeons sometimes prescribe antibiotics for patients who have had joint replacements before they undergo dental work. This is done to protect the implants from bacteria that might enter the bloodstream during the dental procedure and cause infection. The American Academy of Orthopaedic Surgeons has developed recommendations for when antibiotics should be given before dental work and for which patients would benefit.  In general, most people do not require antibiotics before dental procedures. There is little evidence that taking antibiotics before dental procedures is effective at preventing infection.

    Antibiotics may also be considered before major surgical procedures; however, most patients do not require this. Your orthopaedic surgeon will talk with you about the risks and benefits of prophylactic antibiotics in your specific situation.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

An Experts Guide to Avoiding Back Pain

Deciding whether to have spine surgery

By Alan S. Hilibrand, MD | Featured on AAOS

Orthopaedic surgeons encourage “shared decision-making” when it comes to treating patients, because the doctor and patient each provide information needed to make a decision about surgery.

Read more

Knee Replacement Surgery for Arthritis

What Can I Do After Knee Replacement Surgery? When to Return to Normal Activity

Article Featured on AAOS

After having a knee replacement, you may expect your lifestyle to be a lot like it was before surgery— but without the pain. In many ways, you are right, but returning to your everyday activities takes time. Being an active participant in the healing process can help you get there sooner and ensure a more successful outcome.

Even though you will be able to resume most activities, you may want to avoid doing things that place excessive stress on your “new” knee, such as participating in high-impact sports like jogging. The suggestions here will help you enjoy your new knee while you safely resume your daily activities.

Hospital Discharge

Your hospital stay will typically last from 1 to 4 days, depending on the speed of your recovery. If your knee replacement is performed on an outpatient basis, you will go home on the same day as surgery.

Before you are discharged from the hospital, you will need to accomplish several goals, such as:

  • Getting in and out of bed by yourself.
  • Having acceptable pain control.
  • Being able to eat, drink, and use the bathroom.
  • Walking with an assistive device (a cane, walker, or crutches) on a level surface and being able to climb up and down two or three stairs.
  • Being able to perform the prescribed home exercises.
  • Understanding any knee precautions you may have been given to prevent injury and ensure proper healing.

If you are not able to accomplish these goals, it may be unsafe for you to go directly home after discharge. If this is the case, you may be temporarily transferred to a rehabilitation or skilled nursing center.

When you are discharged, your healthcare team will provide you with information to support your recovery at home. Although the complication rate after total knee replacement is low, when complications occur they can prolong or limit full recovery. Hospital staff will discuss possible complications, and review with you the warning signs of an infection or a blood clot.

Warning Signs of Infection

  • Persistent fever (higher than 100 degrees)
  • Shaking chills
  • Increasing redness, tenderness or swelling of your wound
  • Drainage of your wound
  • Increasing pain with both activity and rest

Warning Signs of a Blood Clot

  • Pain in your leg or calf unrelated to your incision
  • Tenderness or redness above or below your knee
  • Increasing swelling of your calf, ankle or foot

In very rare cases, a blood clot may travel to your lungs and become life-threatening. Signs that a blood clot has traveled to your lungs include:

  • Shortness of breath
  • Sudden onset of chest pain
  • Localized chest pain with coughing

Notify your doctor if you develop any of the above signs.

Recovery at Home

You will need some help at home for several days to several weeks after discharge. Before your surgery, arrange for a friend, family member or caregiver to provide help at home.

Preparing Your Home

The following tips can make your homecoming more comfortable, and can be addressed before your surgery:

  • Rearrange furniture so you can maneuver with a cane, walker, or crutches. You may temporarily change rooms (make the living room your bedroom, for example) to avoid using the stairs.
Home recovery center

Prepare a “recovery center” by placing items that you use frequently within easy reach.

  • Remove any throw rugs or area rugs that could cause you to slip. Securely fasten electrical cords around the perimeter of the room.
  • Get a good chair—one that is firm with a higher-than-average seat and has a footstool for intermittent leg elevation.
  • Install a shower chair, gripping bar, and raised toilet seat in the bathroom.
  • Use assistive devices such as a long-handled shoehorn, a long-handled sponge, and a grabbing tool or reacher to avoid bending over too far.

Wound Care

During your recovery at home, follow these guidelines to take care of your wound and prevent infection:

  • Keep the wound area clean and dry. A dressing will be applied in the hospital and should be changed as often as directed by your doctor. Ask for instructions on how to change the dressing before you leave the hospital.
  • Follow your doctor’s instructions on how long to wait before you shower or bathe.
  • Notify your doctor immediately if the wound appears red or begins to drain. This could be a sign of infection.

Swelling

You may have moderate to severe swelling in the first few days or weeks after surgery. You may have mild to moderate swelling for about 3 to 6 months after surgery. To reduce swelling, elevate your leg slightly and apply ice. Wearing compression stockings may also help reduce swelling. Notify your doctor if you experience new or severe swelling, since this may be the warning sign of a blood clot.

Medication

Take all medications as directed by your doctor. Home medications may include opioid and non-opioid pain pills, oral or injectable blood thinners, stool softeners, and anti-nausea medications.

Be sure to talk to your doctor about all your medications—even over-the-counter drugs, supplements and vitamins. Your doctor will tell you which over-the-counter medicines are safe to take while using prescription pain medication.

It is especially important to prevent any bacterial infections from developing in your artificial joint. Some patients with special circumstances may be required to take antibiotics prior to dental work to help prevent infection. Ask your doctor if you should take antibiotics before dental work. You may also wish to carry a medical alert card so that, if an emergency arises, medical personnel will know that you have an artificial joint.

Diet

By the time you go home from the hospital, you should be eating a normal diet. Your doctor may recommend that you take iron and vitamin supplements. You may also be advised to avoid supplements that include vitamin K and foods rich in vitamin K if you taking the blood thinner medication warfarin (Coumadin). Foods rich in vitamin K include broccoli, cauliflower, brussel sprouts, liver, green beans, garbanzo beans, lentils, soybeans, soybean oil, spinach, kale, lettuce, turnip greens, cabbage, and onions.

Continue to drink plenty of fluids and avoid alcohol. You should continue to watch your weight to avoid putting more stress on the joint.

Resuming Normal Activities

Once you get home, you should stay active. The key is to not do too much, too soon. While you can expect some good days and some bad days, you should notice a gradual improvement over time. Generally, the following guidelines will apply:

Driving

In most cases, it is safe to resume driving when you are no longer taking opioid pain medication, and when your strength and reflexes have returned to a more normal state. Your doctor will help you determine when it is safe to resume driving.

Sexual Activity

Please consult your doctor about how soon you can safely resume sexual activity. Depending on your condition, you may be able to resume sexual activity within several weeks after surgery.

Sleeping Positions

You can safely sleep on your back, on either side, or on your stomach.

Return to Work

Depending on the type of activities you do on the job and the speed of your recovery, it may take from several days to several weeks before you are able to return to work. Your doctor will advise you when it is safe to resume your normal work activities.

Sports and Exercise

Continue to do the exercises prescribed by your physical therapist for at least 2 months after surgery. In some cases, your doctor may recommend riding a stationary bicycle to help maintain muscle tone and keep your knee flexible. When riding, try to achieve the maximum degree of bending and straightening possible.

As soon as your doctor gives you the go-ahead, you can return to many of the sports activities you enjoyed before your knee replacement.

  • Walk as much as you would like, but remember that walking is no substitute for the exercises prescribed by your doctor and physical therapist.
  • Swimming is an excellent low-impact activity after a total knee replacement; you can begin swimming as soon as the wound is sufficiently healed. Your doctor will let you know when you can begin.
  • In general, lower impact fitness activities such as golfing, bicycling, and light tennis will help increase the longevity of your knee and are preferable over high-impact activities such as jogging, racquetball and skiing.

Air Travel

Pressure changes and immobility may cause your operated leg to swell, especially if it is just healing. Ask your doctor before you travel on an airplane. When going through security, be aware that the sensitivity of metal detectors varies and your artificial joint may cause an alarm. Tell the screener about your artificial joint before going through the metal detector.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Ankle sprains: what's normal and what's not?

Ankle sprains: what’s normal and what’s not?

By Alexandra E. Page, MD | Featured on AAOS

Ankle sprains are the most common sports injuries, with an estimated 25,000 occurring every day in the US.

Sprains can happen with any sport, including just walking across the yard! Ankle sprains are most common in ball sports such as basketball, soccer, volleyball and others.

What happens? The ankle is designed to have much more motion with the foot turning in, which is how sprains usually happen. The term “sprain” refers to any ligament injury. Ligaments are the tough fibers that connect bones to each other to give the skeleton strength while still allowing joints to move.

The most common ankle sprains involve tearing of the ligaments on the outside of the ankle. The ligament tearing leads to bleeding deep inside, which you see as bruising on the skin.  Fortunately, your body is designed to heal injuries, so these ligaments will almost always heal on their own.

As with any injury, your body quickly sends blood to start the healing process, which leads to the swelling. Remember: your heart is the pump and it is a long way to pump the blood back up from the ankle. For many people, some swelling will continue long after the sprain has “healed” and you are back to activities. This is, again, due to the distance from the ankle to the heart. At night, the swelling gets better but, with activity during the day, the fluid from normal blood flow leads to gradual swelling.

Rest, ice, compression, elevation, known as RICE, is a good way to treat an ankle sprain. This decreases the swelling, lessens your pain, and allows your body to heal the injury. Studies have shown that the sooner you return to activity, the better and typically the faster you will recover.

If pain allows, start moving the ankle early.

When to seek care: If it hurts too much to put any weight on the ankle and you can’t walk, seek treatment immediately. Depending on the amount of injury to the ligaments, it may be days, weeks, or even months to return to high-intensity sports. Sometimes recovery may be slow but, if it gets better day by day or week by week, you are on the right path.

If the ankle seems to stop improving and you just can’t get back to your activities then your orthopaedic surgeon can help.

Prevention: It is always better to avoid the sprain in first place! Remember to stretch before sports to prevent ankle and other injuries to all your bones and joints. Some studies show that taping or an ankle brace can help avoid repeat sprains if you have had sprains in the past.

Don’t let fear of an ankle sprain keep you from your sport. Your orthopaedic surgeon wants you to stay in motion to stay healthy!


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Forearm Fractures in Children

Forearm Fractures in Children

Article Featured on AAOS

Anatomy

The bones of the forearm.

The forearm is made up of two bones: the radius and the ulna. The radius is on the “thumb side” of the forearm, and the ulna is on the “pinky finger side.”
The bones of the forearm
Growth plates are areas of cartilage near the ends of the long bones in children and adolescents. The long bones of the body do not grow from the center outward. Instead, growth occurs at each end of the bone around the growth plate. When a child is fully grown, the growth plates harden into solid bone. Both the radius and the ulna have growth plates.

Description

Fractures can occur in one or both bones of the forearm, and in a number of places along the bone:

  • Near the wrist, at the farthest (distal) end of the bone
  • In the middle of the forearm
  • Near the elbow, at the top (proximal) end of the bone

Fractures in the radius and ulna

Fractures in both bones of the forearm.

There are several types of forearm fractures in children:

  • Torus fracture. This is also called a “buckle” fracture. The topmost layer of bone on one side of the bone is compressed, causing the other side to bend away from the growth plate. This is a stable fracture, meaning that the broken pieces of bone are still in position and have not separated apart (displaced).
  • Metaphyseal fracture. The fracture is across the upper or lower portion of the shaft of the bone and does not affect the growth plate.
  • Greenstick fracture. The fracture extends through a portion of the bone, causing it to bend on the other side.
  • Galeazzi fracture. This injury affects both bones of the forearm. There is usually a displaced fracture in the radius and a dislocation of the ulna at the wrist, where the radius and ulna come together.
  • Monteggia fracture. This injury affects both bones of the forearm. There is usually a fracture in the ulna and the top (head) of the radius is dislocated. This is a very severe injury and requires urgent care.
  • Growth plate fracture. Also called a “physeal” fracture, this fracture occurs at or across the growth plate. In most cases, this type of fracture occurs in the growth plate of the radius near the wrist. Because the growth plate helps determine the future length and shape of the mature bone, this type of fracture requires prompt attention.

Cause

Children love to run, hop, skip, jump and tumble, all of which are activities that could potentially result in a fracture to the forearm should an unexpected fall occur. In most cases, forearm fractures in children are caused by:

  • A fall onto an outstretched arm
  • A fall directly on the forearm
  • A direct blow to the forearm

Symptoms

A forearm fracture usually results in severe pain. Your child’s forearm and hand may also feel numb, a sign of potential nerve injury.

Doctor Examination

Physical Examination

After discussing your child’s symptoms and medical history, your doctor will perform a careful examination of your child’s arm to determine the extent of the injury. He or she will look for:

  • Deformity about the elbow, forearm, or wrist
  • Tenderness
  • Swelling
  • An inability to rotate or turn the forearm

During the physical examination, your doctor will also test to make sure that the nerves and circulation in your child’s hand and fingers have not been affected.

Forearm fracture

This child’s forearm fracture has resulted in a bent appearance of the forearm.
Courtesy of Texas Scottish Rite Hospital for Children

X-Rays

X-rays provide clear images of dense structures such as bones. Because the hand, wrist, arm, and elbow can all be injured during a fall on an outstretched arm, your doctor may order x-rays of the elbow and wrist, as well as the forearm, to determine the extent of the injury.

Treatment

Treatment for forearm fractures depends on the type of fracture and the degree of displacement. Your doctor will use one of the following treatments, or a combination of both, to treat a forearm fracture.

Nonsurgical Treatment

Some stable fractures, such as buckle fractures, may simply need the support of a cast or splint while they heal.

For more severe fractures that have become angled, the doctor may be able to manipulate or gently push the bones into place without surgery. This procedure is called a closed reduction. Afterward, the arm is immobilized in a cast or splint while it heals.

Forearm cast

Casts support and protect broken bones while they heal.
Reproduced from Pring M, Chambers H: Pediatric forearm fractures. Orthopaedic Knowledge Online Journal 2007; 5(5). Accessed October 2014.

Surgical Treatment

In some cases, surgery is needed to align the pieces of bone and secure them in place. Your doctor may recommend surgery if:

  • The bone has broken through the skin—this type of injury (called an open fracture) is at risk for infection and requires specific treatment
  • The fracture is unstable—the ends of the broken bones will not stay lined up
  • Bone segments have been displaced
  • The bones cannot be aligned properly through manipulation alone
  • The bones have already begun to heal at an angle or in an improper position

During surgery, your doctor will open the skin and reposition the broken bone fragments (a procedure called an open reduction). Your doctor may use pins, metal implants, or a cast to hold the broken bones in place until they have healed.

Internal fixation of forearm fractures

In these x-rays, fractures in both the radius and the ulna have been repaired with plates and screws.

Reproduced from Pring M, Chambers H: Pediatric forearm fractures. Orthopaedic Knowledge Online Journal 2007; 5(5). Accessed October 2014.

Recovery

The length of time the cast is worn will vary depending on the severity of the fracture. A stable fracture, such as a buckle fracture, may require 3 to 4 weeks in a cast. A more serious injury, such as a Monteggia fracture, may need to be immobilized for 6 to 10 weeks.

When the cast is removed, the wrist and elbow joints may be stiff for 2 to 3 weeks. This stiffness will go away on its own, usually without the need for physical therapy.

For a short period of time, the forearm bones may be weaker due to immobilization in the cast. To allow the bones to safely regain their normal strength, the child should avoid playing on playground structures, such as monkey bars, for 3 to 4 weeks after the cast is removed.

If the fracture disrupts the growth plate at the end of the bone, it could affect the development of the bone. Your doctor may recommend follow-up visits for up to one year to ensure that growth is proceeding normally.

Statistical data in this article was reviewed by the AAOS Department of Research and Scientific Affairs.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Stay Active, Healthy, and Strong in 50s, 60s, 70s, and Beyond

Stay Active, Healthy, and Strong in 50s, 60s, 70s, and Beyond

Article Featured on Everyday Health | By Dennis Thompson Jr

We all know that exercise is a key component of good health. But some people think that the older we get the more we should slow down to prevent injury and accidents.

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How to Exercise When You Work in Manual Labor

How to Exercise When You Work in Manual Labor

By Sara Lindberg | Article Featured on Verywellfit

When the end of the day rolls around, the last thing a lot of people want to do is head to the gym. With the stress of the day, both physically and mentally, still occupying your mind and body, it can be challenging to shift your attention to working out, especially if you’ve spent the day working a physically demanding job.

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Tips for Taking Care of Your Prosthetic Limb

Tips for Taking Care of Your Prosthetic Limb

Article Featured on Amputee Coalition

Proper limb and skin care is essential to your health and mobility. Prosthetic sockets trap sweat and prevent air from circulating around your residual limb, which can create a virtual paradise for bacteria. Bacterial and fungal infections can lead to skin irritation, abrasions and eventually skin breakdown. Left unchecked, this could lead to infection and ulcerations, leaving you unable to use your prosthesis for an extended length of time.

The following tips can go a long way toward keeping minor problems from turning into a crisis.

Limb Care

  • If you are a new amputee, it’s better to take a bath or shower at night rather than in the morning, as your limb will swell in hot water or when dangling as you sit or stand to shower, making it difficult to put on your prosthesis. In the beginning, you should use a shrinker at night, and put on your prosthesis when you get up from the bed – in other words, don’t let your leg hang down or it will swell. As time goes by, this will become less necessary.
  • If you have a transtibial (below-knee) amputation, never sit or sleep with a pillow under your knee, as this will lead to a contracture (inability to straighten the knee).
  • If you have a transfemoral (above-knee) amputation, do not sleep with:
    • Your limb resting on a pillow, as this promotes a hip flexion contracture (inability to completely straighten your hip)
    • A pillow between your legs, as this lengthens the inner thigh muscle that helps you keep your legs together when you walk, and shortens the outer thigh muscles so that you walk and stand with your feet apart.
  • Do not rest your limb over the handle piece of your crutches.
  • Do stretching exercises daily to make sure that you can straighten your knee and hip; this makes walking, and even lying in bed, more comfortable.

Skin Care

  • Wash your limb with mild soap and water every day (more often if you sweat heavily) and pat it dry with a soft towel. Be patient and allow it to dry completely. If this is not done, you will be at risk for fungal growth that could lead to infection or abrasion.
  • Check your limb for red pressure patches that last more than a few minutes after you remove your prosthesis; these may be a sign that the socket needs checking. If left untended, these red patches may result in skin breakdown.
  • Check for skin breakdown twice a day – if you can’t see the end of your residual limb, use a mirror. This is particularly important for people with diabetes.
  • Softening cream should only be used if the skin is extremely dry and at risk of cracking. It should only be used temporarily unless cleared by your doctor.
  • Do not use talcum powder on your limb, as it can ball up and create an abrasion. If you must use a powder, cornstarch is better.
  • Do not use alcohol or unknown chemicals/ creams on your limb.
  • Remember – your limb is covered all the time, so be very careful if you expose it to the sun. Use sunscreen SPF 30 or better.
  • Do not shave your limb; the resulting short hairs get pushed back into your skin, becoming ingrown hairs that can become infected.
  • If the skin of your limb opens, go straight to your doctor and prosthetist.
  • If you are having a fit problem with your socket, causing skin breakdown, go to your prosthetist for an adjustment. If the breakdown is infected, you will need to go to your physician as well. Stop using the prosthesis; have crutches and a wheelchair for backup.
  • If you have a skin breakdown, don’t use a prosthesis. Put a clean dressing/band-aid on the area daily and see your doctor or prosthetist. Don’t “pad” a pressure area, as that creates additional pressure and will make it worse.
  • A red spot that turns into an ulcer can mean weeks without being able to use your prosthesis. Stop using the prosthesis and call your prosthetist/doctor.
  • If you have reduced or no sensation in your residual limb, check your limb more frequently during the day and don’t put it in hot water or expose it to the sun – it will burn and blister.

Prosthetic Care

  • Wash anything that makes skin contact (liners, socks, the inside of the socket, etc.) every day with mild soap and water and allow plenty of time to dry. Follow manufacturers’ instructions for care of liners. Unless specifically instructed, do not use anything containing alcohol or unknown chemicals.
  • You should know the landmarks of when your socket fits correctly; if you don’t, ask your prosthetist to show you. If your socket is too big or too small, visit your prosthetist immediately.
  • Make sure your shoe height is correct for your prosthesis or your alignment will be wrong, putting a strain on your residual limb and surrounding joints.
  • Keep a “leg” bag handy with items you might need in an emergency (stump socks, pull socks or bandages, antibiotic ointment, antihistamine ointment, etc.).
  • Remember – the fit of your prosthesis changes during the day, so add socks when needed.
  • If you are having trouble with the prosthesis or liner, do not make your own adjustments or alter the prosthesis/ liner – call your prosthetist immediately.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

25 Foods for Strong Bones

25 Foods for Strong Bones

Your bones require specific nutrients to stay strong and healthy. Calcium and vitamin D are the two big ones most people recognize, but magnesium, protein, omega-3 fatty acids, and vitamins A, C, and K are also essential for bone health.

Here are 25 foods that will supply you with those essential nutrients when included in a balanced diet.

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