Lower Body Treatments by Orthopedic Specialist
Cyprus is an exciting tourist spot and a preferred expat location. But did you know that it is also a popular medical tourism destination thanks to the orthopedic specialists, expert doctors, and surgeons?
We previously gave you an introduction to orthopedic and surgery including osteoarthritis. Furthermore, we provided an overview of upper body orthopedic conditions and treatment of the shoulder, elbows, and spinal discs.
In this My Kypros Home article, we present the orthopedic diseases of the lower body – the hips, and the knees. It is important to talk about orthopedic conditions. As, in particular, arthritis is very common, with about one in three people affected.
The musculoskeletal system is particularly prone to osteoarthritis, back and neck pain, fractures associated with bone fragility, injuries and systemic inflammatory conditions like rheumatoid arthritis.
In fact, osteoarthritis and rheumatoid arthritis are among the most common causes of hip pain. Especially in senior adults. Did you know that the hip is one of the most commonly treated orthopedic joints? So, first, let’s take a closer look at the joint which carries your body.
Cause of Hip Pain
The hip is made up of two bones (femoral head and socket in the pelvic bone). These are articulated together. Wrong movements or one-sided stress can lead to hip pain.
In addition to the hip joint itself, muscles, nerves (e.g. the sciatic nerve), tendons or soft tissues can be the cause of the hip pain. If you experience swelling, redness, deformity, fever or pain that is so severe and restricted movement that you can no longer cope with everyday life, you should consult an orthopedic specialist.
Your doctor will examine your hip and surrounding structures closely. Pain can often radiate from other areas, such as the lumbar spine, to the hip. If physiotherapy and pain relievers no longer help, the hip can be minimal invasively operated on – by hip arthroscopy. However, a hip worn out by hip arthrosis must be replaced by a hip prosthesis.
Also known as hip joint replacement, this refers to a minimally invasive operation of the hip joint. Minimal invasive surgery means: so-called bowl-hole-techniques are used to insert the smallest instruments into the hip joint.
Arthroscopy is always recommended when patients regularly experience severe hip pain but the hip joint has not yet developed severe arthrosis. Hip arthroscopy can use these instruments – similar to dental devices – to remove the direct causes of hip arthrosis with the smallest incisions. It is important to eliminate the causes of osteoarthritis before the hip joint has become stiff and immobile due to wear and tear.
Hip arthroscopy is used before articular cartilage and the bony structures of the hip joint have suffered irreparable damage. As the name suggests, hip arthroscopy is an examination and treatment option for the bone joint at the same time.
Hip osteoarthritis (Coxarthrose)
The hip carries the whole body – every day. For many people, the function of the hips gets worse during their lifetime – usually after they turn 50. Hip osteoarthritis (coxarthrosis) aka hip arthrosis refers to the joint wear and tear as well as the cartilage degradation in the hip joint.
Do you have start-up pain in your hip joint in the morning that goes away after a few minutes? Do you feel stiff when you get up after a rest period and initially have a lack of coordination? Have you ever had violently flaring, permanent hip pain that subsides after a few weeks? Then you should get an exam to find out if you have hip osteoarthritis.
The treatment of hip coxarthrosis is a combination of physical therapy, oral or topical pain relievers, and injections. Experts agree that exercise is important to maintain mobility and slow the progression of hip osteoarthritis.
All parts of the hip joint (thigh bone, socket, cartilage) can wear out after an accident, illness or as a result of osteoarthritis. Globally, there are almost 1 million hip prostheses every year. Therefore, it is a very safe routine procedure.
The majority of all hip prostheses are due to hip arthrosis. Fractures of the femur after falling of the elderly often cause about 25% of all hip surgeries. And only around 15% of all patients with a hip prosthesis are younger than 60 when they receive primary care with a hip replacement.
Freedom from pain, a long standing time, and mobility of the hip joint are the main goals when doing a hip prosthesis. In order to achieve these goals for every patient, various parameters like the material, the shape of the prosthesis as well as the surgical technique are important.
In particular, minimally invasive surgical techniques are becoming more and more popular. Through special surgical approaches – especially the so-called anterolateral approach – extensive muscle detachments can be avoided. This makes early rehabilitation much less painful. Muscles and tendons are not severed but preserved. Patients can begin effective training and agility earlier.
The so-called McMinn prosthesis is a partial prosthesis of the hip or hip cap prosthesis. It is particularly effective for younger athletic patients with a high level of activity.
The impingement of the hip refers to joint blockage caused by the disorders of the bony shape of the hip joint. The healthy hip joint allows a wide range of movements of the hip. The well-shaped femoral head glides in the acetabulum without resistance.
If this hip movement is disturbed by bony malformation, and the freedom of movement of the hip is restricted as a result, this is referred to as hip impingement. Hip impingements are the painful striking of the hip bones involved in the joint. One also speaks of femoroacetabular impingement (FAI), because thigh bones (femur) and hip socket (acetabulum) are involved. The patients then feel reproducible, movement-dependent hip pain.
Only 20 years ago, the hip impingement was clearly identified as one of the most important causes of secondary hip arthrosis and hip arthroscopy was established as a causal treatment. And in most cases, hip impingement occurs without a known cause, so it is genetic. Due to higher usage, hip impingement and resulting hip arthritis occur more often in athletes.
As you see, the hip can suffer from many orthopedic conditions. Unlike the hip, the knee is structurally even less stable and far more restricted. Therefore, let’s examine the knee next.
Besides the infamous tennis arm, common sports injuries that require specialized sports medicine treatment are knee injuries. In particular, tear of the anterior cruciate ligament as well as patellofemoral syndrome. The latter is an injury that results from the repetitive movement of your kneecap against your thigh bone. So, let’s take a closer look at the knee and common injuries.
Cause of Knee Pain
Knee pain can manifest itself through a wide variety of symptoms. Explain the pain to your doctor as precisely as possible so that he/she can make the correct diagnosis and recommend a suitable therapy.
As the knee is very complex, various structures such as ligaments, muscles, cartilage, and bones can cause pain. It is important to describe the type, location, timing and situation in which the knee pain occurs (e.g. in the morning after getting up). If the knee is red or overheated, swollen, unstable, or there are cracking or crunching noises, you should see a doctor immediately.
Every knee pain is different. An important indication of the diagnosis is the exact location of the pain. Orthopedic specialists differentiate between knee pain on the inner (medial) side of the knee joint, outside knee pain (lateral pain), front knee pain (in the area of the kneecap, and pain in the back of the knee (back knee pain). Each of these locations of knee pain can be attributed to specific causes of pain.
Knee arthrosis (gonarthrosis)
Osteoarthritis of the knee (gonarthrosis) is progressive damage and, in later stages, also a breakdown of the articular cartilage in the knee joint. The cartilage in the knee becomes rough and cracked and loses its elasticity. The ability of the knee joint to produce cartilage-nourishing synovial fluid decreases with the course of the disease.
The layer of cartilage between the bones of the knee joint becomes narrower and brittle. In the last stage, there is severe pain in the knee joint. The bones that have lost their articular cartilage in severe osteoarthritis then rub directly against each other. The knee ignites and stiffens. The knee loses its pain-free resilience in everyday life with advanced cartilage wear.
Osteoarthritis of the knee is a self-reinforcing disease process. The longer the patient delays diagnosis and treatment for knee pain, the less the treatment options of the attending doctor become. Cartilage is not supplied with blood directly. Therefore, cartilage tissue cannot be regenerated by the body or only very slowly.
Old injuries are often the cause of knee osteoarthritis. Knee osteoarthritis can be treated conservatively with physiotherapy, pain therapy, and cartilage regeneration. The alternative, once other options are exhausted, is surgery: joint-preserving partial prostheses or total knee endoprostheses.
Knee prosthesis, partial knee prosthesis, repicci prosthesis
All anatomical components of the knee can wear out due to an accident, malposition or knee arthrosis (gonarthrosis) and lose their function. The meniscus, articular surfaces, cruciate ligaments and external ligaments of the knee and the patella (patella) are particularly affected.
Cartilage can wear out and become thinner and thinner. The bones in the knee joint form osteophytes (bone spurs). The ligaments lose their tension and can no longer effectively guide the knee joint. The knee becomes stiff and immobile.
The maximum walking distance from which knee pain and swelling appear in the knee joint is getting shorter. One then speaks of knee osteoarthritis (gonarthrosis). For the affected patients, this can lead to considerable suffering and disabilities in everyday life, which they must overcome as quickly as possible in the interest of their health.
If the cartilage has completely or partially lost its function, the bones of the thigh and lower leg rub directly and painfully on one another. This results in stiffness and the pain typical of knee osteoarthritis.
In this situation, the rapid stiffening – loss of mobility – can often only be slowed down by a prosthetic knee. The knee prosthesis can, therefore, replace all or part of the load-bearing and sliding parts of the knee joint. Depending on which parts of the natural knee have to be replaced during the operation of the knee prosthesis, the knee specialist can recommend different prostheses models and partial prostheses of the knee joint (sledge prostheses).
The crescent-shaped menisci in the knee alleviate the strain during running and jumping and thus protect the articular cartilage. The meniscus tear is an injury to this c-shaped pair of shock absorbers made of fibrocartilage.
The causes of the meniscal tear are traumatic (injury-related) overloads during sport. Injuries often occur due to twisting (distortion) or age-related wear on the menisci.
Conservative therapy is again physiotherapy, and surgery the alternative option. A specialized orthopedic surgeon can diagnose a meniscus injury using minimally invasive surgery (arthroscopy) and sew or smooth it directly.
However, this is quite a lengthy procedure. After approximately four days in the hospital, the patient has to relieve the affected leg with forearm crutches for about six weeks.
Cruciate ligament tear
The cruciate ligament tear is one of the most common sports injuries in the knee. The cruciate ligaments are tendons running centrally in the knee joint. They stabilize the thigh bone and shin and center their position in the knee joint.
The tear of the anterior cruciate ligament is usually the result of a sports injury. The typical course of the accident is the fall while skiing. When falling, the lower leg in the knee joint often turns outwards. The anterior cruciate ligament tears with this distortion.
During the accident, the patient often hears a cracking or popping sound: this sound is typical of the tearing cruciate ligament. And cruciate ligament tears are more common among women.
Orthopedic specialists differentiate between the anterior cruciate ligament and the posterior. The acute treatment is lifting the knee, immobilizing and cooling it, as well as taking anti-inflammatory medicine.
During the healing phase, the knee can be soothed and relieved by an orthosis. Physiotherapy and muscle strengthening can promote healing in the injured knee. However, with strong power development and high athletic loads, the muscular compensation is not sufficient to restore the old performance level with intact cruciate ligament function.
Especially in younger and athletic patients, but also in older, very active patients, the lack of cruciate ligament function damages the articular surfaces and menisci. The muscle strength only insufficiently compensates for the over-mobility of the knee joint with a high level of activity. With a success rate of well over 90%, the reconstruction of the anterior cruciate ligament (ACL) is considered a very reliable intervention.
Bursitis on the knee joint
The inflammation of the bursa is usually a result of overload, which can have different causes:
- Working on your knees, e.g. for tilers or pavers.
- Strain on the muscles and tendons of the knee when jogging or cycling
- Direct impact on the knee joint (trauma) due to a fall or collision during contact sports.
- Bacterial infection of a bursa
- Consequences of inflammatory diseases like knee osteoarthritis, rheumatism
- Deposition of uric acid crystals due to gout
- Overload in sports, especially runners
The bursa between the patellar tendon and the shin is particularly affected by runners. In this case, one speaks of infrapatellar bursitis.
You can prevent bursitis by using protection (padding) when working on your knees or doing contact sports, reducing any overweight, and by doing any knee bends correctly.
Often, only a few days of rest are necessary for the therapeutic relief of the inflamed bursa. Further treatment includes anti-inflammatory drugs and ointment, antibiotics, cortisone injections, and physiotherapy.
Surgery becomes necessary with chronic or recurrent bursitis, restriction of mobility due to gluing or scarring of the bursa, lack of access to the bursa for treatment, and suspected infection of the neighboring structures.
Orthopedic Specialists on the Best Time to Treat Patients
Determining the right time to undergo orthopedic surgery is often different from other medical treatments. The surgical decision is based on a lengthy, chronic disease process with sometimes severe pain.
However, orthopedic issues may be painful but are usually not immediately life-threatening. Consider getting a second opinion and trying alternative treatment options before your final decision.
You have now gained insight into the main orthopedic conditions of the lower body (hips, knees) including treatment options.
Are you curious to learn more about the popular Cyprus medical tourism on this beautiful Mediterranean island? Contact the specialists at My Kypros Home to find the best treatment option and facility for your specific needs.
We gladly connect you with the best orthopedic surgeons on the island, who provide the finest orthopedic care to you. They have undergone specialty training, are fellowship-trained and board-certified. Nothing is impossible. Even specialized treatments like limb lengthening surgery can be performed at the highest standard in Cyprus.
Disclaimer: We at My Kypros Home connect you to carefully selected third-party medical providers. We do not offer diagnosis, health advice and medical treatment ourselves.