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Good As New: Guide to Total Hip Replacements

Here at Mass General, we are creating these patient guides for many of our top surgical procedures and services. This particular guide for a total hip replacement summarizes the entire joint replacement process at Massachusetts General Hospital. Includes: introduction to our care team, an explanation of treatment options, surgical preparation information, expectations after surgery and recovery at home. These Patient Guides also provide valuable information for patients’ family members.

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Daniel Lieberman, PhD: What we can Learn about Running from Barefoot Running

Daniel Lieberman at the Mass General Orthopaedic Surgery Grand Rounds Barefoot RunningWhat we can Learn about Running from Barefoot Running
Daniel E Lieberman, PhD
Department of Human Evolutionary Biology
Harvard University, Cambridge, MA
Grand Rounds presented on March 15, 2012 at the O’Keefe Auditorium, Massachusetts General Hospital, Boston, MA


Hands-Only CPR: No Training Necessary

How To:

  1. Call 911
  2. Push hard and fast in the center of the chest, without interrupting
  3. Push deeply, about 100 times per minute. That’s faster than three times every two seconds
  4. Do NOT be afraid, your actions can only help
  5. Look around and invite your friends or other onlookers to help
  6. Continue until trained Emergency Personnel arrive

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Nurse Practitioners & Physician Assistants

Nurse Practitioners & Physician Assistants: Integral members of your healthcare team.

Nurse Practitioner Anne Fiore educates a patient about his upcoming surgery; Mass General Hospital Orthopedics Arun Shanbhag
Nurse Practitioner Anne Fiore educates a patient about his upcoming surgery.

During a visit to our doctor’s offices, patients will likely be treated by several members of our professional staff, including Nurse Practitioners (NPs) and Physician Assistants (PAs). Patients often ask how NPs and PAs are involved in their care and what training they have.

NPs and PAs are highly skilled, licensed professionals, who practice medicine with physician supervision. They are an integral part of every medical and surgical practice and coordinate peri-operative and inpatient care of our patients.
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The Plank: Strengthening the Core

The core is commonly thought of as only your abs, but consists of multiple muscle groups in your abdomen, back and pelvis. Core muscles are engaged during all activities requiring a coordinated movement of the upper and lower body. They generate the force and power required for many activities, while simultaneously playing a foundational role in stabilizing the torso.

Our modern sedentary lifestyle does nothing to working these important core muscles and over time result in their weakening, and the consequent injuries from seemingly simple tasks.

There are various ways to strengthen these core muscles. The PLANK, for instance, is easy to perform, effective and appropriate for any age and fitness level. With no special equipment, the plank can be performed on a carpeted floor or mat in your living room, in the gym between sets of other exercises, or at the end of a workout. Also, the plank literally only takes a minute!

In performing the plank, you hold a steady position by isometrically contracting the deep stabilizing abdominal muscles (transverse abdominus), while keeping the lower back (erector spinae and multifidi) stable, fighting fatigue and simultaneously building endurance. This exercise is not appropriate if you have any shoulder weakness or injury.


Step by Step: How to perform and hold the Plank
Plank Strengthening the Core Aches & Joints

  • Have a wrist watch or clock nearby to track time
  • Place forearms on floor, shoulder distance apart (see above) and elbows directly below the shoulders as demonstrated below
  • Extend legs back, one at a time, straightening the knees and balancing on your toes
  • Keep your body straight as a plank (see below)
  • Relax your neck and look down at the floor
  • As you fatigue, there will be a tendency for your hips to sag. Squeeze your deep abdominal muscles and glutes, and hold your hips in line with the rest of the body
  • For starters, hold the position for 30 seconds and work up to 60 seconds or longer
  • Rest on your knees; when ready, repeat plank for two additional sets

Plank Strengthening the Core Aches & Joints


For a more challenging workout: In the plank position, alternately lift and move each leg outwards (see demonstration below)
Plank Strengthening the Core Aches & Joints


Julie Schlenkerman, Personal Trainer, Clubs at Charles River ParkThe Plank was demonstrated by Julie Schlenkerman, certified personal trainer at the Clubs at Charles River Park, Boston, MA. Julie is an avid runner and ran the 2009 Boston Marathon in 3:16:14!


From our Archives: Simple exercises & Related articles

Understanding Total Shoulder Replacement: A Patient Guide

Patients with severe shoulder arthritis are unable to move their arms through the full range of motion and consequently are unable to perform many activities of daily living. For these patients, total shoulder replacement is a proven surgical procedure relieving their pain, recovering their range of motion and allowing them to return to their active lifestyles.

In this video, Dr JP Warner from the Massachusetts General Hospital, Boston, MA, goes through the necessary examination and the surgical technique. He also points out that in 98% of the patients this is a very successful, proven procedure.

In-Toeing Gait In Children

Intervention is often not necessary for children with in-toeing gait. Kids grow out of it.

If you observe people’s feet as they stand or walk, you may notice that their feet generally point straight ahead or perhaps slightly outward. However, many people point their feet inward. This is called in-toeing or pigeon toes.

In-toeing is common in young children, a frequent concern of many parents and a very common referral to our Pediatric Orthopaedic Clinic. In the overwhelming majority of patients, in-toeing corrects itself with time. Treatment is only necessary in a tiny fraction of patients.

“In-toeing does not lead to arthritis or interfere with sports. Toddlers who in-toe do tend to fall more frequently, because unlike adults, toddlers cannot increase the length of their strides, but can only increase the number of steps, which results in clumsiness and tripping,” asserts Dr Brian Grottkau, Chief of Pediatric Orthopaedic Surgery at the Massachusetts General Hospital, and Assistant Professor of Orthopaedic Surgery at Harvard Medical School, Boston, MA.

Causes of In-toeing Gait
The three most common causes of in-toeing in children are twisting of the thigh bone (femoral anteversion), twisting of the shin bone (internal/medial tibial torsion) and curved feet (metatarsus adductus). Your pediatric orthopaedic surgeon will evaluate your child and determine if in-toeing is coming from the hips, legs, or feet.

schematic of different types of In-toeing gait in children
Illustration by Navina Chabria – Thank you
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What to do with Bunions?

What to do with Bunions? Better to leave them alone.

A bunion is a characteristically large bony bump at the base of the big toe. This alters the alignment of the bones, causing the base of the big toe to angle out and crowding the tops towards the smaller toes. Bunions can often be painful and cause swelling, making it difficult to find comfortably fitting shoes. The big toe pushing against the smaller toes can result in irritation of the skin, forming painful calluses.

Bunions occur more frequently in women and can occur in children as well. Although some footwear can contribute to the deformity, it is not the sole cause. “People who develop bunions often have an underlying predisposition to acquire them, such as a family member who may have them, overly mobile joints, or a disease such as rheumatoid arthritis,” explains Dr A Holly Johnson, Foot & Ankle Surgeon at the Massachusetts General Hospital and Instructor at Harvard Medical School, Boston, MA. Traumatic injuries to feet or toes can also result in bunions. Bunions can occur in people with flatfeet (or over pronation) and may involve deformities of the smaller toes, such as hammer toes.

xray of normal foot (left) and a foot with a bunion (right) hallux valgus
Left: X-ray of normal foot while standing. Right: Foot with a bunion, also called hallux valgus. Notice the bony protuberance and the large angle at the base of the big toe. The top of the big toe is seen crowding towards the smaller toes.
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Joint Replacements and Dental Procedures – Precautions

Joint Replacement Patients May Require Antibiotics Before Dental Procedures

Joint replacements are usually very successful and patients can return to an active lifestyle soon after the procedure. Still, patients should be cautious about the potential for an infection. Infection of any joint replacement (hip, knee, shoulder, or another joint) is a serious concern and may even require removal of the joint replacement components.

Bacteria from your mouth can spread to your blood and from there to your joint replacement, particularly in patients with ongoing dental problems. Thus, good oral hygiene can prevent infection of a joint replacement. Even prior to having a total joint replacement, patients should aspire to achieve good dental health and resolve their dental issues. Importantly, patients with joint replacements should be diligent in maintaining daily oral hygiene.

Radiograph patient total hip replacement
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Rotator Cuff Disease

Primary Cause of Shoulder Pain and Treatment Options.

There are several causes of shoulder pain. In the elderly, shoulder pain is commonly associated with aging and can be traced to rotator cuff disease. In younger people, it is associated with throwing or overhead sporting activities that result in injury to the rotator cuff.

rotator cuff anatomy

The rotator cuff is a band of four muscles and tendons at the shoulder joint, which grasp the end of the upper arm or humerus (HYU-mer-us, see figure), much like four fingers holding a baseball. The rotator cuff thus stabilizes the shoulder joint and provides exceptional mobility to the arm. Pinching, irritation, or tears of the rotator cuff are common causes of shoulder pain.

shoulder rotator cuff anatomy holding baseball

Impingement
Rotator cuff tendons are separated from overlying bones by a soft tissue sac or bursa, allowing them to glide easily. According to one theory, repetitive motion of the arm causes pinching of this sac in the tight space between the acromion (a-KRO-me-un) and humerus (see figure), resulting in irritation, swelling and pain. This inflammation of the bursa and tendons is called impingement. The pain is characteristically worse when the arm is lifted and common at night.

Causes and Symptoms
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