Nicholas Kusnezov

My recommendation, having placed and removed a great deal of hardware over the last 10 years, is to leave it alone unless it is causing you a discrete problem. Many times, after a big injury like a femur fracture, you will have residual pain and achiness that is related to the injury and not to the hardware (rod) itself. So long as there are no obvious issues with the rod on X-rays and nothing concerning on exam (for instance, tenderness directly over a screw or prominence), then removing the rod can be a very big endeavor, even bigger of a surgery than when it was put in. There is an old saying in orthopedics - "no one looks good taking out hardware". While I would say that I've had excellent success with hardware removal, what that saying means is that taking out metal can be a bear and you may always encounter unanticipated problems that may affect your recovery afterward. Hope this helps!

Yes, physical therapy can help after a hip replacement. Interestingly, unlike a knee replacement, walking and some simple daily self-directed exercises may be all that most patients need to make a full recovery after a hip replacement. Sometimes, if you had advanced arthritis or a more complex type of hip replacement, physical therapy may be indicated to facilitate a faster recovery.

It depends on what the surgery was for. If it was for an injury, you may be there a day or two for pain control. Heel surgery is painful and we often have more means at our disposal to control this pain in the hospital right after the surgery than you would at home. That said, if this was an elective surgery, most patients go home the same day with oral medications.

That's an excellent question. It depends on what type of ankle "sprain" you have. There are a few varieties, but you can often think of them as either "high" or "low" ankle sprains. High ankle sprains involve injuries of the syndesmosis, or the ligaments stabilizing your tibia and fibula. These are often the more severe type and can require surgery. These are the ones that you also should not walk on. The other variety, low ankle sprains, are generally less severe and rarely require surgery. You can generally walk on these, though early along (the first 1-2 weeks) you may have less pain and risk of reinjury if you stay off of the ankle. After that point, ankle braces and physical therapy are usually the treatment that most reliably will get you back into the full swing of things. It's very important to determine which type of ankle sprain you have and moreover the severity of the sprain before proceeding with a definitive management strategy. So I would encourage you to follow up with your local orthopedist!

Yes, but I would recommend that you avoid exercises that could exacerbate, or worsen, your symptoms and put undue strain on your back (and injured disc). This would include impact activities, bending and lifting, and twisting. It is however important to perform exercises, either self-directed or under the supervision of a physical therapist, to improve your range of motion. Paradoxically, activity is better than inactivity after a lower back injury!

Yes, they often do. However, when you sprain your ankle, you alter the way your body senses your ankle in space. This makes you prone to re-injury (i.e. rolling your ankle again). To mitigate re-injury and get you back to 100%, you should have a course of physical therapy with focus on proprioceptive exercises. These are exercises focusing on re-establishing your body's sense of your ankle in space.

The good news is that clinically, you really have minimal asymmetry. In other words, your shoulder look appropriately symmetric and you have a small prominence on the back when bending forward. The only way to determine the magnitude of the scoliosis is an X-ray. The good news is that, at 14 years old, you're done (if not almost done) growing, and based on how your back looks in the images, I would not anticipate that you would need any further management. The first step is to make an appointment with an orthopedist to evaluate you clinically, ensure there are no "red flag" findings that might necessitate an MRI, and so long as the curvature on the X-ray at this point in your life is <45-50 degrees, which it appears to be clinically, you're out of the woods and don't need to do anything.

Yes. In fact, most bulging discs, or disc herniations, resolve spontaneously without surgery. Your body essentially re-absorbs the disc material and reconstitutes the disc. This is the case in 80-90% of acute disc herniations. So long as you don't have profound or progressive weakness, dense constant numbness, or issues with bowel or bladder movements, most surgeons will wait anywhere from 8-12 weeks before recommending surgical management.

As an academic joint replacement surgeon with 10 years experience, I can tell you that the technology is not there yet. Once cartilage injury progresses to arthritis, the only viable options in this day and age are (1) to manage your symptoms with conservative management to include exercises, anti-inflammatory medications, and injections, and when this fails, and your symptoms significantly impair your daily life, (2) replace part of or the entirety of the joint. Joint replacement, when performed correctly, can last you a lifetime and provide you with significant and lasting pain relief and improved function.

As a seasoned academic joint replacement surgeon, I can tell you that the technology is not there yet. While we can provide palliative treatment for arthritis pain, once the cartilage injury has progressed to arthritis, you may be looking at a joint replacement. As surgeons, we always exhaust conservative management first, to include exercises, anti-inflammatory medications, and injections, but when these fail to control your symptoms and your pain progresses to the point that it impairs your activities of daily living and quality of life, I can tell you that a joint replacement will significantly and reliably improve your symptoms and your function.

These are tough situations, because we do try to avoid surgery on pregnant patients if not essential. However, it would be good to follow-up with your primary doctor and often orthopedist to make sure nothing is broken. If you don't have a fracture or major ligament injury, the injury should not be time sensitive, and if it does need surgery, you can wait until after birth.

In most cases, yes. I am a joint replacement surgeon and I can tell you with confidence that if your pain is from hip arthritis or long-term damage to the labrum (the gasket in your hip), then a hip replacement is very successful at improving symptoms. The first step is an X-ray and evaluation by an orthopedic surgeon. If you have moderate to severe arthritis, then a hip replacement is indicated. If you are young (<50) and do not have arthritis, the first step is an MRI to evaluate for other sources of pain that may be addressed by more limited procedures such as hip arthroscopy. This said, as orthopedic surgeons, we exhaust nonoperative management first. The first step would be an evaluation to determine the source of your pain. This is generally followed by 6-8wks of physical therapy, oral anti-inflammatory medications, and sometimes a hip injection prior to attempting any of the more invasive surgical management described above. The bottom line - YES - there is hope.

While, there's no "cure" for scoliosis, per se, treatment involves slowing or halting progression. The goal is to prevent curves from getting up to 40-50 degrees, because those curves have been shown to cause pain later in life.

The first step would be getting in front of an Orthopaedic Surgeon to evaluate you clinically and to review your X-rays. Scoliosis is many times over-called on X-rays, as many individuals are walking around with up to 10 degrees of "spinal asymmetry" (not true scoliosis) and don't even know it. Now, if you have greater curvatures (20-25 degrees or more), bracing may be indicated if you're younger and skeletally immature (<14 in girls, <16 in boys). If you reach that 45-50 degree range, surgery may be indicated. If you are an adult with <45-50 degrees, often we just observe these curvatures because most will not progress much. Interestingly enough, while there's no cure, most cases are not associated with any symptoms.

I would recommend following up with your primary care doctor for X-rays. If you have a fracture or significant limitations on motion, you may need referral to an orthopaedic provider to ensure there aren't any soft tissue injuries (tendons or ligaments) that may be contributing to your symptoms and that may need to be addressed.

Knock knees, or "genu valgum", can have many causes, and is often genetic. In childhood, if the knock knees are severe, and the child is still growing (<14 girls, <16 boys), then we can intervene and "modulate" growth to straighten the leg out as the child grows. It is a relatively small procedure and can prevent severe knock knees in adult hood. The best person to see is a pediatric orthopedist.

As an orthopaedic surgeon, we always exhaust nonoperative management before attempting surgery. One of the modalities that I always recommend to patients is topical NSAIDs, such as Voltaren gel. The anti-inflammatories often get at the source of your pain, which is generally inflammation. If you haven't had your shoulder looked at, and the pain is severe, has been getting worse, or has been present for a long time (>6-12wks), I would have this looked at by your local orthopedist!

It's sometimes hard to tell if something is broken or not based on pain alone. If you're concerned, the SAFEST thing to do is see your primary doctor during the week if they have a walk-in appointment available (many do!) OR you can always go to the emergency department so that someone can have a look at it. You may get an X-ray there as well.