Hip

Rothman Orthopaedic Institute’s Joint Replacement Program is one of the nation’s top joint replacement centers performing more than 12,000 surgeries annually. The surgeons of the Rothman Orthopaedic Institute joint replacement team are experienced and skilled in total joint replacement. In addition to their extensive residency training, each physician has undergone advanced subspecialty training and acquisition of skills in programs known as Fellowships. Fellowships provide each surgeon with superior knowledge and expertise in their chosen area of subspecialization.

There are several causes of hip pain. They generally can be broken down into three categories: primary hip problems, secondary hip problems, and referred pain from other areas. Primary hip pain typically results from problems inside the actual hip joint, which includes the femoral head (the ball at the top of the thigh bone), the hip socket (acetabulum), and the labrum (soft tissue that surrounds the socket). This pain can be due to wear of the cartilage of the femoral head or socket (arthritis), labral tears, abnormalities of the shape for the ball and socket (femoroacetabular impingement), inflammation of the tissues inside the joint (synovitis), fracture (stress fractures or injury), or infection. Secondary hip problems are caused by injury, weakness, or inflammation of the structures surrounding the hip, specifically the muscles, tendons and soft tissue. Hip pain can be related to injury to any of the muscles or tendons (muscle strains/tears, tendon strains/tears) or inflammation of these same muscles, tendons or soft tissues. Interestingly, weakness of the muscles surround the hip can also result in pain. Referred pain is pain that comes from other areas of the body that radiate to the hip or feel like pain is in the hip. These areas include the low back (pinched nerve), sacroiliac (SI) joint (inflammation of a joint in the pelvis), muscular weakness, knee (arthritis or injury), and others. The treatment of hip pain would require an evaluation by a physician. This would include investigating the timing and location of the pain, a physical examination and x-rays of the area that is painful. This would help determine the cause and treatment options available.

Arthritis simply refers to the inflammation of a joint that causes pain, swelling, stiffness, instability and often deformity. Severe hip arthritis and hip pain can interfere with a person’s activities and can limit his or her lifestyle. If you are experiencing hip pain caused by hip arthritis, it is important to know that there are treatments available. There are multiple types of arthritis that can affect a joint. The most common ones that are seen are osteoarthritis (degenerative joint disease), rheumatoid arthritis, psoriatic arthritis, and lupus. Rheumatoid, psoriatic, and lupus arthritis are often associated with other conditions that may require treatment from a rheumatologist or other medical doctor. Osteoarthritis or Degenerative Joint Disease is the most common type of arthritis that occurs most commonly in hips, knees, ankles, and foot joints. Osteoarthritis is also known as "wear and tear arthritis" since the cartilage simply wears out. When cartilage wears away, the bone is subjected to higher degrees of stress, which causes pain, stiffness and disability. If the arthritis is severe and all of the cartilage wears away, the bones can actually rub together, causing what some people refer to as “bone on bone arthritis”.

The most frequent reason for osteoarthritis is genetic, since the durability of each individual’s cartilage is based on genes. If your parents have arthritis, you may also be at risk of suffering from degenerative joint disease. In addition, osteoarthritis may be a result of a past trauma, metabolic conditions like gout, previous surgery, or may be a result of your own anatomy.

Pain is the most frequent symptom for patients with hip osteoarthritis. The pain from hip arthritis is usually described as being in the groin or thigh. The pain is frequently worsened with activity and relieved by rest. It may occur at night and, in severe cases, prevent sleep. Patients with hip arthritis also tend to have stiffness and often limp when they walk. They may have difficulty going up and down stairs and putting on their shoes and socks.

Doctors diagnose osteoarthritis by speaking with the patient regarding their medical history and symptoms, performing a physical examination, and performing x-rays of the affected area.  It is typically unnecessary to get an MRI to diagnose arthritis, since x-rays almost always reveal the presence and extent of the problem.

There are multiple options for treating hip osteoarthritis. Treatments depend on the amount of pain that you are in and how severe your osteoarthritis is.

Non-operative treatment

The first line of treatment often involves methods other than surgery.

Options for nonsurgical treatment include:
1) Non-steroidal anti-inflammatory medicines or acetaminophen.
2) Hip injections, which may have some limited benefit, and may also be beneficial when trying to sort out exactly where the pain is coming from (for instance, differentiating between back and knee pain). Hip injections may last for several months, but it is generally not recommended to get repetitive hip injections.
3) For some patients, use of a cane or crutches may help to unload the painful joint.
4) A stretching or physical therapy program has been advocated by some, but relief is less likely when arthritis is at an advanced stage.

Operative treatment
If non-operative treatment fails and the hip pain persists, the best option may be a total hip replacement.

• One of the best ways to avoid or reduce joint discomfort is to lose excess body weight. Less weight equals less stress on your joints.
• Stretching and strengthening activities can help maintain your range of motion, build muscle and promote flexibility. Some activities to consider include gardening, walking, bicycling and swimming. Talk with your physician about which exercises are right for you.
• Keep moving. Sitting or standing all day can cause joint stiffness. When possible, alternate between these two positions, ideally every 30 minutes.
• Remember to warm up and cool down every time you exercise to prevent injury and promote flexibility.
• If you’re having a hard time staying motivated to exercise regularly, consider adding music to your routine or exercise in groups. It’s motivating, it’s social, and it builds self-esteem as you accomplish your goals together.
   

When joint pain is severe that it interferes with daily activities, work and sleep, joint replacement may be an option. The decision to replace your hip is made by you and your orthopedic surgeon mainly based on the degree to which the pain is affecting your life.

The hip pain and the stiffness of joint degeneration may be worse during certain times of the day, or after certain activities such as:

• Walking
• Climbing stairs
• Getting on and off a chair
• Putting on shoes and socks
• Walking on uneven surfaces
• Sexual activities
• Getting in and out of a car

Individuals with arthritis may also feel uncomfortable with pain while resting, sitting in a chair, or lying down.  Sometimes it make it difficult for individuals to care for themselves.

An orthopaedic surgeon can evaluate your condition and help you to decide if joint replacement would be right for you.
 

American Association of Hip and Knee Surgeons (http://www.aahks.org) - Established in 1991, the American Association of Hip and Knee Surgeons (AAHKS) is committed to its mission of providing educational opportunities to its members. For the past several years, Annual Fall meetings have addressed an increasingly broad array of scientific topics, such as implant design, results, surgical techniques and complications of primary and revision total hip replacements, as well as the latest information available on socioeconomic issues affecting the specialty.

The American Academy of Orthopaedic Surgeons (http://www.aaos.org) - The American Academy of Orthopaedic Surgeons is an organization of orthopaedic surgeons that provides comprehensive information on hip issues. This information can be found here: http://orthoinfo.aaos.org/menus/hip.cfm