• Help for Hip Pain

    Rerun image Hip pain results from damage to the hip joint—a ball and socket joint that connects the ball-shaped top of the leg bone (femur) to the hip socket. Damage to the hip joint results from a number of causes, including:
    • Osteoarthritis (which causes a degeneration of the cushioning of the surface of the hip socket)
    • Rheumatoid arthritis (which causes swelling of the hip joint)
    • Avascular necrosis (an interrupted blood supply to the hip joint causing the eventual loss of bone tissue in that area)
    • Injury (caused either by a bone tumor or by a break or fracture of the hip joint)

    Conservative Treatment

    Nonsurgical therapies are often the first choice of treatment but it really depends on the cause of your pain. Your physician will ask about your symptoms and then x-ray the hip joint to assess the extent of the damage. Nonsurgical therapies include:
    • Physical therapy and pain relievers—Physical therapy is prescribed to strengthen the hip. Pain medication may include either nonaspirin relievers (ie, Tylenol) or nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen .
    • Steroid medications—In cases where NSAIDs are no longer effective and the diagnosis includes a form of inflammatory arthritis, steroid-based anti-inflammatory/pain medication such as prednisone may be prescribed. Because these don't control the pain for long and have potential long-term side effects—weakening of joints, weight loss and/or a decrease in the functioning of the immune system—steroids are not considered a long-term option.
    In certain situations, other surgical treatment options may be considered:
    • Osteotomy—In this procedure, the damaged portion of the hip joint is removed and the joint is reconfigured to its proper position. Recovery from an osteotomy may take anywhere from 6-12 months. In many cases, osteotomy requires additional treatments, and in most cases, it serves to delay rather than avoid the need for hip replacement surgery.
    • Core decompression—is used in patients with femoral head osteonecrosis at the early stage
    • Surgical debridement—may be used for a variety of hip disorders
    • Resection arthroplasty —for patients who have a chronic infection of the hip or are affected by certain bone tumors
    • Hip arthroscopy
    • Hip arthrodesis—also known as hip fusion

    Hip Replacement Surgery

    When your hip problems can no longer be controlled by conservative methods, you may become a candidate for hip replacement surgery.. If you are deemed a suitable candidate and decide to have hip replacement surgery, the procedure will consist of the following:
    1. The damaged portion of the hip joint (including the bone and cartilage) are removed.
    2. The hip socket (into which the ball at the top of the femur fits) is lined with a smooth plastic material, allowing for smooth (and painless) movement of the ball in the hip socket.
    3. The rounded ball-shaped portion of bone at the top of the femur is replaced by an artificial ball made of either metal or ceramic.

    Getting Back on Your Feet

    For the first week or two following surgery, activity is very limited. After this initial period, crutches are needed for up to six weeks, and physical therapy and exercise begin (lasting for 3-6 months). Depending on your age, overall condition prior to surgery, and steadfastness in following the prescribed rehabilitation regimen, recovery from hip replacement surgery will take anywhere from 2-6 months.
    Possible postoperative complications from hip replacement surgery include:
    • Hip dislocation (most common complication)—occurs when the ball portion of the prosthesis dislocates from its normal position in the hip
    • Pain
    • Infection
    • Blood clots
    • Swelling or bleeding
    • Loosening of the artificial joint within the hip socket (the most common long-term postoperative problem)
    These postoperative complications can often be treated with medication or other nonsurgical techniques. Sometimes, however, follow-up surgery may be necessary. If the artificial joint is damaged, a second hip replacement may be required. And, even with the current advancements in artificial hip technology, the artificial hip liner or the artificial hip itself will wear out and require replacement within two decades.
    Here are some things you can do to prevent complications and improve the longevity of an artificial hip:
    • Prior to surgery, arrange your home so that during your initial recovery period, you can keep your movement as safe as possible.
    • Follow all of your doctor's and therapist's orders as to what physical activity you can and cannot do, especially while recuperating.
    • Diligently follow your physical therapy and prescribed home exercise regimen.
    • If you develop any unusual pain in the new joint or develop any kind of an infection, contact your primary care doctor or your surgeon immediately.
    • After your rehabilitation period is over, continue with your home-prescribed physical therapy exercises.
    • Avoid activities or sports that can cause you to fall or that put a large amount of stress on your joints (jogging, running , racquetball, singles tennis, basketball, skiing). Instead, opt for exercises that put limited stress on joints ( swimming , walking , or doubles tennis).

    RESOURCES

    Arthritis Foundation http://www.arthritis.org/

    National Institutes of Health http://www.nih.gov/

    CANADIAN RESOURCES

    Canadian Arthritis Network http://www.arthritisnetwork.ca/

    Health Canada http://www.hc-sc.gc.ca/index-eng.php/

    References

    Ganz, R, Gill, TJ, Gautier, E, et al. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br . 2001; 83:1119.

    Kellicker PG. Hip Replacement. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15&topicID=81. Updated November 13, 2009. Accessed March 16, 2010.

    McCarthy, JC. Hip Arthroscopy: Applications and Technique. J Am Acad Orthop Surg . 1995; 3:115.

    Simank, HG, Brocai, DR, Brill, C, Lukoschek, M. Comparison of results of core decompression and intertrochanteric osteotomy for nontraumatic osteonecrosis of the femoral head using Cox regression and survivorship analysis. J Arthroplasty . 2001; 16:790.

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