What’s new in hip pain?

New treatment options are available to alleviate symptoms and allow patients to function at an acceptable level.

An estimated 46 million adults in the United States reported being told by a doctor that they have some form of arthritis. By 2030, an estimated 67 million Americans ages 18 years or older are projected to have doctor- diagnosed arthritis. As our population continues to remain active, and with the addition of the Baby-Boomer generation to the aging population, patients seeking medical treatment for arthritis is expected to explode.

Unfortunately, arthritis can significantly interfere with one’s overall health. Among adults with doctor-diagnosed arthritis, many report limitations in vital activities such as:

• Walking 1/4 mile - 6 million
• Stooping/bending/kneeling - 7.8 million
• Slimbing stairs - 4.8 million
• Social activities such as church and family gatherings - 2.1 million

Hip pain remains a major contributor to declining activity levels and overall health in affected patients. Fortunately, we have a wide array of treatment options available.

Q.What are the Symptoms of Hip Arthritis?

Hip arthritis can present in a variety of ways. The most dependable indicator of a hip joint problem is groin pain. Some patients relate that they have “pulled a muscle”. Others report stiffness or difficulty with activities like tying shoes or getting in and out of a car. Pain that is referred from the buttock is rarely related to the hip socket. This is usually indicative of other pathology such as radiculopathy. Pain about the lateral hip is also rarely associated with hip arthritis. This can be from inflammation of the muscles and bursa about the lateral femur (“hip bursitis”) or from nerve irritation. Patients with hip arthritis will note they have pain with walking that is relieved by rest, and many will have a noticeable limp.

Q. How is Hip Arthritis Diagnosed?

Hip arthritis is diagnosed by a thorough patient history, clinical exam, and plain radiographs. An AP pelvis and lateral of the affected hip will allow comparison to the opposite hip and generally provides sufficient data to make the diagnosis. Occasionally, MRI is useful to more fully evaluate the joint and to make sure other conditions such as avascular necrosis are not present. In some younger patients with hip pain, additional radiographs or imaging studies are necessary to rule out labral pathology or hip impingement.

Q. How is Hip Arthritis Treated?

Hip pain and arthritis can be treated with a combination weight loss, activity modifications, exercise, anti-inflammatory medications, and ambulatory assistive devices (canes). Injections into the hip socket are useful if the diagnosis is in doubt but rarely do injections into the socket give long-term relief as may be the case in the knee or shoulder. If conservative options fail to provide adequate relief, then patients may consider surgery. Surgical options include hip arthroscopy for young patients with minimal disease or labral pathology and replacement for patients with more advanced disease.

Q.What is New in Hip Replacement Surgery?

Patients with advanced arthritis who have failed to have prolonged relief with non-surgical treatment often opt for replacement surgery. Hip replacement is one of the most successful surgical procedures with 95 to 98% of patients having a good to excellent result. The materials used in modern prosthesis are extremely durable, and it is hoped that many of the replacements we use now will last more than 30 years. Hip resurfacing is an option for younger male patients. This option may preserve some bone but its advantage over traditional replacement surgery is highly debatable. Total hip replacement remains the gold standard.

An exciting new development is the application of a muscle-sparing anterior approach to the hip with a specialized surgical table. This allows the surgeon to perform a total hip replacement without cutting muscle and may promote a faster recovery period. It also significantly reduces the chance for dislocation of the prosthetic hip. By preserving the muscles and soft tissues about the hip, patients typically see a recovery time of only 3 to 6 weeks.

As our population ages, the number of patients with hip problems will only increase. Early detection and treatment of hip conditions will allow most patients to continue with their desired activities and to maintain their overall health.