Sunday, 26 February 2017 05:59

Healthy Hips

Written by  Dr. John P. Salvo, Jr., Thomas Jefferson University Hospital

Hip Preservation Has Come a Long Way

 

Senior couple riding bikes together.

Hip and groin pain are a common problem for many patients. For those 50–55 or older, the most likely cause of this type of pain is arthritis or degenerative joint disease—a gradual breakdown of the cartilage of this weight-bearing joint.

For those younger than 50–55 and for athletes, the causes of hip and groin pain are much different. In younger patients the pain may be due to a tear in the lining of the hip combined with a problem with the shape of the hip.

No matter the cause, some patients require surgery for their hip problems. But fortunately there are several less invasive options to try first, regardless of age or injury.

 

Senior Hips

For those in the 50–55 age range or older, prevention is the key to having healthy hips for life. Losing weight, eating well and regular exercise are three of the best things you can do to keep your hips healthy and pain free.

When pain does strike, here are some options to explore as first steps:

  • Losing excess weight is the number one thing you can do to avoid or reduce hip discomfort. Less weight equals less stress on your joints—it’s that simple.
  • Stretching and strengthening exercises maintain your range of motion, build muscle and promote flexibility. Consider walking (walking your furry friend regularly is great exercise), bicycling, swimming or using low impact exercise machines (like the elliptical) at your local gym. Talk with your doctor about which exercises are right for you.
  • Keep moving. When possible, stand up and walk around. You’d be surprised how much those short walks or sets of stairs can benefit your hip health. Try to move around every 30 minutes.
  • Warm up and cool down every time you exercise to prevent injury and promote flexibility. Stretching is key both before and after any activity.
  • Stay motivated. To help with this you may want to add music to your routine or exercise with a friend or in a group. Many gyms offer low-impact group exercise classes, and these classes will help you stay motivated, make new friends and build self-esteem.

If these techniques aren’t sufficient to manage your pain, the next steps are to:

  • Modify your activities. Stop doing what hurts. Back off your activities for a while to see if that relieves your pain.
  • Take oral medications. Simple over-the-counter medicines—nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motirn IB) and naprozen (Aleve)—may relieve hip pain. If you have any questions, consult your doctor first.

When your lack of mobility or pain becomes intolerable, it may be time to consider surgery—including a hip replacement—but not until then. Examples of serious issues that may suggest it’s time to take additional steps include experiencing hip pain that persists despite pain medication, worsens with walking, affects your ability to use stairs, or interferes with your sleep.

Your doctor will generally leave it up to you to decide when it’s the right time to consider surgery as an option.

 

Younger Hips

Even for younger hips, the steps outlined above may help decrease hip and groin pain. And as with older patients, these approaches are generally tried before considering surgery.

Hip and groin pain in young patients and athletes often begins with intermittent symptoms but can soon progress to consistent and sometime debilitating pain. The most common causes of pain in these non-arthritic hips are femoroacetabular impingement (FAI, when the ball and the socket of the hip don’t fit together properly), labral tear (tear in the cartilage of the hip socket), and dysplasia (abnormal growth or misalignment of the hip joint).

Patients with FAI have a problem most often with the shape of the ball and neck of the femur, but can also have the pelvis cover too much of the ball. In these patients, there’s an over-constraint to the joint. Over time this leads to increased pressure in the joint that can damage the labrum (cartilage).

When these issues of FAI and labral tear become painful, surgery may be required.

Fortunately, hip arthroscopy may be successful in many cases. But unfortunately, patients with arthritis, dysplasia, instability or related medical conditions usually are not good candidates for hip arthroscopy.

 

Dr. John P. Salvo, Jr., Thomas Jefferson University HospitalDr. John P. Salvo, Jr., Thomas Jefferson University HospitalLess Than Hip Replacement

Hip arthroscopy and hip preservation procedures have advanced tremendously in the last few decades.

The goal of hip arthroscopy is to fix the hip through a minimally invasive approach. Through very small incisions, a fiber-optic camera is used to enter the hip joint and specialized instruments are used to fix the injury.

The labrum is usually repaired or anchored back to the pelvis so it can do the job it was designed to do. During the same procedure, the FAI can be attended to by decompressing the bone with a burr (a small surgical tool for cutting bone) to ensure the original cause of the problem won’t be an issue in the future.  

These procedures are done on an outpatient basis, although it does take some time to recover. Patients need to do physical therapy for a few months and full recovery typically takes 4 to 6 months after surgery.

Causes of hip pain can vary greatly depending on age, and treatment options to relieve the pain and restore mobility can vary greatly as well.

Because the treatment for every patient is different, if you suffer from hip pain at any age, the best first step is to consult your doctor.

 

Dr. Salvo is double board certified in orthopaedic surgery and sports medicine by the American Board of Orthopaedic Surgeons. He’s a clinical associate professor of orthopaedic surgery at Thomas Jefferson University Hospital and specializes in knee ligament (ACL) reconstructions, shoulder instability and rotator cuff repairs, as well as hip arthroscopy. He’s an active member of several subspecialty societies. RothmanInstitute.com.