Help for hip pain

by Rick Alan

When your hip joint begins to break down, you're in for constant pain that wakes you up at night and curtails most of your physical activities during the day? Fortunately, there are a number of treatment options that can greatly improve this chronic, painful condition.

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. Dr. Paul Pongor, arthritis and reconstructive surgeon at Boston's Beth Israel Deaconess Medical Center and the New England Baptist Hospital, explains that 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

Non-surgical therapies are the first choice of treatment in most cases of hip pain. Your physician will ask about your symptoms and then x-ray the hip joint to assess the extent of the damage. These therapies include:

Physical therapy and pain relievers

Physical therapy is prescribed to strengthen the hip. Pain medication may include either non-aspirin relievers (i.e., Tylenol) or non-steroidal pain and 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 they have potential long-term side effects--weakening of joints, weight loss and/or a decrease in the immune system--steroids are not considered a long-term option.

Osteotomy

Occasionally, in young patients (under 30) or in patients with more demanding physical jobs (i.e., construction workers), a corrective procedure known as an osteotomy may be done. The damaged portion of the hip joint is removed and the joint is reconfigured to its proper position. Recovery from an osteotomy can take anywhere from six to twelve 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.

Hip replacement surgery

When your hip problems can no longer be controlled by conservative methods, you may become a candidate for hip replacement surgery.

In the past, hip replacement surgery was generally reserved for older people whose less strenuous physical activity put minimal strain on the new artificial hip joint. Given the strides in hip replacement technology that make artificial joints much stronger and capable of sustaining greater stress, many more people are candidates 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:
  • The damaged portion of the hip joint (including bone and cartilage) are removed.
  • The hip socket (into which the ball at the top of the femur fits) is lined with a smooth plastic material, allowing for the smooth (and painless) gliding motion of the ball within the hip socket.
  • 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.

Cemented or uncemented?

The one variable in hip replacement surgery is how to "fasten" or "attach" the artificial joint to the remaining natural bone structure.

Cemented method- A special acrylic (very similar to that used to make plexiglass) is used to attach a "solid construction" artificial hip joint to the femur and within the hip socket.

Uncemented method- The material used to make the artificial joint is porous (and occasionally covered with a coral-like material). Over a period of time, the patient's natural bone grows through these pores, thus attaching the artificial joint to the hip's natural remaining bone structure. This allows for a much greater degree of physical activity in the long run.

Hybrid method- In some cases, surgeons may choose a hybrid method, whereby the artificial hip ball and stem is cemented into the femur, and the artificial socket is "press set" into the pelvis. With this method, screws are sometimes used to support the artificial socket within the pelvis.

Whichever method is used, hip replacement surgery provides significant or total pain relief in 90% to 95% of patients. "Overall, no method has proven more or less successful than another," says Dr. Pongor. A number of factors determine which hip replacement surgery is best for each candidate, including age, level of physical activity, and the strength of the underlying bone.

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 three to six 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 two to six months.

Possible postoperative complications from hip replacement surgery include:

  • Dislocation or fracture of the natural bone remaining in the joint
  • Blood clots (most patients are put on a blood thinning drug for a short period of time immediately following surgery)
  • Bleeding in the joint (especially in the days immediately following surgery)
  • Loosening of the artificial joint within the hip socket (the most common long-term postoperative problem)
  • Infection in the joint
  • Pain in the joint

These postoperative complications can often be treated with medication or other non-surgical 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 one to 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.
  • 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).