Do You Suffer from Hip Pain? Learn About Treatment Options
Pain in your hip can be more than just an annoyance. It may limit your daily activities such as walking or climbing stairs. It might even keep you awake at night. So how can you get relief from the pain?
"Making an accurate diagnosis of the cause of a patient's hip pain is the first step in determining the most effective course of treatment," says orthopedic surgeon Dr. John Dearborn, co-medical director of the Institute for Joint Restoration and Research at Washington Hospital.
"Osteoarthritis, which is caused by breakdown of the cartilage that cushions the ends of the bones in a joint, is one of the most common causes of hip-joint pain," he notes. "There are a number of non-arthritis conditions that mimic the pain of actual hip-joint pain, however, including trochanteric bursitis and lumbar radiculopathy. And then there are acute injuries that result in muscle strains or tears in ligaments or cartilage. The cause and severity of the hip pain dictate the proper course of treatment."
To help people in the community learn more about various causes and treatment options for hip pain, Washington Hospital is sponsoring a free Health & Wellness seminar featuring presentations by Dr. Dearborn and orthopedic surgeon Dr. Alexander Sah, who is co-medical director of the Institute for Joint Restoration and Research. The seminar is scheduled for Friday, November 2 from 2 to 4 p.m. in the Conrad E. Anderson, M.D. Auditorium at the Washington West Building, 2500 Mowry Avenue in Fremont.
Dr. Dearborn explains that trochanteric bursitis is an inflammation of the sac of fluid (bursa) that cushions and lubricates the area between the muscles, tendons and bones of the hip joint. It can be caused by an acute injury, prolonged pressure on a bursa or activities that require repeated twisting or rapid joint movement, such as jogging or bicycling long for long distances.
"Trochanteric bursitis is fairly common, and it usually can be diagnosed with a physical exam," he says. "The pain, which is more common on the side of the hip, can often be treated with non-steroidal anti-inflammatory medications such as ibuprofen or naproxen. In addition, physical therapy that includes range-of-motion and stretching exercises can be very helpful. If anti-inflammatory drugs and exercise don't provide relief, a physician may use an injection of corticosteroids to decrease the inflammation and pain."
Lumbar radiculopathy is actually the result of a spinal problem, rather than a hip joint condition. "Lumbar radiculopathy is caused by a pinched nerve in the spine where the nerve root exits the spine just past the hip joint," Dr. Dearborn says. "It produces pain in the hip that usually hurts worst when the person is sitting. It actually may be relieved by standing or walking.
"In these cases, the person should be seen by a spine specialist for screening with an MRI to see where the nerve is being pinched," he adds. "The spine specialist may treat the condition with oral anti-inflammatory medications and physical therapy. Epidural steroid injections might be used if oral medications and physical therapy aren't working."
If there is any question of whether the person's pain is actually coming from the hip joint itself, an injection that combines the pain medication lidocaine and a corticosteroid could be used as both a diagnostic tool and a treatment for hip pain.
"This type of injection directly in the hip joint would provide pain relief only if the source of pain is in the hip joint itself," Dr. Sah explains. "The injection would not help in cases of bursitis or pinched spinal nerves. There actually may be more than one source of pain. It's important to note that combination pain medication and steroid injections are only a temporary solution for actual hip-joint pain."
Surgical Options for Hip-Joint Pain
"If a patient with hip-joint pain has already tried oral medications, physical therapy and steroid injections and is still in pain - or if the patient has severe arthritis in the hip joint, the next step would be surgery," says Dr. Dearborn. "In most of those cases, a total hip replacement is the best option.
"Hip resurfacing is not usually as durable as a hip replacement, he adds. "Plus, hip resurfacing is actually more invasive than the advanced minimally invasive hip replacement techniques we use today. With hip resurfacing, the surgeon must cut through a lot more muscle tissue. In minimally invasive hip replacement surgery, we make a much smaller incision and use specialized instruments that allow us to insert the implant without cutting across any muscles."
At the seminar, Dr. Dearborn and Dr. Sah will discuss the pros and cons of various types of hip-replacement implants, such as metal-on-metal bearings, ceramic hip replacements and cross-linked polyethylene bearings.
"All of the implants have their pros and cons," says Dr. Sah. "We believe, though, that the 'gold standard' for hip replacements is a metal ball with a highly cross-linked polyethylene surface. The goal is to minimize wear, so that the patient can expect the hip replacement to last. Ceramic implants may fracture more easily, and the recent recalls of various metal-on-metal implants validates our long-standing decision not to use them."
The doctors also will discuss the advantages and disadvantages of new surgical techniques. "Some advertisers are claiming that an anterior (frontal) surgical approach to hip replacement is better than a posterior approach, but that's not true in most cases," says Dr. Dearborn. "We also will discuss the pros and cons of computer-assisted surgery. We use computer-guided surgery in some cases, but for most patients it is unnecessary and adds no benefit to balance the substantial cost. Computer-guidance doesn't necessarily make the surgeon more accurate."
Dr. Dearborn urges people who are considering hip replacement surgery to choose their surgeon carefully. "The technology for hip replacement surgery has improved, but the quality of the outcome depends largely on the surgeon's experience and skills," he says. "Surgeons who do relatively few replacements each year have higher complication rates and do not offer less invasive methods."
Together, Dr. Dearborn and Dr. Sah performed more than 450 minimally invasive total hip replacement surgeries over the past year. Several studies have confirmed that hospitals with a higher volume of such surgeries have much better outcomes.
"The bottom line is that we want to give our patients the best possible long-term outcomes for total hip replacement surgeries," says Dr. Sah. "We also want patients to make the most informed decisions possible. There is a lot of information available on the Internet, but it's important to find reputable sources, such as the American Academy of Orthopedic Surgeons (www.aaos.org). Information from manufacturers tends to be biased and promotes their own products. It's also important to ask plenty of questions, and this upcoming seminar will be a good place to start."
To register for the seminar on November 2, visit www.whhs.com and click on the link for "Upcoming Seminars."
Learn More About the Institute for Joint Restoration and Research
A new facility for the Institute for Joint Restoration and Research opened in June. The new facility, features all-private patient rooms and expansive therapy areas that support a healthy, healing environment for patients. In addition, there is an outpatient office and dedicated areas for pre-surgical testing and patient education.
"The new facility is more comfortable and convenient for our patients, and it also allows us to have quicker access to patients since our office space is just upstairs from the care units," says Dr. Dearborn. "We also can conduct clinical research and hold conferences for visiting physicians in the same building."
For more information about the Institute for Joint Restoration and Research, call 888-494-7003 or visit www.dearbornsah.com.