Causes of hip pain | Understanding symptoms | Nonsurgical treatments | Surgical options | Hip prevention

Hip Pain

Your hips, along with your knees, bear your full body weight and have a wide range of motion making them susceptible to injury and arthritis. Northwest Hills Surgical Hospital orthopedic surgeons are experienced experts for the full range of hip problems associated with sports, aging, trauma, and arthritis. Our goal is maximum recovery of hip function with diligent follow-up after surgery and a customized rehabilitation program to get you back to your normal activities as quickly as possible.

At SBO, we work together to provide comprehensive care for the full range of athletic, degenerative, and traumatic disorders of the hip. Feel confident in our long history of providing orthopaedic care and pioneering surgical techniques to Michiana. We provide patients access to the most up-to-date implants and technology available for quicker recovery and longer prosthetic life.

Common Conditions

• Avascular Necrosis (SVN) of the Hip
• Femoral Fractures
• Hip Bursitis
• Labral Tears of the Hip
• Osteoarthritis of the Hip
• Slipped Capital Femoral Epiphysis (SCFE)

Common Procedures

• Femur Fracture Fixation
• Hip Arthroscopy
• Mini Total Hip Replacement
• Revision Hip Surgery

Causes of hip pain

Arthritis

The primary cause of hip pain is arthritis, specifically osteoarthritis. Arthritis is the most common chronic condition and is characterized by inflammation of the joints. Common causes of arthritis include wear and tear on the bones and joint cartilage, most often when the body has too much weight to support. This can be caused by carrying heavy loads consistently for years but is more commonly a byproduct of being overweight.

Common Arthritis Myths

• Only older people have arthritis.
• Arthritis is caused by cold, wet weather.
• Each day is the same for an arthritis patient.
• Arthritis is a minor physical inconvenience.

Osteoarthritis

Osteoarthritis is the most common form of arthritis, affecting over 21 million Americans. Three times as many women suffer from the disease than men.

Osteoarthritis occurs when the covering on the ends of bones gradually wears away, becoming frayed and rough. It typically develops due to many years of use and affects people middle-aged and older. Osteoarthritis targets hands and weight-bearing joints, such as knees, hips, feet and back.

Risk Factors

• Age- 45 yrs or older
• Gender- majority of sufferers are women
• Certain hereditary conditions including defective cartilage and malformed joints
• Joint injuries caused by physical labor or sports
• Obesity
• Diseases that alter normal structure and function of cartilage

Symptoms (usually come on slowly)

• Pain and inflammation
• Pain may develop gradually and feel like a deep ache.
• Swelling and stiffness
• May be worse in the morning and feel better with activity
• Loss of range of motion
• “Sticking” and weakness
• Loose fragments of cartilage and other tissue can cause locking or “sticking."
• Joint may lose strength and buckle or lock.

Overweight

Our hips form and develop in mass and strength in proportion to the amount of weight our body was designed to hold. So if you are a small woman, your hips are meant to hold a smaller amount of weight than if you are a six-foot tall man. Although the body is very adaptable and can learn to hold different weights, a point can be reached where the body is simply not comfortable supporting excess weight.

In some cases, along with surgery, a lifestyle change needs to take place to keep chronic pain at bay. For instance, diet should be addressed immediately, and an exercise regime should ensue following recovery from surgery.

Avascular necrosis

Avascular necrosis occurs when the tissue in the joints literally die when the blood supply is cut off to the bones. This can be a temporary blood supply loss or a permanent loss. Causes of avascular necrosis can include alcoholism, steroids, or blood disorders.

In the early stages of avascular necrosis, pain only occurs when pressure is put on the joint. However, as the necrosis worsens the pain is present even while resting the joint. In many cases, the blood supply is lost permanently and the damage tissue must be removed and replaced with a hip replacement.

Mechanical abnormalities

Mechanical abnormalities are rare, but can stem from childhood disfigurement or fractures that never healed properly. Initially, the body will try to compensate for the abnormality. However, as time passes, this will create wear and tear on other parts of the body. Ultimately, the remedy for this can be hip replacement.

Osteoporosis

Those with fragile bones that may easily break have osteoporosis. The disease is the result of lower than average amounts of phosphate and calcium in the bones, which cases them to become porous and brittle. Bones that most commonly break are the bones in the spine, wrist and hip.

There are both controllable and uncontrollable risk factors that increase or decrease odds of developing the disease. For instance, people of all ages, races and genders get osteoporosis, but it is a condition most commonly found in Caucasian and Asian females over the age of 60. Other uncontrollable risk factors include: family history, certain diseases and hormone levels. Controllable factors encompass those things that an individual can do during their lifetimes to lower their risk for developing osteoporosis. For instance, smoking, excessive drinking (more than 7 ounces of alcohol per week), poor nutrition with low calcium intake and lack of exercise can all contribute to the development of the disease.

The best treatment for the disease is prevention by consuming the recommended amounts of calcium and phosphate throughout a lifetime. When the disease is recognized, calcium is prescribed into the diet immediately, hormone treatments may help and an exercise regimen is recommended to abate further deterioration of the bone. To find out if you have osteoporosis, an energy X-ray absorptiometry (DEXA) scanning can analyze bone density.
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Understanding symptoms

What do symptoms mean? Can you self-diagnose your hip problem? How can you decide if you need to see a doctor for your hip pain?

Here is some helpful information.

• Indicators of a serious problem
• The pain causes you to limp
• The legs feel as though they are different lengths
• You have a limited range of motion in the hip and you hear creaking noises when move it
• Rest relieves the pain and using it hurts
• The hip feels stiff

Misleading Symptoms

Some symptoms that may seem like a hip problem may actually be a more severe back problem. Be sure to check out all persisting hip pain with a specialist. For instance, a tingling or numb sensation in the hip or upper thighs may actually be a symptom of spine damage. Also, when pain does not lessen when lying down or sitting in a way that relieves pressure, than the problem my be rooted in the back, not the hip. This type of pain should be treated immediately.

Hip prevention

One of the main ways to avoid hip pain in the first place is by maintaining a healthy weight and living an active lifestyle. Below are some tips to help maintain good health.

Overall good health

The key to keeping a hip problem at is to stay relatively active and to eat right. The US Government notes that 56 percent of Americans are overweight.

Scientifically speaking, our hips form and develop in mass and strength in proportion to the amount of weight our body was designed to hold. So, if you are a small woman, your hips are meant to hold a smaller amount of weight than if you are a six-foot tall man. Although the body is very adaptable and can learn to hold different weights, a point can be reached where the body is simply not comfortable supporting the excess weight.

Let's talk BMI, or Body Mass Index. BMI is the number you come up with when you divide how much you weigh in kilograms by how tall you are in centimeters squared. The number you come up with is your BMI. A BMI between 18.5 and 25 is considered in the normal range. A BMI above 25 is considered overweight and a BMI of 30 or more is classified as obesity. To find your BMI, there are several calculators on the Internet including the BMI recommendations from the Surgeon General.

Nonsurgical treatments

Weight Management Techniques

The key to keeping a hip problem at bay is to stay relatively active and to eat right. The most recent government report notes that 56 percent of Americans are overweight. This is bad news for our hips and knees.

Scientifically speaking, our hips form and develop in mass and strength in proportion to the amount of weight our body was designed to hold. So, if you are a small woman, your hips are meant to hold a smaller amount of weight than if you are a six-foot tall man. Although the body is very adaptable and can learn to hold different weights, a point can be reached where the body is simply not comfortable supporting the excess weight.

Let's talk BMI, or Body Mass Index. BMI is the number you come up with when you divide how much you weigh in kilograms by how tall you are in centimeters squared. The number you come up with is your BMI. A BMI between 18.5 and 25 is considered in the normal range. A BMI above 25 is considered overweight and a BMI of 30 or more is classified as obesity. To find your BMI, there are several calculators on the Internet including the BMI recommendations from the Surgeon General.

Diet

Losing weight can provide instant relief for the hips. Although we are constantly inundated with new diet fads, remember that logically, the way to lose weight is to consume fewer calories than we burn and the way to maintain weight is to burn approximately the same number of calories that we burn.

Although in reality, this method can be harder to follow than it is to understand, once we build healthy habits, this lifestyle will become easier and easier to maintain. Some diets help you to do this. Others are shams. Be cautious. Anything that seems to good to be true, probably is.

If you have arthritis, there are pain aggravators that should be avoided. For instance, paprika, pepper, tobacco, cayenne, eggplant, large amounts of potatoes and tomatoes can irritate your arthritis because these foods have alkaloids that prevent the repair of collagen and cartilage. Aspartame (found in diet sodas and artificial sweeteners) can also worsen arthritis since in causes inflammation in the joints when regularly consumed.

In study after study, it seems almost innumerable health benefits can be accumulated from eating a diet rich in fiber and complex carbohydrates found in vegetables, whole wheat and fruits. Once again, hips also benefit from this diet.

Exercise

It is also important to incorporate exercise into your routine if you have hip pain. Although it may seem like a Catch-22 (you cannot exercise because your hip hurts, and your hip hurts more because you cannot exercise) strengthening the leg muscles can be crucial in alleviating hip pain.

The more support the muscles can offer, the less stress and therefore less pain. Please refer to our online exercise library, which will show you several hip strengthening exercises. Also, if your hip hurts and you want to start up an exercise routine, why not try a stationary bike or swimming? While running or stair climbing can be taxing to the hips, the stationary bike and swimming are both excellent cardiovascular activities that only minimally put pressure on the hips.

Treatments you can administer at home

Anti-Inflammatories

Non-Steroidal Anti-Inflammatory medication, or NSAID's, such as ibuprofen (Advil, Nuprin and Motrin IB) help reduce swelling and inflammation and can be quite helpful to a torn ligament. The ibuprofen also helps mask the pain of a hip injury. Use NSAID's cautiously, however, as taking them regularly over a long period of time can cause ulcers or other gastro-intestinal problems.

Just remember that while using NSAID's, you should also be taking other precautions to heal your pain. COX-2 inhibitors such as Celebrex by Searle and Vioxx by Merck can help lessen the stiffness brought on by arthritis pain. Vioxx can helps manage both osteoarthritis and rheumetoid arthritis pain. While they are able to help with the pain, they also might make it difficult for the body to heal ulcers, so be sure to consult with your doctor to make sure this is the right treatment for you.

Another anti-inflammatory that can be useful are enzymes. The FDA has labeled them GRAS (or generally regarded as safe) which means they can be used to treat hip pain with little to no side effects.

RICE — Rest, Ice, Compression, Elevation

This is an easy to remember four-step formula for treating a hip injury that is incurred from activity.

• Rest, means to keep the hip away from any stressful activity, preferably immobile initially.

• Ice means to apply ice to the hip to control swelling and inflammation. Wrap ice in a towel so that it does not agitate the skin.

• Compression will help prevent hemorrhaging or internal bleeding.

• Elevation. Elevate the leg above the heart to reduce internal bleeding.

Vitamins & Supplements

Glucosamine & chondroitin sulfate

Jane E. Brody, "Personal Health" columnist for The New York Times, says that European researchers have shown that glucosamine and chondroitin taken by mouth find their way to articular cartilage, and biopsies of some treated patients have shown structural improvements in damaged cartilage. Those who suffer from arthritis pain can find this particularly encouraging. These compounds are already found in the human body and they protect cartilage like a cushion at the ends of the bones. They can structurally improve in damaged cartilage. Glucosamine is able to repair joints by providing the elements the joints need to repair the damage caused by injury or arthritis. The joint cartilage absorbs glucosamine and it helps to form cartilage by capping the ends of bones. Glucosamine also keeps the mechanisms that build and deteriorate cartilage balanced, thereby preventing unnecessary, or untimely tissue loss. Chondroitin keeps the enzymes in the hip from eating away at cartilage, and it helps other enzymes in moving the flow of nutrients to the cartilage in the hip. In test tube studies, chondroitin has been proven to stop certain enzymes from breaking down cartilage further.

MSM

Methyl-Sulfonyl-Methane (MSM) is a sulfide that the body naturally produces. Those suffering from hip pain may find that it helps lessen their pain. MSM is, for the most part, safe. It increases the flow of harmful substances out of the cells and prevents pressure buildup in the cells, which causes inflammation in the joints. MSM is most widely used as an anti-inflammatory for joint and hip pain associated with arthritis.

Although the body produces MSM, additional MSM is found in other foods such as milk, meat, vegetables, fruit, and seafood. However, due to the abundance of processed foods, it can be hard to get the recommended dosage. Steamed foods, washing foods, and aging can also reduce MSM levels.

Shark cartilage

Shark cartilage has been shown to lessen the pain and stiffness in hips. This is because it contains mucopolysaccharides, powerful anti-inflammatory molecules. Shark cartilage is available in capsule form that can be taken as a dietary supplement. While it may not completely eliminate the pain, it might help.

Shark cartilage is a nontoxic, natural supplement that contains calcium, phosphorous, and complex carbohydrates. The calcium and phosphorous is easily absorbed into the body, and the complex carbohydrates have been shown to reduce inflammation.

Using shark cartilage, Dr. Joseph Orcasity, a consultant at the University of Miami Medical School, treated a dozen elderly arthritis patients with severe hip pain. He reported that after taking shark cartilage for four weeks, most patients exhibited reduced pain and swelling and increased mobility.

Gelatin

In a recent study, gelatin capsules have been shown to help reduce pain and stiffness in athletes at Ball State University. The concentration of gelatin must be much greater than what is found in a bowl full of Jell-O but it is essentially the same thing. This supplement is classified by the Food and Drug Administration as GRAS (or generally regarded as safe).

Minerals

Not only can minerals such as boron, copper, manganese, silicon, and zinc help treat osteoarthritis, they can also be beneficial to your health overall. Although many of the foods we eat contain these minerals, they can also be taken as a supplement. Some of these minerals act as anti-inflammatories and others act as antioxidants.

Vitamins

Vitamins can be helpful in alleviating pains associated with rheumatoid arthritis, an autoimmune disorder that attacks tissues in the body. The tissue degeneration causes pain in the joints. Vitamins can help the immune system eliminate these toxins in the body keeping cartilage from breaking down so rapidly.

Herbs

Taking herbs is sometimes considered archaic or analogous. However, grandmother was right. Herbs are good for your health. Certain herbs such as licorice, ginseng, cat's claw, and echinacea can help the immune system by reducing inflammation as they bolster cell membranes. Other herbs that can help alleviate pains associated with osteoarthritis or rheumatoid arthritis are Chinise skullcap, devil's claw, curcumin, yucca, ginger, and witch hazel.

Alternative Medicine

While in some cases, the treatments listed here do not change the structure of the hip, they can be a great way to manage pain — with virtually no side effects if done correctly. Some of these treatments may be more effective on some people than others. If you would like to seek alternative treatment, try to find something that works the best for you.

Acupressure

Acupressure is an ancient Chinese form of therapy where pressure is applied to the body in order to increase blood circulation and relieve pain. This unique form of massage can relax muscles and compress nerve fibers that cause pain. If you are interested in experimenting with this form of therapy, you can either find a professional acupressure therapist or simply go to the bookstore and find a book that will tell you how to try the techniques at home by yourself or by a partner.

Acupuncture

Those suffering from hip pain may find relief from visiting an acupuncture specialist. During acupuncture hair-thin needles are inserted into various parts of the body and are stimulated to alleviate pain in many forms including but not limited to nausea, dental pain, muscle pain, menstrual cramps, and pain from osteoarthritis. This 3000-year-old Chinese art gained credibility in the western world in 1997 when the National Institutes of Health declared it efficacious.

The Chinese believed that by balancing the positive and negative energy in the body, pain relief can be achieved. They found acupuncture to be an effective resource to achieve that balance. Other modern-day doctors believe that acupuncture stimulates pressure points thus releasing relaxing endorphins. Whatever the case may be, acupuncture provides relief to many people suffering from pain.

If you decide to try acupuncture, be sure to have a licensed professional administer the treatment. Also, get a physician's referral for an acupuncturist close to you. An acupuncturist should be certified by the National Commission for the Certification of Acupuncturists. You can obtain a list of certified specialists in your area by calling the American Association of Acupuncture and Oriental Medicine.

Bee Venom

Bee Venom Therapy (BVT) is a toxin that is put into a certain part of the body. The toxin is attacked by the immune system making it stronger and more prepared to deal with future toxins. The body in a way creates its own antibody against the bee venom in that area. This therapy be administered only by a practitioner licensed in it.

Hydrotherapy

Spas and whirlpools are sometimes used to improve circulation and relieve chronic pain from the back and joints. Different therapy uses different temperatures of water. Cold water reduces inflammation, cold and warm water improves circulation. Dr. Nooshin K. Darvish, a specialist in hydrotherapy, recommends that patients apply moist heat to the hip for three minutes followed by cool water for one minute. This should bring relief and stimulate circulation.

Massage

Therapy Massage not only feels good, it is an effective way of relieving pain. A masseuse will increase the circulation of the body through rhythmic hand motion. In sports, massage therapy can be used to prevent strain by warming up athletes prior to a workout. The muscles can also be massaged after a workout to bring blood and oxygen into the muscles to flush out metabolic waste and increase circulation to the muscles to bring them the nutrients they need to heal after strenuous activity.

For those suffering from arthritis, massage can also be very helpful. Massage will help blood circulate in the painful area which brings essential nutrients to the muscles and joints which will help reduce inflammation and can also help break up scar tissue and adhesion which is causing pain.

Reflexology

Reflexology has been used as a method to relieve pain for thousands of years starting in ancient Egyptian culture. The premise is that by massaging the feet or hands, you can help ease pain in another part of your body. By massaging a certain part of your foot, for instance, you may be able to sooth hip pain.

Zen

Over the past few years a scientific affirmation has verified the idea of 'mind over matter'. Zen is a method employed by some to shape the mental state and in some ways actually control pain. In our frenetically paced world, all of us need focus and discipline.

Yoga and Tai Chi

Ancient Eastern exercises are have become increasingly popular in the United States over the past few decades. These exercises stress the importance not only of physical agility, but joining the mind and body to have mental control over the physical state. These exercises are not only trendy, they are useful in increasing flexibility and gaining strength, which can help prevent and alleviate pain.
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Surgical options

Hip Replacement Surgery

Over time, the impact of joint disease, arthritis, or excessive body weight can erode the hip joint.

According to the American Academy of Orthopaedic Surgeons, each year in the United States, about 193,000 hip replacements are performed. With the aging of the baby boom generation, that number is expected to grow as this large segment of the population moves into their 50s and 60s. It is estimated that more than 500,000 knee and hip replacements will be done each year by 2040. Also, the joint implant technology involved is improving, enabling the artificial joint to last longer.

The surgery itself, lasting between two to three hours, is performed on those who experience the chronic and debilitating effects of hip disease. An incision is made in the beauty of the patient. The surgeon then removes the diseased bone and cartilage and fits the prosthesis into the joint. The prosthesis is inserted and the incision is sutured.

Since hip prosthesis rarely lasts longer that 15 to 20 years, and outcomes of revisions are less effective than original replacements, young people are not good candidates for the surgery. In fact, in the United States, 65 percent of hip replacements are given to those over the age of 65. It is also not recommended for the extremely obese, those with a terminal illness, those with nerve disease, those lacking ample skin around the hip.

Types of Hip Prosthesis

Acrylic with Cement Fixation

This is the first type of hip prosthesis developed. Essentially, the prosthesis is secured to the hip with a cement adhesive. Over time (10 to 15 years) the cement will erode and need to be replaced. Usually these implants are used in older, less active adults or in people with weaker bones. The recovery time for this prosthesis is faster than other methods.

Without Cement Fixation

The difference between the cement and uncemented version of the hip prosthesis is the lattice grid that comprises the socket part of the uncemented prosthesis. After the diseased bone and cartilage has been removed, the latticed grid is inserted into the socket. After a while during healing, the remaining hip bone will grow into the grid much like ivy grows into a trellis and suture itself to the prosthesis. The new bone grows into the implant, securing it in place. This is a much more natural cohesion and lasts longer than the traditional prosthesis. Also, it affords much more mobility to the active hip replacement recipient than the cemented type.

Scientists are currently in the process of developing joint replacement methods that will last much longer than the current prototype. While doctors now use a glue to bind the old bone with the new prosthesis, they one day hope to use ceramics as a bone substitute.

When a bone breaks in the body, the bone cells will form together to rejoin the broken bone. In the same way, bone cells can join with coral or ceramics forming one, continuous bone. While the glue or cement that doctors use will eventually deteriorate, ceramics will last much longer as they have better chances of being accepted by the cells. While recovery may take longer initially, the effects of surgery will last much longer than current replacement methods.

Hybrid Fixation

The hybrid fixation is where one part of the hip prosthesis (generally the stem) is cemented together while the other part of the hip (generally the socket) is inserted without cement.

Scientists are now working on using ceramics and coral to be used as joint replacements in the future. Patients typically require an overnight hospital stay to initiate physical therapy and for comfort. Almost all patients are able to go home the day after surgery (usually in the afternoon, after therapy). After the hospital stay, the patient will probably require the aid of a walker for a few days before putting full weight on the leg.
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