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Injuries, Symptoms & Treatments
Hip
Let's keep those hips swiveling !
The hip plays an integral role in the function of walking, sitting, standing and bending. It is one of the largest weight-bearing joints in the body. This ball-and-socket joint allows the leg to move and rotate while keeping the body stable and balanced.
Technologies and procedures for care and repair of the hip have evolved significantly in recent years, and our practice provides state-of-the-art therapies and surgery across the broad spectrum of hip treatments. From minimally invasive surgical techniques to total hip replacement, Dr. Bellapianta diagnoses and treats patients with compassion and the right approach at the right time.
Dr. B's goal is to first explain to patients every available treatment option and then customize a treatment plan specific to the patient’s need. Factors he considers include the injury, activity goals, job requirements and recovery timeline. If conservative treatment options are not effective, he may offer patients the latest advancements in hip surgery, including total hip replacement.
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Diseases/Conditions of the hip
Conditions of the Hip
Problems with our hips can be caused by diseases such as osteoarthritis or avascular necrosis. Other hip problems are attributed to injuries such as sprains, bursitis, dislocations and fractures. Treatments for hip problems range from basic pain management techniques to sophisticated medical treatments to cure disease and repair injuries. Dr. Bellapianta has extensive expereince in Advanced Minimally Invasive Arthroscopic techniques of hip surgery to repair tears and correct pathology with reduced pain and "down time" for the patient.
HIP PAIN
Hip pain is a common complaint that can be brought on for a variety of reasons. The location of your hip pain can provide clues about the cause. Problems within the hip joint tend to result in pain on the inside of your hip or your groin. Hip pain on the outside of your hip, upper thigh or buttock is usually caused by problems with muscles, ligaments, tendons and other soft tissues that surround your hip joint.
Your hip is a ball-and-socket joint that allows you to move and provides the stability needed to bear the weight of your body. The “ball” part of your hip is located at the top of your femur or thighbone, and the “socket” is the cup in your pelvis called the acetabulum.
Many people experience hip pain caused by osteoarthritis, the gradual wearing down of the cushioning surfaces in the hip. Hip pain can also be the result of disease or injury to the components of the hip or surrounding nerves. Additionally, hip pain can sometimes be caused by diseases and conditions in other areas of the body, such as the lower back or knees. This type of pain is called referred pain. Some types of hip pain can be controlled with self-care at home, while others may require medical or surgical treatment.
Hip problems due to Arthritis
Arthritis is the most common cause of hip tissue degeneration and joint pain. There are three types of arthritis that commonly affect hips:
Osteoarthritis: often called “wear and tear arthritis” it is the most common type of arthritis and can occur in one or both hips after years of use and bearing the weight of the body. It results in deterioration of the cartilage that normally acts as a cushion between the bones that come together within a joint. In your hip it would be where the top of the femur (ball) comes together with the acetabulum (socket). When the cartilage at this juncture wears, it allows the bones to come into direct contact causing varying degrees of pain depending upon the amount of deterioration that has occurred. Arthritis in its early and mid stages can be treated with pain relievers and light exercise, while more advanced cases may require surgery such as total hip replacement.
More about Hip Osteoarthritis
Rheumatoid Arthritis: is a systemic or body wide disease that causes the immune system to attack the synovial membrane. This attack causes the production of too much fluid resulting in damage and inflammation to this important structure and to the cartilage within the joint, leading to pain, stiffness, and disability. There is no cure for this disease, and treatments focus on administering inflammation reducing medication to relieve pain and prevent or slow joint damage.
Traumatic Arthritis: is largely the same as osteoarthritis, but this time caused by some source of trauma such as an old injury, sporting injury, or previous joint surgery. These incidents can damage the cartilage and/or the bone, changing the mechanics of the joint and making it wear out more quickly. Treatments are similar to osteoarthritis and range from non-invasive conservative methods, to surgical options such as hip arthroscopy or total hip replacement.
Other Hip Injuries and Disorders
Some of the most common hip injuries and disorders include:
Sparians and Strains: involve a stretched or torn ligament, which are tissues that connect two bones at the hip. Symptoms include soreness, bruising, burning, stabbing, throbbing, aching, swelling and stiffness, and being unable to move your hip. You might feel a pop or tear when the injury happens. Treatment usually involves rest, ice packs, wearing a bandage to compress the area, and medications.
Dislocations: are joint injuries that cause the bones of a joint to go out of position. In the case of a hip dislocation, it’s when the “ball” is forced out of the “socket” resulting in a great deal of pain and immobility. If this happens it is important to get immediate medical attention. When properly repositioned, your hip will usually function normally within a few weeks but you must take extra care to not cause another dislocation.
Fractures: are a physical break in the bone usually caused by accident, fall, or sports injury. Other causes can be due to low bone density or osteoporosis, both of which cause weakening of the bones. Fractures in the hip area include femur shaft fractures and pelvic fractures. These injuries need immediate medical attention so the bones may be realigned by a plaster cast, splint, or surgical procedure to use pins, plates or screws to secure the fracture thus allowing the bones to heal and grow back together.
Hip Pointer: is an extremely painful injury to the muscle that connects at the top of the pelvis just below the waist. It most commonly is the result of a blow, fall or a quick turn of the body and most often occurs in contact sports such as football and soccer. Given time, most hip pointers will heal on their own with conservative treatment and rest.
Snapping Hip:: is a snapping sensation or popping sound experienced in your hip when you walk, get up from sitting, or swing your leg around. It occurs when a muscle or tendon moves over a bony protrusion in your hip. It’s usually painless and harmless, but can be annoying. In some cases the snapping can lead to bursitis (see below) however.
Bursitis: occurs when one of the natural small fluid-filled sacs around the hip area becomes inflamed and painful. This is usually caused by overuse of a joint muscle but can also be caused by injury. Treatment involves rest, ice packs, and medication to reduce inflammation.
Avascular Necrosis: occurs in the head of the femur when the blood supply is interrupted by a fracture or other injury. It can also be caused by developmental disorders such as dysplasia and from use of certain drugs, in particular prednisolone (cortisone or prednisone) which has been used to treat conditions like asthma, skin complaints and other ailments. The course of treatment may only have been a short one and symptoms may surface from weeks to years later. It can also (rarely) occur as an aftermath of certain bone tumours such as bone cysts. Treatment focuses on prevention of further bone loss through medications and therapy. In advanced cases, surgical procedures are often indicated and include core decompression, bone transplant, bone reshaping, and hip replacement.
Burning Thigh Pain: can be experienced on the outer side of the thigh on one side of the body. It can be caused by compression of or damage to one of the large sensory nerves to your legs. The goal in treatment is to remove the source of pressure on the nerve. This may include avoidance of an activity that aggravates the condition, weight loss, medication to reduce inflammation, and in rare cases surgery.
Hip Dislocation
A traumatic hip dislocation occurs when the head of the thighbone (femur) is forced out of its socket in the hip bone (pelvis). It typically takes a major force to dislocate the hip. Car accidents and falls from significant heights are common causes and, as a result, other injuries like broken bones often occur with the dislocation.
A hip dislocation is a serious medical emergency. Immediate treatment is necessary.
Anatomy
The hip is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur.
A smooth tissue called articular cartilage covers the surface of the ball and the socket. It creates a low friction surface that helps the bones glide easily across each other.
The acetabulum is ringed by strong fibrocartilage called the labrum. The labrum forms a gasket around the socket, creating a tight seal and helping to provide stability to the joint. Strong bands of tissue called ligaments provide additional stability to the hip joint.
Description
When there is a hip dislocation, the femoral head is pushed either backward out of the socket, or forward.
Posterior dislocation. In approximately 90% of hip dislocation patients, the femur is pushed out of the socket in a backward direction. This is called a posterior dislocation. A posterior dislocation leaves the lower leg in a fixed position, with the knee and foot rotated in toward the middle of the body.
Anterior dislocation. When the femur slips out of its socket in a forward direction, the hip will be bent only slightly, and the knee and foot will rotate out and away from the middle of the body.
When the hip dislocates, the ligaments, labrum, muscles, and other soft tissues holding the bones in place are often damaged, as well. The nerves around the hip may also be injured.
Cause
Motor vehicle collisions are the most common cause of traumatic hip dislocations. The dislocation often occurs when the knee hits the dashboard in a collision. This force drives the thigh backwards, which drives the ball head of the femur out of the hip socket. Wearing a seatbelt can greatly reduce your risk of hip dislocation during a collision.
A fall from a significant height (such as from a ladder) or an industrial accident can also generate enough force to dislocate a hip.
While far less common, hip dislocations can result from a collision while playing a sport, like football or hockey.
With hip dislocations, there are often other related injuries, such as fractures in the pelvis and legs; and back, abdominal, knee, and head injuries. Perhaps the most common fracture occurs when the head of the femur hits and breaks off the back part of the hip socket during the injury. This is called a posterior wall acetabular fracture-dislocation.
Symptoms
A hip dislocation is very painful. Patients are unable to move the leg, and, if there is nerve damage, they may not have any feeling in the foot or ankle area.
Hip Fractures
A hip fracture is a break in the upper portion of the femur (thighbone). Most hip fractures occur in elderly patients whose bones have become weakened by osteoporosis. When a hip fracture occurs in a younger patient, it is typically the result of a high-energy event, such as a fall from a ladder or vehicle collision.
Each year, more than 300,000 people in the United States sustain a hip fracture. Most of these fractures occur in patients 65 years or older who are injured in household or community falls.
Hip fractures can be very painful. For this reason, prompt surgical treatment is recommended. Treating the fracture and getting the patient out of bed as soon as possible will help prevent medical complications such as bed sores, blood clots, and pneumonia. In very old patients, prolonged bed rest can also lead to disorientation, which makes rehabilitation and recovery much more difficult.
Anatomy
The hip is a ball-and-socket joint. The ball is the head of the femur, which is the upper part of the thighbone. The socket is called the acetabulum. The acetabulum is part of the pelvis bone. It has a rounded shape that fits around the femoral head.
Description
A hip fracture can cause injury to one of four areas of the upper femur:
Intertrochanteric and femoral neck fractures are the most common types of hip fracture. Femoral head fractures are extremely rare and are usually the result of a high-velocity event.
The areas of the femur (thighbone). Most hip fractures occur in the femoral neck or intertrochanteric area.
Cause
Most hip fractures result from low-energy falls in elderly patients who have weakened or osteoporotic bone. In these patients, even a simple twisting or tripping injury may lead to a fracture.
In some cases, the bone may be so weak that the fracture occurs spontaneously while someone is walking or standing. In this instance, it is often said that “the break occurs before the fall.” Spontaneous fractures usually occur in the femoral neck.
Stress fractures or fractures from repeated impact may also occur in the femoral neck. These fractures are often seen in long distance runners, particularly military recruits in basic training. When stress fractures occur in the subtrochanteric region of the hip, they are usually associated with prolonged use of certain osteoporosis medications.
Fractures of the femoral head are rare and are usually the result of a high-impact injury or are part of a fracture dislocation of the hip.
Symptoms
Typically, a hip fracture is acutely painful. The pain is usually localized to the groin and the upper part of the thigh. With most hip fractures, you will not be able to stand, bear weight, or move the upper part of your leg or knee. You will be able to move your ankle and toes, unless there is an injury to your lower leg in addition to your hip.
With some fractures, it may be possible to bear part of your weight on the leg—but it will be severely painful.
Pelvic Fractures
The pelvis is the sturdy ring of bones located at the base of the spine. Fractures of the pelvis are uncommon—accounting for only about 3% of all adult fractures.
Most pelvic fractures are caused by some type of traumatic, high-energy event, such as a car collision. Because the pelvis is in proximity to major blood vessels and organs, pelvic fractures may cause extensive bleeding and other injuries that require urgent treatment.
In some cases, a lower-impact event—such as a minor fall—may be enough to cause a pelvic fracture in an older person who has weaker bones.
Treatment for a pelvic fracture varies depending on the severity of the injury. While lower-energy fractures can often be managed with conservative care, treatment for high-energy pelvic fractures usually involves surgery to reconstruct the pelvis and restore stability so that patients can resume their daily activities.
Anatomy
The pelvis is a ring of bones located at the lower end of the trunk—between the spine and the legs. The pelvic bones include the:
Hip bones
The pelvis helps anchor the muscles and protect the organs in the lower abdomen.
Each hip bone contains three bones—the ilium, ischium, and pubis—that are separate during childhood but fuse together as we grow older. These three bones meet to form the acetabulum—the hollow cup that serves as the socket for the ball-and-socket hip joint.
Bands of strong connective tissues called ligaments join the pelvis to the sacrum, creating a bowl-like cavity below the rib cage.
Major nerves, blood vessels, and portions of the bowel, bladder, and reproductive organs all pass through the pelvic ring. The pelvis protects these important structures from injury. It also serves as an anchor for the muscles of the hip, thigh, and abdomen.
Description
Because the pelvis is a ring-like structure, a fracture in one part of the structure is often accompanied by a fracture or damage to ligaments at another point in the structure. Doctors have identified several common pelvic fracture patterns. The specific pattern of the fracture depends upon the direction in which it was broken and the amount of force that caused the injury.
In addition to being described by the specific fracture pattern, pelvic fractures are often described as "stable" or "unstable," based on how much damage has occurred to the structural integrity of the pelvic ring.
Stable fracture. In this type of fracture, there is often only one break in the pelvic ring and the broken ends of the bones line up adequately. Low-energy fractures are often stable fractures. Stable pelvic fracture patterns include:
Superior and inferior pubic ramus fracture
Unstable fracture. In this type of fracture, there are usually two or more breaks in the pelvic ring and the ends of the broken bones do not line up correctly (displacement). This type of fracture is more likely to occur due to a high-energy event. Unstable pelvic fracture patterns include:
Both stable and unstable pelvic fractures can also be divided into "open" fractures, in which the bone fragments stick out through the skin, or "closed" fractures, in which the skin is not broken. Open fractures are particularly serious because, once the skin is broken, infection in both the wound and the bone can occur. Immediate treatment is required to prevent infection.
Cause
High-Energy Trauma
A pelvic fracture may result from a high-energy force, such as that generated during a:
Depending on the direction and magnitude of the force, these injuries can be life-threatening and require surgical treatment.
Bone Insufficiency
A pelvic fracture may also occur due to weak or insufficient bone. This is most common in older people whose bones have become weakened by osteoporosis. In these patients, a fracture may occur even during a fall from standing or a routine activity such as getting out of the bathtub or descending stairs. These injuries are typically stable fractures that do not damage the structural integrity of the pelvic ring, but may fracture an individual bone.
Other Causes
Less commonly, a fracture may occur when a piece of the ischium bone tears away from the site where the hamstring muscles attach to the bone. This type of fracture is called an avulsion fracture and it is most common in young athletes who are still growing. An avulsion fracture does not usually make the pelvis unstable or injure internal organs.
Symptoms
A fractured pelvis is almost always painful. This pain is aggravated by moving the hip or attempting to walk. Often, the patient will try to keep his or her hip or knee bent in a specific position to avoid aggravating the pain. Some patients may experience swelling or bruising in the hip area.
Burning Thigh Pain (Meralgia Paresthetica)
A painful, burning sensation on the outer side of the thigh may mean that one of the large sensory nerves to your legs—the lateral femoral cutaneous nerve (LFCN)—is being compressed. This condition is known as meralgia paresthetica (me-ral'-gee-a par-es-thet'-i-ka).
The nerves in your body bring information to the brain about the environment (sensory nerves) and messages from the brain to activate muscles (motor nerves). To do this, nerves must pass over, under, around, and through your joints, bones, and muscles. Usually, there is enough room to permit easy passage.
In meralgia paresthetica, swelling, trauma, or pressure can narrow these openings and squeeze the nerve. When this happens, pain, paralysis, or other dysfunction may result.
Symptoms
Deep Vein Thrombosis
Deep vein thrombosis, or DVT, occurs when a blood clot forms in one of the deep veins of the body. This can happen if a vein becomes damaged or if the blood flow within a vein slows down or stops. While there are a number of risk factors for developing a DVT, two of the most common are an injury to your lower body and surgery that involves your hips or legs.
A DVT can have serious consequences. If a blood clot breaks free, it may travel through the bloodstream and block blood flow to the lungs. Although rare, this complication—called a pulmonary embolism—can be fatal. Even if a blood clot does not break free, it may cause permanent damage to the valves in the vein. This damage can lead to long-term problems in the leg such as pain, swelling, and leg sores.
In many cases, DVT occurs without noticeable symptoms and is very difficult to detect. For this reason, doctors focus on preventing the development of DVT using different types of therapies, depending upon a patient's needs. Your doctor will take steps to prevent DVT if you have a major fracture or are having lower extremity surgery—including total hip or total knee replacement.
Blood clots may form in one of the deep veins of the body. While DVT can occur in any deep vein, it most commonly occurs in the veins of the pelvis, calf, or thigh.
Description
Arteries are the blood vessels that carry oxygen-rich blood from the heart to all other parts of the body. Veins return the oxygen-depleted blood back to the heart. There are two types of veins in the body:
Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms within one of the deep veins. While DVT can occur in any deep vein, it most commonly occurs in the veins of the pelvis, calf, or thigh.
Cause
Several factors can affect blood flow in the deep veins and increase the risk for developing blood clots. These include:
Inheriting a blood-clotting disorder
A broken hip or leg, or having major surgery on your hip, knee or lower leg can affect normal blood flow and clotting. In these orthopaedic situations, three primary factors contribute to the formation of blood clots in veins: slow blood flow, hypercoagulation, and damage to the veins.
Blood that Flows Slowly through Veins (Stasis)
The walls of the veins are smooth. This helps blood flow freely and mix with naturally occurring agents (anticoagulants) in the blood that keep the blood cells from clotting. Blood that does not flow freely and does not mix with anticoagulants may be more likely to clot. This is why it is important to watch for signs of DVT in people who are on bed rest, immobilized in a splint or cast, or not able to move for long periods of time.
Hypercoagulation
Blood thickens, or coagulates, around matter that does not belong in the veins. During surgery, matter such as tissue debris, collagen, or fat may be released into the blood system and can cause the blood to coagulate. In addition, during total hip replacement, preparing the bone to receive the prosthesis may cause the body to release chemical substances called antigens into the blood system. These antigens can also stimulate clot formation.
Damage to the Vein Walls
During surgery, the doctor must move, or retract, soft tissues such as ligaments, muscles, and tendons to reach the area being operated on. In some cases, this can release naturally occurring substances that promote blood clotting.
Complications
Pulmonary Embolism
A pulmonary embolism is a blood clot that breaks free and travels through the veins. This can happen right after the formation of the blood clot or it may happen days later. If the blood clot reaches the lungs, it can block the flow of blood to the lungs and heart.
A pulmonary embolism is a serious medical emergency and can lead to death.
Post-thrombotic Syndrome
Some people who have a DVT develop long-term symptoms in the calf, a condition called post-thrombotic syndrome. Post-thrombotic syndrome is caused when damage to the veins results in venous hypertension—or higher than normal blood pressure in the veins. This increased pressure can damage the valves that control blood flow through the veins. This allows blood to pool at the site—sometimes causing lasting impairment.
Patients with post-thrombotic syndrome may experience symptoms that can impact their quality of life, including pain, swelling, skin changes, and leg sores.
Symptoms
Hip Bursitis
Bursae, are small, jelly-like sacs that are located throughout the body, including around the shoulder, elbow, hip, knee, and heel. They contain a small amount of fluid, and are positioned between bones and soft tissues, acting as cushions to help reduce friction.
Bursitis is inflammation of the bursa. There are two major bursae in the hip that typically become irritated and inflamed. One bursa covers the bony point of the hip bone called the greater trochanter. Inflammation of this bursa is called trochanteric bursitis.
Another bursa — the iliopsoas bursa — is located on the inside (groin side) of the hip. When this bursa becomes inflamed, the condition is also sometimes referred to as hip bursitis, but the pain is located in the groin area. This condition is not as common as trochanteric bursitis, but is treated in a similar manner.
Hip bursitis most often involves the bursa that covers the greater trochanter of the femur, although the iliopsoas bursa can also become inflamed.
Symptoms
The main symptom of trochanteric bursitis is pain at the point of the hip. The pain usually extends to the outside of the thigh area. In the early stages, the pain is usually described as sharp and intense. Later, the pain may become more of an ache and spread across a larger area of the hip.
Typically, the pain is worse at night, when lying on the affected hip, and when getting up from a chair after being seated for a while. It also may get worse with prolonged walking, stair climbing, or squatting.
Risk Factors
Hip bursitis can affect anyone, but is more common in women and middle-aged or elderly people. It is less common in younger people and in men.
The following risk factors have been associated with the development of hip bursitis:
Osteoarthritis of the Hip
In many areas, nonessential orthopaedic procedures that were postponed due to COVID-19 have resumed. For information: Questions and Answers for Patients Regarding Elective Surgery and COVID-19. For patients whose procedures have not yet been rescheduled: What to Do If Your Orthopaedic Surgery Is Postponed.
Osteoarthritis, sometimes called "wear-and-tear arthritis," is a common condition that many people develop as they age. It can occur in any joint in the body, but most often develops in weight-bearing joints, such as the hip.
Osteoarthritis of the hip causes pain and stiffness. It can make it hard to do everyday activities like bending over to tie a shoe, rising from a chair, or taking a short walk.
Because osteoarthritis gradually worsens over time, the sooner you start treatment, the more likely it is that you can lessen its impact on your life. Although there is no cure for osteoarthritis, there are many treatment options to help you manage pain and stay active.
Anatomy
The hip is one of the body's largest joints. It is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone).
The bone surfaces of the ball and socket are covered with articular cartilage, a smooth, slippery substance that protects and cushions the bones and enables them to move easily.
The surface of the joint is covered by a thin lining called the synovium. In a healthy hip, the synovium produces a small amount of fluid that lubricates the cartilage and aids in movement.
Description
Osteoarthritis is a degenerative type of arthritis that occurs most often in people 50 years of age and older, though it may occur in younger people, too.
A hip damaged by osteoarthritis.
In osteoarthritis, the cartilage in the hip joint gradually wears away over time. As the cartilage wears away, it becomes frayed and rough, and the protective joint space between the bones decreases. This can result in bone rubbing on bone. To make up for the lost cartilage, the damaged bones may start to grow outward and form bone spurs (osteophytes).
Cause
Osteoarthritis has no single specific cause, but there are certain factors that may make you more likely to develop the disease, including:
Improper formation of the hip joint at birth, a condition known as developmental dysplasia of the hip
You can still develop osteoarthritis even if you don't have any of the risk factors listed above.
Symptoms
The most common symptom of hip osteoarthritis is pain. This hip pain develops slowly and worsens over time, although sudden onset is also possible. Pain and stiffness may be worse in the morning, or after sitting or resting for a while. Over time, painful symptoms may occur more frequently, including during rest or at night. Additional symptoms may include:
Snapping Hip
Snapping hip is a condition in which you feel a snapping sensation or hear a popping sound in your hip when you walk, get up from a chair, or swing your leg around.
The snapping sensation occurs when a muscle or tendon (the strong tissue that connects muscle to bone) moves over a bony protrusion in your hip.
Although snapping hip is usually painless and harmless, the sensation can be annoying. In some cases, snapping hip leads to bursitis, a painful swelling of the fluid-filled sacs that cushion the hip joint.
Anatomy
The hip is a ball-and-socket joint formed where the rounded end of the thighbone (femur) fits into a cup-shaped socket (acetabulum) in the pelvis. The acetabulum is ringed by strong fibrocartilage called the labrum that creates a tight seal and helps to provide stability to the joint.
Encasing the hip are ligaments that surround the joint and hold it together. Over the ligaments are tendons that attach muscles in the buttocks, thighs, and pelvis to the bones. These muscles control hip movement.
Fluid-filled sacs called bursae are located in strategic spots around the hip to provide cushioning and help the muscles move smoothly over the bone.
Description
Snapping hip can occur in different areas of the hip where tendons and muscles slide over knobs in the hip bones.
Outside of the hip. The most common site of snapping hip is at the outer side where the iliotibial band passes over the portion of the thighbone known as the greater trochanter.
When the hip is straight, the iliotibial band is behind the trochanter. When the hip bends, the band moves over the trochanter so that it is in front of it. The iliotibial band is always tight, like a stretched rubber band. Because the trochanter juts out slightly, the movement of the band across it creates the snap you hear.
Eventually, snapping hip may lead to hip bursitis. Bursitis is thickening and inflammation of the bursa, a fluid-filled sac that allows the muscle to move smoothly over bone.
Front of the hip. Another tendon that could cause a snapping hip runs from the front of the thigh up to the pelvis (rectus femoris tendon). Snapping of the rectus femoris tendon is felt in the front of the hip. As you bend the hip, the tendon shifts across the head of the thighbone, and when you straighten the hip, the tendon moves back to the side of the thighbone. This back-and-forth motion across the head of the thighbone causes the snapping. In addition to the rectus femoris tendon at the front of the hip, the iliopsoas tendon can catch on bony prominences at the front of the pelvis bone.
Back of the hip. Snapping in the back of the hip can involve the hamstring tendon. This tendon attaches to the sitting bone, called the ischial tuberosity. When it moves across the ischial tuberosity, the tendon may catch, causing a snapping sensation in the buttock region. This is not as common as other forms of snapping hip
Cartilage problems. The labrum that lines the socket of the hip can tear and cause a snapping sensation. Damaged cartilage can loosen and float in the joint causing the hip to catch or "lock up." Even though this is not a true snapping hip caused by a muscle outside the joint, some of the symptoms may be similar. Symptoms due to a torn labrum, however, may cause more pain deep in the groin then a typical snapping hip.
Cause
Snapping hip is most often the result of tightness in the muscles and tendons surrounding the hip. People who are involved in sports and activities that require repeated bending at the hip are more likely to experience snapping hip. Dancers are especially vulnerable.
Young athletes are also more likely to have snapping hip. This is because tightness in the muscle structures of the hip is common during adolescent growth spurts.
Home Remedies
Most people do not see a doctor for snapping hip unless they experience some pain. If the snapping hip bothers you — but not to the point of seeing a doctor — try the following conservative home treatment options:
Hip Dislocation
With this injury, the head of your femur (which is shaped like a ball) slips out of your hip socket. It may slip forward or backward out of position. This can damage structures around the joint.
Bursitis/Hip
This is an irritation or swelling of the trochanteric bursa. This small, fluid-filled sac is found on the outer side of the femur. It acts as a cushion for the iliotibial band, a tendon in your leg.
Hip Fracture
This therapy treats dying bone tissue in the head of the femur. Cells from your own body are used to help the femur heal.
Osteoarthritis of the Hip
This type of arthritis, also called "degenerative joint disease," is a breakdown of the cartilage in your hip joint. As this protective cartilage wears away, bone rubs against bone.
Common Treatments of the hip
Hip Fracture
Most hip fractures require surgical treatment within 1 to 2 days of injury. Only a very small group of nondisplaced fractures in healthy patients can be treated without surgery, while a separate small group of patients may be too sick to safely have surgery.
Surgical treatment is required to relieve the acute pain of the fracture and to allow the patient to get out of bed. Having surgery as soon as possible can lessen the risk of complications.
If you are admitted to the hospital with a hip fracture, you will have preoperative testing and will most likely be seen by an internist. He or she will make sure that you are medically ready to have surgery. In some cases, you may need to be seen by a specialist, such as a heart doctor (cardiologist) or a lung doctor (pulmonologist), to treat specific medical problems. If you have been on a blood thinner, you may need to wait for your clotting times to improve before you go to the operating room.
This process of getting a patient medically ready for surgery is called optimization. Ideally, it should be done within 48 hours, but sometimes it may take longer. Even if it does takes longer, it is better to be optimized than to rush to surgery.
Treatment for a hip fracture depends upon the type and location of the fracture, as well as the age and condition of the patient.
Femoral Neck Fracture
This type of fracture is also sometimes called a subcapital or intracapsular fracture.
If a femoral neck fracture is not displaced, the most common treatment is in-situ pinning. In this procedure, surgical pins or screws are passed across the fracture site to hold the ball of the femur in place while the fracture heals. Pinning prevents the femoral head from dislodging or slipping off of the femoral neck, a situation that would require hip replacement.
A small number of femoral neck fractures may be treated without surgery. These are typically nondisplaced fractures in young healthy patients. Because there is a risk of displacement, they need to be monitored carefully. Nonoperative treatment consists of limited or protected weight bearing with crutches for several weeks.
Patients who did not walk before surgery or have severe medical problems may also be considered for nonsurgical treatment.
Displaced fractures of the femoral neck present a more difficult problem than nondisplaced fractures. The blood supply to the head of the femur comes through a structure called the posterior capsule. The posterior capsule is often injured with a displaced femoral neck fracture, so the fracture has less chance of healing.
Even if the fracture does heal, a condition called avascular necrosis may develop in the head of the femur. This causes damage to the bone cells, collapse of part of the femoral head, and subsequent arthritis.
For this reason, displaced fractures of the femoral neck are often treated with hip replacement. For elderly patients, a hemi-arthroplasty, or partial hip replacement, is the treatment of choice. In younger, more active patients, total hip replacement may be considered.
In some younger patients, it is desirable to preserve the natural femoral head rather than do a replacement. In these patients an open reduction is performed. This involves making an incision over the hip joint, putting the bone back into place, and then holding the bone with pins, screws, or another type of metal fixation. While this procedure does carry the risks of avascular necrosis and failure to heal, it is felt best to try to preserve a younger person’s normal hip.
Your orthopedic surgeon will review the treatment options with you and your family.
Intertrochanteric Fracture
Intertrochanteric fractures occur below the femoral neck in a broader region between the greater and lesser trochanters. The greater trochanter is the bump you feel on the side of your hip. There may be two, three, or even multiple fracture fragments.
Intertrochanteric fractures are treated surgically with either a sliding compression hip screw and side plate or an intramedullary nail.
The compression hip screw is fixed to the outer side of the bone with bone screws. A large secondary screw (lag screw) is placed through the plate into the femoral head and neck. This design allows for impaction and compression at the fracture site. This will increase stability and promote healing.
The intramedullary nail is placed directly into the marrow canal of the bone through an opening made at the top of the greater trochanter. One or multiple screws are then placed through the nail and into the femoral head.
Fracture of the Greater Trochanter
Isolated fractures of the greater trochanter usually come from a low-energy household fall. While they are often painful, they usually heal without surgery. These fractures are stable and can be treated with protected weight bearing with either crutches or a walker.
If an x-ray shows an isolated fracture of the greater trochanter, it is often helpful to obtain an MRI to make sure that the fracture does not extend to the intertrochanteric area.
Subtrochanteric Fracture
Subtrochanteric fractures involve the upper part of the shaft of the femur, just below the hip joint.
Subtrochanteric fracture
They are treated surgically with an intramedullary nail into the shaft of the femur and a screw placed through the nail into the femoral head.
To keep the bones from rotating around the nail or from shortening (telescoping) on the nail, additional screws may be placed at the lower end of the nail near the knee. These are called interlocking screws.
In some cases, your surgeon may choose to use a compression screw with a long side plate instead of a nail.
Femoral Head Fracture
Femoral head fractures are rare; they account for less than 1 percent of all hip fractures. They usually result from a high-velocity event. Sometimes there may be an associated fracture of the hip joint socket.
If the fracture is not displaced, it may be treated nonsurgically with limited weight bearing. If there is a small displaced fragment that does not involve a large part of the joint surface, then the fragment may be simply removed.
If there is a large fragment in a young active person, open reduction and fixation with screws is often done. In an older person, hip replacement—either partial or total—to replace the damaged femoral head is the treatment of choice.
Recovery
Most patients are able to get of bed and start physical therapy the day after surgery. It is important to begin moving as soon as possible. This helps prevents medical complications, such as blood clots, pneumonia, and bed sores. For older patients, it also helps prevent disorientation and deconditioning.
Hip fractures in the elderly may cause disability and lack of independence. Early movement and rehabilitation have been shown to improve long-term results.
During recovery, you will work with physical and occupational therapists. They will give you exercises and tell you how much weight you can put on your leg. They will also show you how to manage the activities of daily living, such as bathing and dressing.
Medical Care
If you take medications for a problem such as heart disease, an internist or hospitalist will most likely assist in your care. He or she will address any medical problems and prescribe the appropriate treatment.
You will be given antibiotics to prevent infection for 24 hours after surgery.
You will also be placed on a blood thinner to help prevent blood clots in your legs. This may be given as either pills or injections. Your doctor will determine the length of time you need to be on blood thinners. Compression boots may be placed on your legs while you are in bed.
Pain Management
Your doctor and nurses will work with you to help reduce your pain. Typically, you will be given medicine through an IV in the first few hours after surgery. Then you will be switched to oral pain medicine. This may take the form of opioids, nonsteroidal anti-inflammatories, or over-the-counter pain medication such as Tylenol. Your doctor may also use a combination of these medications to manage pain.
Be aware that, while opioids can relieve pain after surgery, they are a narcotic and can be addictive. You should stop taking opioids as soon as your pain begins to improve. Your surgeon will help you with pain management during your recovery.
Rehabilitation
Many patients go home after hip fracture surgery, but some will need short-term care in a rehabilitation facility. Usually, these patients are elderly or have no caregivers at home.
If you go to a rehabilitation facility, you will need to stay there until you can walk independently and manage your daily activities.
If you go directly home, you will have in-home physical therapy until you are strong enough to go to therapy at an outside facility.
Your doctor will manage your care in the postoperative period. He or she will check the wound, prescribe physical therapy, and take x-rays to monitor the healing.
If you have had a procedure that includes internal fixation, it may be several weeks until you can bear full weight. If you have had a hip replacement, you can most likely be fully weight bearing right away.
Hip Dislocation
Reduction Procedures
If there are no other injuries, you will receive an anesthetic or a sedative, and an orthopaedic doctor will manipulate the bones back into their proper position. This is called a reduction.
In some cases, the reduction must be done in the operating room with anesthesia. In rare cases, torn soft tissues or small bony fragments block the femur from going back into the socket. When this occurs, surgery is required to remove the loose tissues and correctly position the bones.
Following reduction, the surgeon will request another set of X-rays, and possibly a computed tomography (CT) scan, to make sure the bones are in the proper position.
Nonsurgical Treatment
If the hip joint is successfully reduced and there is no associated fracture of the femoral head (ball) or acetabulum (socket), nonsurgical treatment may be appropriate. In this case, you will likely not be able to put weight through your leg for 6 to 10 weeks and will be advised to avoid putting your injured leg in certain positions as you heal.
Surgical Treatment
Surgical treatment may be required if there are fractures associated with the dislocation, or if the hip is unstable even after reduction.
The goals of surgery are to restore hip joint stability and to restore the cartilage surfaces to their normal positions. Typically, this requires a large incision, and the surgery may result in a lot of blood loss. Patients may require a blood transfusion during or after this surgery.
Complications
A hip dislocation can have long-term consequences, particularly if there are associated fractures.
Nerve injury. As the femur is pushed out of the socket, particularly in posterior dislocations, it can crush and stretch nerves in the hip. The sciatic nerve, which extends from the lower back down the back of the legs, is the nerve most commonly affected. Injury to the sciatic nerve may cause weakness in the lower leg and affect the ability to move the knee, ankle and foot normally. Sciatic nerve injury occurs in approximately 10% of hip dislocation patients. The majority of these patients will experience some nerve recovery.
Osteonecrosis. As the femur is pushed out of the socket, it can tear blood vessels. When blood supply to the bone is lost, the bone can die, resulting in osteonecrosis (also called avascular necrosis). This is a painful condition that can ultimately lead to the destruction of the hip joint, and arthritis.
Arthritis. The protective cartilage covering the bone may also be damaged, which increases the risk of developing arthritis in the joint. Arthritis can eventually lead to the need for other procedures, like a total hip replacement.
Recovery
It takes time — sometimes 2 to 3 months — for the hip to heal after a dislocation. The rehabilitation time may be longer if there are additional fractures. The doctor may recommend limiting hip motion for several weeks to protect the hip from dislocating again. Physical therapy is often recommended during recovery.
Patients often begin walking with crutches within a short time. Walking aids, such as walkers, crutches, and, eventually, canes, help patients regain their mobility.
Hip Strains
Medical treatment for muscle strains is designed to relieve pain and restore range of motion and strength. The majority of hip strains are treated nonsurgically.
Nonsurgical Treatment
In addition to the RICE method and anti-inflammatory medication, your doctor may recommend using crutches for a few days to limit the weight on your hip. Other recommendations may include:
Surgical Treatment
Severe injuries in which the tendons are completely avulsed from bone may require surgery in order to return to normal function and movement. Surgery typically involves re-attaching the torn tendon tissue back to the bone.
It is important to know that many severe hip strains are successfully treated without surgery. Your doctor will discuss the treatment options that best meet your individual health needs.
Recovery
In most cases, you should avoid the activity that caused your injury for 10 to14 days. A severe muscle strain may require a longer period of recovery. If your pain returns when you resume more strenuous activity, however, discontinue what you are doing and go back to easier activities that do not cause pain.
You can take the following precautions to help prevent muscle strains in the future:
Snapping Hip
Initial treatment typically involves a period of rest and modification of activities. Depending upon the cause of your snapping hip, your doctor may also recommend other conservative treatment options.
Physical Therapy
Your doctor may prescribe exercises like the ones below to stretch and strengthen the musculature surrounding the hip. Guidance from a physical therapist may also be recommended.
Iliotibial band stretch
Piriformis stretch
Corticosteroid Injection
If you have hip bursitis, your doctor may recommend an injection of a corticosteroid into the bursa to reduce painful inflammation.
Surgical Treatment
In the rare instances that snapping hip does not respond to conservative treatment, your doctor may recommend surgery. The type of surgery will depend on the cause of the snapping hip.
Hip arthroscopy. During hip arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your hip joint. The camera displays pictures on a video monitor, and your surgeon uses these images to guide miniature surgical instruments. Because the arthroscope and surgical instruments are thin, the surgeon can use very small incisions (cuts), rather than the larger incision needed for standard, open surgery.
Hip arthroscopy is most often used to remove or repair fragments of a torn labrum.
Open procedure. A traditional open surgical incision (several centimeters long) may be required to address the cause of the snapping hip. An open incision can help your surgeon to better see and gain access to the problem in the hip.
Your orthopaedic surgeon will discuss with you the best procedure to meet your individual health needs.
Osteoarthritis of the Hip
Although there is no cure for osteoarthritis, there are a number of treatment options that will help relieve pain and improve mobility.
Nonsurgical Treatment
As with other arthritic conditions, early treatment of osteoarthritis of the hip is nonsurgical. Your doctor may recommend a range of nonsurgical treatment options:
Lifestyle modifications. Some changes in your daily life can protect your hip joint and slow the progress of osteoarthritis.
Physical therapy. Specific exercises can help increase range of motion and flexibility, as well as strengthen the muscles in your hip and leg. Your doctor or physical therapist can help develop an individualized exercise program that meets your needs and lifestyle.
Assistive devices. Using walking supports like a cane, crutches, or a walker can improve mobility and independence. Using assistive aids like a long-handled reacher to pick up low-lying things will help you avoid movements that may cause pain.
Medications. If your pain affects your daily routine, or is not relieved by other nonsurgical methods, your doctor may add medication to your treatment plan.
Acetaminophen is an over-the-counter pain reliever that can be effective in reducing mild arthritis pain. Like all medications, however, over-the-counter pain relievers can cause side effects and interact with other medications you are taking. Be sure to discuss potential side effects with your doctor.
Nonsteroidal anti-inflammatory drugs (NSAIDs) may relieve pain and reduce inflammation. Over-the-counter NSAIDs include naproxen and ibuprofen. Other NSAIDs are available by prescription.
Corticosteroids (also known as cortisone) are powerful anti-inflammatory agents that can be taken by mouth or injected into the painful joint.
Surgical Treatment
Your doctor may recommend surgery if your pain from arthritis causes disability and is not relieved with nonsurgical treatment.
Total hip replacement.Your doctor will remove both the damaged acetabulum and femoral head, and then position new metal, plastic or ceramic joint surfaces to restore the function of your hip.
Hip resurfacing. In this hip replacement procedure, the damaged bone and cartilage in the acetabulum (hip socket) is removed and replaced with a metal shell. The head of the femur, however, is not removed, but instead capped with a smooth metal covering.
Osteotomy. Either the head of the thighbone or the socket is cut and realigned to take pressure off of the hip joint. This procedure is used only rarely to treat osteoarthritis of the hip.
Complications. Although complications are possible with any surgery, your doctor will take steps to minimize the risks. The most common complications of surgery include:
Recovery
After any type of surgery for osteoarthritis of the hip, there is a period of recovery. Recovery time and rehabilitation depends on the type of surgery performed.
Your doctor may recommend physical therapy to help you regain strength in your hip and restore range of motion. After your procedure, you may need to use a cane, crutches, or a walker for a time.
In most cases, surgery relieves the pain of osteoarthritis and makes it possible to perform daily activities more easily.
Hip Bursitis
Nonsurgical Treatment
The initial treatment for hip bursitis does not involve surgery. Many people with hip bursitis can experience relief with simple lifestyle changes, including:
Surgical Treatment
Surgery is rarely needed for hip bursitis. If the bursa remains inflamed and painful after all nonsurgical treatments have been tried, your doctor may recommend surgical removal of the bursa. Removal of the bursa does not hurt the hip, and the hip can function normally without it.
A newer technique that is gaining popularity is arthroscopic removal of the bursa. In this technique, the bursa is removed through a small (1/4-inch) incision over the hip. A small camera, or arthroscope, is placed in a second incision so the doctor can guide miniature surgical instruments and cut out the bursa. This surgery is less invasive, and recovery is quicker and less painful.
Both types of surgeries are done on an outpatient (same-day) basis, so an overnight stay in the hospital is not usually necessary. Early research shows arthroscopic removal of the bursa to be quite effective, but this is still being studied.
Rehabilitation
Following surgery, a short rehabilitation period can be expected. Most patients find that using a cane or crutches for a couple of days is helpful. It is reasonable to be up and walking around the evening after surgery. The soreness from surgery usually goes away after a few days.
Prevention
Although hip bursitis cannot always be prevented, there are things you can do to prevent the inflammation from getting worse.
Avoid repetitive activities that put stress on the hips.
Total Hip Replacement
Whether you have just begun exploring treatment options or have already decided to undergo hip replacement surgery, this information will help you understand the benefits and limitations of total hip replacement. This article describes how a normal hip works, the causes of hip pain, what to expect from hip replacement surgery, and what exercises and activities will help restore your mobility and strength, and enable you to return to everyday activities.
If your hip has been damaged by arthritis, a fracture, or other conditions, common activities such as walking or getting in and out of a chair may be painful and difficult. Your hip may be stiff, and it may be hard to put on your shoes and socks. You may even feel uncomfortable while resting.
If medications, changes in your everyday activities, and the use of walking supports do not adequately help your symptoms, you may consider hip replacement surgery. Hip replacement surgery is a safe and effective procedure that can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities.
Hip replacement surgery is one of the most successful operations in all of medicine. Since the early 1960s, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of total hip replacement. According to the Agency for Healthcare Research and Quality, more than 450,000 total hip replacements are performed each year in the United States.
Anatomy
The hip is one of the body's largest joints. It is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone).
The bone surfaces of the ball and socket are covered with articular cartilage, a smooth tissue that cushions the ends of the bones and enables them to move easily.
A thin tissue called the synovial membrane surrounds the hip joint. In a healthy hip, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all friction during hip movement.
Bands of tissue called ligaments (the hip capsule) connect the ball to the socket and provide stability to the joint.
Common Causes of Hip Pain
The most common cause of chronic hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease.
Osteoarthritis. This is an age-related "wear and tear" type of arthritis. It usually occurs in people 50 years of age and older and often in individuals with a family history of arthritis. The cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness. Osteoarthritis may also be caused or accelerated by subtle irregularities in how the hip developed in childhood.
Rheumatoid arthritis. This is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage the cartilage, leading to pain and stiffness. Rheumatoid arthritis is the most common type of a group of disorders termed "inflammatory arthritis."
Post-traumatic arthritis. This can follow a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.
Osteonecrosis. An injury to the hip, such as a dislocation or fracture, may limit the blood supply to the femoral head. This is called osteonecrosis (also sometimes referred to as "avascular necrosis"). The lack of blood may cause the surface of the bone to collapse, and arthritis will result. Some diseases can also cause osteonecrosis.
Childhood hip disease. Some infants and children have hip problems. Even though the problems are successfully treated during childhood, they may still cause arthritis later on in life. This happens because the hip may not grow normally, and the joint surfaces are affected.
Description
In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components.
Is Hip Replacement Surgery for You?
The decision to have hip replacement surgery should be a cooperative one made by you, your family, your primary care doctor, and your orthopaedic surgeon. The process of making this decision typically begins with a referral by your doctor to an orthopaedic surgeon for an initial evaluation.
When Surgery Is Recommended
There are several reasons why your doctor may recommend hip replacement surgery. People who benefit from hip replacement surgery often have:
Candidates for Surgery
There are no absolute age or weight restrictions for total hip replacements.
Recommendations for surgery are based on a patient's pain and disability, not age. Most patients who undergo total hip replacement are age 50 to 80, but orthopaedic surgeons evaluate patients individually. Total hip replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.
The Orthopaedic Evaluation
An evaluation with an orthopaedic surgeon consists of several components:
Deciding to Have Hip Replacement Surgery
Talk With Your Doctor
Your orthopaedic surgeon will review the results of your evaluation with you and discuss whether hip replacement surgery is the best method to relieve your pain and improve your mobility. Other treatment options — such as medications, physical therapy, or other types of surgery — also may be considered.
In addition, your orthopaedic surgeon will explain the potential risks and complications of hip replacement surgery, including those related to the surgery itself and those that can occur over time after your surgery.
Never hesitate to ask your doctor questions when you do not understand. The more you know, the better you will be able to manage the changes that hip replacement surgery will make in your life.
Realistic Expectations
An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and cannot do. Most people who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living.
With normal use and activity, the material between the head and the socket of every hip replacement implant begins to wear. Excessive activity or being overweight may speed up this normal wear and cause the hip replacement to loosen and become painful. Therefore, most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports.
Realistic activities following total hip replacement include unlimited walking, swimming, golf, driving, hiking, biking, dancing, and other low-impact sports.
With appropriate activity modification, hip replacements can last for many years.
Medical Evaluation
If you decide to have hip replacement surgery, your orthopaedic surgeon may ask you to have a complete physical examination by your primary care doctor before your surgical procedure. This is needed to make sure you are healthy enough to have the surgery and complete the recovery process. Many patients with chronic medical conditions, like heart disease, may also be evaluated by a specialist, such a cardiologist, before the surgery.
Tests
Several tests, such as blood and urine samples, an electrocardiogram (EKG), and chest x-rays, may be needed to help plan your surgery.
Preparing Your Skin
Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for treatment to improve your skin before surgery.
Medications
Tell your orthopaedic surgeon about the medications you are taking. He or she or your primary care doctor will advise you which medications you should stop taking and which you can continue to take before surgery.
Weight Loss
If you are overweight, your doctor may ask you to lose some weight before surgery to minimize the stress on your new hip and possibly decrease the risks of surgery.
Dental Evaluation
Although infections after hip replacement are not common, an infection can occur if bacteria enter your bloodstream. Because bacteria can enter the bloodstream during dental procedures, major dental procedures (such as tooth extractions and periodontal work) should be completed before your hip replacement surgery. Routine cleaning of your teeth should be delayed for several weeks after surgery.
Urinary Evaluation
Individuals with a history of recent or frequent urinary infections should have a urological evaluation before surgery. Older men with prostate disease should consider completing required treatment before having surgery.
Social Planning
Although you will be able to walk with a cane, crutches or a walker soon after surgery, you may need some help for several weeks with such tasks as cooking, shopping, bathing, and laundry.
If you live alone, a social worker or a discharge planner at the hospital can help you make advance arrangements to have someone assist you at your home. A short stay in an extended care facility during your recovery after surgery also may be arranged.
Home Planning
Several modifications can make your home easier to navigate during your recovery. The following items may help with daily activities:
Your Surgery
You will either be admitted to the hospital on the day of your surgery or you will go home the same day. The plan to either be admitted or to go home should be discussed with your surgeon prior to your operation.
Anesthesia
Upon arrival at the hospital or surgery center, you will be evaluated by a member of the anesthesia team. The most common types of anesthesia are general anesthesia (you are put to sleep) or spinal, epidural, or regional nerve block anesthesia (you are awake but your body is numb from the waist down). The anesthesia team, with your input, will determine which type of anesthesia will be best for you.
Implant Components
Many different types of designs and materials are currently used in artificial hip joints. All of them consist of two basic components: the ball component (made of highly polished strong metal or ceramic material) and the socket component (a durable cup of plastic, ceramic, or metal, which may have an outer metal shell).
The prosthetic components may be "press fit" into the bone to allow your bone to grow onto the components or they may be cemented into place. The decision to press fit or to cement the components is based on several factors, such as the quality and strength of your bone. A combination of a cemented stem and a non-cemented socket may also be used.
Your orthopaedic surgeon will choose the type of prosthesis that best meets your needs.
Procedure
The surgical procedure usually takes from 1 to 2 hours. Your orthopaedic surgeon will remove the damaged cartilage and bone and then position new metal, plastic, or ceramic implants to restore the alignment and function of your hip.
After surgery, you will be moved to the recovery room where you will remain for several hours while your recovery from anesthesia is monitored. After you wake up, you will be taken to your hospital room or discharged to home.
Recovery
The success of your surgery will depend in large measure on how well you follow your orthopaedic surgeon's instructions regarding home care during the first few weeks after surgery.
Pain Management
Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.
Be aware that, although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose have become critical public health issues in the U.S. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.
Wound Care
You may have stitches or staples running along your wound or a suture beneath your skin. The stitches or staples will be removed approximately 2 weeks after surgery.
Avoid getting the wound wet until it has thoroughly sealed and dried. You may continue to bandage the wound to prevent irritation from clothing or support stockings.
Diet
Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength. Be sure to drink plenty of fluids.
Activity
Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal light activities of daily living within 3 to 6 weeks following surgery. Some discomfort with activity and at night is common for several weeks.
Your activity program should include:
Possible Complications of Surgery
The complication rate following hip replacement surgery is low. Serious complications, such as joint infection, occur in less than 2% of patients. Major medical complications, such as heart attack or stroke, occur even less frequently. However, chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur they can prolong or limit full recovery.
Infection
Infection may occur superficially in the wound or deep around the prosthesis. It may happen within days or weeks of surgery. It may even occur years later.
Minor infections of the wound are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement.
Blood Clots
Blood clots in the leg veins or pelvis are one of the most common complications of hip replacement surgery. These clots can be life-threatening if they break free and travel to your lungs. Your orthopaedic surgeon will outline a prevention program which may include blood thinning medications, support hose, inflatable leg coverings, ankle pump exercises, and early mobilization.
Blood clots may form in one of the deep veins of the body. While blood clots can occur in any deep vein, they most commonly form in the veins of the pelvis, calf, or thigh.
Leg-length Inequality
Sometimes after a hip replacement, one leg may feel longer or shorter than the other. Your orthopaedic surgeon will make every effort to make your leg lengths even, but may lengthen or shorten your leg slightly in order to maximize the stability and biomechanics of the hip. Some patients may feel more comfortable with a shoe lift after surgery.
Dislocation
This occurs when the ball comes out of the socket. The risk for dislocation is greatest in the first few months after surgery while the tissues are healing. Dislocation is uncommon. If the ball does come out of the socket, a closed reduction usually can put it back into place without the need for more surgery. In situations in which the hip continues to dislocate, further surgery may be necessary.
Loosening and Implant Wear
Over years, the hip prosthesis may wear out or loosen. This is most often due to everyday activity. It can also result from a biologic thinning of the bone called osteolysis. If loosening is painful, a second surgery called a revision may be necessary.
Other Complications
Nerve and blood vessel injury, bleeding, fracture, and stiffness can occur. A small number of patients continue to experience pain after surgery.
Avoiding Problems After Surgery
Recognizing the Signs of a Blood Clot
Follow your orthopaedic surgeon's instructions carefully to reduce the risk of blood clots developing during the first several weeks of your recovery. He or she may recommend that you continue taking the blood thinning medication you started in the hospital. Notify your doctor immediately if you develop any of the following warning signs.
Warning signs of blood clots. The warning signs of possible blood clot in your leg include:
Warning signs of pulmonary embolism. The warning signs that a blood clot has traveled to your lung include:
Preventing Infection
A common cause of infection following hip replacement surgery is from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections.
Following surgery, patients with certain risk factors may need to take antibiotics prior to dental work, including dental cleanings, or before any surgical procedure that could allow bacteria to enter your bloodstream. Your orthopaedic surgeon will discuss with you whether taking preventive antibiotics before dental procedures is needed in your situation.
Warning signs of infection. Notify your doctor immediately if you develop any of the following signs of a possible hip replacement infection:
Avoiding Falls
A fall during the first few weeks after surgery can damage your new hip and may result in a need for more surgery. Stairs are a particular hazard until your hip is strong and mobile. You should use a cane, crutches, a walker, or handrails or have someone help you until you improve your balance, flexibility, and strength.
Your orthopaedic surgeon and physical therapist will help you decide which assistive aides will be required following surgery, and when those aides can safely be discontinued.
Other Precautions
To assure proper recovery and prevent dislocation of the prosthesis, you may be asked to take special precautions when sitting, bending, or sleeping — usually for the first 6 weeks after surgery. These precautions will vary from patient to patient, depending on the surgical approach your surgeon used to perform your hip replacement.
Your surgeon and physical therapist will provide you with any specific precautions you should follow.
Outcomes
How Your New Hip Is Different
You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending. These differences often diminish with time, and most patients find these are minor compared with the pain and limited function they experienced prior to surgery.
Your new hip may activate metal detectors required for security in airports and some buildings. Tell the security agent about your hip replacement if the alarm is activated.
Protecting Your Hip Replacement
There are many things you can do to protect your hip replacement and extend the life of your hip implant.
Participate in a regular light exercise program to maintain proper strength and mobility of your new hip.
Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may require more surgery.
Make sure your dentist knows that you have a hip replacement. Talk with your orthopaedic surgeon about whether you need to take antibiotics prior to dental procedures.
See your orthopaedic surgeon periodically for routine follow-up examinations and x-rays, even if your hip replacement seems to be doing fine.
Hip Arthroscopy
This outpatient procedure is an examination of the inside of the hip joint. The surgeon uses miniature instruments and a small camera (called an arthroscope) to see inside the joint.
Total Hip Replacement
During this procedure, your damaged hip joint is replaced with implants that recreate the ball and socket of a healthy hip. This can reduce pain and restore your hip function.
Stem Cell Therapy for Avascular Necrosis/Hip
This therapy treats dying bone tissue in the head of the femur. Cells from your own body are used to help the femur heal.
Total Hip Replacement Minimally-Invasive
This method uses a smaller incision than the one used in traditional hip replacement surgeries. This helps speed your recovery.
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We offer the latest in non-invasive treatments including Regenerative Cell and Platelet Rich Injections.
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