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Hip Pain: Conditions, Treatment and Reconstruction

January 26, 2012 12:00 PM with Dr. Anand Srinivasan

What is hip arthritis? When should you consider hip replacement? Are there any advances in the surgery to promote recovery? What activities can I expect to resume? Join Dr. Anand Srinivasan, Orthopaedic Surgeon at NorthShore as he answers your questions about joint pain, recommended exercises and reconstructive procedures. Your participation and early questions are welcomed.

Angela (Moderator) - 11:49 AM:
Welcome! Today’s chat, Hip Pain: Conditions, Treatment and Reconstruction will begin shortly. Please start submitting your questions and Anand Srinivasan, MD will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the Orthopaedics website to obtain more information. We will do our best to answer all of your questions, but because this is such a popular chat, the physician may not be able to answer all of your questions in the time allowed. Your understanding is greatly appreciated.

Dr. Anand Srinivasan (NorthShore) - 12:00 PM:
Hi. Welcome to the online chat. My name is Anand Srinivasan. I am an orthopaedic surgeon at NorthShore University HealthSystem specializing in hip and knee reconstruction. I'm looking forward to answering your questions over the next hour.

  James (Evanston, IL) - 12:00 PM:
How do I know if my hip pain is due to arthritis?
Dr. Anand Srinivasan (NorthShore)
James, Great question. Hip pain usually manifests itself as groin pain. Sometimes, this pain can refer down the thigh but in general, a patient will report groin and less often, pain right behind the trochanter (the bony prominence on the side of the leg). Hip pain from arthritis is a mechanical problem and so often is worse with weight-bearing activities. A lot of people anecdotally say that arthritis pain starts as a stiffness that gets better with light activity and worse with heavy activity. Xrays are a diagnostic measure that can rule out arthritis quickly as well and are usually a first-line study when someone comes in with hip pain. Usually, a patient can get a very quick idea as to whether they have arthritis by having their primary care physician obtaining an xray.

  Sal (Highland Park) - 12:06 PM:
How do you know if you are good candidate for a total hip replacement? If you are, how long is the recovery period?
Dr. Anand Srinivasan (NorthShore)
Sal, Generally, with modern anesthetic and surgical techniques, most patients are candidates for total hip arthroplasty as far as being medically able. As a result, a good candidate is a patient who has hip arthritis that is causing pain and limiting their quality of life (QOL). Hip replacement, in the end, is a quality of life surgery and has been proven with time to be one of the most successful surgeries of all time. A patient must be able to comply with hip precautions after surgery as well as to appropriately rehabilitate the hip. The recovery period can vary based on your conditioning. Generally, most people are doing most things by 6 weeks. Most people are transitioning from using a cane to not using any assist device at this time interval. But like anything, some people recover sooner and some a little later. For example, returning to a labor job can take a little longer.

  Rich (Wilmette) - 12:12 PM:
I will be undergoing hip replacement surgery later this spring. I’m starting to get very nervous that my life won’t be the same. Will I be able to feel “normal” again?
Dr. Anand Srinivasan (NorthShore)
Rich, I think that being nervous in general about surgery is a natural and appropriate response. It depends on what your expectations are, but most people return to a fairly active level after total hip replacement. We (as a profession)encourage doubles tennis, golf, light downhill skiing, swimming and other activities after hip replacement. I think that the chance of returning to "normal" varies from person to person but that total hip arthroplasty has worked well in the past for many patients. I hope that your upcoming surgery goes well.

  Erica (Morton Grove) - 12:18 PM:
I am an avid runner. Over the last couple of months, I’ve started to have hip pain after going for a run. Is this normal? What could be causing this pain?
Dr. Anand Srinivasan (NorthShore)
Erica, If you have groin/thigh pain with running, this could be from many possibilities, and is usually not from arthritic pain. Overuse of the muscles, tendinitis, bursitis can all cause pain around the hip and treated with conservative measures such as stretching and the occasional anti-inflammatory. If this pain does not seem to be improving or limiting your weight bearing, more immediate evaluation may be required for stress fracture or tears around the hip of the labrum. An MRI would usually be needed to see these last two things mentioned. Finally, hip and back pain are very often related as they work together mechanically. Gluteal (or buttock) pain sometimes originates in the lumbar spine. I hope this answers your question sufficiently.

  Dorris (Glencoe, IL) - 12:24 PM:
I want to try to prevent hip pain. Are there certain exercises and stretches that can help? Is there any physical activity I should avoid?
Dr. Anand Srinivasan (NorthShore)
Dorris, Most exercises and stretches are good for our body in that they keep our conditioning and muscle strength at a reasonable level. For my patients who have hip arthritis, I often recommend non-weight bearing activities such as biking (whether real cycles or stationary). As well, swimming and pool activities generally work well. Running and other high impact activities are the only things that should be avoided.

  Christine (Evanston, IL) - 12:28 PM:
What affects does arthritis have on the hip? Is this something that will appear on an x-ray?
Dr. Anand Srinivasan (NorthShore)
The hip joint is a ball and socket joint just like our shoulders. Arthritis is a wearing away of the cartilage (the cushion) between the two bones of the joint. As a result, when a hip has arthritis, it manifests itself as pain. Arthritis does not spread or go to other areas if in one area of your body (except in certain circumstances such as rheumatoid arthritis). X-rays are an excellent diagnostic tool to assess whether someone has arthritis. A patient with severe arthritis will often have no space (or cartilage) left between the two bones.

  Anne (Glenview, IL) - 12:34 PM:
Is there a correlation between age and hip pain? What can I do to reduce my risk for pain as I age?
Dr. Anand Srinivasan (NorthShore)
Anne, complex but good question... There is no true correlation between age and hip pain. In other words, people are not destined to get hip pain as they get older. That being said, most people with hip pain (at least from arthritis) are older as they have had more time for the "wear and tear" processes of life to occur. Reducing your risk of hip pain would include maintaining good muscle strength around your hip. This often helps stabilize your hip even if you do have arthritis and helps a lot of people avoid surgery. Non-weight bearing exercises (biking/swimming) are excellent at helping maintain muscle strength while avoiding the impact of some activities. Healthy eating and maintaining ideal body weight will help reduce the amount of force your joints see over the course of a lifetime as well.

  Michael (Chicago) - 12:40 PM:
What minimally invasive surgical options are available for hip replacement? Are there other advances to consider?
Dr. Anand Srinivasan (NorthShore)
Mike, Minimally invasive surgery is a term that means different things to different people. In general, to me, it implies that the amount of soft tissues (muscles, tendons, etc.) that have been disrupted/dissected is left at a minimum. Most approaches to the hip (anterior, anterolateral, posterior) can be done through a "minimally invasive" approach (based on my above definition). No specific approach has been shown to be superior in terms of outcomes, although what is known is that your recovery is faster as there is less soft tissue that needs to heal. In the end, I always counsel my patients that the goal of every hip replacement surgeon is to get you a long lasting hip that relieves your pain and restores your function. As far as advances, the largest advance is the improvement in plastics that we use now in the hip replacement. Only time will tell but they have done very well at 10 years follow up and are showing that they may last longer than the plastics from earlier.

Dr. Anand Srinivasan (NorthShore) - 12:46 PM:
Mike, (cont.) Finally, hip resurfacing is a surgery to consider; although, with recent concerns about metal on metal bearings in general, you should have a frank discussion with your surgeon before opting for hip resurfacing.

  Hank (Evanston, IL) - 12:46 PM:
My hip makes a grinding noise. It also pops every so often. Is this something I should be concerned about?
Dr. Anand Srinivasan (NorthShore)
Hank, Is this hip replaced already? A grinding noise from your hip (replaced or not replaced) is not normal, especially if someone else in the room can hear it. It can be related to arthritis (in the non-replaced hip) or to wear of the bearing surface (in the replaced hip). Popping around the hip is usually from the muscles and tendons around the hip. The iliotibial band (IT band) can be tight around the side of the hip or the muscles (iliopsoas, gluteal muscles) can snap over the bone. Usually, stretching and anti-inflammatories are first-line treatments for these causes of hip popping. In general, popping is less concerning than audible grinding.

  Eric (Northbrook) - 12:50 PM:
I have hip pain, but don’t think I need to see my doctor about it yet. Other than pain relievers and icing, what are some home techniques I should consider? At what point is it necessary to see my doctor?
Dr. Anand Srinivasan (NorthShore)
Eric, Other than pain relievers, icing... You should consider stretching/strengthening exercises. Some examples include: Gluteal stretching, Iliotibial band stretching, Straight leg raises, and Wall squats with a ball. These are just examples and maybe one or two therapy sessions for someone to go over exercises with you would be helpful. It is likely necessary to see your doctor if you feel this pain is worsening and that your quality of life is being affected by your pain.

Angela Martin-Barcelona (Moderator) - 12:51 PM:
Thank you everyone for your great participation. The chat will be ending in approximately 10 minutes. Please submit your final questions.

  Jen (Chicago) - 12:54 PM:
What is the difference between a hip replacement and a hip resurfacing?
Dr. Anand Srinivasan (NorthShore)
Jen, Very briefly...A hip resurfacing is a more bone-preserving procedure in that you don't cut the femur (thigh bone) at the femoral neck (hard to explain without pictures). If this question is for yourself, you should know that hip resurfacing involves a metal on metal bearing unlike a hip replacement (which usually involves a metal on plastic or ceramic on plastic bearing). Metal on metal bearings in women tend to be more concerning in that the risk of a reaction to the bearing or the implication of metal in your bloodstream if you are still of child-bearing age is still not well defined in the scientific literature. Once again, a frank discussion with your orthopaedic surgeon is a good start to explain this in more detail.

  Peter (Chicago) - 12:59 PM:
What are the main risks for hip surgery? Is there anything I should be mindful of in the recovery process?
Dr. Anand Srinivasan (NorthShore)
Peter, The main risks of hip replacement surgery are infection and blood clots (DVT). Other risks include limb length discrepancy, dislocation, and of course, cardiopulmonary complications or stroke. This is a shortened list but hits the main points that every patient should know. Other patient-specific risks based on your health history could exist. The only thing to be mindful of in the recovery process is to avoid positions that might cause dislocation of the hip. Allowing the post-surgical muscle/tendon repair to heal in is essential and avoiding dislocation is key. It has been shown that those who avoid dislocating their hip in the first six weeks generally have a much lower risk of ever having a dislocation, although that risk is never 0%

Angela (Moderator) - 1:03 PM:
Thank you again for participating in our chat today. For more information please visit the Orthopaedics website . A transcript of this chat will be available shortly.

Dr. Anand Srinivasan (NorthShore) - 1:04 PM:
Once again, thank you for your excellent questions. I hope that this online chat was helpful and I wish you all well! I see patients in Evanston, Highland Park and Vernon Hills. My office number is (847)570-2825.

This chat has ended.

Thank you very much for your participation.