Advances in Hip Surgery

By Nathaniel Stewart, MD
Orthopedic Surgery
Chippewa Valley Orthopedics & Sports Medicine, Eau Claire

Hip disease is a common problem. Prior to the advent of hip replacement surgery some 30 years ago, arthritis of the hip was a leading cause for admission to a nursing home. Within the last several years, numerous advances have improved our ability to treat this disabling condition.

Symptoms in the hip area may be from a variety of causes.
Causes of Pain in the Hip Region

• Hip Joint Disease
• Back Disease
• Bursitis
• Tendonitis

Hip Joint Diseases

• Osteoarthritis (wearing out)
• Systemic arthritis
  (such as rheumatoid and others)
• Avascular necrosis

The three most common causes of hip pain are the hip joint itself, the back and bursitis. Pain from the back tends to be on the outside of the hip and into the buttock region and may be accompanied by numbness and tingling. Bursitic pain is on the outside of the hip and tends to be worse if you lay on the affected side. Hip joint pain tends to affect the buttock area and the outside of the hip as well, and may produce pain in the groin region. Hip pain, due to degeneration of the hip joint, may come and go, but it is progressive and disabling.

One of the first signs of hip disease is difficulty reaching your feet to put on your shoes.

Treatment of hip degeneration begins conservatively with Glucosamine and chondroitin supplements that over several months time can reduce the pain from arthritic joints and are extremely low risk. Tylenol is a very safe medication that can be used to reduce the pain. The group of nonsteroidal anti-inflammatories, including Ibuprofen, Naprosyn, Vioxx, and Celebrex, to name a few, has been included in recent reports of increased cardiac risk. Further information will certainly be coming out with regards to their safety. In some cases, hip disease is easy to diagnose. An exam and x-ray will be all that is needed to determine the cause of pain. At other times, the diagnosis is not clear and additional tests will be required. MRI proves the diagnosis in conditions that may not show on x-ray. When both back disease and hip disease are present, injecting the hip joint with a local anesthetic will allow the patient and doctor to determine how much pain is coming from the hip joint itself.

Hip arthroscopy may be of benefit. Instruments are inserted in to the hip through very small cuts, and the joint is viewed through a fiber optic cable. Loose bodies and torn cartilage can be removed. Arthroscopy of the hip is evolving and will likely play an increasing role in the future.

Hip replacement is the most common procedure to treat the severely damaged hip. While this procedure has been performed for decades, there have been many advances in the last few years. These include improved surgical approaches that disturb less of the muscles about the hip (“mini”hip surgery); improved bearing surfaces (the surfaces that rub against each other); and improvements in component design.

Improvements in surgical equipment and implant design have made the “mini” hip procedure reliable, allowing hip replacements with smaller surgical scars and less tissue disruption. However, certain patients who are overweight, or have a congenitally deformed hip socket, may not be good candidates for this procedure.

Artificial hips wear out over time because the two surfaces that rub against each other slowly wear down. Traditional hip components have metal rubbing on plastic. Newer replacements have ceramic surfaces which are “harder” in terms of their resistance to wear and are predicted to outlast the metal-on-plastic of the past.

Hip surgery continues to advance. Patients can expect faster recovery, with better hip function and longevity. People, who a generation ago would have been confined to a life of severe disability, are now able to return to work and play.

For more information, or to schedule an appointment with Dr. Stewart » 715.832.1400/800.322.1747, Chippewa Valley Orthopedic & Sports Medicine or visit www.cvosm.com