Alternatives to total Hip Replacement
Nathaniel Stewart, MD
Orthopedic Surgery
Chippewa Valley Orthopedics & Sports Medicine
Eau Claire
How do you know if your symptoms are due to a hip problem?
If you have a hip problem you may have pain in the groin, pain on the outside of your hip, or into your buttock. You might feel the pain in your knee, even though the problem is really in the hip. The symptoms may be made worse by activities like labor, walking, sports or even sitting for a prolonged period.
Stiffness may develop. When your hip does not bend well, you will have trouble reaching your feet to put shoes on or crossing your legs. It becomes harder to reach and bend your hip, putting strain on your lower back.
Diagnosing hip disease can be as simple as having your doctor examine it and get an x-ray. In other cases, the cause may not be immediately evident, and further testing such as CT, MRI, and/or injections may be required. The understanding of the treatment of hip problems is rapidly evolving. More complex cases are often referred to an orthopedist that specializes in the treatment of hip disease.
What is the most appropriate treatment for hip disease?
The best treatment for your hip disease depends both on the cause of the hip disease and how far the disease has progressed. Conditions that can lead to destruction of the hip joint include rheumatoid arthritis, Lymes disease and avascular necrosis. By far the most common condition is “degenerative arthritis”.
Degenerative arthritis includes a variety of mechanical imperfections, the most common being “femoral acetabular impingement” or FAI. Many recent studies, including an extensive review of our cases at Chippewa Valley Orthopedics, have shown that FAI is the leading cause of premature hip arthritis.
What is FAI?
FAI is a condition where the femur abuts against the pelvic side of the hip. It can be due to imperfections in the shape of either side of the hip, or both sides. After repetitive impaction of the two bones, the cartilage begins to fail. This condition can present at different stages of life. A teenager or young adult may experience groin pain with sports. These early symptoms are frequently misdiagnosed as muscle problems. In middle age, groin pain can occur with squatting or prolonged sitting. Alternatively, the person with FAI may not be diagnosed until the joint is completely destroyed, and a replacement type surgery is required.
Treatment of FAI
When detected early, FAI can be treated arthroscopically. The portion of the hip that is defective is burred away. If the cup is over grown, its edge can be trimmed back. The labrum, or edge of the cup, can be torn. This tear can be sewn down to the acetabulum (pelvic bone). The mechanical imperfections being addressed, the groin pain resolves and activities can be resumed.
This procedure is commonly performed at OakLeaf Surgical Hospital. With over ten years of arthroscopic hip surgery experience, the procedure is well tested. Patients can attend a class to familiarize themselves with the procedure and their recovery. Patients come from all over western Wisconsin for this specialized care.
Alternative to Hip Replacement May Be Hip Resurfacing
When the joint is completely destroyed, arthroscopic surgery will not help. In these cases an artificial implant is required. Traditionally this has been a total hip arthroplasty. This involves fixing a cup to the pelvic bone and replacing the entire proximal portion of the femoral bone (thigh bone) with a stem. Its advantages are that it has a well known track record of 40 years and can be performedon patients regardless of bone quality. Its disadvantages include risks of dislocation and leg length inequality. Also, a large quantity of bone is removed.
An alternative to total hip replacement is hip resurfacing. Here the pelvic bone has a single piece metal liner and the femur is capped with a metal cap. The risk of dislocation is much less and the legs remain equal in length. Bone is preserved, which may be needed if years later a second replacement type surgery is needed. The disadvantage is the shorter clinical experience with this implant having only 10 years of clinic follow-up. Also, when the bone is preserved, a fracture of the femoral neck is possible, while the metal neck of a total hip will never fracture.
The stability and exact mechanical reconstruction makes resurfacing an appealing option for younger more active patients. Resurfacing, while uncommon ten years ago, is now an accepted alternative for some patients.
Conclusion
In the last decade there have been many advances in the care of patients with hip disease. Where an artificial replacement was the only option, now the hip can be saved. Where total hip was the
only solution, resurfacing provides an option for the younger more active patient.
Dr. Stewart – Chippewa Valley Orthopedics & Sports Medicine
For information or to schedule an appointment:
715-832-1400 | 800-322-1747 | www.cvosm.com
Dr. Stewart sees patients in Eau Claire, Chippewa Falls and Stanley.
