OakLeaf Medical Network Healthy Viewpoints, Winter 2003
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Nathaniel Stewart, MD


Nathaniel Stewart, MD
Joint Reconstruction & Trauma
Chippewa Valley Orthopedics & Sports Medicine
Eau Clair

Hip disease is a common cause of pain and disability. If you suffer from pain in the hip region, a precise diagnosis is critical to provide information for planning effective treatment.

People with disease of the hip will often have symptoms in the groin, thigh and buttock.  The pain is often a stiffness or vague ache and may be hard to pinpoint.  You may find it hard to tie your shoe or in some cases there will be a sharp catch in the groin when getting up from a sitting position.  Hip disease may be confused with lumbar (low) back disease.  While low back disease also produces pain in the thigh and buttock, it rarely is accompanied by groin pain.

Fluoroscope of the hip allows the surgeon to view the hip socket prior to inserting the arthroscope.

Arthroscopic image of a bone spur being removed

Dr. Stewart keeps a close eye on the monitor as he maneuvers the scope during a arthroscopic hip procedure

To determine if the pain is coming from your hip, the doctor will examine your hip to see how well it bends and if certain stresses reproduce the types of pain you describe.  X-rays help in defining the bony anatomy of the hip. An MRI of the hip, or radiographic exam of the back, may be added to further define the cause of pain.  When a problem in the hip joint is strongly suspected, but there is concern that other areas, such as the back or intra-pelvic organs are causing some or all of the symptoms, the hip joint will be numbed with a local anesthetic and any pain relieved can be attributed to the hip itself.  The most common kind of hip disease is arthritis due to wear and tear.

Degenerative arthritis of the hip can be accompanied by small pieces of bone and cartilage that are floating around in the joint.  If a loose piece gets in the wrong place, there can be sharp pain and mechanical catching of the joint.  Some people will describe this as their hip “popping out of place”.  The arthritis can be accompanied by spurs, growths of extra bone which can pinch and limit motion while causing pain. There are less common conditions which produce loose bodies or painful inflammation of the lining of the hip joint. 

Treatment of hip disease depends on the diagnosis, but can be broadly defined as pills, injections, osteotomy ( cutting and redirecting the bone ),  arthroscopy and arthroplasty ( replacement surgery ). Medications include Glucosamine, which is more of a supplement than a drug, and commonly used for mild arthritis. Tylenol and anti-inflammatories, such as ibuprofen and Celebrex  are somewhat effective. Concerns about side effects from anti-inflammatories have reduced their use recently. 

For persistent hip pain a more precise diagnosis is helpful. Injections provide temporary relief and also help to confirm the hip as the cause of the pain.  A shot of cortisone may relieve hip pain for weeks to months, but rarely will an injection provide a permanent solution. 

Osteotomy around the hip joint is an operation primarily used to redirect either the ball or the socket side of the hip, usually due to a congenital malformed hip joint. Occasionally the deformity is from a fracture that healed out of place.  While osteotomy was commonly used many years ago, it is now helpful for certain younger and middle aged patients. Hip replacement surgery is now the most commonly performed operation for severe hip disease. While there have been many recent advances in hip replacement, artificial parts can wear out and are not a perfect solution, particularly in younger people. 

Hip arthroscopy can help in some cases. It is like the more common knee and shoulder arthroscopy.  However, the hip is surrounded by a large set of muscles that make entering the joint with the scope more difficult. The development of arthroscopy equipment specifically for the hip has greatly improved our ability to perform these minimally invasive operations to remove loose bodies, bony growths and/or spurs from both sides of the hip. 

Patients having arthroscopic hip surgery may have either general or regional anesthesia. The operation takes from 30 minutes to two hours and the majority of patients go home the same day.  The length of recovery depends on the exact procedure performed.   Exercises are started the day of surgery and formal physical therapy is begun after one week, as needed.  Depending on the type of work you do and your particular hip problem, you may return to work within one to six weeks.

In selected patients, hip arthroscopy may help reduce or eliminate symptoms that in the past would have either not been treated or would have required a much bigger operation.  This new technique continues to develop and holds promises of even greater ability to treat painful hip conditions with a minimum of trauma and surgical dissection.

If you have questions regarding hip pain or arthroscopic hip surgery or would like to schedule an appointment with Dr. Stewart, Chippewa Valley Orthopedics & Sports Medicine, call 715.832.1400 or 800.322.1747 or visit www.cvosm.com.
Dr. Stewart also sees patients in Arcadia, Chippewa Falls and Stanley.