FAQ Category: Hip

Femoroacetabular refers to the place where the femur (thigh bone) and acetabulum (hip socket) meet. Impingement means pinching.

In the case of femoroacetabular impingement (FAI), the head of the femur butts up against the cartilage and pinches it. Normally, the femoral head moves smoothly inside the hip socket. The socket is just the right size to hold the head in place.

If the acetabulum is too shallow or too small, the hip can dislocate. In the case of FAI, the socket may be too deep. The rim of the cartilage hangs too far over the head. When the femur flexes and rotates, the cartilage gets pinched.

This causes deep groin pain with activities that stress hip motion. Prolonged walking is especially difficult.

The cause of the problem is under considerable debate. For a long time it was assumed that overload of the joint caused this kind of OA. But no one could identify what was causing the stress overload.

Now with better imaging studies, we know that some subtle changes in the shape of the femoral head may be the cause of FAI. Other anatomical changes in the angle of the hip may also contribute to this problem. And as mentioned, FAI can occur if the hip socket is too deep.

Pistol grip deformity describes the abnormal shape of the hip joint. It was first described by Dr. S. D. Stulberg and associates back in 1975. The head and neck of the femur takes on the shape of a pistol grip when viewed on X-ray.

It’s an early sign of osteoarthritis (OA). The edge of the acetabulum (hip socket) is prominent. The head of the femur butts up against the edge of the acetabulum instead of sliding and gliding down smoothly in the socket. It gives the joint the look of a pistol grip shape when seen on X-rays.

The result is that the wrong part of the head of the femur is in contact with the acetabulum. The abnormal part of the head is forced into the socket during hip flexion and internal rotation.

This creates shear forces against the cartilage. This stress produces abrasion and then tearing or shredding of the cartilage. The rim of cartilage around the socket called the labrum is often involved, too.

All of these changes can lead to degenerative joint disease known as osteoarthritis.

Studies have shown that success rates are much better for hip joint resurfacing when patients are selected carefully. Failure rates are reduced when risks are minimized.

A special risk index called the surface arthroplasty risk index (SARI) can be used to pre-screen patients. This tool identifies the number of risk factors present. It also rank orders them according to the importance of each one.

For example, the presence and number of large cysts on the femoral head has the highest risk. Each cyst gets two points. And a total of three points or more suggests you aren’t a good candidate for this operation. Other risks include obesity, previous hip surgery, and low activity level.

Surgeons know now that doing a hip resurfacing isn’t the same as a total hip replacement. The risk of fracture is much higher with resurfacing. Paying attention to risk factors that might cause problems and implant failure is important.

Hip resurfacing arthroplasty replaces the arthritic surface of the hip. Much less bone is removed compared with the traditional total hip replacement.

Because the hip resurfacing removes less bone, it may be a better option for younger patients who may need a second hip replacement surgery later. A revision operation may be needed as they grow older and wear out the original artificial hip replacement.

As far as improvements in the hip implants, there may not be a big difference in just the past year. But much has changed from when the procedure was first introduced.

Changes in the implant design and better surgical tools have helped reduce the 30 per cent failure rate that was reported early on. There are also fewer dislocations and the joint is preserved.

Patients are selected more carefully now than at first. Research has shown that obese adults over the age of 65 are not good candidates for this surgery. Anyone who has osteopenia is also at increased risk for problems. Osteopenia is a decrease in the mineral content of the bone. These patients are more likely to need a total hip replacement.

If you have had your hip resurfaced in the past year, most likely you received the most up-to-date implant and surgical methods. In the future, researchers will continue to find ways to expand who can benefit from this operation.

GTPS stands for greater trochanteric pain syndrome. The greater trochanter is a bony prominence at the top of the femur (thigh bone). Pressure alongside the hip over this point causes tenderness or pain for people with GTPS.

Not all patients with this problem are women. About nine per cent of the general adult male population report symptoms of GTPS. But since 24 per cent of women in the same age group have GTPS, it’s clear that women are affected more often.

Doctors aren’t sure what causes GTPS. There have been many suggestions over the years and studies to find out. Some suggest the flared pelvic rim in women alters the pull of muscles and connective tissue causing the problem. Others suggest that hormonal factors affecting pain generators in the bursa is the source of the problem.

Obesity, knee arthritis, and low back pain are common among people with GTPS but which came first (the GTPS or the other problems) is also unknown. Since the back, hip, and soft tissues are all connected, there’s some thought that a problem in one area leads to problems in the other areas.

Some people have GTPS on both sides (bilateral), others only have one hip affected (unilateral). More study is needed to find out what causative and risk factors might be present and how it’s different for people with unilateral versus bilateral symptoms.

Hip bursitis is an inflammation of the bursa located between layers of tissue over the hip. The bursa is a round or oval-shaped, gel-filled protective pad. There are several bursaes located throughout the body, usually over a bony prominence.

With inflammation, there are usually symptoms of warmth, redness, or swelling over the painful area. A closer look at many women with hip pain suggests a different problem called greater trochanteric pain syndrome (GTPS). There is no inflammation with this problem. The person experiences pain or tenderness with pressure along the outside of the hip. It’s worse when lying on that side.

Women seem to be affected by this condition more than men but men are not immune to it. The cause of the problem remains unknown. With the gender differences, there may be hormonal or anatomic issues. But since nine per cent of the adult male population also report this problem, it’s likely there are other factors.

Some medical conditions put patients at a higher risk for complications after surgery. A previous history of cancer affecting the bone or previous joint replacement surgery are two common examples.

Older adults with serious bone fractures may also be advised to seek the services of a surgeon in a specialty clinic. Complicating factors such as osteoporosis or poor nutrition may be present. Or infection or diabetes may require extra care.

In a specialty clinic or hospital, the staff is trained to work with at-risk or high-risk patients. They have steps already worked out to deal with typical emergencies that might come up. And if they cannot handle the problem, they know when to transfer the patient to a more acute care setting.

Specialty clinics are fairly new. Studies to compare them to general hospitals are just beginning to get published. Based on large groups of Medicare patients, it looks like specialty hospitals do perform better than general hospitals. This is especially true for specific patient groups.

The risk of adverse outcomes including death are 50 per cent lower in specialty orthopedic hospitals. Specialty hospitals may deliver better care but there may be other interpretations of those outcomes. More study is needed to sort this all out.

Hip replacements are associated with older people, most of the time. It only stands to reason because their hips are wearing out because of osteoarthritis, injury, or other reasons. However, some younger people also have osteoarthritis or a problem that causes their hips to degenerate faster than they should.

While in most types of surgeries, being young would be an advantage, when it comes to weigh-bearing joint replacements, it actually works against you. Artificial joints have a limited life span and when they are placed in people who are in their 60s, 70s, and older, doctors believe that the chance of outliving the replacements is smaller than the other way around. But, if you are only 46 when you need a replacement, doctors are looking at replacing it again when you are in your 60s. While it may seem that if a patient needs a hip or a knee replacement, he or she should get it, the doctors have to weigh other issues as well, such as the seriousness and risk of such surgeries.

Newer treatments are being tried for younger patients. One such treatment doesn’t replace the whole hip but just a part of it. This procedure, called metal-on-metal resurfacing, is showing good results so far.

Yes, both hips can be replaced at the same time; this is called a bilateral hip replacement. Some advantages to the bilateral hip replacement include only having to go under general anesthetic once, a shorter overall hospital stay rather than two individual ones, and one rehabilitation. Drawbacks include that it can be harder to recover from two replacements at once, and some studies show a higher level of complications among patients with bilateral replacements.

Only your doctor can decide which is best for you.

It’s very possible. Younger adults with active lifestyles who are too young for a total hip replacement are turning to this new option. Instead of cutting off the head of the femur (thighbone), the surgeon puts a cap over the damaged bone.

If and when you need a total hip replacement years from now, the bone will be undisturbed. At that time, the surgeon can remove the damaged bone and replace it with a complete implant. And you won’t lose leg length from having a second hip surgery.

Hip resurfacing isn’t an option for everyone. An orthopedic surgeon will need to assess your situation. If you are a good candidate for this procedure, you may be able to start riding again two to three months after the operation.

Rehab begins right away. A physical therapist will work with you to restore motion, function, balance, and coordination. Be sure and let your surgeon and your therapist know your goal to return to riding. Your treatment can be tailored with that in mind.

Total hip resurfacing is one of the fastest growing orthopedic procedures today. It’s a good option for adults with osteoarthritic changes of the hip who are too young for a total hip replacement.

Instead of cutting off the head of the femur and replacing it with an artificial implant, a metal cap is placed over the bone. Special powered instruments are used to shape the bone of the femoral head.

The new metal surface fits snugly on top of the bone.The cap is placed over the smoothed head like a tooth capped by the dentist. The cap is held in place with a small peg that fits down into the bone. You must have enough healthy bone to support the cap.

The hip socket may remain unchanged, but more often it is replaced with a thin metal cup. Motion can be restored fully after healing takes place. Your chances for recovery of full hip motion are better if you have good motion before the procedure. The stiffer you are before joint resurfacing, the less likely you will get full motion back.

But studies so far do show it’s possible to regain full hip flexion, extension, abduction (movement away from the midline), and rotations. In fact, your motion will be restored by the end of six months. Most patients do not regain any more motion between six months and one year.

Hip resurfacing arthroplasty is a type of hip replacement that saves bone at the top of the femur (thigh bone). It is an option for patients who don’t want or need a total hip replacement. Many younger adults are taking advantage of this option.

In theory, by removing less bone, if the resurfacing procedure fails, the patient can convert to the total hip replacement (THR). But there are very few studies to prove this can really be done safely and easily.

Surgeons at the Joint Replacement Institute in California say that’s because it’s a fairly new operation. They also comment that joint resurfacing is so successful that very few patients even need to convert.

In their limited experience, they report conversion is possible with good results. In fact, when they compared the results of a conversion group to a group of patients who had a THR first, the outcomes were the same. Both groups had the same pain levels, function, activity, and X-ray results.

Studies with a longer follow-up time will help answer some of these questions. For now, it looks like joint resurfacing is indeed a good option for many people. And it is possible to convert to a THR later if necessary.

Long-term studies of hip joint resurfacing have not been reported yet. There’s been one study of a small number of patients (20) who had a failed hip resurfacing. They all had a second operation to convert to a total hip replacement and did quite well.

The patients who needed conversion surgery either had a femoral neck fracture or loosening of the femoral component. Fortunately, this doesn’t happen very often. But that means we don’t have much to report from research studies yet.

Based on results of total hip replacements, most implants are expected to last at least 10 to 15 years. With today’s improved materials and surgery techniques, there’s some hope that many patients will actually get longer use than that.

At age 28, if you live another 50 years, it’s likely that at some point you will have to convert to a total hip replacement. Wear rates are somewhat dependent on how active you are. Although it’s advised to stay active, too much activity (for example training for and running marathons) can reduce the life of your implant.

Many people have heard a snap or a pop come from their hips from time to time. This can happen when they’re doing something that puts a lot of stress on the hips or if they’ve been injured. While snapping hips can be harmless, they can be caused by injury as well.

Snapping can occur when your hip bends and the band of tissue that runs along your hip to your shin passes over your thigh bone. That band might catch, causing the snapping sound. If this happens often enough, there can be swelling and this can cause pain. You could also get the snapping from a tear in the tissue in your hip, or by the tension of a tendon as it’s stretched across the thigh bone.

Many people will hear the snap and think it odd, but won’t go to a doctor because they aren’t feeling any pain or discomfort. If your hip is bothering you, it’s best you see your doctor so you can be checked to be sure it’s not something serious.

Hip pain can affect your quality of life because the pain can interfere with your every day activities and it can cause you to become isolated if you are unable to go out and socialize. When this happens, other issues can come up like depression or anxiety. If pain is beginning to interfere with every day life, this is a good indication that if a hip replacement is an option, this might be a good time.

Usually, before deciding that a hip replacement is needed, many other treatments are tried to try to relieve the pain and discomfort. This can include medications to reduce pain and/or swelling, physiotherapy or rest. If none of these treatments are effective and you are generally healthy otherwise, you might be a good candidate for hip replacement surgery.

Thigh pain can be caused by a wide range of problems. Pain can be referred to the thigh from a problem in the abdomen, low back, hip, or knee. For example, kidney stones, tumors, or blood clots can cause thigh pain.

But muscle strains, bursitis, pressure on the nerve, and hernias can also cause thigh pain. It is also possible that a problem with the implant can send pain to the thigh. Loosening of the implant, infection, and wear debris from the implant can cause thigh pain.

A simple X-ray can help show what might be going on. First, the radiologist will look for fractures. Rotation of the femur (thigh bone) indicates loosening of the implant. The X-ray can also show subsidence or sinking of the implant down into the bone.

Don’t put off having this problem checked. Early diagnosis and treatment can prevent more serious problems later. It could be something as simple as muscle weakness or even a problem with posture. If this is the case, a physical therapist can help your mother with a program of exercise and posture awareness. More serious problems can be addressed by the surgeon.

Thinning of the bone allows light coming from the other side to stream through the thin section. This light stream through the bone is called the skylight sign. It can only be seen from the side. The surgeon must use a lateral (from the side) approach to see the skylight sign.

From this angle, the bone is exposed as the muscles are cut away. Using other methods, won’t allow the surgeon to check for the skylight sign. Patients with a positive skylight sign are at increased risk for fracture. Fracture can be prevented by changing the surgical technique or size of the implant.

Sometimes reinforcing the bone with wire cables can help prevent fracture during the operation. The cables are placed around the bone. If a fracture occurs during the surgery, the cables can be left in place to help stabilize the bone during recovery and rehab.

High versus low-volume hospitals refers to the number of procedures done at that facility. A low-volume hospital for total hip replacements (THRs) probably refers to a hospital where one to 10 THRs are done each year. High-volume refers to facilities where 100 or more procedures are completed on an annual basis.

Some studies show there is a connection between volume and outcomes. The more surgeries of one type done, the better the chances are for a good result. But other studies fail to show any major link between hospital volume and patient outcomes.

It may be that finding a high-volume surgeon is more important than a high-volume hospital. There are some studies that support the idea that hospital-volume effect is important, but it’s the surgeons who perform the most number of a specific operation who have the best results.

A large survey recently conducted by the Agency for Healthcare Research and Quality (AHRQ) also reported that hip replacements done in smaller hospitals on older, sicker patients were likely to have higher complication rates. The surgery was usually unplanned because of an emergency. This result was reported when compared to total hip replacements performed on an elective (or planned) basis.

You are observing the lack of a skill called automaticity. This is the ability to do two things at once. In this case, your father can’t combine a motor task (walking) with a cognitive task (talking).

Experts refer to the interruption of one task while doing another as dual-task interference. Attention-demanding activities such as talking can interfere with tasks that are usually automatic. Decline in these skills can affect activities of daily living. You’ve already noticed this with your father.

Some older adults may be able to talk while walking but when they do so, the speed of their gait slows down quite a bit. Automaticity is influenced by how complex or demanding the tasks are. Sometimes a hearing loss affects automaticity.

Reduced or absent automaticity is a risk factor for falls among older adults. You may want to think about having your father tested for hearing loss. A cognitive assessment might be a good idea, too. Early identification and treatment can prevent many other problems from occurring.

Insecurity and inactivity are common problems in many total hip patients during the rehab period. The short hospital stay cuts down costs but isn’t always in the patient’s best interests.

Some hospitals have developed a special at-home program for patients like your sister. It includes videos showing how and what to do after surgery. Nurses from the center make extra phone calls to check on the patients. They receive written material every week for the first month.

The idea is to increase social support as a way to help people cope better. The hope is to foster faster recovery with better rehab results. So far, research is scarce in this area and not too encouraging.

At least one study from the Netherlands was unable to show any difference between patients who did have the extra support compared to those who didn’t. More study will help look at a wide range of factors. It may be that some skills and abilities are improved more than others by a program of this type.

If you don’t think your sister is in need of special services such as physical therapy, then invite her to walk with you. Start with short distances in the neighborhood or at the mall. Try to get a consistent schedule first, then increase the speed (pace) of walking or increase the distance walked at the slower pace.

Studies show that improvements in walking and other activities occur the most in the first six months after hip replacment surgery. Since it’s only been a month, there’s still plenty of time to get a program of activity and exercise going.