FAQ Category: Hip

Hip motion is very important in the mechanics of your backswing. Studies show that golfers with more outward rotation than inward rotation of the hip are more likely to have low back pain.

The lead hip acts as a pivot point during the golf swing. This puts quite a bit of torque or twist on the hip. If the hip doesn’t have enough motion, the force is transferred to the lumbar spine. Injury of the low back or sacroiliac area can occur.

Check with your doctor before golfing. You should do well with a good rehab program and training in preparation for golf. A physical therapist can help you by checking your motion and teaching proper stretches for your hip and low back.

It’s not uncommon for pain in other places to go away after a hip fusion. It’s more common for joint pain caused by the unstable fracture site to be relieved by the new hip position. Relief of chronic back pain isn’t as likely.

Doctors think the reason for the pain relief is caused by changes in position of the hip and spine. Improved stability in the area may take the load off joints and soft tissue structures above and below the fused site.

If you’ve been turned down by your surgeon for a hip joint replacement, then you’ve probably been advised about pain medications. If not, be sure and ask your doctor what over-the-counter or prescription drugs would be helpful.

Research continues to look at joint replacement in younger patients. In the meantime, hip fusion is emerging as a possible alternative operation. When hip fusion is done with the hip in a good position, pain relief and improved function are the results. With a solid
fusion you’ll have steady pain relief.

You didn’t say what’s wrong with your hip that would need a fusion. In general hip fusion isn’t advised for a hip with inflammation from arthritis. Infection in the hip will also keep a patient from having this operation.

Most doctors don’t advise hip fusion if there’s pain or loss of motion in the knee on the same side. The same is true for problems in the spine or the opposite hip. Injury, instability, or deformity of the knee on the same side requires careful evaluation before
having the hip on the same side fused.

Poor health, older age, and obesity are red flags. The surgery is not readily advised in these cases. A poor or negative attitude is also reason not to do the surgery.

Hip pain and loss of motion after a fracture in a young patient is one reason doctors advise hip arthrodesis. Fracture and chronic alcohol use can result in a condition called osteonecrosis. Loss of blood supply to the hip leads to death of the bone. Osteonecrosis is another reason hip fusion is considered.

Only a few studies have been done to look at age differences with total hip replacements. Since most patients do wait until age 50 or older, finding out how younger patients fare isn’t easy.

Doctors at the Anderson Orthopaedic Research Institute in Virginia have given us some answers. They looked at 561 hip replacements done over a period of 20 years. All patients were 50 years old or younger. This group included 256 hips in patients who were 40 years
old and younger.

The authors were surprised to find no difference in wear rates between the two groups. They followed the patients for five, 10, and 15 years. Wear rates were calculated using repeated X-rays over the years. They found implants lasted five years in 97 percent of patients under 40. This is called the five-year survivorship rate.

The 10-year survivorship rate in the same group was 85 percent. And at 15 years the survivorship rate was 54 percent overall. That last figure means about half the implants had failed by 15 years, but the researchers found only part of the implant failed. The
whole implant didn’t need to be replaced. Revision surgery could be done just to replace the worn part.

Studies like this are very encouraging. Your chances of an earlier operation may improve as more information is reported.

Studies show total hip replacements have been done in patients as young as 16 years old. Usually doctors prefer to wait until you’re at least 50 years old. The reason for this has more to do with the longevity of the implant than how long you’ll live.

Since most implants last between 10 and 15 years and your life expectancy is in the 70s, you could go through two or three implants in the next 35 years. The soft tissues and bone around the joint don’t hold up well after that many operations.

The good news is that more and more studies are being done in this area. Doctors are finding out which implants hold up the best. They’re also seeing how to improve the implants for longer and better wear.

Your best bet is to make use of drugs and exercise to hold on as long as you can. Keep regular contact with your doctor in case anything changes in this area.

It probably stands for polyethylene liner. This is a plastic insert that goes inside the cup or socket portion of the implant. It provides a cushion and surface
against which the ball of the joint can glide over and move around.

Studies show the PE liner is the weak link in hip joint replacement. The other parts of the implant hold up and wear well for five, 10, even 15 years and beyond. But thinning, cracking, and breaking of the PE requires implant revision.

Some companies are making a thicker liner for surgeons to try. The next step is to see how long the liners last in various hip implants. Do they last longer in a ceramic or metal prosthetic? Do they last longer in younger patients? These questions are under study today.

If you pull a chicken leg out of its socket, you’ll see a fibrous white ligament. That’s the equivalent of the ligamentum teres in the human. It helps hold the head of the femur (thigh bone) in the hip socket.

Traumatic or twisting injuries can cause this ligament to tear. Hip dislocation can stretch it to the tearing point, too.

Doctors don’t have a test to help them find this type of tear. In fact, it wasn’t until arthroscopic surgery came along that they even knew it occurs as often as it does. Now that we know it’s a problem, more studies will be done to find easier ways to diagnose it.

More often than we ever thought before! Only a few cases have been
reported from time to time over the years. Then Dr. Byrd from the
Nashville Sports Medicine Center started looking at every hip he was
operating on using an arthroscope.

An arthroscope is a special tool that’s inserted into the joint.
There’s a tiny TV camera on the end of the scope. It gives the surgeon a chance to see inside the joint. Unusual damage can be found and repaired this way.

He found 41 cases of ligamentum teres injury in about 15 percent of the 271 patients he examined.

You mentioned arthroscopic surgery. In this operation, the doctor
uses a special tool called an arthroscope that’s inserted
into the joint. There’s a tiny TV camera on the end of the arthroscope. This gives the doctor a view inside your hip joint. Special shaving and suction tools can also go through the scope into
the joint.

The surgeon uses three things to help in an operation like this. The
arthroscope and special curved tools makes it possible to reach all
around inside the hip joint. The scope can enter the joint from one
of several places. This gives the surgeon access to the hard to
reach areas. The patient’s hip can also be put in a position that
gives the surgeon a better view.

Maybe not directly, but we may have some information to offer. A recent study from Finland compared 27 men with hip osteoarthritis (OA) to 30 men of similar ages without OA. Hip motion and function were measured and compared.

Everyone was tested twice (on two separate days) with two to six weeks time in between the first test and the retest. Subjects stood on one leg to test standing balance. Marching in place with the knee lifting up to the hip level was another test. Stair climbing, knee bending and hip range of motion were also included.

It turned out that the men without OA were much more flexible than the men with OA. They had more hip motion, especially moving the legs out and rotating the hip in or out. Men with more hip deterioration had less motion. Men without OA also had better function when walking, climbing stairs, standing on one leg, or moving the hip.

Disability pension is often based on the doctor’s recommendations. A physical exam, X-rays, and strength testing are performed. Tests of flexibility and function are also measured. These tests may consist of hip range of motion measurements, deep knee bending, and balance while standing on one foot.

Studies show there isn’t always a direct link between the results of X-rays and the patient’s symptoms. You can have severe pain and stiffness without major changes in the
hip. The opposite is also true. A patient can have severe changes as seen on the X-ray but have no symptoms.

There are other key factors in the decision, too. Will you be applying for a private company disability pension or government pension? This is decided based on who employed you.

There’s usually an appeal process if you are turned down. Working closely with your doctor is your best option for a favorable decision.

Standing balance depends on a variety of factors. Muscle strength of the hip and leg muscles is important, but so is strength and control of your core trunk and abdominal muscles. Standing balance also depends on vision and your inner ear function.

Balance is much easier with the eyes open. Try balancing both ways (eyes open and then eyes closed) and see the difference for yourself. Make sure you stand next to a wall or chair in case you lose your balance while doing this exercise.

The inner ear (vestibular system) has a lot to do with balance. The structures inside the ear signal to the brain the position of the head. The goal is to keep the head upright
over the body. It does this while the head is moving, whether fast or slow.

If you find you are losing your balance, it may be a good idea to have your physician or a physical therapist test your balance. Finding a problem early can save you from falls and fractures later on.

Yes. In order to remove the old, diseased hip joint the doctor carefully pops it out of the socket. Muscles, capsule, and connective tissue are often cut in order to do this. Sometimes the soft tissues are sewn back or reattached to the bone, but not always.

Once the new implant is in place, the joint is “reduced” or put back in place. The patient is given strict instructions about what movements and positions to avoid. This is to prevent the hip from dislocating again while the tissues are healing.

Studies show about a four percent chance of dislocation after a posterior approach hip replacement. This means four out of every 100 patients who have this operation end up with a hip dislocation.

A recent report from Brigham and Womens Hospital in Boston, Massachusetts shows doctors how to reduce this to 0.4 percent. They used a special method of cutting and reattaching the joint capsule. They believe this method will increase the elasticity of the hip during the healing phase.

Using this new approach brings the risk of hip dislocation down equal to hip replacement using the anterior (front) or lateral (side).

Pain control is one of the biggest challenges after surgery of any kind. Some doctors are using a much smaller incision to do some hip replacements. It depends on the type of hip implant being used. With a small incision there’s less damage to the muscles and less pain. Ask your doctor if you might be a candidate for this mini-incision operation.

Other methods of pain control are used such as acupuncture, electrical stimulation, hypnosis, and patient controlled analgesia (PCA). A recent study from Japan suggests using constant cold therapy for the first four days. A cooling pad is placed over the surgical site. A computer keeps it at a constant temperature.

More than half the patients were pain free by the end of the third day. This reduced painful days by at least two full days. Tell your doctor about your concerns. Find out what’s available at your hospital or surgery site.

Cold therapy, also known as cryotherapy is thought to help joints that are closer to the surface of the skin. The knee doesn’t have much soft tissue, fat, or muscle covering the joint. The cold can get down into the joint easier.

Large muscles and at least one layer of fat cover the hip. It’s always been thought unlikely that the cooling action would reach deep into the hip joint.

However a new study from Japan may prove this idea wrong. They used cryotherapy with a group of 23 total hip replacement patients. The group was compared to another group who had a hip replacement but without cold therapy afterwards.

The researchers report good success with the cold therapy. Patients got pain relief faster. They used fewer pain meds. They could begin rehab sooner. Based on this study, the use of cold after hip surgery may become more popular in the months and years ahead.

Many factors can play a part in hip dislocation after replacement. For example, which side of your hip is the scar located? Any position you get in that can push the hip in that direction has the potential to cause a dislocation.

When you are on your hands and knees, you have your body weight against that hip. If you twist or angle your body against the hip, injury can occur. Your weight and bone density are also important factors. Being overweight means that much more pressure through the hip. Having osteoporosis (brittle bones) or decreased bone density makes it harder for the bone to grow around the new implant and hold it in place. Bone or muscle weakness can also lead to injury.

Most patients are given positioning precautions for the first 12 weeks post-op. In theory at 12 months you should be free to assume any position possible. In practice, sometimes our theories (and hips) don’t hold up.

If you pull a chicken leg out of its socket, you’ll see a fibrous white ligament. That’s the equivalent of the ligamentum teres in the human. It helps hold the head of the femur (thigh bone) in the hip socket.

Traumatic or twisting injuries can cause this ligament to tear. Hip dislocation can stretch it to the tearing point, too.

Doctors don’t have a test to help them find this type of tear. In fact, it wasn’t until arthroscopic surgery came along that they even knew it occurs as often as it does. Now that we know it’s a problem, more studies will be done to find easier ways to diagnose it.

More often than we ever thought before! Only a few cases have been reported from time to time over the years. Then Dr. Byrd from the Nashville Sports Medicine Center started
looking at every hip he was operating on using an arthroscope.

An arthroscope is a special tool that’s inserted into the joint. There’s a tiny TV camera on the end of the scope. It gives the doctor a chance to see inside the joint. Unusual damage can be found and repaired this way.

He found 41 cases of ligamentum teres injury (partial or full tear) in 271 patients. That’s about a 15 percent incident.