FAQ Category: Hip

Hip implants have a fairly long history with many changes from the 1960s to the present day. In fact, just like families with multiple generations (great-grandparents, grandparents, parents, children), objects like hip replacements have generations. The first group of hip implants designed in the 1960s are now referred to as first-generation products. Eventually, they gave way to second generation implants in the 1970s and 80s.

Better technology and improved materials led to the switch from cobalt-chromium-molybdenum (CoCrMo) for the bearings used to create motion to cast alloy in the second generation. By the third generation of hip implants (1990s), materials changed again to high- and low-carbon alloys.

With the fast evolving technology today and improved surgical techniques, we expect to see continued changes in the next decade or so. And as you have discovered, there are three choices for bearings: the traditional metal-on-polyethylene (plastic) and two alternatives: metal-on-metal and ceramic-on-ceramic.

Each type of bearing has its own advantages and disadvantages. For example, ceramic materials are at risk for fracture. Metal bearings cannot fracture but they are more likely to loosen requiring a second (revision) surgery.

Metal bearings can release tiny particles of metal into the joint, which does not happen with ceramics. Well, to clarify that last point a bit, ceramic debris is possible — it’s just much less than with metal bearings. And the body does not seem to react to ceramic wear particles like it does to the less biocompatible metal debris.

Current studies suggest that metal-on-metal bearings are more likely to loosen and wear out compared with bearings made of ceramic materials. Therefore metal bearings with polyethylene liners are recommended for older, less active individuals who are going to want this surgery to be their last.

The best bearing surface for younger, active patients will have to be decided on a case by case basis. The surgeon and patient should consider all the pros and cons of the different types of bearings (metal-on-metal, metal-on-polypropylene, ceramic-on-ceramic). The choice of bearings is made according to age, activity level, bone density, and relative risks and advantages of metal-on-metal versus ceramic-on-ceramic bearings. Potential complications must also be examined and every effort made to prevent any anticipated problems.

Your question comes at a good time with the recent publication of a study conducted at the Health Services Research Unit at the University of Aberdeen in Scotland. They conducted a very thorough electronic literature search on-line for any and all studies comparing the results of a mini-incision approach to hip replacement to the results using a standard incision.

More and more hip replacements are being performed with a mini-incision (less than 10 centimeters or two and a half inches long). Surgeons need to know what evidence there is to favor this approach when advising patients which way to go (mini-incision versus traditional open surgery). What they found may be helpful to you in your discussions with the surgeon.

There were 15 studies that met the eligibility requirements for good quality studies with a total of 1857 patients (when all combined together). Outcomes were compared by looking at amount of blood lost, length of operative time, number of days in the hospital, and complication rate. Complications included dislocations after surgery, level of pain, excessive blood loss, nerve injury, infection, fractures, blood clots, and the need for a second (revision) surgery.

Analysis of all the data showed that there were small differences in early results but in the end, no major differences in outcomes between the two groups. Sure, there was a bit less blood lost during the mini-incision procedures and the hospital stay was a day or two shorter. But there were no significant differences between the two groups when looking at complications or revision rates.

The authors point out the fact that the available studies were all fairly short-term. So long-term results cannot be compared at this time. Without the benefit of 10 to 20 year studies, it’s not clear if the mini-incision approach provides any major advantages over the traditional standard-incision surgery. The authors of the study summarize it well in a single statement: Current evidence is not strong enough to support one surgical technique over the other.

More and more hip replacements are being performed with a mini-incision (less than 10 centimeters or two and a half inches long). Surgeons and patients alike are searching for proof that one approach (mini-incision versus traditional open surgery) is better than the other.

To help with these management decisions, a group of researchers from the Health Services Research Unit at the University of Aberdeen in Scotland conducted a very thorough electronic literature search. They searched on-line for any and all studies comparing the results of a mini-incision approach to hip replacement to the results using a standard incision.

The studies they found were not all equal in quality or design. For example, the number of subjects ranged anywhere from 20 to 219. In some studies, the surgeon had a great deal of experience performing the minimally invasive procedure. Other studies noted that the cases involved were with surgeons just getting started with this approach and technique.

Follow-up varied from six weeks to three years. But outcomes could be compared by looking at amount of blood lost, length of operative time, number of days in the hospital, and complication rate. Complications included dislocations after surgery, level of pain, excessive blood loss, nerve injury, infection, fractures, blood clots, and the need for a second (revision) surgery. These are probably the types of complications and post-op problems you’ll want to talk with your surgeon about.

Analysis of all the data collected by the Aberdeen group showed that there were small differences in early results. No major differences in outcomes were observed between the two groups. There was less blood loss during the mini-incision procedures and the hospital stay was a day or two shorter. But there were no significant differences between the two groups when looking at complications or revision rates.

The authors point out the fact that the available studies were all fairly short-term. So long-term results cannot be compared at this time. Without the benefit of 10 to 20 year studies, it’s not clear if the mini-incision approach provides any major advantages over the traditional standard-incision surgery.

With more direct marketing to consumers, a greater number of American adults are seeking what is now referred to as “the operation of the century” — total hip replacement. As consumers making their own informed choices, today’s patients need clear evidence, not advertising hype to guide them. And before that can be possible, more high-quality, well-designed studies are needed.

At this point all that can be said for sure is there aren’t any major differences in short-term results between standard and mini-incision for total hip replacement. The authors of the study summarize it well in a single statement: Current evidence is not strong enough to support one surgical technique over the other.

It sounds like you may have a hip problem called femoroacetabular impingement or (FAI). Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.

Early diagnosis and treatment may be able to restore normal hip motion. Sometimes surgery is recommended right away. In other cases, conservative (nonoperative) care with antiinflammatories and physical therapy works just fine.

Delaying surgery is possible for other patients but the long-term effect(s) of putting surgery off have not been determined. There is concern for the development of osteoarthritis without treatment or with delayed treatment. This seems to describe your situation.

The first noticeable symptom of femoroacetabular impingement (FAI) is often deep groin pain with activities that stress hip motion. Prolonged walking is especially difficult. Although the condition is often present on both sides, the symptoms are usually only felt on one side. In some cases, the groin pain doesn’t start until the person has been sitting and starts to stand up. There is often a slight limp because of pain and limited motion.

Groin pain associated with femoroacetabular impingement can be accompanied by clicking, locking, or catching when chronic impingement has resulted in a tear in the labral cartilage. When femoroacetabular impingement and a labral tear are both present, symptoms get worse with long periods of standing, sitting, or walking.

Pivoting on the involved leg is also reproduces the pain. Some patients have a positive Trendelenburg sign (hip drops down on the right side when standing on the left leg and vice versa). As is often the case, one problem can lead to others. With femoroacetabular impingement, hip bursitis can develop. The gluteal (buttock) muscles may be extra tender or sore from trying to compensate and correct the problem. The pain can be constant and severe enough to limit all recreational activities and sports participation.

In your case, it sounds like the symptoms were mild enough to cause modification in your activities but not severe enough to seek medical help early on. Many people who are asymptomatic (symptom free) or nearly without symptoms look back and realize there were more indicators of a problem than they either recognized or wanted to admit. But 20, 30, 40 (or more) years later, it’s time to deal with the ‘what now’ rather than the ‘what if’ of years past. Fortunately, hip replacements are available for this problem and you can look forward to resuming some of your lost activities.

This is a good question and very timely as well. Current clinical evidence for the treatment of femoroacetabular impingement (FAI) was recently published by two surgeons from Children’s Hospital in Boston. The authors set out to report on current outcomes of surgical correctoin for FAI but came up empty-handed.

They discovered that most studies were from one clinic or hospital (referred to as single institution studies), which is what your study would likely be as well. Single- institution studies usually have a smaller number of cases and only one or two surgeons performing the procedures.

Single-institution studies are quite acceptable if the data collected is the same from institution to institution so that results could be combined and analyzed together (called a meta-analysis). But as these authors discovered, there was a lack of consistency in what information was collected and/or reported on.

They suggested that in order to generate useful information, it is necessary for everyone to collect and report on the same types of data. This is called standardization of data collection. For example, patients can vary tremendously in the type and severity of hip impingement. Patients can be professional athletes or stay-at-home parents so the goals and hoped for results may be different from one patient to another and one group to another.

The way surgeons measure disease severity isn’t always the same. The type of surgery performed and the way surgery is performed (open versus arthroscopic) can vary. Even the way the surgery is described differs in published studies. Finally, documentation and reporting of complications are not similar enough from study-to-study to combine the results toward any useful conclusions or recommendations.

What can be done to correct this problem? A universal, consistent, and standard way to collect, process, and analyze data is needed in order to shape treatment and provide successful outcomes. The studies must use reliable tools to measure pain and level of activity as appropriate outcome measures for patients with femoroacetabular impingement (FAI).

With long-term data reporting, it will be possible to see the natural history (what happens over time) with FAI, determine who is getting the best results and why, and thus guide treatment decisions. This type of approach could make it possible for surgeons to predict which patients will do best with conservative (nonoperative) care or surgery. If surgery is deemed best, then the same process can aid in determining what approach is best: an open procedure or an arthroscopic approach?

Based on currently published studies of femoroacetabular impingement (FAI), there is a clear need for long-term data collection that is standardized across all studies. Only then will the goal be met to provide best practice and thus best outcomes for the treatment of all patients with FAI.

If you follow these principles, your study can certainly provide your surgeon with the information you are looking for within your own institution. You want to publish the outcomes in a way that makes the results useful to all. That requires careful planning to see how others are reporting results. Make every effort to conform to the high standards already set by other publications.

Young patients who have hip disease early on requiring fixation with hardware such as pins, wires, plates, and/or screws provide surgeons with some interesting challenges. Conversion to a total hip replacement does require removal of some (if not all) previously placed hardware.

Holes placed in the bone for the screws do create stress points that can result in fracture during removal. The surgeon may need to surgically dislocate the hip in order to reduce the amount of force placed on the bone during hardware removal. Although it may sound extreme, surgical hip dislocation actually results in fewer complications.

If there is extensive hardware that would require destroying much of the bone to remove, then the surgeon may choose to leave the hardware alone. Each patient is evaluated individually. All factors are considered including your age, general health, underlying diagnosis (reason hip has been a problem), presence of structural deformity, biomechanics, and so on.

Your surgeon is the best one to advise you properly on what to expect and any plans for hardware removal. Every effort will be made to preserve bone integrity, joint motion, and muscle function. Now that more younger patients are having this type of surgery, surgical techniques, tools, and approaches have improved quite a bit. The result has been better outcomes, even in the long-term.

Femoroacetabular impingement (FAI) occurs in the hip joint. Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.

In some cases, conservative (nonoperative) care with antiinflammatories and physical therapy are all that are needed. A physical therapist will carry out an examination of joint motion; hip, trunk, and knee muscle strength; posture; alignment; and gait/movement analysis (looking at walking/movement patterns). A plan of care is designed for each patient based on his or her individual factors and characteristics.

Nonoperative care starts with activity modification (e.g., avoiding pivoting on the involved leg when there is a labral tear, avoiding prolonged periods of inactivity or activity). This part of the program must be followed for at least six months (often longer).

Improving biomechanical function of the hip involves strengthening appropriate muscles, restoring normal neuromuscular control, and addressing any postural issues. Tight muscles around the hip can contribute to pinching between the femoral head and acetabulum in certain positions. A program of flexibility and stretching exercises won’t change the bony abnormalities present but can help lengthen the muscles and reduce contact and subsequent impingement.

For other patients, surgery may be advised. Early diagnosis and surgical correction may be able to restore normal hip motion.The goals of surgery are to return the patient to full, normal activities without pain and to prevent (or at least slow down) hip osteoarthritis.

Studies show a good-to-excellent short- to mid-term result for the surgical treatment of FAI. Long-term outcomes are currently being studied. The fact that you are having ongoing pain and stiffness (and probably loss of hip motion) suggests further medical follow-up would be a good idea now.

There could be something very simple that needs attention. For example, the same type of physical therapy program mentioned might be all that’s needed to turn your situation around. If there is a labral tear, surgery can be done arthroscopically to repair the damage. The surgeon trims the acetabular rim and then reattaches the torn labrum. This procedure is called labral refixation.

For all patients, the surgeon tries to save the hip. But when there is extensive damage to the cartilage, hip resurfacing or total joint replacement may be needed. There are many factors to consider when making this decision. Your age, findings on imaging studies, type and severity of deformity, and the presence of arthritic changes are important.

Femoroacetabular refers to the place in the hip where the round head of the femur (thigh bone) comes in contact with the acetabulum or hip socket. Two types of impingement are known to cause pinching of the soft tissues in this area.

The cam-type impingement occurs when the round head of the femur isn’t as round as it should be. It’s more of a pistol grip shape. It’s even referred to as a pistol grip deformity. The femoral head isn’t round enough on one side (and it’s too round on the other side) to move properly inside the socket.

The result is a shearing force on the labrum and the articular cartilage, which is located next to the labrum. The labrum is a dense ring of fibrocartilage firmly attached around the acetabulum (socket). It provides depth and stability to the hip socket. The articular cartilage is the protective covering over the hip joint surface.

The rim of the cartilage hangs too far over the head. When the femur flexes (bends) and internally rotates, the cartilage gets pinched. Over time, this pinching or impingement of the labrum can cause fraying and tearing of the edges and/or osteoarthritic changes at the impingement site.

The second type of impingement is called pincer-type (more common in women). In this type, the socket covers too much of the femoral head. As the hip moves, the labrum comes in contact with the femoral neck just below the femoral head.

No matter which type of impingement is present, every time the athlete bends the hip up fully combined with internal rotation of the hip, the femur jams into the pelvis. Besides pain, the athlete experiences decreased hip motion, and difficulty with activities like sitting, climbing stairs, squatting, changing clothes, driving, and sports participation.

Once a diagnosis has been made, a course of action is determined. This may be the wait-and-see approach suggested to you. An alternative conservative (nonoperative) approach may be with antiinflammatories and physical therapy. In some cases, surgery is recommended right away. Early diagnosis and surgical correction may be able to restore normal hip motion. Delaying surgery is possible for other patients but the long-term effect(s) of putting surgery off have not been determined.

A physical therapist will carry out an examination of joint motion; hip, trunk, and knee muscle strength; posture; alignment; and gait/movement analysis (looking at walking/movement patterns). A plan of care is designed for each patient based on his or her individual factors and characteristics.

Nonoperative care starts with activity modification (e.g., avoiding pivoting on the involved leg when there is a labral tear, avoiding prolonged periods of inactivity or activity). This part of the program must be followed for at least six months (often longer).

Improving biomechanical function of the hip involves strengthening appropriate muscles, restoring normal neuromuscular control, and addressing any postural issues. Tight muscles around the hip can contribute to pinching between the femoral head and acetabulum in certain positions. A program of flexibility and stretching exercises won’t change the bony abnormalities present but can help lengthen the muscles and reduce contact and subsequent impingement.

Surgery is advised when there is persistent pain despite a good effort at conservative care and when there are obvious structural abnormalities of the hip. Anyone needing surgery will also benefit from physical therapy first to address muscle imbalances resulting in abnormal movement patterns that lead to femoral acetabular impingement.

It sounds like you may have a condition known as femoroacetabular impingement or (FAI) or simply hip impingement. Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed.

Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.

FAI as an “incidental” finding just means the radiologist was examining the X-rays looking for something else. It could have been a low back problem or even an abdominal condition. In any case, while looking for something else, the radiologist noticed the impingement condition. Treatment (if any) for the impingement may depend on the type and severity of the problem.

For more complete information on femoroacetabular impingement, see our Patient Guide to Femoroacetabular Impingement available at /content/femoroacetabular-impingement

Information on anatomy, causes, complete diagnosis, and treatment is provided. Both conservative (nonoperative) care and orthopedic surgery are discussed. The type of problem you describe falls into a bit of a gray zone just now. The best treatment approach remains unknown for someone who has impingement but without the symptoms of pain and limited motion.

Researchers from Belgium have recently been able to identify some features of this condition that suggest the need for more research. They were able to see that the control group (people with normal hips and no symptoms) had no risks that might predict the development of femoroacetabular impingement (FAI). Patients in the group without symptoms but obvious changes seen on X-rays were more likely to develop hip impingement compared with the control group but less likely when compared with the group who already had known FAI.

It’s clear that people without symptoms and no sign of hip problems don’t need any further treatment or intervention. At the same time, those with painful, limited hip motion and clearly documented femoroacetabular impingement (FAI) need careful management. Surgery is often done to reshape the femoral head and reduce the risk of osteoarthritis.

But what should be done to best aid those individuals in the middle group? These are the folks like yourself who have some anatomic changes in the hip suggestive of FAI but no symptoms yet. The authors suggest more research is needed before suggestions and guidelines can be issued.

Questions to be answered by future studies include: 1) Is there any cartilage damage occurring in people with signs of impingement but no symptoms? 2) Should sports participation be discouraged? 3) Or is it only necessary to limit the use of certain hip positions? 4) Will the group with signs of FAI but no symptoms eventually develop a full blown case of FAI?

Degenerative osteoarthritis of the hip along with degenerative lumbar spinal stenosis (DLSS) is referred to as the hip-spine syndrome. This is actually a fairly common problem in older adults. The term “degenerative” usually indicates it’s something that happens over time as we age.

The processes related to both conditions could easily be inter-related and affect one another. In other words, what makes one condition worse can also make the second problem worst. For example, lumbar stenosis (narrowing of the spinal canal) causes pain when standing upright.

The affected person tends to stoop forward to get pressure off the nerves. That results in shortening of the hip flexor muscles along the front of the body and can contribute to problems with posture, balance, and alignment. The end result may be worsening of the already developing hip arthritis.

Other conditions that can cause symptoms like hip-spine syndrome include bone fractures, neuropathy from diabetes, poor circulation, labral tears of the hip, or even cancer metastasized to the bones. X-rays, MRIs, CT scans, myelography, and electromyography are all ways to evaluate the symptoms patients are presenting with. Sometimes the physician must rely on diagnostic treatment such as steroid injection to help sort out what is hurting and why.

Once the source of pain has been identified, then treatment to manage those symptoms is started. For example, conservative (nonoperative) care can be provided first to obtain pain relief before considering the more invasive surgery.

The difficulty is in knowing when two or more different sources of pain are present. Treatment is needed to address all the individual problems before patient comfort and quality of life are restored.

Physical therapy is often recommended first. Restoring balance, alignment, and muscle flexibility is an important part of the treatment process. Studies show a poorer result if problems with posture, alignment, and flexibility are not taken care of before surgery (e.g., replacing the hip without addressing the problem of tight hip flexor muscles).

Treating one problem (hip) without treating the second area (spine) may lead to some relief of symptoms but not all. The patient is not happy nor satisfied with the results. A second surgery may be needed that could have been avoided otherwise.

Patients who have severe spinal stenosis should receive treatment for this problem first, then have a hip replacement (if needed) when fully recovered. Anyone who experiences pain beyond the expected time (after the first surgery) should be

Osteoarthritis (OA) of the hip is actually seen on X-rays taken for something else in one-quarter of all adults age 45 and older. That is a pretty significant portion of the adult population. Only about one in 10 of those adults will have any symptoms (e.g., pain, stiffness, difficulty walking, loss of motion).

Hip osteoarthritis tends to be divided into two categories: those caused by a previous injury or trauma of some kind and arthritis from degenerative processes (aging). There is one other problem that can contribute to hip symptoms, even in someone as young as you are and that is something referred to as hip-spine syndrome.

Hip-spine syndrome is made up of hip osteoarthritis and lumbar spinal stenosis (narrowing of the spinal canal). Both of these are degenerative diseases that come with aging. Adults 65 and older are affected most often, but younger, active or previously injured adults can have their fair share of problems, too.

When present together at the same time, it can be difficult to sort out where the pain is coming from and what is causing it. The physician will have to take a thorough patient history and conduct several (sometimes many) clinical tests to sort it all out. Treatment is based on the final differential diagnosis.

Surgery for femoroacetabular impingement (FAI) has been reported “successful” but results are only available for the early or short-term postoperative period. A recent study from Switzerland has some information that might be helpful in answering your question.

They followed a group of 185 patients treated with open hip surgery for this problem. The follow-up period was at least five years. The measures of “success” included hip range-of-motion, X-ray results, patient satisfaction, and activity level. The need for further surgery (and especially conversion to a total hip replacement) was also recorded.

Femoroacetabular impingement (FAI) causes abnormal contact between the femoral neck and the acetabular (hip socket) rim. Pinching of the labrum (cartilage around the edge of the socket causes damage to the cartilage and to the bone. The result can be a stiff, painful hip with loss of motion and function.

One treatment used for this condition is surgery to alter the anatomic abnormalities that contribute to the problem. For the patients in this study, the hip was surgically dislocated, the tissue was trimmed, and the bone was reshaped to eliminate the abnormal contact that causes this type of pinching.

The goals of surgery are to return the patients to full, normal activities without pain and to prevent (or at least slow down) hip osteoarthritis. Most of the patients with FAI are young, athletes. Patient satisfaction depends on good-to-excellent long-term results. This study provides mid-term results with the intention of following these patients into the long-term.

Outcomes of activity and function were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the SF-12 Physical and Mental Scores, and the University of California – Los Angeles (UCLA) activity scale. Before and after measurements showed improvement in hip motion and function. Eighty-three per cent (83%) of the group said their hips were normal (or near normal) in the follow-up period.

Long-term follow-up will be able to determine whether open surgery with surgical dislocation to correct FAI helps prevent degeneration of the joint. Slowing the formation of osteoarthritis would be an acceptable outcome as well. Finding ways to prevent the need for hip replacement in young, active individuals with FAI will be another focus of future studies.

Hip resurfacing arthroplasty is a type of hip replacement that replaces the arthritic surface of the joint but removes far less bone than the traditional total hip replacement. Because the hip resurfacing removes less bone, it may be preferable for younger patients. It is an attractive option for those who want to stay active.

Most of the time, patients who have this procedure are able to regain hip motion fairly quickly. Walking and stair climbing (up and down) are possible before going home from the hospital. After a short rehabilitation program under the supervision of a physical therapist, patients are usually on their own to continue advancing their activity level.

Sports activity without any restrictions are usually possible six to eight weeks after the procedure. By now (nine months later), you could be back to your preoperative level of activity. Some people are indeed running up to four hours a week after this procedure.

But beware: common sense and logic tells us that repeated movements and pounding the pavement with a hip replacement (or hip resurfacing) may not be such a good idea. It is believed that the metal-polyethylene bearings of the implant will break down with increased pressure and load that comes with activity.

Some experts are questioning if this assumption really true. What evidence do we have that running activity after hip resurfacing is a bad idea? The first study to look at this more closely has been published. Surgeons from the Department of Sports Medicine at the University of Lille in France studied 40 of their patients who were runners and who received a hip resurfacing procedure.

By measuring the amount of time spent running, level of impact, their weekly mileage, and return to sports competition, they offer us the first look into running activity after this procedure. Symptoms such as stiffness, pain, and weakness were also evaluated. Follow-up took place over the months to years after the procedure (a minimum of two years, up to 41 months).

The younger patients (50 years old and younger) were able to maintain their same level of running after surgery as before. Some runners were even able to run competitively once again. Older patients were more likely to report a decrease in their weekly mileage. Seven of the 40 patients also commented that they felt nervous or apprehensive during sports. A few patients had pain only during activity but not intense enough to need pain medications.

The authors of this study point out that newer implants are less likely to fracture or break with weight-bearing load. Hip resurfacing gives the hip higher wear resistance. More than ever before, these new implants make it possible for patients to resume low to medium level impact sports.

The results of this study suggest that high-impact activities are also possible. Of course, this was a short-to mid-term length study. Long-term results will tell the rest of the story. Patients will be better able to make decisions about the level of physical activity they want to pursue after hip resurfacing when they know what to expect over the entire life of the implant.

For now, caution is advised when counseling patients regarding activity level, intensity, and level of impact. Before engaging in any new activity of this type, see your surgeon and find out what are his or her recommendations. Perhaps discuss the findings of this study and work with your surgeon and the supervision of a physical therapist to design an exercise program that is best for you. You do want your new hip to last a very long time with the least amount of restriction on what you want to do.

You may have seen some folks who have the hip resurfacing procedure (not a complete total hip replacement). Hip resurfacing arthroplasty is a type of hip replacement that replaces the arthritic surface of the joint but removes far less bone than the traditional total hip replacement. Because the hip resurfacing removes less bone, it may be preferable for younger patients. It is an attractive option for those who want to stay active.

These newer implants are less likely to fracture or break with weight-bearing load. Hip resurfacing gives the hip higher wear resistance. More than ever before, these new implants make it possible for patients to resume low to medium level impact sports.

The results of a recent study from France suggest that high-impact activities are also possible. Surgeons from the Department of Sports Medicine at the University of Lille in France studied 40 of their patients who were runners and who received a hip resurfacing procedure.

They measured the amount of time spent running, level of impact, weekly mileage, and return to sports competition for this group. The younger patients (50 years old and younger) were able to maintain their same level of running after surgery as before. Some runners were even able to run competitively once again. Older patients were more likely to report a decrease in their weekly mileage.

This was a short-to mid-term length study. Long-term results will tell the rest of the story. Patients will be better able to make decisions about the level of physical activity they want to pursue after hip resurfacing when they know what to expect over the entire life of the implant. For now, caution is advised when counseling patients regarding activity level, intensity, and level of impact.

Of course there’s no guarantee after any surgery that everything will go exceedingly well. Surgeons are usually conservative in their recommendations after any implant surgery because studies often show a higher rate of implant failure with increased activity. Return to sports participation is a challenge and a very individual process.

That’s where this short-stem implant comes in. Short-stem implants are just as the name implies. The long part of the implant referred to as the “stem” fits down inside the femur (thigh bone). The surgeon reams out bone inside the femur in order to set the stem down inside and stabilize the implant. With a short-stem implant, less bone is removed making it possible to consider revision surgery later if it is needed.

The surgery is performed with less invasive technique. This allows for less pain, better post-operative motion, faster healing, and a speedier recovery. And improvements made in the implant design also makes the procedure easier. Short-stem implantation is usually offered to younger patients (less than 55-years-old) who are in better physical condition before surgery. They tend to be able to begin rehab sooner and recover with fewer problems or complications.

But older adults (over the age of 65) who have good bone stock may be suitable candidates for this procedure. Studies show results are excellent with a high degree of patient satisfaction based on return-to-sports at a level desired by the patients. With more and more adults in need of hip replacement who want (and expect) to stay active, the short-stem implant is likely to be recommended more often now.

More than ever before, adults are seeking and receiving hip replacements at a younger age and with the intent of remaining active in recreational and sports activities. The results of a recent study from the University of Munich in Germany may help answer your question.

In their report, this team of surgeons described their success using short-stem hip replacements for adults who were very active before surgery. The majority of patients in this group of patients returned to sports afterwards as well. They didn’t mention marathon running but their patients did participate in Nordic walking, hiking, jogging, and other high-impact activities (e.g., handball, soccer, basketball).

Short-stem implants are just as the name implies. The long part of the implant referred to as the “stem” fits down inside the femur (thigh bone). The surgeon reams out bone inside the femur in order to set the stem down inside and stabilize the implant. With a short-stem implant, less bone is removed making it possible to consider revision surgery later if it is needed.

Patients were selected carefully for this study from a group of adults less than 65 years of age and with no hip deformities. The ratio of men to women was 60 per cent men and 40 per cent women. They had to have good bone stock with no sign of osteoporosis (bone thinning or decreased bone density). They were all given the same short-stem implant with a ceramic femoral head using a modified minimally invasive surgical procedure.

The main measure used in this study to report outcomes was sports participation before and after hip replacement. Various measurements were used such as frequency of sports play (how often each week) and duration of participation (number of minutes each session). They also looked at how long it took for each patient to get back to regular and full participation in sports. And the patients rated their pain from zero (no pain) to 10 (worst pain) during the post-operative time period.

Most of the people in the study were able to return to sports participation. But they did tend to gravitate toward lower impact activities, which the surgeons thought was a better idea all around. High-impact activities such as running, jogging, or tennis are not advised by most surgeons.

Patients who engage in these types of activities must be warned of the increased risk of implant failure. However, this study did not support the idea that high-impact activities are necessarily detrimental to the short-stem implant. Patients who progressed slowly from low to high-impact activities and sports were very successful. Overall results were excellent with a high degree of patient satisfaction based on return-to-sports at a level desired by the patients.

Metallosis is defined as the body’s reaction to the presence of wear debris in the joint from metallic corrosion. This metallic corrosion occurs as a result of two metal surfaces rubbing against each other. In the case of hip resurfacing, there is a metal implant covering the head of the round femur (thigh bone) that sits inside the hip socket. The material is usually cobalt chromium as titanium and stainless steel are no longer used.

Symptoms of metallosis include hip pain, noises coming from the hip, joint swelling, and elevated metal levels in blood. Noise by itself is not very diagnostic. All joint implants make some noise — most of the noise is vibrational and at a frequency the human ear cannot detect. But with enough friction, the noise may become louder. Squeaking sounds are not as diagnostic of metallosis as clunking sounds that can also be felt as a clunking sensation.

Implant loosening is often a natural consequence of metallosis. When examined, the joint tissues are thickened (fibrotic) and have a grey discoloration. Soft tissue masses called pseudotumors (meaning they are like tumors but aren’t malignant or infected) often develop.

Anyone with metal-on-metal (cobalt) implants will have some increase in cobalt in their hair, blood, urine, and organs. It has even been detected in the placenta of pregnant women with this type of hip implant. The placenta is the organ that connects the developing fetus to the uterine wall. It allows nutrients in and other substances (such as metal debris) in and waste out.

To monitor for metallosis, anyone with metal-on-metal hip resurfacing implants is tested periodically to look for rising levels of cobalt in the blood. The diagnosis of metallosis is made based on patient symptoms, blood testing, and fluid taken from the joint. Early diagnosis is important in effective treatment.

Treatment is usually by surgical means. Sometimes it’s just a matter or repositioning the implant to reduce an uneven wear pattern. In other cases, it becomes necessary to replace the metal-on-metal implant to one that is metal-on-polyethylene (plastic). Advanced or progressive metallosis may only respond by replacing the entire hip joint with an entirely new joint.

Of course, your surgeon will advise you on what to do. The best course of action will be determined based on diagnostic tests including X-rays, blood work, removal and examination of fluid from the joint, and your symptoms. Hopefully this information today will give you a better idea of what to ask your surgeon in making the follow-up decisions about treatment.

Metallosis is defined as the body’s reaction to the presence of wear debris in the joint from metallic corrosion. This metallic corrosion occurs as a result of two metal surfaces rubbing against each other. In the case of hip resurfacing, there is a metal implant covering the head of the round femur (thigh bone) that sits inside the hip socket. The material is usually cobalt chromium as titanium and stainless steel are no longer used.

It remains a mystery why metallosis can develop in someone with a perfect surgical result but not in others who have less than satisfactory implant placement. And regardless of the implant placement, not all patients develop metallosis. So what is the key factor or factors involved?

Experts suggest there may be many different contributing factors making this a multifactorial problem. There could be specific patient characteristics, features of the implant itself, and possibly surgical technicalities at fault.

Some patients may develop hypersensitivity to the cobalt leading to the death and breakdown of bone (a process referred to as osteonecrosis). Since there is no way to test for cobalt hypersensitivity before putting the implant in place, surgeons have no way to predict or avoid the problem.

Others may have a reduced ability to absorb and excrete the cobalt through lymphatic flow, blood circulation, and kidney function. Anyone with impaired circulatory systems involving any of these systems may not be a good candidate for a metal-on-metal hip resurfacing implant.

Anyone with metal-on-metal (cobalt) implants will have some increase in cobalt in their hair, blood, urine, and organs. It has even been detected in the placenta of pregnant women with this type of hip implant. The placenta is the organ that connects the developing fetus to the uterine wall. It allows nutrients in and other substances (such as metal debris) in and waste out.

To monitor for metallosis, anyone with metal-on-metal hip resurfacing implants is tested periodically to look for rising levels of cobalt in the blood. The diagnosis of metallosis is made based on patient symptoms, blood testing, and fluid taken from the joint. Early diagnosis is important in effective treatment so it’s a good thing this has been discovered now so that you may benefit from correction of the problem sooner than later.

Probably not — at least according to a recent study done at the Hospital for Special Surgery in New York City. The orthopedic surgeons there compared 23 cases of acute and chronic proximal hamstring rupture. Proximal refers to the place where the muscle attaches at the top. For the hamstrings, the proximal muscle attachment is to the ischial tuberosities — the bump of bone you feel in your buttocks when sitting down.

There are three separate tendons that meld together at this site. For a complete rupture, all three tendons are torn. The rip or tear could be anywhere along the muscle but this study focuses on tears at the ischial tuberosities. If it’s the tendon that is torn and the attachment is pulled away from the bone, it’s called an avulsion.

Chronic injuries (those that occurred more than a month ago) that are asymptomatic (no symptoms, no pain) can be treated conservatively (without surgery). But for patients like yourself with significant symptoms who don’t seem to recover, surgery may be indicated.

The surgeon also relies on the bowstring sign and MRI findings to make the diagnosis and determine the severity of the problem. A positive bowstring sign (indicating full rupture of the hamstrings) occurs when the examiner presses on the back of the knee just above the joint.

There should be a cord of tendon that is easily felt on either side of the knee back there. But with a proximal rupture, the tension on the hamstring muscle is less so those tendons don’t tense up or form a palpable cord. A positive bowstring sign is one indicator that surgery is needed.

But to make sure that following these guidelines really provides the intended results, these surgeons followed their 23 cases for at least one full year (and up to nine years in some participants) to see what kind of results they got.

Tests were done to measure muscle strength and endurance. Level of return to activity was reported along with any symptoms (pain, weakness, numbness, stiffness). One-third of the group had acute injuries repaired surgically within four weeks after the trauma. The remaining two-thirds were considered chronic because the injury occurred more than a month before the surgery was done.

The researchers looked to see if age (patients ranged in age from 19 to 65 years old), sex (male versus female), and time-to-surgery (acute versus chronic) made a difference in the final results. The majority of patients (18 of the 23) had an excellent result with full return to their preinjury level of activity, including sports participation. Five patients never had that full (100 per cent) assurance that they could engage in all activities normally.

Those same 18 patients with excellent results had no symptoms of pain, stiffness, or numbness. Their strength was measured as equal to or better when compared with the other (uninjured) leg. Those patients who achieved full return of hamstring strength and endurance got back normal faster. Larger hamstring tears seemed to lag in endurance but not necessarily strength. Age was not a significant factor.

The authors of this study suggest that larger tears observed in patients with a positive bowstring sign may be the best candidates for surgery. In other words, the degree of displacement or retraction of the ruptured tendon is a reliable factor in pointing to the need for surgery. Chronic injuries can and do heal and patients recover fully.

To help you understand your brother-in-law’s condition, let’s define an acetabular fracture. The acetabulum is the socket side of the hip joint. It is made of cartilage over bone just like every other joint. The reason it breaks is because the person falls (and lands) in such a way that the head of the femur (thigh bone) is driven up into the hip socket (acetabulum) with enough force to break bone.

When that happens, there can be a single break or fracture line but more often the acetabular bone breaks into many tiny pieces. That type of break is called a comminuted fracture. Older men are affected more often than women by this type of damage. Their femoral bones are thicker, stronger, and transfer a greater destructive force into the acetabulum. Women tend to develop a break in the neck of the femur — long before there is any force up into the socket.

Until recently, this type of fracture was always treated conservatively (without surgery). And many times, this is still the most appropriate treatment. The presence of dementia, poor health, severe bone loss, and nonambulatory status before the fracture are reasons why surgery may not be possible.

So long as the fracture isn’t displaced (shifted), those patients who could walk before the injury are allowed to walk with the support of a walker. But only minimal weight through the hip is allowed until healing occurs.

A physical therapist helps move the hip through its motions but with some limitations to protect it. Bedrest (even for displaced fractures) with tracton was once prescribed. But this is no longer recommended due to the many complications that arise with immobility in this age group (e.g., blood clots, bed sores, pneumonia, deconditioning).

For those patients who will have to have surgery, there are several options. A procedure called open reduction and internal fixation (ORIF) pretty much describes what happens. The surgeon makes an incision to open up the hip, lines everything back up as much as possible, and uses plates, screws, pins, and/or wires to hold it all together until it heals.

The more closely the hip is restored to its normal shape and configuration, the better the results will be. The more bone fragments and the farther apart the bone fragments separate, the poorer the prognosis. If the patient is not a good candidate for ORIF (or if the ORIF procedure fails), then a total hip replacement may be the next step.