FAQ Category: Hip

Increasing age combined with certain risk factors such as osteoporosis (decreased bone density) makes it more and more likely that an older adult will end up in the hospital with an acetabular fracture.

What’s 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.

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. And in your wife’s case, a second surgery so soon after the first may not be tolerated.

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. However, this approach is not the best way to rehab a total knee replacement (which needs to keep moving), so that is another consideration.

With or without surgery, patients with acetabular fractures are encouraged to get up and move as early as possible. The goals of treatment for all acetabular fractures are four-fold: 1) restore the weight-bearing surface of the socket, 2) keep good bone stock (strength and density), 3) maintain joint stability, and 4) prevent deformities.

In some cases, it’s clear that the patient should have a hip replacement right from the start. For your wife between the hip and the knee, the decision becomes more complex and challenging because now there are twice as many things to consider. The decision is made on a case-by-case (individual) basis. The surgeon evaluates the best way to reduce blood loss, minimize operative times, and prevent complications.

There are different types of hip fractures based on location. Femoral neck fractures are just one type of several different hip fractures. The femur is the long thigh bone with a round bony “head” at the top. The femoral head fits inside the acetabulum or hip socket.

Fractures can occur anywhere in the long shaft of the femur, the neck (between the shaft and the femoral head), and the acetabulum. There is also intertrochanteric fractures. The intertrochanteric region of the hip is just below the femoral neck.

Two of the major problems that develop with femoral neck fractures are loss of blood to the femoral head and shortening of the femoral neck. Unless the patient cannot tolerate surgery for some reason, femoral fractures are best treated surgically. And the most common choices are as you described: internal fixation with metal plates, screws, pins, and/or wires or hip replacement.

Fixation is available to a limited number of patients. The fracture must be stable. If displaced (separated), it must be possible to bring the pieces together and precisely match them up again. If the surgeon sees reasons and predictive factors that point to the strong possibility of nonunion and failed fixation, then hip replacement is the treatment of choice.

Older adults who are active and wish to remain active may prefer this approach as well. It bypasses the possibility of a second surgery (from fixation to replacement). Current studies show fixation failure at 25 per cent right now.

Results of total hip replacement (measured by pain, function, and revision rates) have been good-to-excellent for the “active and fit” older adults. Benefits and risks of this surgery for this age group with femoral neck fractures are still being investigated and reported.

No doubt the surgeon will go over the pros and cons of each treatment option (if she hasn’t already). The final decision is usually left to the surgeon once the hip has been opened up and it’s possible to take a look at the full extent of the damage. Having the patient’s preferences known is a key factor but not the only one.

In a recent article, Dr. Robert Probe, an orthopedic surgeon in Texas offered a review of and some insight into surgical treatment of femoral neck fractures. There are different types of hip fractures based on location.

The femur is the long thigh bone with a round bony “head” at the top. The femoral head fits inside the acetabulum or hip socket. Fractures can occur anywhere in the long shaft of the femur, the neck (between the shaft and the femoral head), and the acetabulum. There is also intertrochanteric fractures. The intertrochanteric region of the hip is just below the femoral neck.

Two of the major problems that develop with femoral neck fractures are loss of blood to the femoral head and shortening of the femoral neck. Unless the patient cannot tolerate surgery for some reason, femoral fractures are best treated surgically.

But that’s where the decision becomes much more complicated. Is the fracture stable enough to pin it back together until it heals? Will it heal? Are there patient factors that might result in a nonunion? How likely is a nonunion? Should the femoral head be replaced? If the decision is made to replace the femoral head, then the surgeon must choose between a cemented or uncemented stem (the piece that fits down into the shaft of the femur).

That’s not the end of the possibilities. The femoral head is available in several different models with different options (e.g., unipolar, bipolar) for achieving movement of the femoral head. It may be necessary to perform a complete hip joint replacement (femoral head and stem along with replacing the acetabulum). Should the surgeon try and save the hip knowing the patient may end up in surgery again in order to replace a failed fixation?

Fixation refers to the use of screws, nails, pins, and metal plates to hold the broken pieces of bone together until healing can take place. This option is only available to a limited number of patients. The fracture must be stable. If displaced (separated), it must be possible to bring the pieces together and precisely match them up again.

Dr. Strobe describes the technique he uses when placing screws in the hip for a stable femoral neck fracture. He also discusses the use of a fixed-angle hip compression screw fixation. The compression screw keeps the femur from further bone displacement that would change the angle of the femur as it places the femoral head in the acetabulum (hip socket).

If the surgeon sees reasons and predictive factors that point to the strong possibility of nonunion and failed fixation, then hip replacement is the treatment of choice. Older adults who are active and wish to remain active may prefer this approach as well. It bypasses the possibility of a second surgery (from fixation to replacement). Current studies show fixation failure at 25 per cent right now.

Results of total hip replacement (measured by pain, function, and revision rates) have been good-to-excellent for the “active and fit” older adults. Benefits and risks of this surgery for this age group with femoral neck fractures are still being investigated and reported.

Dr. Probe summarizes the article by saying that femoral neck fractures in older adults can be complex and challenging to treat. The surgeon makes every effort to save the natural anatomy. Patient health, strength of the bone, mobility, level of community activity, and predicted life span are all taken into consideration when making a decision about fracture fixation versus hip replacement.

The question of early mobility following surgery for a hip fracture is one that has been debated and studied quite a bit. Clearly, the complications of being bedfast are dangerous (e.g., blood clots, bedsores, pneumonia). So what is the best timeline for getting patients up and going after intertrochanteric hip fractures?

According to a recent review by an orthopedic surgeon published in Current Orthopaedic Practice, avoiding weight-bearing is no longer advised. The value of early mobility is clear now. So unlike in the past (when the patient might have been kept in bed or at least off that leg for up to six months), today’s patient can get up soon after surgery. Pain is the guide so patients are allowed to put weight on the leg “as tolerated”.

If the fracture was stabilized with metal plates, screws, or pins, the newer, improved fixation systems of this type allow for safe weight-bearing. Usually, a walker is supplied so the patient is supported and protected.

Sicker patients may find it more difficult to get up and moving quite so quickly. Sometimes just lifting the leg can seem like a tremendous effort. The physical therapist will know how much your mother can do in these early days. A program of movement, mobility, and strengthening will be started and slowly progressed according to your mother’s abilities.

The goal is to restore normal function without compromising the healing surgical/fracture site. Preventing deformities and complications are important goals as well. Feel free to express your concerns and ask the hospital staff (surgeon, nurse, physical therapist) to help you understand the treatment plan.

Well, of course, today we have the benefit of X-rays to pinpoint the problem, take stock of the severity, and plan treatment accordingly. Not to mention the ability to fix or repair the fracture surgically, which wasn’t part of the treatment back in those days.

In fact, according to a recent historical review of the treatment for one particular type of hip fracture (intertrochanteric), hip fractures were treated with “benign neglect” well into the 1900s. In those days, that meant being an invalid or getting around in anyway possible (but not often described).

For those who survived and healed, there was usually a lasting deformity and limp. In many cases, the cause of the hip fracture (e.g., being run over by a carriage) resulted in many other more serious injuries, often leading to death.

Today, we have a wide range of treatment methods including internal fixation (metal plates, screws, and pins to hold the bones together while healing) and total hip replacement. And we have the benefit of 100 years of research into the problem.

We understand the importance of getting the person up and moving as quickly as possible to avoid lethal blood clots or pneumonia. With the aid of supportive devices such as walkers, patients can be out of bed and moving around without compromising the healing fracture site. In fact, earlier problems with screws cutting through the bone have been reduced with the improvement in fixation systems.

It is expected that continued research into better ways of treating various types of hip fractures will continue to yield better and better results. Hopefully, your great great grandchildren will have a very different tale to tell about their ancestor’s medical problems.

Although this type of fracture is relatively uncommon, there have been reports published so there is some information available. With more and more older adults like yourself remaining active, we expect to see this problem on the rise.

By definition, what you have is an interprosthetic fracture — a fracture of the femur below the hip joint replacement and above the knee joint replacement.

Treatment is guided by a classification system that takes into account 1) whether or not the implants are broken or damaged, 2) the quality (and quantity) of bone around the implant, 3) location of the fracture, and 4) severity of the fracture.

For example, some minor fractures of the bone surface can be left alone. If treatment is needed at all, a small bone graft may be done. Nonoperative care is often reserved for patients who weren’t walking before the injury or who wouldn’t tolerate surgery due to poor health. This certainly doesn’t describe you!

The surgeon will have to evaluate your X-rays and any other imaging studies ordered. The fracture site will have to be examined for severity and the presence of any displacement (separation of the bone at the fracture site). Likewise, both implants will also be assessed to determine any problems, damage, and stability.

All efforts are made to save the bone and the implants. The goal will be to preserve alignment and function. Fixation with metal plates, screws, pins, and/or wires may be needed. Special locking plates and screws are now available to help span the fracture site, especially for patients with brittle bones.

Your recovery will depend on any additional complications such as failure of the fracture to heal (called a nonunion), malunion, or infection. Reports suggest an average of three months for the fracture to heal and another 12 to 16 months to recover fully. “Recover fully” means to return to your previous activity level before the break.

Once the surgeon meets with you, you will have a better idea what to expect. Having this information ahead of time might help you formulate whatever questions you might have for the surgeon.

The surgeon will be looking at X-rays and other imaging studies to determine the severity of the implant damage. The surrounding bone will be examined for any fractures as well. The X-rays will show the surgeon if your implant is still in good position (or not).

The films also reveal any subisdence that might be present. Subsidence is the medical term to describe when an implant like a joint replacement sinks down into the bone. Sometimes it is even possible to see if there was any pre-injury loosening that you didn’t know about.

There are several different surgical treatment options for a break in the tip of a femoral stem. The surgeon will decide on the best approach keeping in mind the need to maintain limb length, limb alignment, and promote fracture union. Some of the tools available for this type of injury include bone grafts, a metal plate with a special cable system, locking screws, or some combination of these choices.

Clinical reports from other patients with this same type of problem suggest a healing time of 17 weeks on average. “On average” means some patients recovered faster while others took longer. General health of the patient can make a difference in healing time. Medical problems such as diabetes, heart disease, or poor circulation can create delays in healing. Poor nutrition is another risk factor for slow or delayed healing or even nonunion (failure to heal).

Hip dislocations can be mild to severe requiring anything from closed reduction. to open surgery to put it back in place. Many times there is damage to the soft tissues of the hip.

The labrum is one area that can be torn without knowing it right off. The labrum is the fibrous rim of cartilage around the hip socket. As the hip dislocates (anteriorly/forward or posteriorly/backwards there can be enough force to pull the labrum away from the bone.

There can also be damage to the cartilage around the head of the femur (round end of the upper thigh bone) and/or the acetabular (socket) side of the joint. When pieces of bone or cartilage are left floating around inside the joint, symptoms such as you described may be the underlying cause.

Even when X-rays and CT scans are negative, a look inside the joint is still recommended when pain and loss of motion persist after hip reduction. Floating fragments of bone or cartilage can be present that don’t show up on imaging studies.

Arthroscopy may also be needed to see other damage such as tears of the ligamentum teres (the ligament holding the head of the femur in the middle of the socket). If this ligament isn’t repaired or restored, the femoral head won’t stay in the center of the socket.

You may have none of these problems but the only way to find out is to see an orthopedic surgeon for an evaluation. Sooner is better than later as uneven wear and deformity of the hip joint from these complications can lead to degeneration and osteoarthritic changes. Studies show that hip osteoarthritis is more likely to develop if and when loose fragments are left in the joint after the dislocation has been reduced.

Femoroacetabular impingement (FAI) of the hip joint can be a very painful condition — even while sitting in a saddle. 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.

Treatment may include surgery to restore normal hip motion but conservative (nonoperative) care with antiinflammatories and physical therapy can be tried first. Some patients may also benefit from intra-articular injection with a numbing agent combined with an antiinflammatory (steroid) medication.

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 getting on and off the horse, 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. 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.

Femoroacetabular impingement (FAI) is a pinching of the soft tissues close to, next to, or around the hip. 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.

One of the main areas affected is the labrum, the rim of fibrous cartilage around the hip socket that your surgeon may repair or trim away. The labrum is designed to give the hip a bit more depth and stability. But even a small amount of asymmetry of the hip socket and/or femoral head in the hip socket can cause impingement of the labrum with certain hip motions.

For example, a slightly oval shape instead of a perfectly round head of the femur or a slightly off-angle of the socket can result in painful pinching of the labrum or other soft tissues of the hip.

Sometimes it’s a case of a hip socket that’s deeper than normal. 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 affected individual experiences hip and/or groin pain along with decreased hip motion. The condition may look like a chronic muscle strain or groin injury but an X-ray, CT scan, or arthroscopic examination confirms femoroacetabular impingement as the true cause of the problem.

Surgery may be needed to restore normal hip motion. Whenever possible, surgery is done arthroscopically to repair the damage. The surgeon trims the acetabular rim and then reattaches the torn labrum. This procedure is called labral refixation.

Each layer of tissue is sewn back together and reattached as closely as possible to its original position along the acetabular rim. When repair is not possible, then debridement (shaving or removing) the torn tissue or pieces of tissue may be necessary.

Postoperative care and recovery may depend on your age, your surgeon’s preferences, and the exact type of surgery that is done. Most patients go home the same days as the surgery.

A standard rehab program often includes six weeks in a splint to keep the hip quiet. For the first few weeks, you’ll probably be allowed to put a small amount of weight on the foot — so long as you use crutches and don’t put your full weight down.

A physical therapist will teach you and a family member how to move the leg/hip passively (without using active muscle contraction). Gradually, you will be allowed to begin active movement.

The therapist will guide you through a series of phases from passive motion to active motion and finally to strengthening and conditioning. You can expect to be in some type of rehab program for about three months. Most of this is done at home on your own with occasional visits to the physical therapy clinic to make sure you are doing the exercises correctly and to progress the program along as you improve.

Athletes are usually advised to expect a four to six month rehab period after surgery for femoroacetabular impingement. The timing depends somewhat on what the surgeon has to do, how extensive the surgery is, and the surgeon’s preferences.

Reshaping the femoral head and/or femoral neck is a technical challenge for the surgeon. There is a risk that the bone will fracture during the procedure. If all goes well and there are no complications with fractures or infections and blood clots, (the usual concerns after any surgery), the patient will be up and walking with crutches right away.

Your son probably won’t be allowed to put full weight on the leg while the bone is healing. Weight-bearing restrictions could last a month to six weeks. Full bone healing will take a full three months. During that time, the athlete must avoid high-impact or twisting activities.

But the athlete doesn’t have to be inactive. He will probably be working with a physical therapist to maintain good joint motion. Regaining normal muscle control, strength, and function begins about 12 weeks after surgery.

The therapist will continue to advance the exercise program as the athlete progresses. Exercises and activities geared toward his specific sport’s requirements are added toward the end of rehab until he is back to full participation.

Again, the full scope of rehab and its timing depend somewhat on the surgeon, type of surgery performed, and patient’s response to both the procedure and the rehab program. This should give you a general idea of what to expect.

With impingement, the soft tissues around the joint get caught between the femur and the hip socket. There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.

Femoroacetabular impingement occurs when abnormal hip anatomy is aggravated by repetitive movements of the hip. There could be a slightly off center placement of the hip in the socket or a femoral head that isn’t perfectly round that is contributing to the problem.

Or the hip socket may be too deep for the size of the femoral head or the rim of the hip socket is too prominent. Sometimes the angle of the femoral neck is bent or twisted just a tad from normal. There could be a separate piece of bone called the os acetabulum along the front rim of the hip socket. Any of these morphologic changes can lead to impingement.

The labrum, a fibrous rim of cartilage around the hip socket is the most likely area to get pinched. Add repetitive motion and you get repetitive pinching or compression until the labrum starts to fray and tear.

No one knows for sure just yet why some athletes with this problem are affected while others seem not to notice a problem. With your sons, it could be there is just enough difference in the shape of one boy’s hip that he is spared the painful loss of motion and function. There could be differences in the degree of pinching that is going on or the tension of the soft tissues, muscles, and tendons around the joint.

Studies show that some high level athletes with abnormal hip joints never develop problems. Who does develop femoroacetabular impingement and how to predict if/when it should be treated are areas where further study is needed.

Pain along the side of the hip is still a common spot for bursitis (also known as greater trochanter pain syndrome. A large tendon passes over the bony bump on the side of the hip called the greater trochanter.

Inflammation in the bursa (a protective gel sac) between the tendon and the greater trochanter is called trochanteric bursitis or lateral hip bursitis. You can see there are many names for this problem.

Hip bursitis is common in older individuals. Women seem affected more often than men. Pain associated with this problem is often made worse by lying directly on the hip, walking, or going up stairs or steep inclines. It may not be possible to walk without a limp because of the pain.

The muscles involved most often include the gluteus minimus and the gluteus medius, the so-called rotator cuff muscles of the hip. There are three types of hip rotator cuff tears that can cause lateral hip bursitis: 1) degenerative or traumatic tears seen most often in older adults, 2) nonpainful tears associated hip fractures or hip osteoarthritis, and 3) tendon avulsion (tendon is not just torn but pulled completely away from the bone).

Other causes of lateral hip pain can be hip osteoarthritis, an undetected hip fracture, nerve injury, or problem in the lumbar spine (low back) such as stenosis or spondylosis. The surgeon uses certain clinical tests (e.g., hip range-of-motion, straight leg raise) and imaging studies (e.g., X-rays, MRIs) to sort out what’s really going on in the hip.

MRIs are especially helpful in seeing the condition of the tendons and muscles and identifying partial tears from full-thickness tears and avulsion injuries of the gluteal muscles. Individuals who have had a previous total hip replacement may develop lateral hip pain from tendon avulsion, which will show up on an MRI.

Treatment early on can prevent this painful condition from becoming a chronic problem that might require surgery. The effectiveness of conservative (nonoperative) care depends on a correct diagnosis and assessment of the severity of the underlying tendon injury.

Short-term use of nonsteroidal anti-inflammatory medications along with physical therapy may be all the person needs. If the MRI reveals a full-thickness tear or avulsion of the tendon, then surgery to repair the damage may be needed.

Pain along the side of the hip is still a common spot for bursitis (also known as greater trochanter pain syndrome. A large tendon passes over the bony bump on the side of the hip called the greater trochanter.

Inflammation in the bursa (a protective gel sac) between the tendon and the greater trochanter is called trochanteric bursitis or lateral hip bursitis. You can see there are many names for this problem.

Hip bursitis is common in older individuals. Women seem affected more often than men. It may also occur in younger patients who are extremely active in exercises such as walking, running, or biking.

Sometimes a bursa can become inflamed (swollen and irritated) because of too much friction or because of an injury to the bursa. An inflamed bursa can cause pain because movement makes the structures around the bursa rub against it.

Friction can build in the bursa during walking if the long tendon on the side of the thigh is tight. It is unclear what causes this tightening of the tendon. The gluteus maximus attaches to this long tendon. As you walk, the gluteus maximus pulls this tendon over the greater trochanter with each step.

When the tendon is tight, it rubs against the bursa. The rubbing causes friction to build in the bursa, leading to irritation and inflammation. Friction can also start if the outer hip muscle (gluteus medius) is weak, if one leg is longer than the other, or if you walk or run on banked (slanted) surfaces.

Most cases of trochanteric bursitis appear gradually with no obvious underlying injury or cause. Trochanteric bursitis can occur after artificial replacement of the hip joint or other types of hip surgery. The cause may be a combination of changes in the way the hip works, the way it is aligned, or the way scar tissue has formed from the healing incision.

So, in answer to your question — yes! Hip bursitis is still a real problem with a real diagnosis. Treatment early on can prevent this painful condition from becoming a chronic problem that might require surgery.

Short-term use of nonsteroidal anti-inflammatory medications along with physical therapy may be all the person needs. The physical therapist will correct any postural components, muscle imbalances, and help restore normal function of the affected hip muscles.

Hip dislocation in young adults is usually the result of a sports injury or high-speed traumatic event (e.g., car accident). Studies show that getting to the emergency department as soon as possible with an injury like this is very important.

Waiting more than six hours to get treatment is linked with serious complications (even death of the femoral head called osteonecrosis). If the blood vessel to the head of the femur is damaged, loss of blood supply can result in death (necrosis) of the bone (osteo) — that’s why it’s called osteonecrosis.

Not everyone develops osteonecrosis but it is a fairly significant complication in up to one-third of all cases. It depends on how severe the injury was and how soon the dislocation was reduced (put back in place). Other damage is often reported such as tears of the ligamentum teres. that’s the ligament holding the head of the femur in the middle of the socket. If this ligament isn’t repaired or restored, the femoral head won’t stay in the center of the socket.

The goal of treatment is to get the hip back into the socket and make sure it a) stays there and b) keeps its normal shape (round head of the femur in the center of the socket). Any deviation from the normal anatomical position can increase the risk of unever wear and tear leading to osteoarthritis.

Close follow-up by the treating surgeon is really the best way to avoid further problems. Your nephew should be told to get back to the surgeon as quickly as possible if painful symptoms and/or loss of hip joint motion occurs. Not everyone develops additional problems — let’s hope your nephew is one with a simple case that doesn’t require further treatment.

Your surgeon is giving you the typical average lifespan of a joint replacement. For some people, it’s less while for others it can be longer. There are more than a few cases where people report excellent results 20 to 25 years later!

But the truth is that even with today’s modern improvements in hip replacements, active adults and overweight patients have a greater chance of creating wear and tear on the implant resulting in its eventual failure.

Sometimes, it’s just a matter of replacing the liner — that can be a fairly simple revision surgery. There is a polyethylene (plastic) liner that goes inside the hip socket. The head of the femur fits into the liner. The liner or insert helps absorb impact on the implant so it must be as durable as possible.

Extensive wear of the liner or insert can result in failure of the entire implant, the release of debris into the joint, and osteolysis (bone loss). Too much wear of the liner or insert can result in the need for a revision surgery to remove the worn liner or insert and to replace it with a new liner or insert.

Liner wear is one of the most common problems. Other complications include heterotopic ossification (HO) (formation of bone in the muscles and soft tissues around the joint), hip dislocations, bone fractures around the implant, infections, and deep vein thrombosis (DVTs or blood clots). Any of these complications can put you at risk for early implant failure.

How can you squeeze out a few more years? Stay active but don’t overdo. Running marathons (or other similar repetitive motions) will definitely increase the risk of wear and tear on the implant. It’s not indestructible.

If you are overweight, take measures to lose a few pounds. Your surgeon may be able to offer other suggestions based on the type of implant you have and the surgical technique used to insert it. Don’t hesitate to ask him or her this same question.

The Spotorno System named for a town in Italy where it was developed has been on the European market since 1984. It is now available in the United States as well. It is a cementless implant.

Like all other hip implant systems, the CLS has two basic components: the acetabular cup (socket) and the femoral head and stem. The cup and stem are made of titanium. The femoral head is ceramic. There is a polyethylene (plastic) liner that goes inside the socket. The head of the femur fits into the liner. The liner or insert helps absorb impact on the implant so it must be as durable as possible.

This system has become a popular implant because of the good results achieved. According to a recent study done in The Netherlands, long-term results (10 to 15 years) are now available.

Most of the patients in this study had osteoarthritis of the hip but there were a few with rheumatoid arthritis (RA) or osteonecrosis (bone death from loss of blood supply to the bone). Everyone was 66 years old or younger.

Long-term results were measured by looking at hip motion, pain, walking ability, and X-rays to look at wear and tear on the implant and any underlying bone loss. Surgeons involved in the study also used type and number of complications, number of revisions, and overall survival of the implant as outcome measures.

In the final evaluation, there were 14 of the 102 patients who had a second surgery to revise the implant. Most had a loose cup without infection. Like other types of hip implant systems, the CementLess Spotorno System (CLS) had some problems with wearing of the polyethylene liner.

Analysis of the data showed that risk factors for implant failure (especially liner wear) in this group of patients included younger age at the time of surgery (more active), larger femoral head component part, smaller socket size, larger body-mass index (BMI), and male sex.

All implants did quite well during the first 10-years (first decade). Problems didn’t start to develop until the second decade (years 11 through 20). The number of CLS hip implants that were still intact and working fine after the first ten years was 92 per cent. That’s called the survival rate. Survival rate after 15 years was 78.4 per cent (good but not as good as the first decade). Survival rates past 15 years are not available yet.

How does the CementLess Spotorno System (CLS) stack up against other similar hip implant systems? The authors say, “very favorably.” Survival rates, complication rates, and improvements in pain, motion, and function were all in the same ranges.

The biggest problem remains loosening of the cementless cup during the second decade of use. Knowing what some of the risk factors might be may help shape future patient selection and management approaches. More long-term studies following patients a full 20 years are also needed.

Antiinflammatory medications are used after a total hip replacement to prevent a complication called heterotopic ossification (HO). HO is the formation of bone in the soft tissues around the joint. This postoperative problem causes pain and stiffness — the very symptoms a joint replacement is supposed to eliminate!

No one knows for sure why some patients (quite a few actually) end up with heterotopic ossification after a hip replacement. Some experts think that trauma to the muscles or bone sets up a response that results in new bone formation in these tissues.

Nonsteroidal antiinflammatory drugs (NSAIDs) are used as a prophylactic (preventive) treatment. But as you found out, antiinflammatory medications don’t come without their own unique set of potential problems.

Standard nonsteroidal antiinflammatory drugs (NSAIDs) are known to cause gastrointestinal side effects (e.g., nausea, vomiting, bleeding). A newer line of NSAIDs called COX-2 inhibitors have fewer side effects and may be just as effective in preventing heterotopic ossification. Bleeding is not as likely with COX-2 inhibitors as it is with standard NSAIDs. However, the risk of high blood pressure is greater with COX-2s.

Some people are at increased risk for heterotopic ossification. You may be one of these people. This is a good question to pose to your surgeon before the procedure. This would be a good opportunity to assess your risk of heterotopic ossification. With your surgeon, you can also weigh the benefits against the risks of nonsteroidal antiinflammatories versus COX-2 inhibitors.

A common complication after total hip replacement is the formation of bone in the soft tissues around the joint called heterotopic ossification (HO). This postoperative problem causes joint pain, stiffness, and loss of hip motion — the very symptoms a joint replacement is supposed to eliminate!

No one knows for sure why some patients (quite a few actually) end up with heterotopic ossification after a hip replacement. Some experts think that trauma to the muscles or bone sets up a response that results in new bone formation in these tissues.

Studies show that one fourth (25 per cent) up to almost half of all patients develop heterotopic ossification (HO). That raises the question of if so many people develop HO, why doesn’t everyone?

It seems that patients with certain risk factors are the most likely to develop HO. Those risk factors include male sex and age older than 60 years. A past history of another bone condition called ankylosing spondylitis or a past history of HO in either hip also increases the risk.

Until we know for sure what triggers this response and how to avoid it, there are two preventive techniques that seem to help. One is to radiate the tissues but that might increase the risk of cancer. So the use of nonsteroidal antiinflammatory drugs (NSAIDs) is the front runner prophylactic (preventive) treatment.

There are potential gastrointestinal (GI) problems with taking antiinflammatories. The newer COX-2 inhibitors (antiinflammatories without the GI side effects) seem to be just as effective in preventing heterotopic ossification. They can raise the blood pressure in some patients. The short-term use of these medications following hip replacement may prevent that from happening.

Unspecified hip pain with no known cause may have a clear diagnosis once you are examined. But without a more in-depth history, some clinical tests to see what’s involved, and maybe some imaging studies, it’s difficult to say what’s going on.

With involvement in two different sports activities, there could be microtrauma from repetitive actions. The hip joint itself could be affected but more likely the soft tissues around the hip (the hip capsule, other ligaments, labrum) are generating some discomfort.

The best thing to do is seek professional medical help. Your primary care physician is a good place to start. A few simple tests and perhaps an X-ray may be all that’s needed. Or your physician may refer you to an orthopedic or sports medicine physician.

The specialist will conduct more specific tests and possibly order some additional imaging studies to inspect the hip anatomy. The presence of any deformities, tears, or other structural changes that might account for your symptoms will be noted. CT scans show any loose fragments of bone or cartilage inside the joint. Fractures of the acetabulum (hip socket) also show up on CT scans.

Early examination and diagnosis is always advised. Waiting too long could make a simple problem more complex over time.