Treatment Options for Hip Pain

1
Treatment Options for Hip Pain
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Anatomy of the Hip

• Ball and socket joint.
• Femoral head or ball is at the end of thighbone
  or femur.
• Socket or acetabulum holds the ball.

Source www.jointreplacement.com, 2003
3
Hip Joint

• Healthy hip joint

• Arthritic hip joint

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Causes of Hip Pain

• Osteoarthritis
• (Wear and tear)
• Avascular necrosis
• Abnormalities from fractures and congenital
  abnormalities

Source www.allaboutarthritis.com, 2003
5
Symptoms of Hip Arthritis

• Pain
• Dull, aching pain affecting the groin, outer
  thigh or buttocks.
• At rest or sleeping.
• Stiffness and decreased movement
• Bone spurs

Source www.aaos.org , 2003
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Preparing for Examination

• Have the following information ready for your
  exam
• Chief complaint (Where it is hurting the most?)
• Chronology of illness
• What effect does the pain have on your life?
• Family history

Source www.arthritis.org, 2003
7
Diagnosing Hip Arthritis

• Physical examination and history
• Magnetic Resonance Imaging (MRI)
• X-Rays
• Blood tests
• Blood Count
• Rheumatoid Factor (for RA)
• C-Reactive Protein

Source www.allaboutarthritis.com, 2003
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How Can My Life Change with Treatment?

• A return to mobility
• Regaining a sense of your former lifestyle
• A change in pain symptoms

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Non-surgical Treatment Options for Hip Pain
Over-the-Counter Medications

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDS)
• Usually first drug used to treat arthritis
• Can reduce pain, swelling and redness
• Relief can take several months
• Examples
• ibuprofen (Advil, Motrin)
• naproxen (Aleve)
• Aspirin
• Reduce joint pain and inflammation
• Form of NSAIDs

Source www.AllAboutArthritis.com , 2003
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Non-surgical Treatment Options for Hip Pain
Over-the-Counter Medications

• Acetaminophen
• Reduces pain
• Lowers fever
• Does not reduce inflammation of arthritis
• Examples
• Tylenol
• Datril Extra Strength
• Tempra

Source www.AllAboutArthritis.com , 2003
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Non-surgical Treatment Options for Hip Pain
Prescription Medications

• NSAIDS
• Most popular type for osteoarthritis treatment
• Includes ibuprofen (Motrin), naproxen sodium
  (Anaprox), oxaprozin (Daypro), sulindac
  (Clinoril) , etc.
• Analgesics
• Provide pain relief, but do not reduce
  inflammation
• Includes Acetaminophen with codeine (Tylenol
  with Codeine), Oxycodone (OxyContin,
  Roxicodone), Hydrocodone with acetaminophen
  (Vicodin, Dolacet), etc.

Source www.AllAboutArthritis.com , 2003
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Non-surgical Treatment Options for Hip Pain
Prescription Medications

• Biological Response Modifiers
• Treat rheumatoid arthritis may postpone injury
  to the joints
• Includes Infliximab (Remicade), Etanercept
  (Enbrel )
• Glucocorticoids or Corticosteroids
• Treat rheumatoid arthritis fight inflammation
• Includes cortisone, hydrocortisone (Cortef,
  Hydrocortone), Prednisolone (Prelone)
• DMARDS
• Treat rheumatoid arthritis slow joint
  destruction
• Includes methotrexate, injectable gold,
  penicillamine (Depen), Azathioprine (Imuran),
  etc.

Source www.AllAboutArthritis.com , 2003
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Non-surgical Treatment for Hip Arthritis

• Cortisone Injections.
• Powerful anti-inflammatory medication.
• Temporary pain relief lasting several weeks to a
  month.
• Assistive devices.
• Walking (cane, walker).
• Getting around (seat lifts).
• Bathing and hygiene.
• Dressing.
• Rest and activity modification.

Source www.AllAboutArthritis.com , 2003
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Non-surgical Treatment for Hip Arthritis

• Physical therapy
• Help increase range of motion and maintain muscle
  tone.
• Swimming is good for hip arthritis patients.
• Weight control
• Foods with lower saturated fats help avoid
  swelling in tissue.
• Eat a variety of foods from food groups.
• Avoid fad diets.

Source www.allaboutarthritis.com , 2003
15
Surgical Options for Hip Pain

• Synovectomy
• Total hip replacement
• Minimally invasive hip replacement

Source www.aaos.org, 2003
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Synovectomy

• Early stages of rheumatoid arthritis.
• Removes inflamed tissue lining.
• Potentially saves joint from further damage.

Source www.AllAboutArthritis.com , 2003
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Synovectomy

• Small incision is made.
• Arthroscope is used to inspect the joint.
• Diseased synovium is removed.
• Physical therapy usually required.

Source www.AllAboutArthritis.com , 2003
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Synovectomy

• Benefits
• Alleviates rheumatoid arthritis pain in the
  joint.
• Joint may be saved from further damage.
• Synovium could grow back over time.
• Disadvantages
• Not a permanent solution.

Source www.AllAboutArthritis.com , 2003
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When is Hip Replacement Surgery Right for You?

• Experience significant pain and loss of function
  despite non-surgical treatments.
• Typical patients have severe
• Rheumatoid Arthritis
• Osteoarthritis
• Hip fracture

Source www.allaboutarthritis.com, 2003
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Hip Replacement Components

• Acetabular component, made of metal shell with a
  medical grade plastic or metal inner socket liner.

Cup
Shell
Source www.jointreplacement.com, 2003
21
Hip Replacement Components

• The femoral component (stem portion), is made of
  metal.
• Femoral head is made either of metal or ceramic.

Head
Neck
Stem
Source www.jointreplacement.com, 2003
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Hip Replacement Cemented or Uncemented

• Cemented implant is held in place by a type of
  epoxy cement that attaches the metal to the bone.
• Uncemented implant has a fine surface (mesh of
  holes) allowing tissue to grow into.

Source www.jointreplacement.com, 2003
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Choice Among Cups and Liners

• Cross-linked polyethylene-
• High medical grade plastic
• Strong Minimal debris
• Metal
• Usually titanium
• Strong
• Matches your natural hip joint movement
• Ceramic
• Least amount of debris
• Less wear
• Most fragile

Source www.jointreplacement.com, 2003
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Benefits to Patient from Surgery

• Return to mobility
• Restores lifestyle
• Freedom

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Total Hip Replacement

• The goal is to reduce hip pain and improve the
  motion in your hip.
• More than 220,000 people in the United States
  annually undergo hip replacement surgery.

Source www.jointreplacement.com, 2003
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Surgical Procedure

• Incision made on the side of the thigh.
• Socket is re-shaped to fit new cup implant that
  replaces the diseased socket.
• New cup is placed in the socket.

Source www.Allaboutarthritis.com, 2003
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Surgical Procedure

• Femur is prepared for the stem.
• Hip stem is implanted and the ball is put in
  place on top of stem.
• Incision is closed.

Source www.Allaboutarthritis.com, 2003
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Minimally Invasive Hip (MIH) Surgery

• New surgical technique.
• Smaller incisions with traditional hip implant
  components.
• Different techniques, including mini-incision and
  two-incision.

Individual results may vary. There are potential
risks and recovery can take time. The
performance of any new joint will depend on your
weight, activity level, age and other factors.
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Different Techniques Used for MIH

• Two-incision
• Two incisions of approximately 2 inches long on
  both the front and rear of the thigh.
• Mini-incision
• One incision generally 3 to 4 inches on the
  thigh.
• Two basic types of mini-incision
• anterior
• posterior

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Preparing for Joint Replacement Surgery

• Ease anxiety by mentally preparing with
• Breathing exercises
• Meditation
• Talking with friends and family
• Learn more about hip replacement surgery
• Brochures
• Handouts
• Websites
• Videos

Source www.jointreplacement.com, 2003
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The Night Before Surgery

• Avoid medications, such as blood thinners
  (aspirin, ibuprofen, etc.)
• Do not consume any food or liquid after midnight.
• Make sure you have everything youll need at the
  hospital.
• Ask any questions you may have before surgery.

Source www.jointreplacement.com, 2003
32
After Surgery

• Switch to a pain drug taken by mouth that you may
  need for up two weeks.
• Basic range-of-motion exercises are started.
• Begin a physical therapy program a few days after
  surgery.

Source www.jointreplacement.com, 2003
33
Artificial Hip Dislocation Precautions

• Limited range of safe motion during healing
  process.
• For about 3 months, follow special safety rules
  to protect hip.

Source www.jointreplacement.com, 2003
34
Artificial Hip Dislocation Precautions

• Don't bend hip past 90 degrees.
• Don't raise your leg in bed.
• Don't raise thigh past 90 degrees
• Even when sitting or laying down.

Source www.jointreplacement.com, 2003
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Artificial Hip Dislocation Precautions, continued

• Don't bend too far when standing.

Source www.jointreplacement.com, 2003
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Artificial Hip Dislocation Precautions, continued

• Don't roll leg inward.
• Especially important when on side or turning in
  bed.

Source www.jointreplacement.com, 2003
37
Artificial Hip Dislocation Precautions, continued

• Don't turn foot of operated leg inward.
• Keep toes pointed forward when standing, sitting
  or walking.

Source www.jointreplacement.com, 2003
38
Hospital Discharge

• You will be released from the hospital as soon as
  you
• Use hospital precautions with all activities.
• Get in and out of bed safely.
• Walk with the right amount of weight on your hip
  using a walking aid.
• Do exercises by yourself.
• Expect a three or four day hospital stay after
  surgery.

Source www.jointreplacement.com, 2003
39
A Caregivers Role

• Provide support and show patience
• Help with needs that the patient can not do,
  like
• Dressing
• Bathing and Hygiene
• Everyday chores
• Walking

Source www.jointreplacement.com, 2003
40
Recovery in the First Week

• Begin physical rehabilitation to regain strength
  in your hip.
• Decrease medication because pain is decreasing.

Source www.jointreplacement.com, 2003
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Recovery in the First Month

• Expect some personal limitations on activities.
• Important not to place too much stress on the
  hip.
• Motion exercises should be progressing.

Source www.jointreplacement.com, 2003
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Recovery After Six Weeks

• You may begin participating in more activities.
  Limits are reduced.
• Begin active range-of-motion exercises and move
  to strengthening exercises.
• Ability to return to work will depend on progress
  and type of work.

Source www.jointreplacement.com, 2003
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Questions?
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Thank You