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Your Guide to Hip Pain and its Treatment Chronic hip pain can change your life

Your Guide to Hip Pain and its Treatment Chronic hip pain can change your life by limiting your ability to walk, sit comfortably or perform normal daily activities. When hip pain interferes with your ability to do the things you need to do each day, it’s time to seek medical advice. Chronic hip pain can change your life by limiting your ability to walk, sit comfortably or perform normal daily activities. When hip pain interferes with your ability to do the things you need to do each day, it’s time to seek medical advice. Hip pain has many causes If you develop hip pain that persists, possibly with swelling or tenderness, a doctor can help you sort out the possible causes. The physician will thoroughly examine you, take your health history, and order hip X-rays or other imaging to view the joint. Here are some key causes of hip pain: Osteoarthritis Osteoarthritis is a wearing down of the cartilage that allows the bones to glide smoothly over one another in joints such as the hip. It is one of the most common causes of hip pain in people over 65, usually triggering pain in the front of the thigh or the groin. As the cartilage wears away, the head of the thigh bone rubs directly against the inner hip socket. Splinters of bone and cartilage can interfere with normal hip movement. Pain in the groin and front of the thigh is the most common symptom of hip arthritis, especially when walking or during ac- tivities that require twisting, such as putting on socks or getting out of a car. The pain is caused by the bones rubbing against each other. The hip joint also may become swollen and stiff. Hip fractures Older individuals are susceptible to breaking a hip during nor- mal everyday activities if their bones are weak due to osteopo- rosis. Although osteoporosis chiefly affects women, men over 65 are at risk as well. Hip fractures are medical emergencies and require immediate surgery. In addition, younger active individuals can develop stress fractures of the hip. When muscles become fatigued, they fail to absorb the shock of impact from jumping and other activi- ties, and forces are transferred to the bone itself, causing tiny cracks. Stress fractures in the hip joint can cause pain. Bursitis Bursitis is inflammation of any of the fluid-filled sacs protecting the body’s joints after an injury. Trochanteric bursitis affects the outer surface of the hip joint, producing pain when standing up, walking, climbing steps or driving. Osteonecrosis Insufficient blood flow to bone can destroy bone cells, a pro- cess called osteonecrosis (also avascular or aseptic necrosis). Years of corticosteroid use to suppress the immune system for different medical conditions can cause osteonecrosis. The hip is the most common site affected by osteonecrosis. Tendonitis The tendons – rope-like connective tissues connecting muscles to bone at the hip and other joints – can become painfully inflamed by repetitive and strenuous movement. Tendonitis is a common sports injury, caused by overuse of the same parts of the body. Strains Strains are small tears in the muscle from overuse/irritation. Lower back strains can be caused by twisting, quickly turning, and “pulling” the muscles that support the spinal column. The back and hip muscles often become strained because the abdominal muscles are too weak to lend support. Herniated discs Falls and heavy lifting can injure the discs, the “shock absorb- ers” in the spinal column. They separate and cushion the vertebrae, but as we age the discs become more brittle and can rupture, or herniate. Pain from a ruptured disc in the lower spine radiates down the nerve extending from the spinal cord to the leg (sciatica). Septic hip Septic arthritis can develop in the hip during infancy and throughout childhood. Young immune systems may not be mature enough to kill bacteria that enter the bloodstream and settle in the hip, resulting in pain and limping. Fever, and warmth and redness over the hip, point to possible infection. There are other possible causes of hip pain; be sure to seek medical help if you: • can’t walk normally because of the pain • can’t bend your hip • experience hip pain for more than a few days • notice a deformity or swelling in your hip or upper thigh • experience hip pain at night or while resting • develop a fever, with redness and warmth over the hip Many Treatments for Hip Pain Conservative care Most types of hip pain can be resolved with conservative treatments such as: Rest When the hip is inflamed, as in bursitis, tendonitis or arthritis, it’s important to rest the joint and avoid overusing it. Ice Applying cold packs or ice bags to the hip when pain is severe can reduce inflammation and swelling. Physical therapy Once your doctor diagnoses the cause of your hip pain, physical therapists can show you stretches and exercises to increase flexibility and strength in the hip. For problems such as bursitis, they can use ultrasound and massage techniques. Physical therapists can also advise you about helpful aerobic exercises, such as swimming, aqua therapy or cycling, that won’t aggravate hip pain as high-impact activities would. You may be advised to lose weight to relieve pressure on your joints. Finally, physical therapists will show you good “body mechanics” – the proper ways to sit, stand, lift and sleep – to avoid aggravating hip pain. Pain relievers Anti-inflammatory medicines can be purchased over the counter to relieve hip pain if needed, and include acetaminophen (Tylenol®), ibuprofen (Advil®) or naproxen (Aleve®). Injections For hip problems caused by inflammation, steroids may be injected to settle the inflammation down. When swelling is severe, fluid may need to be drained from the hip. Surgical options Hip problems such as osteoarthritis do not disappear on their own. They tend to worsen with age, and eventually conservative measures may not be enough to control pain. At that point, your doctor may recommend surgery. Hip replacement In severe osteoarthritis, hip pain can become constant, and joint swelling and stiffness can cause limping and difficulty moving. This may cause individuals to restrict their normal daily activities. In these cases, hip replacement surgery can dramati- cally improve the quality of life. In 2008, 240,000 people in the United States will have hip replacement surgery. Besides osteoarthritis, hip replacement may be indicated for osteonecrosis. During the 90-minute procedure, the orthopaedic surgeon removes damaged bone from the hip socket, as well as the ball and upper end of the thigh bone (femur). An artificial joint, or prosthesis, made of metal and plastic, replaces the hip socket, and the head and upper end of the femur. The prosthesis parts must sometimes be cemented in place. Hip replacement surgery has been performed all over the world for more than three decades, with many refinements in the operation and in the design of hip prostheses during this time. Today’s artificial hips can last up to 30 years, important for middle-aged individuals facing hip replacement. Minimally invasive direct anterior hip replacement surgery Cleveland Clinic Florida is one of the only hospitals in the region to offer minimally invasive direct anterior hip replacement surgery, an advanced procedure involving no muscle cutting. The procedure spares any invasion into the large muscle or tendon groups around the hip and is usually done through a smaller incision. Minimally invasive direct anterior hip replacement surgery typically provides the following benefits: • Shorter hospital stay • Quicker recovery times • Less pain and need for pain meds • Less risk of dislocation and no need for postoperative restrictions in motion • Use of assistive devices (walkers or canes) for shorter times (typically 7-10 days only) Recovery from surgery Physical therapy is key to recovering mobility and can begin the first day after surgery in some cases. Helping patients get out of bed and put weight on the new hip can help speed recovery. Recovery is individualized, but in general, the younger you are, the faster your rehabilitation and recovery are likely to be, and the less time you’ll spend in the hospital. Most people do not require assistive devices after four weeks. After completing rehabilitation, most patients can perform normal daily activities easily and without pain. They can also return to recreational pastimes such as walking, cycling, golf, skiing, tennis and horseback riding. The only things they need to avoid are jogging on hard surfaces and jumping from heights. To schedule an appointment with one of our orthopaedic specialists, call 877.463.2010 or visit www.clevelandclinicflorida.org. In 2009, Cleveland Clinic Florida was named one of the nation’s 100 Top Hospitals® by Thomson Reuters, a leading provider of information and solutions to improve the cost and quality of healthcare. The award recognizes hospitals that have achieved excellence in clinical outcomes, patient safety, patient satisfaction, financial performance, and operational efficiency. uploads/Sante/ hip-pain-guide.pdf