Does Hip Arthritis Really Warrant A Hip Replacement?

By Colin A. Mudrick, MDColin A. Mudrick, MD, Joint Replacement, Tuckahoe Orthopaedics

A rising number of people are suffering from chronic hip pain and arthritis. In response, hip replacements are becoming increasingly common in the United States. While a hip replacement is an option for pain relief, there may be non-invasive treatment methods worth exploring first.

Here’s a look at the common sources of hip pain and a few ideas for you to discuss with your doctor before considering a hip replacement.

Understanding Hip Arthritis

Hip arthritis is most commonly caused by mechanical wear and tear of the joint surface known as osteoarthritis. This is a physical breakdown of the cartilage that covers the ball and socket joint of your hip.

The first step in understanding hip arthritis is to identify the source of the pain. Pain from an arthritic hip is most often felt in the groin and/or thigh. Pain can also be located in the buttocks or lateral aspect of hip. There are many other causes of pain in the hip region, thus it is important to work with a physician who treats hip problems. He/She can identify the source of the pain through a physical exam and X-ray findings.

Carefully Monitor Your Hip Pain Level

The earlier the diagnosis, the more non-surgical options there are. You’re more likely to reduce pain and increase range of motion without surgery. This is important to note regardless of the level of pain.

Patients typically do not come in until their pain begins to limit daily activity.  This begins with mild discomfort during exercise, but can progress to pain when walking. Eventually the pain is present even without activity and can even make it difficult to sleep.

If you’re experiencing hip pain, we recommend documenting the time of day, severity, and activity causing the pain. That will help us better diagnose your pain and find the best treatment plan for you.

Non-Surgical Treatments for Hip Arthritis

If you’ve been diagnosed with hip arthritis, a hip replacement is not your only option. If you’ve seen a doctor early on, you may be able to address your hip arthritis with treatments such as the following:

Activity Modification:

Repetitive loading of your hip joint, such as with running or tennis, can aggravate hip arthritis. Try activities such as cycling or using the elliptical. They will still give you a great cardiovascular workout while minimizing the stress to your hip.

Weight Loss:

Your hip experiences 2-3 times your body weight while performing normal daily activities. Losing weight can help reduce the wear and tear on your hip joint. Anyone overweight with hip pain can benefit from losing weight. This is especially true for someone who is considering surgery. Recent studies have shown a dramatic increase in infection risk in patient who are over a certain weight.

Pharmaceutical Treatments:

Many patients may have already tried over the counter medications, such as ibuprofen or Tylenol. These medications treat inflammation and therefore reduce pain. There are also prescription anti-inflammatory medications that are used to aid in pain reduction. It’s important however, to be careful about how you medicate.

Many anti-inflammatory medications are processed by your kidneys. Taken chronically, they can increase your risk of cardiovascular disease. It’s important that your doctor follows you closely if you are taking the medications for an extended period of time. This might mean anything longer than 2 to 3 months.

If you can’t tolerate anti-inflammatory medications, there are other pharmaceutical treatment options. These include topical gels and steroid injections directly into the joint. Both can cause significant relief, although likely temporary.

Physical Therapy:

Hip-strengthening exercises can help you regain strength in your hip and leg muscles, reduce pain, and increase range of motion.

Hip Arthroscopy:

Hip arthroscopy is a procedure in which your doctor puts a scope or camera into the hip. This treatment typically treats younger patients predisposed to hip issues.

Many of the above mentioned options will help to alleviate the pain temporarily. At some point these measures begin to lose their efficacy or the arthritis progresses. The more permanent solution becomes a hip replacement.

When to Consider Hip Replacement

An appropriately prescribed hip replacement fixes the mechanical issues you may be experiencing. And it’s the only treatment option that does such.

The hip replacement experience has drastically improved over the past 20-30 years. Many improvements are directly tied to the way in which pain is managed post-operatively. Many surgeons use a “multi-modal” pain regimen that targets different pain receptors in the brain and the site of the surgery. Patients are getting up faster and are leaving the hospital sooner. Thirty years ago, many patients spent up to two weeks in the hospital after surgery.  Today, many people go home within 1-2 days and in some centers in the country are even going home the same day.

If you have tried alternative treatment methods for your hip arthritis, it may be time to discuss the next step.  Your doctor may suggest a hip replacement as the best option for you. If so, contact our doctors at Tuckahoe Orthopaedics today to discuss what’s next for you.

Common Causes of Pinched Nerves

Spine | Tuckahoe Orthopaedics
Walter N. Rabhan, MD | Tuckahoe OrthopaedicsBy Walter N. Rabhan, MD

Many patients, when they have a pinched nerve in the spine or neck, aren’t aware they have a pinched nerve. Instead, they talk about the associated symptoms without knowing the underlying cause. At Tuckahoe Orthopaedics, we use testing and medical knowledge to get to the root of the problem and find the cause of your pain.

Symptoms of Pinched Nerves

Common symptoms of a pinched nerve in the lower back or spine include:

  • Pain, burning, or stinging sensation in one or both buttocks, thighs, or calves
  • Hip pain
  • Pain or burning down to the toes or foot

Symptoms of a pinched nerve in the upper back neck usually include these same sensations, but the symptoms radiate into the upper extremities (arms, shoulders, scapula, hands).

Keep in mind, these are only symptoms, not conditions in and of themselves. A pinched or irritated nerve is really an indication of some other, underlying condition. If you have a pinched nerve, it’s a sign something else is going on in your body.

Causes of Pinched Nerves

Any one of these conditions can result in the symptoms described above.

  • Bulging of the disc.
  • Protrusion of the disc.
  • Ruptured disc
  • Degenerative disc disease (an early form of arthritis)
  • Bone spurs.
  • Fractures.
  • Inflammation of soft tissue from a severe sprain or strain

In rarer instances, pinched nerves may be caused by tumors, fractures, or what is called Piriformis Syndrome (an irritation of the sciatic nerve caused by muscle spasms).

Causes of a pinched nerve often vary by age. From ages 20 to 45, pinched nerves will most often occur as a result of disc or soft tissue problems. From ages fifty to eighty and onward, pinched nerves are most likely a result of degenerative arthritis, spinal stenosis, or other age-related causes.

Diagnosis and Treatment of Pinched Nerves

Diagnosis of a pinched nerve starts with a basic examination and X-ray. A physical exam will tell the doctor at what level of the spine the problem is occurring. Most of the time, barring extraordinary circumstances or significant abnormalities in the examination, the treatment for a pinched nerve is the same.

Routine treatment begins with anti-inflammatory medication, physical therapy, rest, and modified physical activity for three to four weeks. If the symptoms have not abated after this time, then further examination may be necessary, such as an MRI. This will show the doctor the disc, soft tissue, and the nerves to check for stenosis, bulging, protrusions, or other conditions that do not show up on an X-ray.

Beyond the non-invasive treatments are solutions such as cortisone shots and (as a last resort) surgery. However, most patients recover from a pinched nerve before even needing an MRI.

Are you experiencing ongoing neck or back pain that fits the symptoms above? Request an appointment with Tuckahoe Orthopaedics today so we can diagnose your options.