20 maja 2019
20 maja 2019
Because of hip pain, performing everyday activities can become a real challenge. Are patients with this condition actually excluded from active life? What solutions for treatment is offered by modern medicine?
The problem of hip pain mainly affects people over 65 who have degenerative changes that are the result of wear and damage to the cartilage of the femoral head and acetabulum. Two exposed bone surfaces begin to rub against each other, leading to joint destruction. Patients suffer from pain, stiffness, instability, later they have a significant reduction in the range of motion.
The first typical symptom is pain in the groin, which occurs during walking. The patient begins to limp and sometimes may have a problem in performing simple everyday activities, like putting on shoes. Degeneration of the cartilage of the hip joint progresses. As a consequence, it loses its mobility and endurance. Bone spurs (so-called osteophytes) are formed on it. This, among other things, causes a growing pain, which also annoys patients even at rest. Unfortunately, as many as 3 million people in Poland suffer from osteoarthritis of the hip.
However, hip pain is not just a problem of seniors. The number of patients aged 20-40 is increasing. The cause of hip pain, however, may be different. The sedentary lifestyle is definitely an important factor. Many people spend 10 hours at a desk during the week and intensively play sports at the weekend. In the case of such athletes – amateurs, it ends with contractures and muscle spasms and tendons on the thigh or hip area. Typical sports injuries include those in the hip joint, the quadriceps muscle, or the hip flexor muscles or adductor muscles.
Hip pain also applies to people with congenital hip joint dislocation, even if operated on in childhood, sterile osteonecrosis of the femur and dysplasia (i.e. abnormal development of the hip joint), resulting in numerous deformities in the joint and degenerative changes.
Patients whose persistent hip pain limits everyday functioning, feel excluded from normal life and give up their daily activities. They lose the joy of life and spend most of their time at home.
Does your hip hurt? Do not wait! Diagnose the cause of pain!
Hip pain does not always mean the pain of a hip joint. Trailers of muscles and tendons may hurt. The pain may come from the hip joint, but its causes may be different. It does not necessarily have to be associated with degenerative changes. This may be hip inflammation or damage to the labrum (often in case of young athletes). To determine the cause of pain, appropriate imaging should be performed - says Jacek Laskowski MD PhD Ort, an orthopedist at the Carolina Medical Center.
The basic test is an X-ray. If we suspect that the reason for the pain may be torn muscle trailer, then the next step is ultrasound examination. This test is also carried out when probable cause of pain is inflammation in the hip joint. If the doctor suspects damage to the labrum or cartilage in the joint, then it will be necessary to perform magnetic resonance (MRI) with intraarticular contrast.
The first step in the treatment of hip joint disorders is pharmacological treatment. This is a solution for patients who experience pain as a result of contusion or injury, but also for people with degenerative joint disease and degeneration of joint cartilage. Pharmacotherapy consists of the administration of analgesics and non-steroidal anti-inflammatory drugs either orally or by injection into the joint, as well as using ointments and gels with anti-inflammatory and analgesic properties.
To reduce pain of damaged hip joint, the injection method can be used (administration of the drug directly to the joint). In the past, steroid injections were a common method. However, they caused a lot of side effects. They led to necrosis and tendon rupture. Currently, injections with platelet-rich plasma (PRP) and growth factors are applied (the series of injections has anti-inflammatory and analgesic effect), or stem cells obtained from adipose tissue, or else hyaluronic acid. The latter works like lubricant in the engine – injected into the joint reduces friction and has analgesic effect. In case of degenerative changes with inflammation or exudations, Orthokine or N-Stride therapy is used in which the plasma concentrate is obtained from the venous blood of the patient.
An inherent element in the treatment of diseases and injuries of the hip is also rehabilitation, which relieves pain, strengthens the muscles and increases mobility in the joint. A great solution is rehabilitation in water, which does not overload the joint and reduces pain.
In the case the hip joint is not severely damaged, arthroscopy is performed – a minimally invasive method of treatment of diseases and injuries of the hip joint, especially in case of people under 50 and physically active. Arthroscopy prevents the development of the disease, often allows a patient to return to a normal life and practice sports. During surgery, the doctor repairs the damaged joint by only 2-3 small incisions on the skin, through which necessary surgical tools and an arthroscopic camera is entered, which allows excellent visibility of the joint.
There are people who have degenerative changes due to age or, in the case of young patients, due to deformities, such as congenital hip dislocation, which was operated on in childhood, dysplasia (or abnormal hip development). If the cartilage of the hip has been damaged in large areas, then arthroscopy will definitely not help. Then we have to start thinking about hip replacement - says doctor Jacek Laskowski.
Who qualifies for endoprosthesis? Above all, patients complaining of severe pain at night and those who cannot normally function due to degenerative changes.
Nowadays, hip replacement is a standard procedure for treating degenerative changes. In Poland, tens of thousands of endoprostheses are implanted annually. Surgery involves removing the two damaged parts of the hip joint, i.e. the acetabulum and the femoral head. In their place, implants are inserted, which together form a prosthesis. After cutting off and removing the head and femoral neck, the medullary cavity is recessed and then the endoprosthesis stem is inserted. An acetabular shell is implanted into the pelvis.
The number of implanted endoprostheses is growing from year to year, because people live longer and longer. And it is the elderly who usually have degenerative changes in the hip joint, and they are the main group (though not the only one) qualified for such surgery. Hip replacement is implanted even in very elderly people (85+). The age itself is not a contraindication to hip surgery, only the poor condition of the patient may be a contraindication.
Almost 99% of patients have a series-produced implants. They can be long, short, covered with titanium or cemented, made of polyethylene, ceramic, two-mobile, mono-mobile. The physician decides on which implant will be the best based on the severity of the disease, joint damage, bone condition, age or patient’s expectations.
Medical personalization, which is more common in medicine, also applies to hip replacement. Currently, the doctor does not have to choose the best implant among those which are available. Today we have "custom made" implants, or "made to measure". Based on a computed tomography examination, a three-dimensional image of the hip joint is made and based on it an individual implant is created, dedicated only to a specific patient - says doctor Laskowski.
Hip replacement is a very serious surgery! In returning to a normal life, the patient’s cooperation with the physiotherapist is crucial. The role of the specialist is to teach the patient how to function with the new hip and how to safely and properly perform the exercises. After the hip replacement surgery, it is necessary to modify the current lifestyle and include certain precautions in daily routines, for example when sitting in a chair or using the toilet. It is not allowed to cross legs, the use of a raised toilet is also required. Among the permitted activities you cans marching, cycling, gymnastics and swimming. On the other hand, martial arts and team games, tennis, golf and skiing are forbidden. There is a risk of dislocation or loosening of the implant.
There are patients who cannot have a classic prosthesis implanted. They are usually people actively doing sports, which they do not want or cannot give up. For them, the best way to treat hip degeneration will be hip resurfacing. It involves replacing of the hip joint with the BHR (Birmingham Hip Resurfacing) method. This is a bone-saving treatment, because the whole femoral head is preserved, which is covered with so-called cup. The second element of the prosthesis is an artificial acetabulum, devoid of a large femoral stem, characterizing the traditional endoprosthesis.
This is the only implant with which the patient can do whatever he wants. It guarantees a full return to sports activities. The patient can practice not only "low impact" sports (e.g. swimming or cycling), but also those from the "high impact" group, i.e. martial arts, playing tennis or golf or riding a bicycle without the risk of dislocation or loosening of the implant - adda doctor Jacek Laskowski.
Hip resurfacing is currently the least invasive and the most effective method of replacing a damaged hip joint.
 P. Biegański, E. Polewska: Choroba zwyrodnieniowa stawów biodrowych – pacjent i problemy funkcjonalne (ang. The hip joint Osteoarthritis – patient and functional problems). Journal of Education, Health and Sport, 2015.