treatment options for hip pain. anatomy of the hip ball and socket joint. ball and socket joint....

Treatment Options Treatment Options for Hip Painfor Hip Pain

Anatomy of the HipAnatomy of the Hip

Ball and Ball and socket joint.socket joint.

Femoral head Femoral head or ball is at or ball is at the end of the end of thighbone or thighbone or femur.femur.

Socket or Socket or acetabulum acetabulum holds the ball.holds the ball.

Source: www.jointreplacement.com, 2003

Hip JointHip Joint

Healthy hip jointHealthy hip joint • Arthritic hip Arthritic hip jointjoint

Causes of Hip PainCauses of Hip Pain

Osteoarthritis Osteoarthritis (Wear and tear)(Wear and tear) Avascular Avascular

necrosisnecrosis Abnormalities Abnormalities

from fractures from fractures and congenital and congenital abnormalitiesabnormalities

Source: www.allaboutarthritis.com, 2003

Symptoms of Hip ArthritisSymptoms of Hip Arthritis

PainPain Dull, aching pain affecting the groin, Dull, aching pain affecting the groin,

outer thigh or buttocks.outer thigh or buttocks. At rest or sleeping.At rest or sleeping.

Stiffness and decreased movementStiffness and decreased movement Bone spursBone spurs

Source: www.aaos.org , 2003

Preparing for ExaminationPreparing for Examination

Have the following information Have the following information ready for your exam:ready for your exam: Chief complaint (Where it is hurting Chief complaint (Where it is hurting

the most?)the most?) Chronology of illnessChronology of illness What effect does the pain have on What effect does the pain have on

your life?your life? Family historyFamily history

Source: www.arthritis.org, 2003

Diagnosing Hip Arthritis Diagnosing Hip Arthritis

Physical examination and historyPhysical examination and history Magnetic Resonance Imaging (MRI)Magnetic Resonance Imaging (MRI) X-RaysX-Rays Blood testsBlood tests

Blood CountBlood Count Rheumatoid Factor (for RA)Rheumatoid Factor (for RA) C-Reactive ProteinC-Reactive Protein


How Can My Life ChangeHow Can My Life Change with Treatment? with Treatment?

A return to mobilityA return to mobility Regaining a sense of your Regaining a sense of your

former lifestyleformer lifestyle A change in pain A change in pain

symptomssymptoms

Non-surgical Treatment Options Non-surgical Treatment Options for Hip for Hip

Pain: Over-the-Counter Pain: Over-the-Counter MedicationsMedications

Nonsteroidal Anti-Inflammatory Drugs Nonsteroidal Anti-Inflammatory Drugs (NSAIDS)(NSAIDS) Usually first drug used to treat arthritisUsually first drug used to treat arthritis Can reduce pain, swelling and rednessCan reduce pain, swelling and redness Relief can take several monthsRelief can take several months Examples:Examples:

ibuprofen (ibuprofen (Advil®, Motrin®)Advil®, Motrin®) naproxen (naproxen (Aleve®)Aleve®)

AspirinAspirin Reduce joint pain and inflammationReduce joint pain and inflammation Form of NSAIDsForm of NSAIDs

Source: www.AllAboutArthritis.com , 2003

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

MedicationsMedicationsAcetaminophenAcetaminophen

Reduces painReduces pain Lowers feverLowers fever Does not reduce inflammation of Does not reduce inflammation of

arthritisarthritis Examples:Examples:

Tylenol®Tylenol® Datril® Extra StrengthDatril® Extra Strength Tempra®Tempra®


Non-surgical Treatment Options Non-surgical Treatment Options for Hip Pain: Prescription for Hip Pain: Prescription

MedicationsMedications NSAIDS NSAIDS

Most popular type for osteoarthritis treatmentMost popular type for osteoarthritis treatment Includes ibuprofen (Includes ibuprofen (MotrinMotrin®®), ), naproxen sodium naproxen sodium

((AnaproxAnaprox®®)), oxaprozin , oxaprozin (Daypro(Daypro®®)), sulindac , sulindac (Clinoril(Clinoril®®) ) , etc. , etc.

AnalgesicsAnalgesics Provide pain relief, but do not reduce Provide pain relief, but do not reduce

inflammationinflammation Includes Acetaminophen with codeine (TylenolIncludes Acetaminophen with codeine (Tylenol®®

with Codeine), Oxycodone (OxyContinwith Codeine), Oxycodone (OxyContin®®, , RoxicodoneRoxicodone®®), Hydrocodone with acetaminophen ), Hydrocodone with acetaminophen (Vicodin(Vicodin®®, Dolacet, Dolacet®®), etc.), etc.


Non-surgical Treatment Options Non-surgical Treatment Options for Hip Pain: Prescription for Hip Pain: Prescription

MedicationsMedications Biological Response ModifiersBiological Response Modifiers

Treat rheumatoid arthritis; may postpone injury to the jointsTreat rheumatoid arthritis; may postpone injury to the joints Includes: Infliximab (RemicadeIncludes: Infliximab (Remicade®®), Etanercept (Enbrel ), Etanercept (Enbrel ®®))

Glucocorticoids or CorticosteroidsGlucocorticoids or Corticosteroids Treat rheumatoid arthritis; fight inflammationTreat rheumatoid arthritis; fight inflammation Includes: cortisone, hydrocortisone (CortefIncludes: cortisone, hydrocortisone (Cortef®®, ,

HydrocortoneHydrocortone®®), Prednisolone (Prelone), Prednisolone (Prelone®®) ) DMARDSDMARDS

Treat rheumatoid arthritis; slow joint destructionTreat rheumatoid arthritis; slow joint destruction Includes: methotrexate, injectable gold, penicillamine Includes: methotrexate, injectable gold, penicillamine

(Depen(Depen®®), Azathioprine (Imuran), Azathioprine (Imuran®®), etc.), etc.


Non-surgical Treatment for Non-surgical Treatment for Hip ArthritisHip Arthritis

Cortisone Injections.Cortisone Injections. Powerful anti-inflammatory medication.Powerful anti-inflammatory medication. Temporary pain relief lasting several weeks Temporary pain relief lasting several weeks

to a month. to a month. Assistive devices.Assistive devices.

Walking (cane, walker).Walking (cane, walker). Getting around (seat lifts).Getting around (seat lifts). Bathing and hygiene.Bathing and hygiene. Dressing.Dressing.

Rest and activity modification.Rest and activity modification.


Non-surgical Treatment for Non-surgical Treatment for Hip ArthritisHip Arthritis

Physical therapyPhysical therapy Help increase range of motion and maintain Help increase range of motion and maintain

muscle tone.muscle tone. Swimming is good for hip arthritis patients.Swimming is good for hip arthritis patients.

Weight controlWeight control Foods with lower saturated fats help avoid Foods with lower saturated fats help avoid

swelling in tissue.swelling in tissue. Eat a variety of foods from food groups.Eat a variety of foods from food groups. Avoid fad diets.Avoid fad diets.

Source: www.allaboutarthritis.com , 2003

Surgical Options for Hip PainSurgical Options for Hip Pain

SynovectomySynovectomy Total hip replacementTotal hip replacement Minimally invasive hip replacementMinimally invasive hip replacement

Source: www.aaos.org, 2003

SynovectomySynovectomy

Early stages of rheumatoid Early stages of rheumatoid arthritis.arthritis.

Removes inflamed tissue lining.Removes inflamed tissue lining. Potentially saves joint from further Potentially saves joint from further

damage.damage.



Small incision is made.Small incision is made. Arthroscope is used to inspect the Arthroscope is used to inspect the

joint.joint. Diseased synovium is removed.Diseased synovium is removed. Physical therapy usually required.Physical therapy usually required.



BenefitsBenefits Alleviates rheumatoid arthritis pain in the Alleviates rheumatoid arthritis pain in the

joint.joint. Joint may be saved from further damage.Joint may be saved from further damage. Synovium could grow back over time.Synovium could grow back over time.

DisadvantagesDisadvantages Not a permanent solution.Not a permanent solution.


When is Hip Replacement When is Hip Replacement Surgery Right for You?Surgery Right for You?

Experience significant pain and Experience significant pain and loss of function despite non-loss of function despite non-surgical treatments.surgical treatments.

Typical patients have severe:Typical patients have severe: Rheumatoid ArthritisRheumatoid Arthritis OsteoarthritisOsteoarthritis Hip fractureHip fracture


Hip Replacement Hip Replacement ComponentsComponents

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

Cup

Shell


Hip Replacement Hip Replacement ComponentsComponents

The femoral component The femoral component (stem portion), is made (stem portion), is made of metal. of metal.

Femoral head is made Femoral head is made either of metal or either of metal or ceramic.ceramic. Neck

Stem

Head


Hip Replacement: Hip Replacement: Cemented or UncementedCemented or Uncemented Cemented implant is Cemented implant is

held in place by a type held in place by a type of epoxy cement that of epoxy cement that attaches the metal to attaches the metal to the bone.the bone.

Uncemented implant Uncemented implant has a fine surface has a fine surface (mesh of holes) (mesh of holes) allowing tissue to grow allowing tissue to grow into.into.


Choice Among Cups and Choice Among Cups and LinersLiners

Cross-linked polyethylene- Cross-linked polyethylene- High medical grade plasticHigh medical grade plastic Strong Minimal debrisStrong Minimal debris

MetalMetal Usually titanium Usually titanium StrongStrong Matches your natural hip joint movementMatches your natural hip joint movement

CeramicCeramic Least amount of debrisLeast amount of debris Less wearLess wear Most fragileMost fragile


Benefits to Patient from Benefits to Patient from SurgerySurgery

Return to mobilityReturn to mobility Restores lifestyleRestores lifestyle FreedomFreedom

Total Hip ReplacementTotal Hip Replacement

The goal is to The goal is to reduce hip pain and reduce hip pain and improve the motion improve the motion in your hip.in your hip.

More than 220,000 More than 220,000 people in the people in the United States United States annually undergo annually undergo hip replacement hip replacement surgery.surgery.


Surgical ProcedureSurgical Procedure Incision made on the Incision made on the

side of the thigh.side of the thigh. Socket is re-shaped Socket is re-shaped

to fit new cup implant to fit new cup implant that replaces the that replaces the diseased socket.diseased socket.

New cup is placed in New cup is placed in the socket.the socket.

Source: www.Allaboutarthritis.com, 2003

Surgical ProcedureSurgical Procedure Femur is prepared for Femur is prepared for

the stem.the stem. Hip stem is implanted Hip stem is implanted

and the ball is put in and the ball is put in place on top of stem.place on top of stem.

Incision is closed.Incision is closed.

Source: www.Allaboutarthritis.com, 2003

Minimally Invasive Minimally Invasive Hip (MIH) SurgeryHip (MIH) Surgery

New surgical technique.New surgical technique. Smaller incisions with traditional Smaller incisions with traditional

hip implant components.hip implant components. Different techniques, including Different techniques, including

mini-incision and two-incision.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.

Different Techniques Used for MIHDifferent Techniques Used for MIH

Two-incisionTwo-incision Two incisions of approximately 2 inches Two incisions of approximately 2 inches

long on both the front and rear of the long on both the front and rear of the thigh.thigh.

Mini-incisionMini-incision One incision generally 3 to 4 inches on One incision generally 3 to 4 inches on

the thigh.the thigh. Two basic types of mini-incision: Two basic types of mini-incision:

– anterior anterior – posteriorposterior

Preparing for Joint Preparing for Joint Replacement SurgeryReplacement Surgery

Ease anxiety by mentally preparing with:Ease anxiety by mentally preparing with: Breathing exercisesBreathing exercises MeditationMeditation Talking with friends and familyTalking with friends and family

Learn more about hip replacement surgeryLearn more about hip replacement surgery BrochuresBrochures HandoutsHandouts WebsitesWebsites VideosVideos


The Night Before SurgeryThe Night Before Surgery

Avoid medications, such as “blood Avoid medications, such as “blood thinners” (aspirin, ibuprofen, etc.)thinners” (aspirin, ibuprofen, etc.)

Do not consume any food or liquid Do not consume any food or liquid after midnight.after midnight.

Make sure you have everything Make sure you have everything you’ll need at the hospital.you’ll need at the hospital.

Ask any questions you may have Ask any questions you may have before surgery.before surgery.


After SurgeryAfter Surgery

Switch to a pain drug taken by Switch to a pain drug taken by mouth that you may need for up mouth that you may need for up two weeks.two weeks.

Basic range-of-motion exercises Basic range-of-motion exercises are started.are started.

Begin a physical therapy program Begin a physical therapy program a few days after surgery.a few days after surgery.


Artificial Hip Dislocation Artificial Hip Dislocation PrecautionsPrecautions

Limited range of safe motion Limited range of safe motion during healing process.during healing process.

For about 3 months, follow special For about 3 months, follow special safety rules to protect hip.safety rules to protect hip.


Artificial Hip Dislocation Artificial Hip Dislocation PrecautionsPrecautions

Don't bend hip past 90 degrees.Don't bend hip past 90 degrees. Don't raise your leg in bed. Don't raise your leg in bed.

Don't raise thigh past 90 degrees Don't raise thigh past 90 degrees Even when sitting or laying down.Even when sitting or laying down.


Artificial Hip Dislocation Artificial Hip Dislocation Precautions, continuedPrecautions, continued

Don't bend too Don't bend too far when far when standing. standing.



Don't roll leg Don't roll leg inward.inward.

Especially Especially important important when on when on side or side or turning in turning in bed. bed.



Don't turn foot of operated leg inward.Don't turn foot of operated leg inward. Keep toes pointed forward when Keep toes pointed forward when

standing, sitting or walking.standing, sitting or walking.Source: www.jointreplacement.com, 2003

Hospital DischargeHospital Discharge

You will be released from the hospital as You will be released from the hospital as soon as you:soon as you: Use hospital precautions with all activities.Use hospital precautions with all activities. Get in and out of bed safely.Get in and out of bed safely. Walk with the right amount of weight on Walk with the right amount of weight on

your hip using a walking aid. your hip using a walking aid. Do exercises by yourself.Do exercises by yourself.

Expect a three or four day hospital stay Expect a three or four day hospital stay after surgery.after surgery.


A Caregiver’s RoleA Caregiver’s Role

Provide support and show patienceProvide support and show patience Help with needs that the patient Help with needs that the patient

can not do, like:can not do, like: DressingDressing Bathing and HygieneBathing and Hygiene Everyday choresEveryday chores WalkingWalking


Recovery in the First WeekRecovery in the First Week

Begin physical rehabilitation to Begin physical rehabilitation to regain strength in your hip.regain strength in your hip.

Decrease medication because pain Decrease medication because pain is decreasing.is decreasing.


Recovery in the First MonthRecovery in the First Month

Expect some personal limitations Expect some personal limitations on activities.on activities.

Important not to place too much Important not to place too much stress on the hip.stress on the hip.

Motion exercises should be Motion exercises should be progressing.progressing.


Recovery After Six WeeksRecovery After Six Weeks

You may begin participating in You may begin participating in more activities. Limits are reduced.more activities. Limits are reduced.

Begin active range-of-motion Begin active range-of-motion exercises and move to exercises and move to strengthening exercises.strengthening exercises.

Ability to return to work will Ability to return to work will depend on progress and type of depend on progress and type of work.work.


Questions?Questions?

Thank YouThank You

treatment options for hip pain. anatomy of the hip ball and socket joint. ball and socket joint....

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