Pain in hip joint
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Pain in the hip involves any pain in or around
the hip joint. This type of pain is usually not felt directly over the hip.
Instead it may be felt in the middle of your thigh.
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- Hip fracture
- Avascular necrosis (insufficient blood flow)
- Strain or sprain of hip muscles
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- Hip fracture is a medical emergency and should be dealt with right way.
- Minimize or avoid activities that may worsen the hip pain
- Sleep on the side that is not painful
- Place a pillow between your legs
- Take nonsteroidal anti-inflammatory drugs (NSAID's) like aspirin, tylenol
or ibuprofen to relieve pain and inflammation.
- Learn exercises to stretch, strengthen and improve the tone of your muscles
around the hip joint.
- Swimming is a good activity that does not strain your hip joint.
- Prevent osteoporosis by walking, exercising and calcium supplements.
- Avoid falls
- Stretch your hips, low back and thighs.
- Hip Replacement Surgery
- What Is a Hip Replacement?
Hip replacement, or arthroplasty,
is a surgical procedure in which the diseased parts of the hip joint
are removed and replaced with new, artificial parts. These artificial
parts are called the prosthesis. The goals of hip replacement surgery
are to improve mobility by relieving pain and improve function of the
- Who Should Have Hip Replacement Surgery?
The most common reason that people have hip replacement surgery is the
wearing down of the hip joint that results from osteoarthritis. Other
conditions, such as rheumatoid arthritis (a chronic inflammatory disease
that causes joint pain, stiffness, and swelling), avascular necrosis (loss
of bone caused by insufficient blood supply), injury, and bone tumors
also may lead to breakdown of the hip joint and the need for hip replacement
Before suggesting hip replacement surgery, the doctor is likely to try
walking aids such as a cane, or non-surgical therapies such as medication
and physical therapy. These therapies are not always effective in relieving
pain and improving the function of the hip joint. Hip replacement may
be an option if persistent pain and disability interfere with daily activities.
Before a doctor recommends hip replacement, joint damage should be detectable
on x rays.
In the past, hip replacement surgery was an option primarily for people
over 60 years of age. Typically, older people are less active and put
less strain on the artificial hip than do younger, more active people.
In recent years, however, doctors have found that hip replacement surgery
can be very successful in younger people as well. New technology has improved
the artificial parts, allowing them to withstand more stress and strain.
A more important factor than age in determining the success of hip replacement
is the overall health and activity level of the patient. For some people
who would otherwise qualify, hip replacement may be problematic. For example,
people with chronic diseases such as those that result in severe muscle
weakness or Parkinson's disease are more likely than people without chronic
diseases to damage or dislocate an artificial hip. Because people who
are at high risk for infections or in poor health are less likely to recover
successfully, doctors may not recommend hip replacement surgery for these
- What Are Alternatives to Total Hip Replacement?
Before considering a total hip replacement, the doctor may try other
methods of treatment, such as an exercise program and medication. An
exercise program can strengthen the muscles in the hip joint and sometimes
improve positioning of the hip and relieve pain.
The doctor also may treat inflammation in the hip with nonsteroidal
anti-inflammatory drugs, or NSAIDs. Some common NSAIDs are aspirin and
ibuprofen. NSAIDs also include Celebrex and Vioxx, so-called COX-2 inhibitors
that block an enzyme known to cause an inflammatory response. Many of
these medications are available without a prescription, although a doctor
also can prescribe NSAIDs in stronger doses.
In a small number of cases, the doctor may prescribe corticosteroids,
such as prednisone or cortisone, if NSAIDs do not relieve pain. Corticosteroids
reduce joint inflammation and are frequently used to treat rheumatic
diseases such as rheumatoid arthritis. Corticosteroids are not always
a treatment option because they can cause further damage to the bones
in the joint. Some people experience side effects from corticosteroids
such as increased appetite, weight gain, and lower resistance to infections.
A doctor must prescribe and monitor corticosteroid treatment. Because
corticosteroids alter the body's natural hormone production, patients
should not stop taking them suddenly and should follow the doctor's
instructions for discontinuing treatment.
If physical therapy and medication do not relieve pain and improve
joint function, the doctor may suggest corrective surgery that is less
complex than a hip replacement, such as an osteotomy. Osteotomy is surgical
repositioning of the joint. The surgeon cuts away damaged bone and tissue
and restores the joint to its proper position. The goal of this surgery
is to restore the joint to its correct position, which helps to distribute
weight evenly in the joint. For some people, an osteotomy relieves pain.
Recovery from an osteotomy takes 6 to 12 months. After an osteotomy,
the function of the hip joint may continue to worsen and the patient
may need additional treatment. The length of time before another surgery
is needed varies greatly and depends on the condition of the joint before
- What Does Hip Replacement Surgery Involve?
The hip joint is located where the upper end of the femur meets the
acetabulum. The femur, or thigh bone, looks like a long stem with a
ball on the end. The acetabulum is a socket or cup-like structure in
the pelvis, or hip bone. This "ball and socket" arrangement
allows a wide range of motion, including sitting, standing, walking,
and other daily activities.
During hip replacement, the surgeon removes the diseased bone tissue
and cartilage from the hip joint. The healthy parts of the hip are left
intact. Then the surgeon replaces the head of the femur (the ball) and
the acetabulum (the socket) with new, artificial parts. The new hip
is made of materials that allow a natural, gliding motion of the joint.
Hip replacement surgery usually lasts 2 to 3 hours.
Sometimes the surgeon will use a special glue, or cement, to bond the
new parts of the hip joint to the existing, healthy bone. This is referred
to as a "cemented" procedure. In an uncemented procedure,
the artificial parts are made of porous material that allows the patient's
own bone to grow into the pores and hold the new parts in place. Doctors
sometimes use a "hybrid" replacement, which consists of a
cemented femur part and an uncemented acetabular part.
- Is a Cemented or Uncemented Prosthesis Better?
were developed 40 years ago. Uncemented prostheses were developed about
20 years ago to try to avoid the possibility of loosening parts and the
breaking off of cement particles, which sometimes happen in the cemented
replacement. Because each person's condition is unique, the doctor and
patient must weigh the advantages and disadvantages to decide which type
of prosthesis is better.
For some people, an uncemented prosthesis may last longer than cemented
replacements because there is no cement that can break away. And, if
the patient needs an additional hip replacement (which is likely in
younger people), also known as a revision, the surgery sometimes is
easier if the person has an uncemented prosthesis.
The primary disadvantage of an uncemented prosthesis is the extended
recovery period. Because it takes a long time for the natural bone to
grow and attach to the prosthesis, people with uncemented replacements
must limit activities for up to 3 months to protect the hip joint. The
process of natural bone growth also can cause thigh pain for several
months after the surgery.
Research has proven the effectiveness of cemented prostheses to reduce
pain and increase joint mobility. These results usually are noticeable
immediately after surgery. Cemented replacements are more frequently
used than cementless ones for older, less active people and people with
weak bones, such as those who have osteoporosis.
- What Can Be Expected Immediately After Surgery?
allowed only limited movement immediately after hip replacement surgery.
When the patient is in bed, the hip usually is braced with pillows or
a special device that holds the hip in the correct position. The patient
may receive fluids through an intravenous tube to replace fluids lost
during surgery. There also may be a tube located near the incision to
drain fluid and a tube (catheter) may be used to drain urine until the
patient is able to use the bathroom. The doctor will prescribe medicine
for pain or discomfort.
- How Long Are Recovery and Rehabilitation?
On the day after surgery or sometimes on the day of surgery, therapists
will teach the patient exercises that will improve recovery. A respiratory
therapist may ask the patient to breathe deeply, cough, or blow into
a simple device that measures lung capacity. These exercises reduce
the collection of fluid in the lungs after surgery.
A physical therapist may teach the patient exercises, such as contracting
and relaxing certain muscles, that can strengthen the hip. Because the
new, artificial hip has a more limited range of movement than an undiseased
hip, the physical therapist also will teach the patient proper techniques
for simple activities of daily living, such as bending and sitting,
to prevent injury to the new hip. As early as 1 to 2 days after surgery,
a patient may be able to sit on the edge of the bed, stand, and even
walk with assistance.
Usually, people do not spend more than 10 days in the hospital after
hip replacement surgery. Full recovery from the surgery takes about
3 to 6 months, depending on the type of surgery, the overall health
of the patient, and the success of rehabilitation.
- How to Prepare for Surgery and Recovery
People can do many things
before and after they have surgery to make everyday tasks easier and help
speed their recovery.
- Before Surgery
- Learn what to expect before, during, and after surgery. Request
information written for patients from the doctor or contact one of
the organizations listed near the end of this document.
- Arrange for someone to help you around the house for a week or two
after coming home from the hospital.
- Arrange for transportation to and from the hospital.
- Set up a "recovery station" at home. Place the television
remote control, radio, telephone, medicine, tissues, waste basket,
and pitcher and glass next to the spot where you will spend the most
time while you recover.
- Place items you use every day at arm level to avoid reaching up
or bending down.
- Stock up on kitchen staples and prepare food in advance, such as
frozen casseroles or soups that can be reheated and served easily.
- After Surgery
- Follow the doctor's instructions.
- Work with a physical therapist or other health care professional
to rehabilitate your hip.
- Wear an apron for carrying things around the house. This leaves
hands and arms free for balance or to use crutches.
- Use a long-handled "reacher" to turn on lights or grab
things that are beyond arm's length. Hospital personnel may provide
one of these or suggest where to buy one.
- What Are Possible Complications of Hip Replacement Surgery?
According to the American Academy of Orthopaedic Surgeons, approximately
120,000 hip replacement operations are performed each year in the United
States and less than 10 percent require further surgery. New technology
and advances in surgical techniques have greatly reduced the risks involved
with hip replacements.
The most common problem that may happen soon after hip replacement
surgery is hip dislocation. Because the artificial ball and socket are
smaller than the normal ones, the ball can become dislodged from the
socket if the hip is placed in certain positions. The most dangerous
position usually is pulling the knees up to the chest.
The most common
later complication of hip replacement surgery is an inflammatory reaction
to tiny particles that gradually wear off of the artificial joint surfaces
and are absorbed by the surrounding tissues. The inflammation may trigger
the action of special cells that eat away some of the bone, causing
the implant to loosen. To treat this complication, the doctor may use
anti-inflammatory medications or recommend revision surgery (replacement
of an artificial joint). Medical scientists are experimenting with new
materials that last longer and cause less inflammation.
Less common complications of hip replacement surgery include infection, blood
clots, and heterotopic bone formation (bone growth beyond the normal edges
- When Is Revision Surgery Necessary?
Hip replacement is one of
the most successful orthopaedic surgeries performed--more than 90 percent
of people who have hip replacement surgery will never need revision surgery.
However, because more younger people are having hip replacements, and
wearing away of the joint surface becomes a problem after 15 to 20 years,
revision surgery is becoming more common. Revision surgery is more difficult
than first-time hip replacement surgery, and the outcome is generally
not as good, so it is important to explore all available options before
having additional surgery.
Doctors consider revision surgery for two reasons: if medication and lifestyle
changes do not relieve pain and disability, or if x rays of the hip show that
damage has occurred to the artificial hip that must be corrected before it
is too late for a successful revision. This surgery is usually considered only
when bone loss, wearing of the joint surfaces, or joint loosening shows up
on an x ray. Other possible reasons for revision surgery include fracture,
dislocation of the artificial parts, and infection.
- What Types of Exercise Are Most Suitable for Someone With a Total Hip Replacement?
Proper exercise can reduce joint pain and stiffness and increase flexibility
and muscle strength. People who have an artificial hip should talk to their
doctor or physical therapist about developing an appropriate exercise program.
Most exercise programs begin with safe range-of-motion activities and muscle
strengthening exercises. The doctor or therapist will decide when the patient
can move on to more demanding activities. Many doctors recommend avoiding high-impact
activities, such as basketball, jogging, and tennis. These activities can damage
the new hip or cause loosening of its parts. Some recommended exercises are
cross-country skiing, swimming, walking, and stationary bicycling. These exercises
can increase muscle strength and cardiovascular fitness without injuring the
- What Hip Replacement Research Is Being Done?
To help avoid unsuccessful
surgery, researchers are studying the types of patients most likely to
benefit from a hip replacement. Researchers also are developing new surgical
techniques, materials, and designs of prostheses, and studying ways to
reduce the inflammatory response of the body to the prosthesis. Other
areas of research address recovery and rehabilitation programs, such as
home health and outpatient programs.
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National Institute of
Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse
NIAMS/National Institutes of Health
American Academy of Orthopaedic
The Hip Society
American Physical Therapy Association
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