Category: Hip

Signs It May Be Time For Hip Replacement©

When you have tried everything an all non-surgical treatments stop relieving your chronic hip pain, or your pain reaches debilitating levels, hip replacement surgery may be the best option to relieve your discomfort, restore your mobility and improve your quality of life.

Hip pain due to Osteonecrosis is an increasing problem for many.

After time over-the-counter pain medications can lose their efficacy and chronic hip pain can quickly escalate often requiring prescription medications, physical therapy, and the use of canes or walkers to aid mobility.

If your pain is severe and debilitating, isn’t it time to do something about it.

Talk to your Doctor or Orthopedic because you don’t need to suffer and have a poor quality of life.

What Signs & Symptoms Indicate a Need for Hip Replacement Surgery?

Hip pain can have a number of causes, not all of which can be relieved by a hip joint replacement.

Among the listed causes of AVN are steroid use, trauma, hypertension, rheumatoid arthritis, and alcoholism, blood clot disorder, smoking, vasculitis Bisphosphonate use, Chemo or radiation or it could be idiopathic, meaning no cause can be determined. Certainly Napoli has had his share of wear and tear, being a catcher.

For instance, constant or long-lasting stiffness in your hip joint can be a sign of rheumatoid arthritis while pain that centers in the buttocks region and radiates down the leg may be related to sciatica.

However, many cases of hip pain and discomfort are directly related to your hip joint.

Symptoms and signs that it may be time for hip replacement surgery include:

• Mobility issues, especially if your level of mobility progressively worsens

• Persistent or recurring pain, swelling or discomfort in your hip

• Hip pain that worsens during rainy weather

• Inability to sleep due to hip pain and discomfort

• A “grating” feeling in your hip joint

• Increasing difficulty in climbing stairs or getting in and out of cars, bathtubs, and chairs

• OTC medications no longer effectively manage your hip pain

If you have any or all of these symptoms, talk to an orthopedic surgeon about the possible need for hip replacement surgery.

How Is a Diagnosis Made?

To determine if you are a good candidate for hip replacement surgery, you will need a thorough examination by an experienced orthopedic surgeon. This examination will include:

• A complete medical history evaluation, including any previous injuries or illnesses that could be contributing to your pain

• A physical assessment to determine your range of motion, pain level and the strength of your affected hip

Your orthopedic surgeon may also order additional medical testing, including MRIs and X-rays. If your surgeon decides that the next step is hip replacement surgery, be sure to discuss any questions or concerns you have about the surgery or recovery from hip replacement surgery.

What Do You Need to Know About Hip Replacement Surgical Procedures?

Potential candidates for hip replacement surgery need to know that the surgery is a time-tested procedure that has been used successfully for more than four decades to relieve chronic hip pain and improve both flexibility and mobility. More than 300,000 Americans opt for hip replacement surgery each year to rid themselves of hip pain and improve their quality of life.

Total hip replacement surgery, or total hip arthroplasty, uses a ball and socket prosthetic joint to replace your damaged one. Special metals, such as cobalt-chromium and titanium, and polyethylene plastics, are used to make your prosthetic joints. These materials are safe for use inside the body and are extremely durable and long lasting.

The procedure for your total hip replacement surgery will most likely include the following steps:

1 Separating your femur from your hip socket

2 Removing the damaged ball from the femur

3 Removing your damaged bone and cartilage

4 Inserting a metal shell into your pelvic bone socket and using bone grafting material to secure it

5 Completing the artificial socket by adding the plastic liner

6 Preparing your femur to receive the metal implant

7 Placing the metal implant into the hollowed end of your femur

8 Attaching a metal ball component to the stem

Hip replacement surgery is a very effective procedure, and most patients experience a dramatic reduction in pain and improvements in their mobility and stamina. With the proper recovery procedures and physical therapy, you should be able to enjoy walking, swimming, biking and other low-impact activities without impediment.

 

If you can no longer bare the pain or have problems walking talk to your ortho about your options.

 

Good luck

We’re praying for you

Text ©Debla2014

 

Is Your Hip Pain The Sign of a Rare Condition?

Your hips are largest and most powerful of muscle groups—the glutes, quads, and hamstrings—all connect at the hips, and they allow you to walk, run, climb. The hip joint is crucial to all movement, in sports and day-to-day life, which is why persistent hip pain can be such a pain in the ass literally and often debilitating.

hip

 

Wear and tear on your hip joint can worsen with age. According to the Centers for Disease Control and Prevention, 7 percent of adults in the U.S. suffer from hip pain, the third most common joint pain behind shoulder pain, at 9 percent, and knee pain, at 18 percent. There’s also a growing prevalence of young athletes with hip injuries, especially young women, due to repetitive overuse and acute trauma.

Trauma can sometimes lead to osteonecrosis  in any joint but we are focusing on the hip , and some of the medications given to help inflammation and strengthen bones can also be a cause of osteonecrosis aka avascular necrosis.

Your Hip Pain May be the Sign of a Rare Condition

If you have hip pain don’t always brush it off as arthritis, if it persists, get it checked out to be safe

Persistent or worsening hip pain warrants a visit to your health care provider and possibly a sports medicine specialist or ortho. Some problems, particularly hip stress fractures, are commonly misdiagnosed due to the confusing presentation of symptoms.

 

A thorough evaluation is necessary and often includes X-rays and other studies, such as an MRI or bone scan. As with all injuries, the absence of pain does not mean that all is well. Strength and flexibility deficits must be addressed to allow a healthy return to helping your quality of life.

 

 

Although a person may not initially experience symptoms, hip pain is usually the first indicator. The earlier the diagnosis is achieved, the better the patient’s potential outcome. AVN has four stages that can progress over a period of several months to more than a year. In Stage I, the hip is healthy; in Stage II, the patient experiences mild to moderate pain in direct proportion to the deterioration of the head of the femur (or ball of the hip joint). By Stage III, usually the patient will find it difficult to stand and bear weight on the hip, and joint movement will be painful. During this stage, the ball of the hip has deteriorated to what is called a subchondral fracture and early collapse. Stage IV is a full collapse of the femoral head and degenerative joint disease (DJD).

 

Treatment for AVN is recommended based on the stage of the disease coupled with the age of the patient. In Stage I, medication and crutches may be prescribed to provide relief and enable the bone to heal on its own. This treatment may require the patient to be non-weight-bearing for up to six months. It also has a failure rate greater than 80-percent.

On the horizon treatments are stem cell.

 

Surgical treatment is recommended with a Stage II diagnosis, or very early in a Stage III diagnosis. A procedure, known as a core decompression, typically involves drilling one large hole in the core of the effected bone, with or without a bone graft, to reduced pressure and improve blood circulation in the hip. Another surgical option is the vascularized fibular graft, which takes a healthy piece of bone from the fibula, along with the artery or vein, and transplants and reattaches it into the hip, to help healthy bone grow. Recovery can take several months.

 

Because most patients are diagnosed in late Stage III or IV of the disease, when the bone quality of the femoral head is poor (subchondral fracture) or has collapsed, total hip replacement is the most successful treatment for AVN. This procedure replaces the damaged bone with artificial parts. Recovery takes about eight to twelve weeks. If left untreated, AVN progresses and results in pain and severe debilitating osteoarthritis.

Treatment decisions for AVN are ultimately up to the patient and are based on his or her lifestyle and goals. If you are suffering with hip pain, talk with your primary care doctor about a referral to an orthopedic surgeon

Hip Osteonecrosis -Stages- Info

Osteonecrosis of the Hip

Osteonecrosis of the hip is a painful condition that occurs when the blood supply to the head of the femur (thighbone) is disrupted. Because bone cells need a steady supply of blood to stay healthy, osteonecrosis can ultimately lead to destruction of the hip joint and severe arthritis.

Osteonecrosis is also called avascular necrosis (AVN) or aseptic necrosis. Although it can occur in any bone, osteonecrosis most often affects the hip. More than 20,000 people each year enter hospitals for treatment of osteonecrosis of the hip. In many cases, both hips are affected by the disease. 

Doctor Examination

After discussing your symptoms and medical history, your doctor will examine your hip to discover which specific motions cause your pain.

Patients with osteonecrosis often have severe pain in the hip joint but relatively good range of motion. This is because only the femoral head is involved in the earlier stages of the disease. Later, as the surface of the femoral head collapses, the entire joint becomes arthritic. Loss of motion and stiffness can then develop.

Osteonecrosis is typically seen as a wedge-shaped area with a dense whitish sclerotic border in the superior lateral portion of the femoral head. On lateral view, a lucent line called a “crescent sign” can often be seen just below the surface of the femoral head. 

Magnetic resonance imaging (MRI) scans.Early changes in the bone that may not show up on an x-ray can be detected with an MRI scan. These scans are used to evaluate how much of the bone is affected by the disease. An MRI may also show early osteonecrosis that has yet to cause symptoms (for example — osteonecrosis that may be developing in the opposite hip joint). 

Stages of Avascular Necrosis-Osteonecrosis Hip

photo credit AAOS American Academy of Orthopaedic Surgeons

Video Link of Stages of Avascular Necrosis-Osteonecrosis Hip

Dr Nabil Ebraheim Shows Info on Hip Avascular Necrosis

You can have Avascular Necrosis in one hip or both , if in both hips it’s called bilateral which means both sides.

And if you have Avascular Necrosis- osteonecrosis in more that 3 different joints

Multifocal osteonecrosis is defined as disease involving three or more anatomic sites.

Example

Hips

Knees

Shoulder

That is called multi focal Avascular Necrosis- Osteonecrosis

Read more

Multifocal osteonecrosis Article in The Journal of Rheumatology 25(10):1968-74 · November 1998

Multifocal ON, which ON involves three or more distinct anatomical sites [5], is rare, being seen in only approximately 3% of all ON patients [5]. Corticosteroid use is a known risk factor for multifocal ON [5,6], as are certain comorbidities, including systemic lupus erythematosus (SLE), renal failure, leukemia, and lymphoma [5,7,8]. However, almost all studies of multifocal ON are case reports and case series, so the inci- dence and clinical characteristics of the condition remain poorly defined [5,[8][9][10][11][12][13]. …

Non-operative Treatment

There is no known pharmaceutical cure for osteonecrosis. Several non-operative treatments have been studied including hyperbaric oxygen therapy, shock wave therapy, electrical stimulation, pharmaceuticals (anticoagulants, bisphosphonates, vasodilators, lipid lowering agents), physiotherapy and muscle strengthening exercises, and combinations thereof. There are conflicting results for some of these treatments, therefore, rigorous, randomized controlled trials with large numbers of patients are still needed to determine the effectiveness of these treatments. Non-operative treatment may be part of a wait-and-see approach based on the size of the area of dead bone. Non-operative treatments cannot be labeled as conservative, since many of them do not slow the progression of the disease or lead to avoidance of a total hip arthroplasty. Most are simply pain-relieving at best.

Reduced weight bearing does not alter the course of the disease and is not a treatment. It may be used to simply permit the patient to better cope with pain until appropriate treatment is instituted. 

Surgical Treatment

Core decompression – This surgical procedure removes or drills a tunnel into the area of the affected bone, which reduces pressure within the bone. Core decompression works best in people who are in the earliest stages of osteonecrosis, before the collapse of the dead bone. This procedure sometimes can reduce pain and slow the progression of bone and joint destruction in these patients.

Osteotomy – This surgical procedure reshapes the bone to reduce stress on the affected area. There is a lengthy recovery period, and the patient’s activities are very limited for 3 to 12 months after an osteotomy. This procedure is most effective for patients with advanced osteonecrosis and those with a small area of affected bone.

Bone graft – Bone grafts can be used as part of the surgical treatment for osteonecrosis. Bone grafts can use bone from the same patient or donor bone. Bone graft or synthetic bone graft can be inserted into the hole created by the core decompression procedure. A specialized procedure, called vascularized bone grafting, involves moving a piece of bone from another site (often the fibula, one of the bones of the calf, or the iliac crest, a portion of the pelvic bone) with a vascular attachment. This allows for support of the diseased area as well as a new source of blood supply. This is a complex procedure and is performed by surgeons that are specially trained. Another type of bone grafting, involves scraping out all of the dead bone and replacing it with healthier bone graft, often from other portions of the patient’s skeleton. 

A unique type of bone graft involves the use of a patient’s own cells that are capable of making new bone. Often these cells are a type of stem cell from the bone marrow or other bodily tissues. There has been increasing interest in the potential of stem cell therapy. This is also being studied for the treatment of osteonecrosis. Mesenchymal stem cells, which are a type of ‘adult’ stem cell, can grow and develop into many different cell types in the body. Physicians take the patient’s own mesenchymal stem cells (autologous transplant) and place them into the affected bone to stimulate bone repair and regeneration.

Arthroplasty/total joint replacement – Total joint replacement is the treatment of choice in late-stage osteonecrosis when the joint is destroyed. In this surgery, the diseased joint is replaced with artificial parts. It may be recommended for people who are not good candidates for other treatments, such as patients who do not do well with repeated attempts to preserve the joint. Various types of replacements are available, and people should discuss specific needs with their doctor.

For most people with osteonecrosis, treatment is an ongoing process. Doctors may first recommend the least complex and invasive procedure, such as protecting the joint by limiting high impact activities, and watch the effect on the patient’s condition.

Other treatments then may be used to prevent further bone destruction and reduce pain such as core decompression with bone graft/stem cell therapy. Eventually patients may need joint replacement if the disease has progressed to collapse of the bone. It is important that patients carefully follow instructions about activity limitations and work closely with their doctor to ensure that appropriate treatments are used.

Investigational Therapies

Scientists, researchers, and physicians continue to pursue a better understanding of how this disease occurs as well as compare the effectiveness of current and newly developed therapies. Often, this requires a clinical trial to answer questions and gain additional knowledge.

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site. 

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Toll-free: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today? A Ten-Year Update.

By Dr. Michal Mont MD

There is hope

Treatment

The goal is to prevent further bone loss.

Medications and therapy

In the early stages of avascular necrosis, symptoms might be eased with medication and therapy. Your doctor might recommend:

  • Nonsteroidal anti-inflammatory drugs.Medications, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) might help relieve the pain associated with avascular necrosis.
  • Osteoporosis drugs. Medications, such as alendronate (Fosamax, Binosto), might slow the progression of avascular necrosis, but the evidence is mixed.
  • Cholesterol-lowering drugs. Reducing the amount of cholesterol and fat in your blood might help prevent the vessel blockages that can cause avascular necrosis.
  • Blood thinners. If you have a clotting disorder, blood thinners, such as warfarin (Coumadin, Jantoven), might be recommended to prevent clots in the vessels feeding your bones.
  • Rest. Reducing the weight and stress on your affected bone can slow the damage. You might need to restrict your physical activity or use crutches to keep weight off your joint for several months.
  • Exercises. A physical therapist can teach you exercises to help maintain or improve the range of motion in your joint.
  • Electrical stimulation. Electrical currents might encourage your body to grow new bone to replace the damaged bone. Electrical stimulation can be used during surgery and applied directly to the damaged area. Or it can be administered through electrodes attached to your skin.

Surgical and other procedures

Because most people don’t develop symptoms until avascular necrosis is fairly advanced, your doctor might recommend surgery. The options include:

  • Core decompression. The surgeon removes part of the inner layer of your bone. Besides reducing your pain, the extra space within your bone stimulates the production of healthy bone tissue and new blood vessels.
  • Bone transplant (graft). This procedure can help strengthen the area of bone affected by avascular necrosis. The graft is a section of healthy bone taken from another part of your body.
  • Bone reshaping (osteotomy). A wedge of bone is removed above or below a weight-bearing joint, to help shift your weight off the damaged bone. Bone reshaping might enable you to postpone joint replacement.
  • Joint replacement. If your diseased bone has collapsed or other treatments aren’t helping, you might need surgery to replace the damaged parts of your joint with plastic or metal parts.
  • Regenerative medicine treatment. Bone marrow aspirate and concentration is a newer procedure that might be appropriate for early stage avascular necrosis of the hip. Stem cells are harvested from your bone marrow. During surgery, a core of dead hipbone is removed and stem cells inserted in its place, potentially allowing for growth of new bone. More study is needed.

Talk to your doctor about treatment options and the stage of your Avascular Necrosis of the Hip.

If this helped you please like comment or share this.

Thank You

Wishing you a pain free day

Debbie