Conservative Hip Solutionsby Dr. Paul E. Beaule
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Biological or "joint preserving" solutions are those that preserve your own living tissues.

In the active adult, consrvative treatment is recommended whenever possible, including biological solutions as well as prosthetic procedures.

Anterior Hip Joint (Figure 1)The hip joint is commonly called a "ball and socket" joint. The "ball" of the hip joint, the femoral head, rests within a "socket" called the acetabulum (See Figure 1). The femoral head and acetabulum are covered by a specialized surface, articular cartilage, which allows smooth and painless motion of the joint. With hip injury or disease, articular cartilage deteriorates and wears away. The joint surfaces become rough and irregular resulting in pain and stiffness. This is commonly known as "arthritis" but it has many causes including developmental dysplasia, osteonecrosis and femoro-acetabular impingement.

(Continued here from home page:) The labrum can tear suddenly as a result of a fall or by moving the hip to its upper limits of motion or it can tear gradually from repetitive stresses. The patient may experience catching or clicking associated with discomfort on the front of the hip. Pain may worsen with long periods of sitting. Only 1/3 of patients recall trauma to the hip joint.

A labral tear can also occur if the hip socket is shallow or as a result of impingement. In this condition, the labrum is trying to compensate for insufficient bone covering the femoral head and it is bearing the majority of the load. In this type of “hip dysplasia”, repairing the labral tear is not indicated as it will not solve the underlying cause (i.e., shallow socket) and an osteotomy needs to be considered. It should be noted that pure labral tears with no underlying hip malformation are rare in comparison to other conditions that necessitate hip repair, reconstruction or replacement.

The onset of pain is gradual and, initially, it occurs only after higher levels of physical activity. Pain gradually increases and may also become present at rest. Physical disability includes a limp, muscle spasm, and decreased range of motion with increasing stiffness. Treatment options include reducing stress on the hip, physical therapy, and medications. Weight reduction is highly desirable, since one pound weight loss equals three pounds in stress reduction on the hip while walking! The use of a cane or walking stick is also a very effective means of reducing stress on the hip. Physical therapy and exercises are directed at preserving muscle strength and range of motion within the limits of pain. Recommended medications include anti-inflammatory agents and supplements such as glucosamine.

Many patients ask the question: “Why has my hip become painful only now?” The best answer is that cartilage does have the capacity to function within an adverse environment for a period of time without the patient experiencing pain. However, at some point just as with tread on a tire, the cartilage begins to wear out and treatment becomes necessary.

Selection of the optimal treatment plan should be consistent with the degree of pain, the amount of hip disability, and the nonsurgical and surgical alternatives. The individual's anticipated life span will also influence the selection of treatment. In the younger, more active adult, conservative treatment is recommended whenever possible, including biological solutions as well as prosthetic procedures.

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