We specialize in hip care and advanced hip replacement techniques. Our very own Dr. David F. Scott, MD, is a specialist in this field. He consults with parts manufacturers and contributes significantly to ongoing research in hip treatment. He has also collaborated in many significant advances for hip replacement.
The hip joint is formed by the articulation of the rounded head of the femur and the cup-like acetabulum of the pelvis. Its primary function is to support the weight of the body in both static (e. g. standing) and dynamic (e. g. walking or running) postures. It forms the primary connection between the bones of the lower limb and the axial skeleton of the trunk and pelvis. Both joint surfaces are covered with a strong, lubricated layer called articular hyaline cartilage. A thin neck region attaches the shaft to the head of the femur which leads into the hip. This area is often prone to fracture in the elderly, mainly due to the degenerative effects of osteoporosis.
Overall, the hip joints are a determining factor in retaining balance. The pelvic inclination angle, which acts as the single most important element of human body posture, is adjusted at the hips.
What Causes Hip Problems?
The hip joint—the body’s largest ball-and-socket joint—fits together to allow for fluid movement. The ball-like top of your thigh bone moves within a cup-like space in your pelvis. For this reason, whenever the thigh bone moves in the hip socket, a cushion of cartilage helps prevent friction. The hip’s design thus promotes its ability to withstand repeated motion and a fair amount of wear and tear. Despite its durability, however, the hip joint isn’t indestructible. Due to age or use, injury or arthritis, the cartilage can wear down or become damaged. Muscles and tendons in the hip can get overused. The hip bone itself can fracture during a fall or other injury. Any of these conditions can lead to hip pain or problems.
How Do We Diagnose Hip Problems?
Evaluation may include
- Medical History
- Physical Examination
- Bone Scan
How Do We Treat Hip Problems?
Computer-aided surgery (navigation) has received much attention in recent years. This type of surgery involves a camera and computer system to guide the surgeon through the procedure. Proponents of computer-aided surgery believe that it gives the physician the opportunity to better customize the surgery for the patient’s specific anatomy. Researchers claim that this can allow for less invasive techniques and quicker recovery times. Dr. Scott was the first orthopaedic surgeon in the Inland Northwest to test computer-aided surgery technology. He also helped to develop the system for a major manufacturer. While this technique can be effective, however, it’s important to know that current non-computer-assisted techniques are also highly effective and can be preferable for many patients. Dr. Scott is an expert in this area of computer-assisted navigation. It’s important to talk with him about the most effective surgery technique for your needs.
Ceramic-on-Metal Hip Replacements
Ceramic-on-metal hip implants are a more recent development. Dr. Scott has completed important research on this type of hip replacement, making Orthopedic Specialty Clinic one of just 12 sites nationwide leading this clinical research. Early studies show a minimal amount of wear, making these implants a promising option for younger patients who need a durable hip that can last for decades. This ground-breaking technology is still in the process of receiving FDA approval, but Dr Scott‘s patients have already received access to its benefits.
Hip Implant Options
Many brands and several types of implants are available to patients in need of hip replacement surgery. Some manufacturers of these implants perform extensive advertising online. With such abundant information and so many choices available, however, it’s important to remember that Internet-based information can be confusing or misleading. Your physician should always help you identify your optimal treatment.
Dr. Scott will support you, therefore, in making the most informed decision regarding your care. He has years of experience with all the hip replacement options. In some cases, Dr. Scott has been involved in the design of new hip implant systems and can provide details to help you determine the option best suited to you. Hip implants vary according to your medical condition, age, gender, etc. Each implant has materials that attach to your leg bone (femur) and your hip socket (acetabulum). Common options include metal and polyethylene, ceramic-on-ceramic, and metal-on-metal materials. Patients may also choose between acrylic cement for bone adherence or non-cement implant options. Typically, older patients benefit from the cement options due to their weakened bones while younger patients can benefit from non-cement materials.
Minimally Invasive Surgery
True to its name, minimally invasive surgery seeks to minimize tissue damage and recovery times as much as possible. The term “minimally invasive” is used frequently in orthopaedics today, with some perceiving it to be more effective than traditional surgery. Taking a more balanced stance, however, Dr. Scott sees the ideal surgery as minimally traumatic rather than minimally invasive. Like building a model ship in an empty bottle, a procedure that focuses exclusively on minimal invasion (that is, the prioritization of a small incision) can be done. However, it doesn’t offer the surgeon much room to work. Without the complications of the small opening, the surgeon would gain more flexibility and freedom to build the best joint possible.
Dr. Scott’s approach to the surgery focuses on minimizing the damage to—and taking the best care of—the soft tissue within your joint. His minimally traumatic method is efficient, precise, and tailored to your body. Moreover, this efficiency translates to shorter surgery time for patients, quicker recovery and the lowest possible complication rate. This surgical focus isn’t on the size of your scar, but on the quality of the care you receive, the rapid healing you will experience, and the longevity of your successful surgery. Dr. Scott was one of the first surgeons in the Pacific Northwest to perform less-invasive, minimally traumatic hip and knee replacement. He has the experience required to provide patients the best possible care in the least traumatic way.
A recent innovation in hip implants is the concept of modular design. Because everyone’s body is different, it is often necessary to customize the implant design to individual anatomy. With modular implants, therefore, orthopaedic surgeons have the flexibility to select from a range of head, neck, and stem sizes, while remaining confident that the different components will operate together optimally. This benefits patients by allowing physicians to better match the implant to the patient’s natural body and movement. Dr. Scott has utilized modular hips for years to provide his patients better outcomes.
Biologic Reconstruction Alternatives – Surgical Dislocation and Debridement for FAI
Femoroacetabular Impingement (FAI) is a relatively newer diagnosis that describes a precursor condition to hip arthritis. Dr. Scott offers and performs procedures that treat this condition without requiring the implantation of prosthetic parts. These alternatives are expected to postpone or eliminate the need for future hip replacement for select patients with this condition.
Total Hip Resurfacing
Hip resurfacing is a newer surgical variation of hip replacement that may offer advantages to the younger patient. Much misleading information about hip resurfacing exists on the Internet, but several brands have been recently approved for sale and advertised in the U.S. Dr. Scott performed the first hip resurfacing procedure in the Inland Northwest. Hip resurfacing can be an excellent choice for a small subset of patients with hip arthritis. The team at Orthopaedic Specialty Clinic has the expertise and preparation needed to discuss the pros and cons of hip resurfacing with you.
What Are the Most Common Hip Problems?
Hip pain is a common problem, which can be confusing due to its many possible causes.
Osteoarthritis is the most common type of hip arthritis. Also called wear-and-tear arthritis or degenerative joint disease, osteoarthritis is characterized by progressive wearing away of cartilage in the joint.
Symptoms tend to progress as the condition worsens. However, patients can often experience good months and bad months or symptom changes corresponding to weather states.
The most common symptoms of hip arthritis are:
- Pain with activities
- Limited range of motion
- Stiffness of the hip
- Walking with a limp
- Physical examination
- Weight loss if necessary
- Activity modification
- Walking aids
- Physical therapy
- Anti-inflammatory medications
- Joint supplements
- Hip replacement surgery
- Hip resurfacing surgery: an alternative to hip replacement, some patients opt to pursue hip resurfacing or partial hip replacement, affecting only the arthritic element.
- Trochanteric Bursitis
Inflammation or irritation of the trochanter bursa (fluid-filled sac near a joint) at the outside point of the hip is a common condition which causes pain in the hip.
Symptoms of Pain:
- On the outside of the hip and thigh or in the buttock
- When you lie on the affected side.
- When you press in on the outside of the hip
- Worsening during activities such as getting up from a deep chair or exiting a car
- Walking up stairs
- Injury to the point of the hip: falling, bumping, or lying on one side for an extended period
- Overuse or injury
- Incorrect posture
- Stress on the soft tissues as a result of an abnormal or poorly positioned joint or bone
- Other diseases or conditions. These may include rheumatoid arthritis, gout, psoriasis, thyroid disease, or an unusual drug reaction. In rare cases, bursitis can result from infection.
- Previous surgery around the hip or prosthetic implants in the hip.
- Hip bone spurs or calcium deposits in the tendons that attach to the trochanter.
Goals of treatment:
- Pain reduction
- Inflammation reduction
- Preserving mobility
- Preventing disability and recurrence
Treatment recommendations may include a combination of:
- Heat and cold applications
- Nonsteroidal anti-inflammatory drugs
- Cortisone injections
- Physical therapy
When should you seek medical advice?
Most cases of bursitis improve without any treatment over a few weeks. See your health care provider if you have any of the following signs or symptoms:
- Pain that interferes with your normal day-to-day activities or have soreness that doesn’t improve despite self-care measures.
- Recurrence of bursitis
- Fever or redness, swelling, or warmth in the affected area
- In addition, see your doctor if you have other medical conditions that may increase your risk of an infection, or if you take medications that increase your risk of infection, such as corticosteroids or immunosuppressants.
Prevention is the best cure. Therefore, it is important to avoid or modify the activities that cause the problem. Additional, underlying conditions such as leg length differences, improper posture, or poor technique in sports or work must be corrected.
- IT Band Syndrome
IT Band Syndrome
Athletes are prone to developing an inflammation of the iliotibial (IT) band, a thick band of fibrous tissue that runs down the outside of the leg. The band functions in coordination with several thigh muscles to provide stability to the outside of the knee joint. When inflamed, the IT band does not glide easily, and pain associated with movement is the result. In particular, runners who suddenly increase their activity levels often develop IT band syndrome.
- Pain over the outside of the knee joint
- Swelling at the location of discomfort
- Snapping or popping sensation when the knee bends
- Anti-inflammatory medications
- Physical therapy
- Cortisone injection
- Surgery, in rare circumstances
- Osteonecrosis of the Hip
Osteonecrosis of the Hip
When the blood supply to the bone is disrupted, a painful condition called osteonecrosis of the hip develops. Without adequate nourishment to the bone, osteonecrosis can ultimately lead to destruction of the hip joint and arthritis. Although it can occur in any bone, the condition most often affects the hip. More than 20,000 people each year enter hospitals for treatment of osteonecrosis of the hip.
Osteonecrosis develops in stages. Typical symptoms include:
- Hip pain, including a dull ache or throbbing pain in the groin or buttock area
- Difficulty standing and weight bearing
Although nonsurgical treatment options like medications or crutches can relieve pain and slow the progression of the disease, the most successful treatments tend to be surgical. Patients are good candidates for hip preserving procedures when their osteonecrosis is caught in the very early stages (prior to femoral head collapse). Total hip replacement is typically very successful in relieving pain and restoring function for patients.
- Hip Snapping
Snapping hip syndrome, sometimes called dancer’s hip, occurs when you hear a snapping sound or feel a snapping sensation in your hip when you walk, run, get up from a chair, or swing your leg. For most people, the condition is little more than an annoyance, with the only symptom the snapping sound or sensation itself. For dancers or athletes, however, snapping hip syndrome symptoms may also include pain and weakness that interfere with performance.
- Decreased activity
- Over-the-counter pain relievers
- Physical Therapy
- Hip Fracture
- Inability to move immediately after a fall
- Severe pain in your hip or groin
- Inability to put weight on your leg on the side of your injured hip
- Stiffness, bruising and swelling in and around your hip area
- Shorter leg on the side of your injured hip
- Turning outward of your leg on the side of your injured hip
Treatment of a hip fracture almost always requires surgery.
- Stress Fracture of the Hip
Stress Fracture of the Hip
During running and other high-impact activities, the hip joint absorbs some of the greatest forces in the body. Repeated high-impact activities and overuse can result in a stress fracture—a break that occurs when minor injuries to the bone build up beyond its capacity to repair itself. Therefore, stress fractures of the hip are critical to diagnose and treat quickly. Without treatment, they can lead to severe damage to the hip joint, even in young athletes.
Symptoms include pain in the groin or front of the hip. If the stress fracture worsens, pain may become constant.
- Activity modification until symptoms resolve
- Surgery to stabilize the fracture in severe cases, where the fracture area is large or symptoms do not respond to rest