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, contributes significantly to the ongoing research in this field, and has been a contributor to 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 and 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 but lubricated layer called articular hyaline cartilage.
The head of the femur which leads into the hip is attached to the shaft by a thin neck region that is often prone to fracture in the elderly, which is mainly due to the degenerative effects of osteoporosis. The hip joints are the most important part in retaining balance. The pelvic inclination angle, which is the single most important element of human body posture, is adjusted at the hips.
What Causes Hip Problems?
The hip joint is called a ball-and-socket joint because the ball-like top of your thigh bone moves within a cup-like space in your pelvis. This ball-and-socket joint — the body’s largest — fits together in a way that allows for fluid movement. The hip is designed to withstand repeated motion and a fair amount of wear and tear. Whenever you use the hip a cushion of cartilage helps prevent friction as the hip bone moves in its socket. Despite its durability, the hip joint isn’t indestructible. With age and use or arthritis, the cartilage can wear down or become damaged. Muscles and tendons in the hip can get overused. The hip bone itself can be fractured during a fall or other injury. Any of these conditions can lead to hip pain or problems.
How Are Hip Problems Diagnosed?
- Medical History
- Physical Examination
- Bone Scan
How Are Hip Problems Treated?
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. Claims are made that this allows less invasive techniques and quicker recovery times. Dr. Scott was the first orthopaedic surgeon in the Inland Northwest area to test and make use of computer-aided surgery technology and also helped to develop the system for a major manufacturer. While this technique can be effective, it’s important to know that current non-computer-assisted techniques are very effective and can be preferable for many patients. Dr. Scott is an expert in this area of computer-assisted navigation and it’s important to talk with him about the most effective surgery technique for your needs.
Ceramic-on-metal Hip Replacements
Ceramic-on-metal replacements are a more recent development in hip replacement. Dr. Scott has completed important research on this type of hip replacement and the Spokane Joint Replacement Center is one of just 12 sites nationwide leading this clinical research. Early clinical studies show a minimal amount of wear, making these implants a promising option for younger patients who will need a durable hip that can last for decades. This is not yet FDA-approved, but Dr Scott‘s patients were allowed access to this leading technology.
Hip Implant Options
There are many brands and several types of hip implants available to patients who need a hip replacement. Each implant option has materials that attach to your leg bone (femur) and your hip socket (acetabulum). There is abundant information available on the Internet, and some manufacturers of these implants perform extensive advertising. With so many choices out there, remember that your physician should help you identify the treatment you need. Some of the Internet material is confusing or misleading.
Dr. Scott can help you make the most informed decision regarding your care as he has years of experience with all the hip replacement options, and in some cases has been involved in their development. Hip implant options vary according to your medical condition, age, gender, etc. Implant options include materials made of metal, plastic, and ceramic and are adhered to the bone using acrylic cement or other non-cement options. Typically, older patients benefit from the cement options due to their weakened bones while younger patients can benefit from non-cement materials. Typical types of implant options include metal and polyethylene, ceramic-on-ceramic, and metal-on-metal. 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.
Minimally Invasive Surgery
Minimally invasive surgery is true to its name, seeking to minimize tissue damage and recovery times as much as possible. The term “minimally invasive” is used a lot in orthopaedics today, with some perceiving it to be more effective than traditional surgery. Dr. Scott sees it as minimally traumatic as opposed to minimally invasive: like building a model ship in an empty bottle – it can be done but it doesn’t leave you a lot of room to work in its small opening. If the complications of working through the small opening weren’t a factor, you would have a lot more flexibility and freedom to build the best ship possible.
Dr. Scott’s precise 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. This efficiency translates to shorter surgery time for patients, quicker recovery and the lowest possible complication rate. This kind of surgery isn’t about the size of your scar, but about 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 each situation. With modular implants, orthopaedic surgeons have the flexibility to select from multiple sizes of heads, necks, and stems while remaining confident that the different sizes will fit and work well together. This benefits patients greatly as it allows physicians to better match the implant to the patient’s natural body and movement. Dr. Scott has been utilizing 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 condition that is a precursor to hip arthritis. Dr. Scott is performing surgical procedures that treat this condition without requiring the implantation of prosthetic parts. This is expected to postpone or eliminate the need for hip replacement in the future for select patients with this condition.
Total Hip Resurfacing
Hip resurfacing is a newer surgical procedure. It is a variation of hip replacement that may offer some advantages to the younger patient. Dr. Scott performed the first hip resurfacing procedure in the Inland Northwest. Dr. Scott has found that there is a lot of misleading information about hip resurfacing on the Internet. Several brands have been approved for sale in the U.S. more recently, and there has been some advertising. Hip resurfacing is an excellent procedure for a small subset of patients with hip arthritis. Dr. Scott and his team at Spokane Joint Replacement Center are the best prepared to discuss the pros and cons of hip resurfacing with you.
What Are the Most Common Hip Problems?
Hip pain is a common problem, and it can be confusing because there are many 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 the cartilage of the joint.
Symptoms tend to progress as the condition worsens, however, patients often have good months and bad months or symptom changes with weather changes.
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 are opting to pursue hip resurfacing which is a partial hip replacement of only the arthritic element.
- Trochanteric Bursitis
Trochanteric bursitis is inflammation of the bursa (fluid-filled sac near a joint) at the outside point of the hip. When this bursa becomes irritated or inflamed, it causes pain in the hip and is very common.
Symptoms of Pain:
- On the outside of the hip and thigh or in the buttock
- When lying on the affected side.
- When you press in on the outside of the hip
- Gets worse during activities such as getting up from a deep chair or getting out of a car
- Walking up stairs
- Injury to the point of the hip: Falling, bumping or lying on one side for an extended period of time
- 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:
- Experience pain that interferes with your normal day-to-day activities or have soreness that doesn’t improve despite self-care measures.
- Have recurrence of bursitis
- You have a fever or the area affected appears red, swollen or warm
- 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. It is important to avoid or modify the activities that cause the problem. 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
Is 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 of the 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. Elite athletes are especially prone to developing IT band syndrome. Runners, in particular, who suddenly increase their level of activity 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, osteonecrosis can ultimately lead to destruction of the hip joint and arthritis. 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.
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 using crutches can relieve pain and slow the progression of the disease, the most successful treatment options are 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 around. For most people, the condition is little more than an annoyance and the only symptom is the snapping sound or sensation itself. But for dancers or athletes, snapping hip syndrome symptoms may also include pain and weakness that interfere with performance.
- Decrease in activity
- Using 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 highest forces in the body. Repeated high impact activities and overuse can result in a stress fracture of the hip. A stress fracture is a break in the bone that occurs when minor injuries to the bone build up beyond the capacity of the bone to repair itself. Stress fractures of the hip are critical to diagnose and treat quickly because 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
- Severe cases, where the fracture area is large or symptoms do not respond to rest, require surgery to stabilize the fracture