ARTHRITIS IN THE HIP

What better way to start my blog than with a home run! He did it! Barry Bonds finally broke Hank Aaron's home run record with number 756 out of the park, making Bonds the official "Home Run King". Some people say he had help from steroids, and I know that debate will rage on, but let's put that aside and congratulate the man on his perseverance, his dedication to the sport, and his tremendous ability to hit the ball. Another man whose dedication to the sport is both admirable and ferocious is Pat Riley. Who could ever forget the Showtime Lakers? They were unstoppable. Riley has had an amazing career- from a player, to a coach, to management, to coach again - and he remains one of the most successful coaches in NBA history. This past year was a difficult one for him with his decision to have hip surgery AND knee surgery within weeks of each other. Can we blame the Heat's poor performance on Pat's absence? It might have something to do with it, but I'll leave that debate to someone else and focus on today's topic: hip injuries, hip pain, and arthritis.

Let's talk about arthritis in the hip. Now, this is a different sort of pain than feeling soreness when you stand from a sitting position or when you first wake up in the morning. Arthritis in the hip joint is usually related to ortheoarithis, otherwise known as degerative arthritis. It happens when the cartilage between the femoral head (the ball portion of the hip joint) and the acetabulum (the cup portion of the hip joint) wears away, leaving the two bones to scrape against each other. After time, the joint becomes pitted, eroded and uneven. As the protecting cartilage of the bone disintegrates, new bone, or spurs, which are called osteophytes, develop. The result is pain, stiffness and instability. In some cases, motion of the leg may be greatly restricted. This condition is commonly referred to as "wear and tear" arthritis. Although the degenerative process may accelerate in persons with a previous hip injury, many cases of osteoarthritis occur with the natural process of aging, and the hip simply wears out. Yes, we are all headed that way, and I'll tell you the symptoms and what you can do to slow down the inevitable. (No, it's not Botox).

The first and most common symptom of osteoarthritis is pain in the hip or groin area during weight bearing activities such as walking. People with hip pain usually compensate by limping, or reducing the force on the arthritic hip. As the condition worsens, the pain may be present all the time, even during non weight-bearing activities, like sitting. Eventually, shortening of the leg can occur and the discomfort becomes continual - so not only are you walking like a penguin, you're in a load of pain each and every minute, even sleeping can be difficult.

People often confuse hip pain with knee pain, and think their knees have gone bad, when in fact, it's their hip that's giving out. I've had many patients, relatively young people in their mid-50’s, who come to me thinking they need knee replacement surgery, and upon examination, I’ve found the pain source to be their hip. Not infrequently, people who have arthritis of the hip can flex, extend, or bend and straighten their hip, but when they are turning or twisting they notice most of the pain. For example, getting out of a car, crossing their legs, even pushing a vacuum.

A person may deal with this condition for months or even years before seeking treatment. Usually, the pain reaches such severe levels that your everyday life is disrupted and you are left with no choice but to have surgery. This is what happened to Pat Riley, and I'm pretty sure his kicking lockers didn't help. Pat was a worse case scenario, hip degeneration doesn't always lead to hip replacement surgery, there are other treatment options before surgery becomes necessary.

I recommend my more sedentary patients start with light stretching every day. For more active patients, I suggest an exercise program such as stationary biking, swimming or walking. If you are currently exercising, I would modify your workouts and certainly stop all types of exercise which directly hurt your hip, such as basketball, baseball, and running - let your body be your guide here - if it hurts while doing a certain activity, stop! For overweight patients, a weight reduction is absolutely necessary, the less of you there is, the less stress your joints and bones will feel, so say goodbye to the Krispy Kremes for a while. Anti-inflammatory medications will also help to releive the pain. These include over the counter medications like Aleive, motrin and aspirin. Check with your doctor before taking any prescription anti-inflammatory medications.

Another cause, although much less common, of degenerative arthritis is a dislocation of the hip. Rarely do hips dislocate, it takes quite a significant or violent occurrence for that to happen. I think I've only seen two or three traumatically dislocated hips in the 25 years that I've practiced orthopedic surgery. One that I recall quite vividly was a tennis player who lunged for a ball, twisted in an awkward position, and dislocated his hip. Ouch doesn't cover it! Even after the hip joint is put back into place, a loss of fit between the femoral head and the acetabulum can occur. This results in thinning or complete loss of the cartilage, limitation of joint motion, continual pain and disability, all of which can actually lead to shortening of the leg. Hip replacement surgery is a legitimate option at this point.

Dislocation of the hip can bring some very serious consequences. You can injure the sciatic nerve, fracture the rim of the pelvis around the socket (acetabulum), or disrupt the blood supply to the femoral head - sometimes to the point where the round ball portion will actually start to decay and crumble. This is a condition referred to as avascular necrosis (AVN) or osternecrosis - literally, death of the bones. Osteonecrosis occurs when your bones lose their blood supply, die and eventually collapse, which leads to a certain type of arthritis called osteoarthritis.

Other causes of AVN can be related to high doses of steroids. We're not talking about anabolic steroids, like the ones Barry Bonds was accused of taking. These are called corticosteroids, and they are drugs closely related to cortisol, a hormone which is naturally produced in the adrenal cortex - the outer layer of the adrenal gland. Your adrenal gland is a triangle-shaped gland that sits on top of your kidneys, and it is responsible for regulating your stress responses. So, when your body has a tramautic injury, like a hip dislocation, the adrenal gland kicks in to help. Sometimes, you need more help than the body can supply, thus the use of corticosteroids. These types of steroids are used in the treatment of everything from joint pain and arthritis to dermatitis, brain tumors and inflammatory bowel disease. One of the more unfortunate side effects of these steroids is that the blood supply to the hip joint can be impaired. It's sort of a catch-22 situation.

Another cause of hip degeneration is the use of alcohol. I've seen several patients who for one reason or another increased their alcohol consumption and suddenly they're dealing with hip pain. Well, alcohol can interrupt the blood supply to the hip joint, and excessive alcohol will most likely cause you more than a hangover. How much is too much? It does vary from person to person, but if you are concerned, I would limit imbibing to one drink per day. If you can leave alcohol all together, I would recommend abstinence, and in this case instead of making the heart grow fonder, it'll make your hips feel better!