Jason Cochran D.O.
Michigan Orthopedic Center
Sparrow Health System
Lansing, MI
517-267-0200
Hip pain in the active patient
Who is the active patient?
Why do you hurt?
Goals
Causes of hip painNonsurgical optionsSurgical optionsFinal thoughts
Socket– Cartilage – Labrum
Ball– Smooth weight-
bearing surfaces
Smooth cartilage
Anatomy of a hip
Labral Tears
Often misdiagnosed as “groin pull”Cartilage tears of the hipCommon cause of pain in young athleteMechanical symptoms of catching, clickingSimilar to meniscal tear of knee
Labral Tears
Diagnosed by examConfirmed with MRI arthrogram
Impingement
DevelopmentalabnormalityCan affect either the femoral head or the socketCan precedeosteoarthritis
Impingement
Occurs when the head is out of round!Leads toosteoarthritis
Osteoarthritis (OA)
• “Wear and tear”arthritis
• Symptoms of groin pain and lateral hip pain
• Often confused with groin pull, or a hernia
Osteoarthritis (OA)
• Joint becomes pitted, eroded
• Bone spurs form
Avascular necrosis (AVN)
– Caused when there is a disruption of the blood supply to the hip
– Leading causes: Alcohol, corticosteroids(asthmatics, chronic lung disease), unknown
– Other risk factors: blood vessel blockage due to sickle cell anemia, or from trauma
Now that we know the problem, what do we do about it?
Non-surgical alternatives–Lifestyle
modification–Exercise and
physical therapy–Anti-
inflammatorymedication
–Ambulatory aidsIe: cane, walker
Non-surgical alternatives
Most patients demand an active lifestyle
Surgical alternative
Hip ArthroscopyHip resurfacingHip replacement– Less invasive surgery– Advanced bearing surface
Hip arthroscopy
OverviewExcellent option for hipsLabral tearsLoose cartilageInflammation of the joint
Hip arthroscopy
BenefitsSmaller incisionsQuicker recoveryOutpatient surgery
Hip Resurfacing– Two FDA approved– BHR-Smith Nephew– Cormet-Stryker– 99.5% of patients
were “Pleased”or “Extremely Pleased”with the results
Who is the typical candidatefor Hip resurfacing?
– Adults under age 60 with active lifestyles
– Active adults over age 60 may be candidates, depending on their bone quality
What is Hip Resurfacing?
Hip Resurfacing
Healthy hip Cuts Implantcomponents
Implanted
Is hip resurfacing Minimally invasive?
That depends on how you define “Minimally Invasive.”
– Soft TissueNo. Incision length of 6 to 8 inches
– BoneYes. Preserves your body’s natural bone structure; It resurfaces rather than replaces
Conserved bone
The key benefits– Head size– Advanced bearing
surface– Bone conservation
Head Size and Bone Conserving
Closely matches the size of your natural femoral head
Preserves your natural femoral neck
Healthy headresurfaced head
Total hip head
Bone conservation (cont.)
– Revises to a primary
If you need “revision” surgery, you don’t get a revision implantThe follow-up procedure would be the same total hip replacement you would otherwise have received
What other options do I have?
Conventional hip replacement
Most successful surgery in orthopedicsUp to 99% 10 year survivorship
Who is a candidate?
Any patient with advanced arthritisFemale patients >60 years old or males with osteoporosis
Conventional hip replacement
Healthy hip Cuts Implantcomponents
Implanted
What has improved in hip surgery?
Alternative bearingsLess invasive approachQuicker recovery – Better pain
management– Rapid recovery therapy
Alternative Bearing Surfaces
Advances in bearingsurfaces=less wearless wear=longer survival
Alternative Bearing Surfaces
Wear of current ceramic and metal hip replacements are virtuallyimmeasureableAll-metal total hip replacementsreduce joint wear by 97% versus metal on plastic total hips
Less invasive
Incision– Around 4 inches in
length
Smallerincisions=better pain control and decreased blood loss
Improved RehabAfter surgery
– Patients undergo a rapid recovery protocol
– Better pain management protocols
– Up at bedside that day– Walking the next day– Achieve Therapy goals by
post op day one or two
What can I do after surgery?
– During year-one: Low-impact activities as your bone and muscles adjust to the new stresses (swimming, walking, bicycling)
– After year-one: Higher impact physical activity may be appropriate (doubles tennis, jogging)
Final Thoughts?
When and Who?
When should I have a Hip Replacement ?ArthritisPain that interefereswith Daily activities and Quality of LifeAll non-surgical treatment fails to relieve pain
Who should I choose to perform my Hip Replacement?
Orthopedic Surgeon– Regularly performs Hip Replacement Surgery– Specialized Training?– Fellowship?– Someone you are comfortable with
Q&APhysician:Dr.Jason Cochran Practice: Michigan Orthopedic CenterAddress: 2815 South Pennsylvania avenueContact: 517-267-0200