1. Treatment Options for Hip Pain

2. Anatomy of the Hip Ball and socket joint. Ball and socket joint. Femoral head or ball is at the end of thighbone or femur. Femoral head or ball is at the end of thighbone or femur. Socket or acetabulum holds the ball. Socket or acetabulum holds the ball. Source: www.jointreplacement.com, 2003www.jointreplacement.com

3. Hip Joint Healthy hip joint Healthy hip joint Arthritic hip jointArthritic hip joint

4. Causes of Hip Pain Osteoarthritis Osteoarthritis (Wear and tear) (Wear and tear) Avascular necrosis Avascular necrosis Abnormalities from fractures and congenital abnormalities Abnormalities from fractures and congenital abnormalities Source: www.allaboutarthritis.com, 2003www.allaboutarthritis.com

5. Symptoms of Hip Arthritis Pain Pain Dull, aching pain affecting the groin, outer thigh or buttocks. Dull, aching pain affecting the groin, outer thigh or buttocks. At rest or sleeping. At rest or sleeping. Stiffness and decreased movement Stiffness and decreased movement Bone spurs Bone spurs Source: www.aaos.org, 2003www.aaos.org

6. Preparing for Examination Have the following information ready for your exam: Have the following information ready for your exam: Chief complaint (Where it is hurting the most?) Chief complaint (Where it is hurting the most?) Chronology of illness Chronology of illness What effect does the pain have on your life? What effect does the pain have on your life? Family history Family history Source: www.arthritis.org, 2003www.arthritis.org

7. Diagnosing Hip Arthritis Physical examination and history Physical examination and history Magnetic Resonance Imaging (MRI) Magnetic Resonance Imaging (MRI) X-Rays X-Rays Blood tests Blood tests Blood Count Blood Count Rheumatoid Factor (for RA) Rheumatoid Factor (for RA) C-Reactive Protein C-Reactive Protein Source: www.allaboutarthritis.com, 2003www.allaboutarthritis.com

8. How Can My Life Change with Treatment? A return to mobility A return to mobility Regaining a sense of your former lifestyle Regaining a sense of your former lifestyle A change in pain symptoms A change in pain symptoms

9. Non-surgical Treatment Options for Hip Pain: Over-the-Counter Medications Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) Usually first drug used to treat arthritis Usually first drug used to treat arthritis Can reduce pain, swelling and redness Can reduce pain, swelling and redness Relief can take several months Relief can take several months Examples: Examples: ibuprofen ( Advil®, Motrin®) ibuprofen ( Advil®, Motrin®) naproxen ( Aleve®) naproxen ( Aleve®) Aspirin Aspirin Reduce joint pain and inflammation Reduce joint pain and inflammation Form of NSAIDs Form of NSAIDs Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

10. Non-surgical Treatment Options for Hip Pain: Over-the-Counter Medications Acetaminophen Reduces pain Reduces pain Lowers fever Lowers fever Does not reduce inflammation of arthritis Does not reduce inflammation of arthritis Examples: Examples: Tylenol ® Tylenol ® Datril ® Extra Strength Datril ® Extra Strength Tempra ® Tempra ® Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

11. Non-surgical Treatment Options for Hip Pain: Prescription Medications NSAIDS NSAIDS Most popular type for osteoarthritis treatment Most popular type for osteoarthritis treatment Includes ibuprofen ( Motrin ® ), naproxen sodium ( Anaprox ® ), oxaprozin (Daypro ® ), sulindac (Clinoril ® ), etc. Includes ibuprofen ( Motrin ® ), naproxen sodium ( Anaprox ® ), oxaprozin (Daypro ® ), sulindac (Clinoril ® ), etc. Analgesics Analgesics Provide pain relief, but do not reduce inflammation Provide pain relief, but do not reduce inflammation Includes Acetaminophen with codeine (Tylenol ® with Codeine), Oxycodone (OxyContin ®, Roxicodone ® ), Hydrocodone with acetaminophen (Vicodin ®, Dolacet ® ), etc. Includes Acetaminophen with codeine (Tylenol ® with Codeine), Oxycodone (OxyContin ®, Roxicodone ® ), Hydrocodone with acetaminophen (Vicodin ®, Dolacet ® ), etc. Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

12. Non-surgical Treatment Options for Hip Pain: Prescription Medications Biological Response Modifiers Biological Response Modifiers Treat rheumatoid arthritis; may postpone injury to the joints Treat rheumatoid arthritis; may postpone injury to the joints Includes: Infliximab (Remicade ® ), Etanercept (Enbrel ® ) Includes: Infliximab (Remicade ® ), Etanercept (Enbrel ® )Remicade ® Remicade ® Glucocorticoids or Corticosteroids Glucocorticoids or Corticosteroids Treat rheumatoid arthritis; fight inflammation Treat rheumatoid arthritis; fight inflammation Includes: cortisone, hydrocortisone (Cortef ®, Hydrocortone ® ), Prednisolone (Prelone ® ) Includes: cortisone, hydrocortisone (Cortef ®, Hydrocortone ® ), Prednisolone (Prelone ® ) DMARDS DMARDS Treat rheumatoid arthritis; slow joint destruction Treat rheumatoid arthritis; slow joint destruction Includes: methotrexate, injectable gold, penicillamine (Depen ® ), Azathioprine (Imuran ® ), etc. Includes: methotrexate, injectable gold, penicillamine (Depen ® ), Azathioprine (Imuran ® ), etc. Source: www. AllAboutArthritis.com, 2003www. AllAboutArthritis.com

13. Non-surgical Treatment for Hip Arthritis Cortisone Injections. Cortisone Injections. Powerful anti-inflammatory medication. Powerful anti-inflammatory medication. Temporary pain relief lasting several weeks to a month. Temporary pain relief lasting several weeks to a month. Assistive devices. Assistive devices. Walking (cane, walker). Walking (cane, walker). Getting around (seat lifts). Getting around (seat lifts). Bathing and hygiene. Bathing and hygiene. Dressing. Dressing. Rest and activity modification. Rest and activity modification. Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

14. Non-surgical Treatment for Hip Arthritis Physical therapy Physical therapy Help increase range of motion and maintain muscle tone. Help increase range of motion and maintain muscle tone. Swimming is good for hip arthritis patients. Swimming is good for hip arthritis patients. Weight control Weight control Foods with lower saturated fats help avoid swelling in tissue. Foods with lower saturated fats help avoid swelling in tissue. Eat a variety of foods from food groups. Eat a variety of foods from food groups. Avoid fad diets. Avoid fad diets. Source: www.allaboutarthritis.com, 2003www.allaboutarthritis.com

15. Surgical Options for Hip Pain Synovectomy Synovectomy Total hip replacement Total hip replacement Minimally invasive hip replacement Minimally invasive hip replacement Source: www.aaos.org, 2003www.aaos.org

16. Synovectomy Early stages of rheumatoid arthritis. Early stages of rheumatoid arthritis. Removes inflamed tissue lining. Removes inflamed tissue lining. Potentially saves joint from further damage. Potentially saves joint from further damage. Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

17. Synovectomy Small incision is made. Small incision is made. Arthroscope is used to inspect the joint. Arthroscope is used to inspect the joint. Diseased synovium is removed. Diseased synovium is removed. Physical therapy usually required. Physical therapy usually required. Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

18. Synovectomy Benefits Alleviates rheumatoid arthritis pain in the joint. Alleviates rheumatoid arthritis pain in the joint. Joint may be saved from further damage. Joint may be saved from further damage. Synovium could grow back over time. Synovium could grow back over time.Disadvantages Not a permanent solution. Not a permanent solution. Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

19. When is Hip Replacement Surgery Right for You? Experience significant pain and loss of function despite non-surgical treatments. Experience significant pain and loss of function despite non-surgical treatments. Typical patients have severe: Typical patients have severe: Rheumatoid Arthritis Rheumatoid Arthritis Osteoarthritis Osteoarthritis Hip fracture Hip fracture Source: www.allaboutarthritis.com, 2003www.allaboutarthritis.com

20. Hip Replacement Components Acetabular component, made of metal shell with a medical grade plastic or metal inner socket liner. Acetabular component, made of metal shell with a medical grade plastic or metal inner socket liner. Cup Shell Source: www.jointreplacement.com, 2003www.jointreplacement.com

21. Hip Replacement Components The femoral component (stem portion), is made of metal. The femoral component (stem portion), is made of metal. Femoral head is made either of metal or ceramic. Femoral head is made either of metal or ceramic. Neck Stem Head Source: www.jointreplacement.com, 2003www.jointreplacement.com

22. Hip Replacement: Cemented or Uncemented Cemented implant is held in place by a type of epoxy cement that attaches the metal to the bone. Cemented implant is held in place by a type of epoxy cement that attaches the metal to the bone. Uncemented implant has a fine surface (mesh of holes) allowing tissue to grow into. Uncemented implant has a fine surface (mesh of holes) allowing tissue to grow into. Source: www.jointreplacement.com, 2003www.jointreplacement.com

23. Choice Among Cups and Liners Cross-linked polyethylene- Cross-linked polyethylene- High medical grade plastic High medical grade plastic Strong Minimal debris Strong Minimal debris Metal Metal Usually titanium Usually titanium Strong Strong Matches your natural hip joint movement Matches your natural hip joint movement Ceramic Ceramic Least amount of debris Least amount of debris Less wear Less wear Most fragile Most fragile Source: www.jointreplacement.com, 2003www.jointreplacement.com

24. Benefits to Patient from Surgery Return to mobility Return to mobility Restores lifestyle Restores lifestyle Freedom Freedom

25. Total Hip Replacement The goal is to reduce hip pain and improve the motion in your hip. The goal is to reduce hip pain and improve the motion in your hip. More than 220,000 people in the United States annually undergo hip replacement surgery. More than 220,000 people in the United States annually undergo hip replacement surgery. Source: www.jointreplacement.com, 2003www.jointreplacement.com

26. Surgical Procedure Incision made on the side of the thigh. Incision made on the side of the thigh. Socket is re-shaped to fit new cup implant that replaces the diseased socket. Socket is re-shaped to fit new cup implant that replaces the diseased socket. New cup is placed in the socket. New cup is placed in the socket. Source: www.Allaboutarthritis.com, 2003www.Allaboutarthritis.com

27. Surgical Procedure Femur is prepared for the stem. Femur is prepared for the stem. Hip stem is implanted and the ball is put in place on top of stem. Hip stem is implanted and the ball is put in place on top of stem. Incision is closed. Incision is closed. Source: www.Allaboutarthritis.com, 2003www.Allaboutarthritis.com

28. Minimally Invasive Hip (MIH) Surgery New surgical technique. New surgical technique. Smaller incisions with traditional hip implant components. Smaller incisions with traditional hip implant components. Different techniques, including mini- incision and two-incision. Different techniques, including mini- incision and two-incision. Individual results may vary. There are potential risks and recovery can take time. The performance of any new joint will depend on your weight, activity level, age and other factors.

29. Different Techniques Used for MIH Two-incision Two-incision Two incisions of approximately 2 inches long on both the front and rear of the thigh. Two incisions of approximately 2 inches long on both the front and rear of the thigh. Mini-incision Mini-incision One incision generally 3 to 4 inches on the thigh. One incision generally 3 to 4 inches on the thigh. Two basic types of mini-incision: Two basic types of mini-incision: –anterior –posterior

30. Preparing for Joint Replacement Surgery Ease anxiety by mentally preparing with: Ease anxiety by mentally preparing with: Breathing exercises Breathing exercises Meditation Meditation Talking with friends and family Talking with friends and family Learn more about hip replacement surgery Learn more about hip replacement surgery Brochures Brochures Handouts Handouts Websites Websites Videos Videos Source: www.jointreplacement.com, 2003www.jointreplacement.com

31. The Night Before Surgery Avoid medications, such as “blood thinners” (aspirin, ibuprofen, etc.) Avoid medications, such as “blood thinners” (aspirin, ibuprofen, etc.) Do not consume any food or liquid after midnight. Do not consume any food or liquid after midnight. Make sure you have everything you’ll need at the hospital. Make sure you have everything you’ll need at the hospital. Ask any questions you may have before surgery. Ask any questions you may have before surgery. Source: www.jointreplacement.com, 2003www.jointreplacement.com

32. After Surgery Switch to a pain drug taken by mouth that you may need for up two weeks. Switch to a pain drug taken by mouth that you may need for up two weeks. Basic range-of-motion exercises are started. Basic range-of-motion exercises are started. Begin a physical therapy program a few days after surgery. Begin a physical therapy program a few days after surgery. Source: www.jointreplacement.com, 2003www.jointreplacement.com

33. Artificial Hip Dislocation Precautions Limited range of safe motion during healing process. Limited range of safe motion during healing process. For about 3 months, follow special safety rules to protect hip. For about 3 months, follow special safety rules to protect hip. Source: www.jointreplacement.com, 2003www.jointreplacement.com

34. Artificial Hip Dislocation Precautions Don't bend hip past 90 degrees. Don't bend hip past 90 degrees. Don't raise your leg in bed. Don't raise your leg in bed. Don't raise thigh past 90 degrees Don't raise thigh past 90 degrees Even when sitting or laying down. Even when sitting or laying down. Source: www.jointreplacement.com, 2003www.jointreplacement.com

35. Artificial Hip Dislocation Precautions, continued Don't bend too far when standing. Don't bend too far when standing. Source: www.jointreplacement.com, 2003www.jointreplacement.com

36. Artificial Hip Dislocation Precautions, continued Don't roll leg inward. Don't roll leg inward. Especially important when on side or turning in bed. Especially important when on side or turning in bed. Source: www.jointreplacement.com, 2003www.jointreplacement.com

37. Artificial Hip Dislocation Precautions, continued Don't turn foot of operated leg inward. Don't turn foot of operated leg inward. Keep toes pointed forward when standing, sitting or walking. Keep toes pointed forward when standing, sitting or walking. Source: www.jointreplacement.com, 2003www.jointreplacement.com

38. Hospital Discharge You will be released from the hospital as soon as you: You will be released from the hospital as soon as you: Use hospital precautions with all activities. Use hospital precautions with all activities. Get in and out of bed safely. Get in and out of bed safely. Walk with the right amount of weight on your hip using a walking aid. Walk with the right amount of weight on your hip using a walking aid. Do exercises by yourself. Do exercises by yourself. Expect a three or four day hospital stay after surgery. Expect a three or four day hospital stay after surgery. Source: www.jointreplacement.com, 2003www.jointreplacement.com

39. A Caregiver’s Role Provide support and show patience Provide support and show patience Help with needs that the patient can not do, like: Help with needs that the patient can not do, like: Dressing Dressing Bathing and Hygiene Bathing and Hygiene Everyday chores Everyday chores Walking Walking Source: www.jointreplacement.com, 2003www.jointreplacement.com

40. Recovery in the First Week Begin physical rehabilitation to regain strength in your hip. Begin physical rehabilitation to regain strength in your hip. Decrease medication because pain is decreasing. Decrease medication because pain is decreasing. Source: www.jointreplacement.com, 2003www.jointreplacement.com

41. Recovery in the First Month Expect some personal limitations on activities. Expect some personal limitations on activities. Important not to place too much stress on the hip. Important not to place too much stress on the hip. Motion exercises should be progressing. Motion exercises should be progressing. Source: www.jointreplacement.com, 2003www.jointreplacement.com

42. Recovery After Six Weeks You may begin participating in more activities. Limits are reduced. You may begin participating in more activities. Limits are reduced. Begin active range-of-motion exercises and move to strengthening exercises. Begin active range-of-motion exercises and move to strengthening exercises. Ability to return to work will depend on progress and type of work. Ability to return to work will depend on progress and type of work. Source: www.jointreplacement.com, 2003www.jointreplacement.com

43. Questions?

44. Thank You