Hip pain in the active patient. Jason Cochran D.O. Michigan Orthopedic Center Sparrow Health System Lansing, MI

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1 Hip pain in the active patient Jason Cochran D.O. Michigan Orthopedic Center Sparrow Health System Lansing, MI

2 Who is the active patient?

3 Why do you hurt?

4 Goals Causes of hip pain Nonsurgical options Surgical options Final thoughts

5 Anatomy of a hip Socket Cartilage Labrum Ball Smooth weightbearing surfaces Smooth cartilage

6 Labral Tears Often misdiagnosed as groin pull Cartilage tears of the hip Common cause of pain in young athlete Mechanical symptoms of catching, clicking Similar to meniscal tear of knee

7 Labral Tears Diagnosed by exam Confirmed with MRI arthrogram

8 Impingement Developmental abnormality Can affect either the femoral head or the socket Can precede osteoarthritis

9 Impingement Occurs when the head is out of round! Leads to osteoarthritis

10 Osteoarthritis (OA) Wear and tear arthritis Symptoms of groin pain and lateral hip pain Often confused with groin pull, or a hernia

11 Osteoarthritis (OA) Joint becomes pitted, eroded Bone spurs form

12 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

13 Now that we know the problem, what do we do about it?

14 Non-surgical alternatives Lifestyle modification Exercise and physical therapy Antiinflammatory medication Ambulatory aids Ie: cane, walker

15 Non-surgical alternatives Most patients demand an active lifestyle

16 Surgical alternative Hip Arthroscopy Hip resurfacing Hip replacement Less invasive surgery Advanced bearing surface

17 Hip arthroscopy Overview Excellent option for hips Labral tears Loose cartilage Inflammation of the joint

18 Hip arthroscopy Benefits Smaller incisions Quicker recovery Outpatient surgery

19 Hip Resurfacing Two FDA approved BHR-Smith Nephew Cormet-Stryker 99.5% of patients were Pleased or Extremely Pleased with the results

20 Who is the typical candidate for Hip resurfacing? Adults under age 60 with active lifestyles Active adults over age 60 may be candidates, depending on their bone quality

21 What is Hip Resurfacing?

22 Hip Resurfacing Healthy hip Cuts Implant components Implanted

23 Is hip resurfacing Minimally invasive?

24 That depends on how you define Minimally Invasive. Soft Tissue No. Incision length of 6 to 8 inches Bone Yes. Preserves your body s natural bone structure; It resurfaces rather than replaces Conserved bone

25 The key benefits Head size Advanced bearing surface Bone conservation

26 Head Size and Bone Conserving Closely matches the size of your natural femoral head Preserves your natural femoral neck Total hip head Healthy head resurfaced head

27 Bone conservation (cont.) Revises to a primary If you need revision surgery, you don t get a revision implant The follow-up procedure would be the same total hip replacement you would otherwise have received

28 What other options do I have?

29 Conventional hip replacement Most successful surgery in orthopedics Up to 99% 10 year survivorship

30 Who is a candidate? Any patient with advanced arthritis Female patients >60 years old or males with osteoporosis

31 Conventional hip replacement Healthy hip Cuts Implant components Implanted

32 What has improved in hip surgery? Alternative bearings Less invasive approach Quicker recovery Better pain management Rapid recovery therapy

33 Alternative Bearing Surfaces Advances in bearing surfaces=less wear less wear=longer survival

34 Alternative Bearing Surfaces Wear of current ceramic and metal hip replacements are virtually immeasureable All-metal total hip replacements reduce joint wear by 97% versus metal on plastic total hips

35 Less invasive Incision Around 4 inches in length Smaller incisions=better pain control and decreased blood loss

36 Improved Rehab After 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

37 What can I do after surgery? During year-one: Lowimpact 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)

38 Final Thoughts? When and Who?

39 When should I have a Hip Replacement? Arthritis Pain that intereferes with Daily activities and Quality of Life All non-surgical treatment fails to relieve pain

40 Who should I choose to perform my Hip Replacement? Orthopedic Surgeon Regularly performs Hip Replacement Surgery Specialized Training? Fellowship? Someone you are comfortable with

41 Q&A Physician:Dr.Jason Cochran Practice: Michigan Orthopedic Center Address: 2815 South Pennsylvania avenue Contact:

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