DO YOU NEED A HIP JOINT REPLACEMENT?

People don't generally think of back or joint pain as the end of the world. I wish they knew better. Joint pain can be so agonizing that the sufferer would yell "Oh Lord! Could you cut off this darn leg of mine? I can't stand it anymore!"

(HIP JOINT REPLACEMENT)

The right time for surgery

Well, cutting the leg off certainly sounds too drastic, but replacing the old joint with an artificial one is certainly feasible. But first, let’s see when it makes sense and what can be done to avoid surgery. Hip joint pain often starts with a persistent piercing pain in the groin area that extends along the inner thighs. The patient has difficulty rising and walking.   At first, these symptoms will come and go, but the outcome is permanent pain and stiffness.

The hip joint connects the lower limbs with the pelvis. This largest and the most heavily loaded joint in the human body relies on the ball-socket design. Its cavity is filled with a viscous lubricant.

Here is a typical example. Sergey, 56, a taxi driver, enjoyed skydiving in his youth. He experienced a few rough landings but does not remember any major injuries. Five years ago, as he tried to lift a heavy suitcase, his back suddenly started hurting and he could not straighten himself up for three days. Though the condition slowly went away, his back problems would periodically recur. A year ago, as he was getting into the car, Sergey felt piercing pain ("like from a dull needle") in the groin area. It returned with almost every effort to stand up or sit down. As the pain became unbearable, he sought medical help -- but all physical therapy and chiropractic treatments failed. An injection of a steroid hormone by an orthopedic surgeon brought him some relief for a few weeks. Regrettably, the pain slowly returned with a vengeance.  The surgeon suggested a hip joint replacement.

Don’t make a mountain out of a molehill:  hip joint replacement is a fairly routine procedure whose methodology keeps improving every year.

So, what are the key arguments for having your hip joint replaced? First of all, do not to make a mountain out of a molehill. Hip joint replacement is a complicated yet fairly routine procedure. Its methodology keeps improving with every year. The share of patients with complications is dropping steadily, millions of people have got rid of pain and regained their ability to walk.

The principal issue is how badly you need this surgery. Pain is a less important criterion than the extent of degeneration, wear, and deformation of the joint as evidenced by radiography and MRI. If the shape of the joint surfaces has visibly changed, it's too late for physical therapy. Surgery is the only option. 

But is there an alternative?

Since Sergey's X-ray images showed no distinct changes, the surgeon offered to postpone the operation pending further deterioration. After holding out for three more months, Sergey decided that things could not get any worse and gave his consent to the surgery. He visited me two weeks before the operation. I inspected his X-ray images and checked the ailing joint. Despite Sergey’s marked limping, its movements were almost unrestricted and I did not detect any audible "pops" or squeaking that would indicate degeneration. I agreed to do my best to help.

A flattened and fractured disk can pinch the root of the nerve going to the hip joint, causing pain in this joint.

Pain in the hip joint may be caused by intervertebral disk problems. A flattened and fractured disk can mechanically pinch the root of the nerve going to the joint. In this case, pain may be eliminated simply by removing pressure from the nerve root -- in other words, by performing a spinal manipulation that we shall discuss later. On the other hand, a damaged disk often falls short of pinching the nerve root. Instead, it merely causes irritation and inflammation, much like tight shoes cause calluses. If the doctor can eradicate this inflammation and use spinal manipulations to create some more room for the pinched root, the patient can be saved from pain both in the lower back and in the hip joint.

Easier said than done, right?  In this case, however, to my surprise and Sergey's delight, he started feeling much better after the very first injection into spinal muscles and a series of light manipulations. Both his pain and his limping were substantially reduced. Sergey was so inspired with this success that he canceled the scheduled surgery and we started working regularly on his spine.

The treatment is not finished yet; his pain is too resilient and the happy ending is still not guaranteed -- don't think of me as a magician. Although I do believe in medical miracles, I think they happen not because we want them to but rather because the patient's body is capable of self-healing. The outcome can never be easily predicted.

Three components of successful therapy

How can a doctor help your body to perform a miracle? First, by a selection of a proper anti-inflammatory treatment that includes pills, injections and ointments. This therapy alleviates edema and irritation in the inflamed tissue, providing an opportunity for carefully setting compressed joints and roots in motion.

The patient must have a good deal of endurance and discipline at this stage. If you "hate drugs" and arbitrarily change the dosage and frequency of your medications, it would do you much more harm than the (imaginary) side effects of medications.

The three components of successful non-surgical treatment are proper medication, manual therapy, and the patient's own efforts.

The next component of successful treatment is manual therapy. Let me remind you of a world of difference between a skilled manual therapist and all those assorted joint-cracking bonesetters. All the talk about "reduced" hernias and "reset" vertebrae does not stand up to professional criticism. Never trust those promising a speedy recovery. There are many excellent osteopaths and manual therapists out there.  Seek, and ye shall find!

The patient's efforts are the third and probably the most difficult component of the treatment. It's a grueling and (initially) rather thankless task.  Muscles that have been "turned off" due to a strong spasm or damaged innervation do need to be restored, but sometimes they are too weak to cope with the limb's own weight. This does not mean the damage is irreversible.

Like a man cannot lift a 200-pound weight without proper training, your muscles must also be gradually prepared to handle their weight. That's why underwater exercise is so important. Once capable of functioning underwater, your muscles will soon gain enough strength to work on land.

If the components of autonomous work and professional help are well aligned and multiplied by the patient's endurance and the doctor's skills, your chances of relief from joint pain without replacement surgery become much higher. On the other hand, your decision must certainly rely on all the specific details of the case and a professional opinion.