Friday, June 2, 2023

How To Treat Hip Arthritis Without Surgery

Rheumatoid Arthritis Of The Hip

Treating Hip Arthritis Without Surgery

Rheumatoid arthritis is a disease resulting from the immune system attacking healthy tissue in the joints, including the hip. It causes inflammation of the synovial membrane, the capsule surrounding the hip joint. Inflammatory cells release substances that break down hip cartilage over time. RA typically affects smaller joints such as the wrist and fingers first, and may not be noticeable in the hip until it causes symptoms.

What Is The Gel Injection And How Is It Different From Cortisone Injections

Gel injections are hyaluronic acid injections. Cortisone injections are anti-inflammatory injections. A cortisone injection is putting anti-inflammatory medication directly into the joint to decrease inflammation. Hyaluronic acid injections are more of a lubricant type of injections and can be beneficial in earlier stages of arthritis. Cortisone injections have stronger data in the published literature, but many patients do receive relief from gel injections. However, hyaluronic acid injections are more expensive and insurance companies often require pre-authorization. I recommend you talk with your doctor about the type of injection that is right for you.

What You Need To Know

  • There are several types of hip arthritis, including osteoarthritis, rheumatoid arthritis, psoriatic arthritis and post-traumatic arthritis.
  • The causes of hip arthritis vary depending on the type. The most common cause is age-related wear and tear in the hip joint.
  • Symptoms of hip arthritis may include pain in or near the hip joint, stiffness, audible clicking sounds when moving the hip, and weakness.
  • While hip arthritis is usually a chronic condition, there are treatments to help ease the symptoms and reduce further damage. If your quality of life suffers, surgery such as hip replacement can provide long-term relief.

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Start Your Day With Exercise

Doing the bridge exercise in the morning gets your muscles working, activated, and engaged and will help support you the rest of the day, says Humphrey. Lie on your back with your legs bent and your feet flat on the floor, hip-width apart. Press down through your ankles and raise your buttocks off the floor while you tighten your abdominal muscles. Keep your knees aligned with your ankles and aim for a straight line from knees to shoulders, being sure not to arch your back hold this position for three to five seconds and then slowly lower your buttocks back to the floor. Start with one set of 10 and build up to two or three sets.

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What Is Hip Arthritis


Hip arthritis is, by definition, a wearing away of cartilage between the bones that form the hip joint. Cartilage is the amazing material that lines and lubricates our human joints. Because cartilage is smoother than any man-made bearing and has no nerve endings, healthy joints with intact cartilage move easily and without pain.

However, in an arthritic joint where the cartilage has worn away, the underlying bonewhich does have nerve endingsis exposed. Any movement that causes the joints bones to brush against one another produces significant pain. It also generates debris, which causes an inflammatory response that accelerates the destruction of the joint.

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Hip & Knee Braces/assistive Devices

A brace can provide external support for the joint, and therefore reduce load, improve stability, and relieve pain. While braces are more common for knee arthritis, there are new brace options for hip arthritis, as well.

Assistive devices are another option for hip arthritis or knee arthritis, such as a cane or walker. These can help with improving balance and providing support. A cane can support up to 25 percent of a persons weight, while a walker can support up to 50 percent. I also utilize these assistive devices as a part of my post-surgical rehab plan after hip and knee replacements.

Prior to purchasing a brace, cane or walker, it is important to see an orthopedic specialist who can help determine if an assistive device is the best option for you.

Adding Or Removing Some Bone Around A Joint

If you have osteoarthritis in your knees but youâre not suitable for knee replacement surgery, you may be able to have an operation called an osteotomy. This involves your surgeon adding or removing a small section of bone either above or below your knee joint.

This helps realign your knee so your weight is no longer focused on the damaged part of your knee. An osteotomy can relieve symptoms of osteoarthritis, although you may still need knee replacement surgery eventually.

If you have osteoarthritis in your knees and your doctor has recommended an osteotomy, you can watch a video about how an osteotomy works, including the risks and benefits of having this type of surgery, on The Health and Care Video Library.

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Is Too Much Walking Bad For Your Knees

No, not in my opinion. My advice is to let pain be your guide. Walking is a low-impact exercise that can be beneficial not only for your joints but also for your cardiovascular system. If youre walking several miles a day and having to ice your knees all evening, you may be walking too much in that case.

The Evidence For Alternatives To Hip Replacement Addressing Hip Instability With Regenerative Medicine Injections

Hip Arthritis Treatment Without Surgery
  • Note: Hip replacement may be the only option for people with advanced degenerative hip disease. This is where degeneration is so advanced that it has deformed the hip ball and socket and caused a frozen or locked hip situation, a lot of pain, and loss of quality of life. In our opinion, this is the only time hip replacement should be considered the number 1 option but it should also be the number 1 option when regenerative medicine injections are not considered a realistic option.

Whether you choose to have surgery or you are seeking not to have the surgery by using regenerative medicine injections, you need to function quickly and pain-free. There is a degree of urgency here because your hip will get worse and worse at an accelerated rate. One of the first things that will happen if it has not already is that your hip will start causing you much more pain than your doctor or MRI shows. This is a critical time and we cover this patient problem in our article: Your hip hurts worse than your MRI is saying it should and your doctor doesnt believe you. When you have more hip pain than an MRI is showing you should, your hip is sending signals to the brain that it is sinking.

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What Kind Of Physical Therapist Do I Need

All physical therapists are prepared through education and experience to treat hip osteoarthritis and people with hip replacements. However, you may want to consider:

  • A physical therapist who is experienced in treating people with hip osteoarthritis and people who have had hip replacement surgery. Some physical therapists have a practice with an orthopedic focus.
  • A physical therapist who is a board-certified orthopaedic clinical specialist. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when youre looking for a physical therapist :

  • Get recommendations from family, friends, or other health care providers.
  • When you contact a physical therapy clinic for an appointment, ask about the physical therapists experience in helping people who have hip osteoarthritis or hip replacement.
  • Be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

The American Physical Therapy Association believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

Alternative Remedies And Treatments

Nutritional supplementation is helpful to some patients though the science on this is not entirely supportive of their effectiveness.

There are some studies to suggest that acupuncture can decrease the pain associated with osteoarthritis of the hip.

Although there is little hard science on this point, most hip surgeons and rheumatologists believe that patients with osteoarthritis of the hip should consider avoiding impact sports such as running in order to avoid increasing the rate at which the disease progresses.

It is important that patients with osteoarthritis of the hip avoid decreasing their activity level and it is important that they remain fit. However this often does require some modification of exercise programs running and walking programs are usually poorly tolerated by patients with osteoarthritis of the hip. Stationary bike, swimming and water aerobics usually are well-tolerated and they are recommended.

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Muscle Or Tendon Strain Osteoarthritis And Tendinitis

Pain caused by strains, tendinitis, and some forms of arthritis can be managed at home. Besides the tips above, try tai chi and yoga. These are slow exercises that combine gentle stretching with deep breathing. Both can relax and move the body in ways that wont worsen your pain.

Sign up for a class with a certified instructor to make sure your experience is enjoyable and safe. Once you learn which movements feel best to you, you can use them to treat your pain.

Do People Who Have Adverse Effects That Cannot Be Confirmed Through Medical Testing Really Have Adverse Effects

Best Hip &  Knee Arthritis Treatment

The doctors of this study then sought to determine the effect of confirmed and perceived adverse effects on patient-reported outcome measures after primary total hip replacement.

Here are the learning points of this research:

  • Forty-one adverse effects were reported in a group of 417 patients , with 30 adverse effects reported by 3 months after surgery.
  • Eleven infections, two periprosthetic fractures, and two dislocations were confirmed.
  • Those in the no adverse effects group reported significantly better outcomes than the reported adverse effects group.
  • Patients who report adverse effects have worse outcomes than those who do not, regardless of whether the adverse effects can be confirmed by standard medical record review methods.
  • The observed negative trends suggest that patient perception of adverse effects may influence the patient outcome in a similar way to those with confirmed adverse effects.

What are we to make of this? Do people who have adverse effects that cannot be confirmed through medical testing really have adverse effects? In our experience they do. Because it cannot be confirmed, does that mean it is not reported as an adverse effect? The bottom line here is that people are reporting adverse effects, are they being taken seriously?

Lets move on now to solutions.

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Summary Of Hip Arthritis

  • Osteoarthritis of the hip is common and can result in severe hip joint pain and disability. as a result of this condition, several hundred thousand people each year in the U.S. undergo total hip replacement.
  • Most people with osteoarthritis of the hip can be managed without surgery.
  • The cause of osteoarthritis of the hip is not known but some risk factors include obesity, severe hip trauma, and acquired conditions in adulthood, such as osteonecrosis and genetics.
  • There are many other kinds of arthritis that can affect the hip. It is important to make sure that the correct diagnosis is made as some of these other conditions are treated very differently.
  • The diagnosis of osteoarthritis of the hip is usually very straightforward and is made in almost all cases by a physician taking a thorough history, performing a physical examination, and getting x-rays with the patient standing up.
  • Patients usually seek care for the typical symptoms of hip arthritis, including pain located in the groin thigh or buttock. The pain associated with osteoarthritis of the hip is generally worse with weight bearing or twisting. Stiffness and leg-length inequality are other symptoms.

Medication For Joint Pain And Swelling

The first line option for arthritis symptoms is medication. This includes predominantly both over-the-counter nonsteroidal anti-inflammatory drugs , such as Motrin, and prescription form, such as naproxen sodium. Acetaminophens is solely an analgesic, which is a pain reliever, without anti-inflammatory effects. It is usually better tolerated by patients with kidney problems.

Do not take any OTC medications for more than 14 days without checking with a doctor. Taking them for long periods of time can increase the chance of side effects.

Additionally, I want to emphasize the importance of minimizing narcotics. Common narcotics used for arthritis include hydrocodone, oxycodone and morphine. While narcotics can be very effective in reducing pain, they can often lead to addiction and cause withdrawal when trying to quit. I typically prescribe narcotics as a part of a multi-modal pain protocol that Ive developed specifically for short-term, post-surgical pain control. However, they are not a long-term solution.

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Osteoarthritis Of The Hip

Osteoarthritis is a degenerative joint disease, which means it causes gradual damage to the joint. It is the most common form of hip arthritis and can affect other joints. Hip osteoarthritis is typically caused by wear and tear related to aging and worsens over time. The breakdown of cartilage leads to pain and inflammation.

Hip osteoarthritis may develop faster in some people due to irregular shape of the bones forming the hip joint. For example, if the ball and the socket parts of the hip joint dont perfectly fit together , they may rub against each other, eventually leading to osteoarthritis. This may also happen in people with hip dysplasia, who have a hip socket that is too shallow to support the ball of the femur. This places abnormal stress on the cartilage, causing it to wear away prematurely.

Stages of Osteoarthritis of the Hip

How To Know If You Have Hip Arthritis

Treating Knee Arthritis Without Surgery

Having problems with one particular routine task is a common giveaway that hip arthritis is affecting your life: putting on your socks and shoes. You need an adequate range of motion in your hips to put your foot up on your opposing leg to put on your shoes and socks. People with hip arthritis tend to lose the range of motion in the hips. Problems putting on your socks and shoes are not always associated with pain but rather just becomes more difficult to do.

You can also tell how long you have been affected by hip arthritis by looking back at how long you have been having problems putting on your socks and shoes. Hip arthritis can onset rapidly and deteriorate the range of motion in the hips quickly. A patient can go from seeing no signs to needing a hip replacement in less than 24 months.

While that is a common symptom, there are many others that a person could be experiencing. Regardless of the type of arthritis, other signs of hip arthritis can include:

  • Pain in the groin or thigh that radiates to your knee, outer thigh or buttocks.
  • Pain that is worse in the morning or after sitting for a while.
  • Flare ups after vigorous activity.
  • Limping or pain that causes difficulty walking.
  • Sticking or locking of the hip joint.
  • Difficulty getting out of a car.
  • Pain when leaning over.

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When To See A Doctor

Most of the time you can treat your hip pain yourself with simple self-help treatments. If your pain is extremely bad or hasnt improved after two weeks of regularly taking painkillers, you should see your doctor.

You should see your doctor straight away if:

  • youve had a fall or injured your hip
  • the pain is getting worse
  • youre having difficulty with daily activities, for example walking, going up stairs or leaning forwards when sitting
  • you feel feverish or unwell, or youve been losing weight.

Strengthening And Repairing Ligaments With Comprehensive Prolotherapy Injection

So now we have reached a point where we will discuss the alternative to treatments you have been trying for years without effectiveness. We will now turn to Prolotherapy injections.

In this video for athletes and active patients, a demonstration of the type of Comprehensive Prolotherapy offered at Caring Medical is shown.

  • This should also be seen as a demonstration of how Prolotherapy can help get the worker back to the job, and the hip osteoarthritis patient back to mobility. In the video, the patient is comfortable receiving these injections.

In this video, you also see that the injections are not only targeted at the center of the joint, as in PRP injections but also around the joint. What this does is address joint instability by treating the ligaments of the peri-articular or outside hip region.

Caring Medical published its research in 2009 where we looked at 61 patients, 33 of them had hip pain in both hips. Twenty of these patients were told that there were no treatment options available to them, with eight being recommended surgery as their only hope, for hip pain alleviation.Of the 94 hips treated in the 61 patients:

  • 89% experienced more than 50% of pain relief with Prolotherapy
  • more than 84% showed improvements in walking and exercise ability, anxiety, depression, and overall disability
  • 54% were able to completely stop taking pain medications.

After treatment:

After treatment:

Pain Medication Utilization.

Walking Ability.

Exercise and Athletic Ability.

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Research: Iliofemoral And Ischiofemoral Ligament Reconstruction Techniques Following Hip Replacement May Help Salvage A Bad Hip Replacement

Here is an understanding of the idea, you dont know what you got until you dont get it.

In December 2020, surgeons writing in the medical journal Orthopaedics and Traumatology, Surgery and Research discussed the problems of chronically dislocating hip replacements. Again, we do want to stress that many people have very successful hip replacement procedures, and some people have very successful hip preplacement repair or revision surgeries. These are typically not the people we see at our center. We see people looking for help with hip replacement procedures that have not fared well for them.

In this paper, the surgeons discuss the problems of recurrent dislocations of the patients total hip arthroplasty . For many people, this problem, as they note, can be repaired by going into the hip again and replacing the socket hardware or the cup with a dual-mobility and constrained cup. This hardware can limit the range of motion to prevent recurrent dislocations or your replacement from popping out of place. But, this hardware replacement may also fail in the case of hip abductor mechanism loss.

Hip abductor mechanism sacrifice and lossWe are going to quickly discuss hip abductor mechanism loss. While this is in regard to hip replacement fixes, we are going to show just how important the hip ligaments are in building our opinion that treating the hip ligaments, non-surgically can reduce or eliminate the need for hip replacement in selected patients with hip osteoarthritis.

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