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An assistant professor of orthopedic surgery at Mount Sinai, Dr. Darwin Chen performs between 200 and 300 hip and knee replacement surgeries a year, and specializes in using minimally invasive techniques. May is Arthritis Awareness Month.
WHO’S AT RISK
As one of the most common chronic conditions in this country, arthritis affects over 25 million Americans. “Arthritis is a painful joint condition caused by damage to the joints’ lining, usually as the result of wear and tear,” says Chen. “It’s estimated that 15-20% of Americans will suffer from hip arthritis in their lifetime.”
The hip is one of the largest joints in the body. “It’s a ball and socket joint, in which the ball is the upper part of the femur, or thigh bone, and the socket is part of the pelvis bone,” says Chen. “Both the ball and socket bones are covered in cartilage that cushions the impact. With arthritis, the cartilage has worn away, and bone grinds against bone.”
In addition to the normal wear and tear that comes with age, hip arthritis can also be caused by abnormalities in the hip. “Of the two main structural problems for the hip joint, the first is hip impingement — which is when the shape of the ball and socket doesn’t fit well, causing abnormal contact forces in the hip,” says Chen. “The second is hip dysplasia, when the socket itself is too shallow and doesn’t cover the femoral head well, causing cartilage damage of the course of a lifetime.”
Just about anyone can develop hip arthritis, though some people are at increased risk. “Both men and women are affected equally, though men are more likely to be affected by hip impingement and women are more prone to hip dysplasia,” says Chen. “Hip arthritis also affects people from all ethnic backgrounds. There is very likely a genetic component, but it’s not limited to one gene or genetic pattern, it’s multifactorial.”
Aging is also a risk factor for hip replacements. “In most cases, the wear and tear on the hip cartilage accumulates over time, which is why the average age for a hip replacement is 60-65,” says Chen. “However, people of all different ages can be affected — I’ve performed hip replacements for patients from age 19 to 92.”
SIGNS AND SYMPTOMS
Like other forms of arthritis, hip arthritis commonly manifests as pain. “The most common symptom is a deep-seated groin pain, a dull achy pain deep in the joint, which is frequently accompanied by joint stiffness,” says Chen. “The pain can start in the groin and can radiate down the leg, on either the front or side of the thigh; it can also cause pain in the buttock.”
Because the hip joint is essential to many of the tasks of daily life, severe hip arthritis can be debilitating. “Ordinary things can become painful, like standing up, walking, or getting out of a chair,” says Chen. “A classic first sign is difficulty in putting shoes and socks on, because that requires flexibility in the hip joint.” Severe hip arthritis can cause night pain and sleep disturbance.
Another feature of hip arthritis is that it tends to come and go. “Most arthritis patients have good days and bad days, the pain waxes and wanes,” says Chen. “It’s often an insidious onset — where there’s slow deterioration over the period of years, which can really sneak up on people.” In some cases, the spouses will notice a limp before the patient does.”
The diagnosis of hip arthritis isn’t usually a tough call. “We make the diagnosis based on X-rays and physical examination,” says Chen. “On rare occasion an MRI might be called for.”
Doctors take a stepwise approach to treating hip arthritis. “We usually start with a course of conservative therapy, which can include weight loss, physical therapy, and the use of anti-inflammatory medications,” says Chen. “We can also use injections to help control the pain.” Weight loss has a powerful affect on arthritis pain because the pressure of 3 to 4 times the body weight is put on the hips when getting out of a chair or going up the stairs.
When is it time to consider hip replacement surgery? “You’re a candidate for surgery when the bad days outnumber the good and when the pain limits your daily routine,” says Chen. “There are 300,000 hip replacements done each year for advanced arthritis, and it’s one of the safest surgeries we do.”
The new direct anterior surgical approach is minimally invasive — we enter the pelvic joint from the front, which allows for muscle sparing.
There’s a traditional method of doing hip replacements and a new minimally invasive approach. “The traditional hip replacement is called the posterior approach because it entered the hip from the back; it required cutting through some of the muscles around the hip and back and the restriction of activity for a short period of time,” says Chen. “The new direct anterior approach is minimally invasive — we enter the pelvic joint from the front, which allows for muscle sparing. We also use X-rays to allow us to place the implant more precisely.”
Patients recover much more quickly from hip replacement today than they did ten years ago. "Surgery now takes 1-2 hours, and patients get up and out of bed on the same day; they have surgery in the a.m. and start PT in the p.m.,” says Chen. “Most patients are discharged on day 2 or 3, and almost back to normal within 4-6 weeks. There are really dramatic outcomes for hip replacements — patients who could barely walk have a new lease on life.”
Already, surgical improvements like porous implants and rapid rehab protocols are becoming the standard of care across the country. “The next generation of treatments will probably be geared more toward biologic therapy — in which biologic agents will be injected into the hip to cause the cartilage to regenerate,” says Chen. “That is still a ways away, though it might happen within our lifetime.”
QUESTIONS FOR YOUR DOCTOR
If you are diagnosed with early arthritis, ask, “What can I do to extend the longevity of my hip?” Staying active and keeping your weight down are two of the most important things you can do. If you have mild symptoms that are starting to bother you, ask, “What other therapies can I consider for symptom relief?” One of the big questions for surgical candidates both before and after surgery is, “What kind of limitations should I abide by?” Many patients return to tennis, skiing, and even running, though running does place the hip replacement parts under extra pressure. “Hip arthritis is not cancer or stroke or a heart attack — it’s nothing that’s going to kill you, but having a hip replacement does dramatically improve your life in terms of pain and function,” says Chen. “Current-day hip replacement works tremendously well — it gets patients back to the lives they want."
WHAT YOU CAN DO
For online information you can rely on, start your web search with the American Academy of Orthopaedic Surgeons (aaos.org), the Arthritis Foundation (arthritis.org), and Mount Sinai (mountsinai.org/patient-care/service-areas/orthopaedics/orthopaedic-services/joint-replacement-center).
Don’t ignore hip pain.
See you doctor so you can get a proper diagnosis and treatment plain. "You may have a structural problem-knowing that and taking preventives measures can potentially delay the onset of arthritis," says Chen.
Leading a healthy active lifestyle in general is the key to healthy joints. Working to improve your flexibility can also help you maintain joint mobility.
See an expert.
If you are considering having a hip replacement, be sure to go to a center with a high volume, low complication rate, and low readmission. Look for a surgeon who specializes in hip and knee surgeries, and does at least 200 a year.
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Source : http://www.nydailynews.com/life-style/health/daily-checkup-hip-arthritis-strikes-americans-article-1.2202361