Jason Cochran D.O.

Michigan Orthopedic Center

Sparrow Health System

Lansing, MI

517-267-0200

Hip pain in the active patient

Who is the active patient?

Why do you hurt?

Goals

Causes of hip painNonsurgical optionsSurgical optionsFinal thoughts

Socket– Cartilage – Labrum

Ball– Smooth weight-

bearing surfaces

Smooth cartilage

Anatomy of a hip

Labral Tears

Often misdiagnosed as “groin pull”Cartilage tears of the hipCommon cause of pain in young athleteMechanical symptoms of catching, clickingSimilar to meniscal tear of knee

Labral Tears

Diagnosed by examConfirmed with MRI arthrogram

Impingement

DevelopmentalabnormalityCan affect either the femoral head or the socketCan precedeosteoarthritis

Impingement

Occurs when the head is out of round!Leads toosteoarthritis

Osteoarthritis (OA)

• “Wear and tear”arthritis

• Symptoms of groin pain and lateral hip pain

• Often confused with groin pull, or a hernia

Osteoarthritis (OA)

• Joint becomes pitted, eroded

• Bone spurs form

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

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

Non-surgical alternatives–Lifestyle

modification–Exercise and

physical therapy–Anti-

inflammatorymedication

–Ambulatory aidsIe: cane, walker

Non-surgical alternatives

Most patients demand an active lifestyle

Surgical alternative

Hip ArthroscopyHip resurfacingHip replacement– Less invasive surgery– Advanced bearing surface

Hip arthroscopy

OverviewExcellent option for hipsLabral tearsLoose cartilageInflammation of the joint

Hip arthroscopy

BenefitsSmaller incisionsQuicker recoveryOutpatient surgery

Hip Resurfacing– Two FDA approved– BHR-Smith Nephew– Cormet-Stryker– 99.5% of patients

were “Pleased”or “Extremely Pleased”with the results

Who is the typical candidatefor Hip resurfacing?

– Adults under age 60 with active lifestyles

– Active adults over age 60 may be candidates, depending on their bone quality

What is Hip Resurfacing?

Hip Resurfacing

Healthy hip Cuts Implantcomponents

Implanted

Is hip resurfacing Minimally invasive?

That depends on how you define “Minimally Invasive.”

– Soft TissueNo. Incision length of 6 to 8 inches

– BoneYes. Preserves your body’s natural bone structure; It resurfaces rather than replaces

Conserved bone

The key benefits– Head size– Advanced bearing

surface– Bone conservation

Head Size and Bone Conserving

Closely matches the size of your natural femoral head

Preserves your natural femoral neck

Healthy headresurfaced head

Total hip head

Bone conservation (cont.)

– Revises to a primary

If you need “revision” surgery, you don’t get a revision implantThe follow-up procedure would be the same total hip replacement you would otherwise have received

What other options do I have?

Conventional hip replacement

Most successful surgery in orthopedicsUp to 99% 10 year survivorship

Who is a candidate?

Any patient with advanced arthritisFemale patients >60 years old or males with osteoporosis

Conventional hip replacement

Healthy hip Cuts Implantcomponents

Implanted

What has improved in hip surgery?

Alternative bearingsLess invasive approachQuicker recovery – Better pain

management– Rapid recovery therapy

Alternative Bearing Surfaces

Advances in bearingsurfaces=less wearless wear=longer survival

Alternative Bearing Surfaces

Wear of current ceramic and metal hip replacements are virtuallyimmeasureableAll-metal total hip replacementsreduce joint wear by 97% versus metal on plastic total hips

Less invasive

Incision– Around 4 inches in

length

Smallerincisions=better pain control and decreased blood loss

Improved RehabAfter 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

What can I do after surgery?

– During year-one: Low-impact 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)

Final Thoughts?

When and Who?

When should I have a Hip Replacement ?ArthritisPain that interefereswith Daily activities and Quality of LifeAll non-surgical treatment fails to relieve pain

Who should I choose to perform my Hip Replacement?

Orthopedic Surgeon– Regularly performs Hip Replacement Surgery– Specialized Training?– Fellowship?– Someone you are comfortable with

Q&APhysician:Dr.Jason Cochran Practice: Michigan Orthopedic CenterAddress: 2815 South Pennsylvania avenueContact: 517-267-0200