Understanding Hip Arthritis - Boulder & Broomfield · form of arthritis. It is estimated that the...

Understanding Hip ArthritisMichael J. Repine MDBoulder Medical Center Orthopedics(303) 647-5173

Your Treatment OptionsOptionsHip PainDoes this sound familiar?

“It would be embarrassing to get out of a car because everybody had to help me. Somebody would have to pull me up. I felt like this old woman.”

“My life got progressively less active, less fun, and less participative.”

“Just a day on my feet was exhausting and the pain became greater and greater until Advil and ibuprofen and all of those kinds of drugs couldn't numb it out. It just got worse and worse.”

Your Treatment OptionsOptionsHip Pain

You’re Not Alone

More than 43 million people have some form of arthritis. It is estimated that the number of people affected by arthritis will increase to 60 million by 2020.

Source: CDC


This program will touch upon the following topics:

Review of Hip AnatomyDiscussion of ArthritisLatest Treatment Options for Hip ArthritisExpectations/Outcomes


About Myself

Oldest of sixIdentical twinColorado native Two young boys


About MyselfOldest of sixIdentical twinColorado native Two boysI enjoy traveling and languages


About My PracticeUndergraduate at CU BoulderUniversity of Colorado School of Medicine for medical school and residencyBoard certified in 2005, 2015Fourteen years at the Boulder Medical CenterIn addition to the management of arthritis, I enjoy trauma, sports-related, and hand injuries

Your Treatment OptionsOptionsHip PainANATOMY

Your Treatment OptionsOptionsHip PainNormal Hip

Bony Anatomy


The Hip JointMusculature

Multiple muscles enveloping the hip jointProvide additional stability to the hip joint

Posterior


The Hip JointMusculature

Multiple muscles enveloping the hip joint anteriorly as well

Anterior

Your Treatment OptionsOptionsHip PainThe Hip Joint

Ligaments

StabilityStabilityComplex array of ligamentsAugments stability to the ball and socket


The Hip JointCartilage

Cartilage is critical in understanding arthritis


The Hip JointCartilage

Transmits applied loads across mobile surfacesLines the ends of bones Surfaces roll or slide during motionHyaline cartilage is fluid-filled wear-resistant surfaceIt reduces friction coefficient to 0.0025.

“Like the frosting on a piece of cake”


Normal Cartilage

Healthy, normal cartilage rolls easilySmooth motion

“Like the tires on your car”


Damaged Cartilage

When the cartilage is thinned or absent, problems such as pain, instability, limited motion occur.

This mechanical wearing of the cartilage surface leads to deterioration in the joint or ARTHRITIS


What is What is ARTHRITIS?

Definition: Inflammation of a joint, usuallyaccompanied by pain, swelling, andstiffness.


What is What is ARTHRITIS?

Definition: The mechanical wearing of the cartilage surface resulting in pain and limited function.

Importantly, this mechanical change is accompanied by biochemical changes


Normal Anatomy Normal XraysWhat is Normal AnatomyWhat is ARTHRITIS?


Arthritis Anatomy Arthritic Xrays What is Arthritis AnatomyWhat is ARTHRITIS?


Most Common Causes of Arthritis

Degenerative – “wear and tear”

Osteoarthritic – traumatic

Rheumatoid – inflammatory

Bacterial - infectious


Evaluation of Hip Arthritis


Diagnosing Hip Pain

Medical historyPhysical examinationX-rays, Radiographic StudiesOther tests


SymptomsPAIN

Weight-bearing activitiesWhile sleeping at nightLocated over groin, lateral hip, sometimes buttock pain

*Important to evaluate for spinal source

Usually slow in onset


Diagnosis

How and when did the pain start?If the pain has occurred before, how was it treated?What activities aggravate the pain?What activities relieve the pain?

Medical History


Diagnosis

Tenderness to the touchWeakness in the musclesExtent of passive and active range of motionCrepitation

Physical Examination


Diagnosis

X-rays of an arthritic hip:narrowing of the joint spacecystic changes in the boneformation of bone spurs (osteophytes)

X-ray Evaluation


Diagnosis

Blood testsComputerized Topography (CT) scansMagnetic Resonance Imaging (MRI) scans

– Best non-surgical modality to identify focal cartilage defects

– RARELY NECESSARY FOR HIP ARTHRITIS

Arthroscopy– Small areas of traumatic arthritis, loose

bodies

Additional Tests


Non-Surgical Treatment Options for Arthritis


Nonsurgical treatment optionsPhysical Therapy

Almost always start with physical therapy

– Improve range of motion– Improve strength– Decreases pain


Nonsurgical treatment options

Medications

NSAIDS– Decreases inflammation– Decreases pain



Supplements

Lots of claims

NONE have passed FDA testing as provenPersonal trials



Cortisone injectionPROS

Relatively easy procedure under fluoroscopyExcellent diagnostic toolWell-toleratedVery predictable reduction in pain



Cortisone injectionCONS

Must be placed carefullyMasks symptomsCan soften cartilageUsed to “buy” time



Viscosupplement

Purify Hylauronic acid from rooster combs or bacterial growth“Oil-additive” to joint fluid



ViscosupplementPROS

Protects remaining cartilaageImproves biochemical environment of jointReliable reduction in pain



ViscosupplementCONS

“Off label use”

Currently, approved for knees onlyCurrently being studied


Nonsurgical treatment optionsStem Cell Therapy

Great claims of what can be treatedPromising early anecdotal reportsExpensiveLikely the best future option for moderate arthritis


Surgical Treatment Options for Arthritis


Decision Variables

Moderate or

extensive arthritis

Age, strength, range of motion


Decision VariablesYour Treatment OptionsOptions

Hip PainSurgical Treatment

Moderate Cartilage Damage


Surgical treatment

Moderate cartilage damage

Must catch damage earlyBest treated before secondary changes occur within the hip

“Pothole”


Surgical treatment

Focal cartilage damageMicrofracture

Largely treated arthroscopically


Surgical treatmentFocal cartilage damageCartilage Transplantation


Surgical treatment

Focal cartilage damage

Partial replacementResurfacing

Your Treatment OptionsOptionsHip PainSurgical Treatment

Advanced Arthritis

Your Treatment OptionsOptionsHip PainSurgical treatment

Advanced ArthritisBecause hip replacement is predictably so good in restoring function and pain relief, the choice is really replacement or not.

Your Treatment OptionsOptionsHip PainSurgical treatment

Advanced ArthritisPatient determines the appropriate time for surgical interventionNot determined by X-ray Can’t really “miss the boat”

with hip arthritis



Surgical TreatmentAdvanced Arthritis

ANTERIOR ANTERIOR HIP REPLACEMENT


Anterior Hip ReplacementWhat is it?– The DIRECT ANTERIOR

approach


Anterior Hip ReplacementAdvantage(s)– True intermuscular

approach to the hip joint

– Originally described in 1883

– Regained popularity


Anterior Hip ReplacementAdvantage(s)– Patient is positioned

supine (on their back)– Sometimes use

specialized leg holder– Easier for patient,

surgeon and anesthesia


Anterior Hip ReplacementAdvantage(s)– Intermuscular– Limited trauma to

muscles and tissue– Anterior capsular

incision– No disruption of the

posterior structures to the hip at all


Anterior Hip ReplacementAdvantage(s)– Allows excellent

visualization– With more limited

surgical dissection– Faster recovery– Less pain


Anterior Hip ReplacementAdvantage(s)– Patients are up walking

on the hip the same day– Most patients go home

after just one night in the hospital

– No pillows between legs– Minimal positional

precautions


Surgical TreatmentAdvanced Arthritis

COMPUTER COMPUTER ASSISTED ASSISTED

HIP REPLACEMENT


Computer Assisted Hip ReplacementMakoplasty

Rationale:– Allows extreme

precision when performing hip replacement surgery



Rationale:– Correct positioning of

the components leads to lower wear rates and reduced risk of dislocation



Technique:– Preoperative CT scan

data is synced to intraoperative data with a probe

– Implant positioning and surgical resection can be planned before any cuts are actually made



Technique:– Robotic arm assists

with controlled resection of bone

– Real-time evaluation



Technique:– Allows single stage

reaming– Solid, stable fit of the

acetabular component


Recovery


Recovery

Begins immediatelyImprovements in anesthesia also facilitate immediate mobilityStart working with therapy to get out of bedWBATAnterior hip precautions


Summary

You choose the time to intervene for hip replacementGold Standard of all joint replacementsVery predictable outcome with a painless and fully functional hip joint


Summary

Combining techniques of computer assistance with an anterior hip surgical approach utilize the best of current technologies to maximize your recovery and outcome

Your Treatment OptionsOptionsHip PainThank You

Michael J. Repine MDBoulder Medical Center Orthopedics

(303) 647-5173


Replaced Hip X-ray

Understanding Hip Arthritis - Boulder & Broomfield · form of arthritis. It is estimated that the...

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