As we age our bodies change. This can affect a number of our healthy systems and can lead to long-term issues. Weight gain and hormonal changes can affect our overall health as well as some common conditions related to aging. We can mitigate some of the effects of the natural aging process by maintaining a healthy diet and committing to regular exercise. However, hip pain continues to be a major health challenge, especially for older adults in the United States. A hip replacement can help with hip pain in some cases, but only after other less-invasive pain management options have been tried.
What causes hip pain?
Approximately 15% of people over the age of 65 report hip pain. The pain can be the result of:
- A fracture
- Lack of blood flow
- A fall or other injury to the hip
This video gives a brief overview of hip pain and its major causes.
What is osteoporosis?
Osteoporosis is a chronic condition that causes the bones to become weak and brittle. With severe cases of the disease, simple and natural ranges of motion can cause a break in the bone. These fractures are most likely to occur in the spine, wrist, or hip. Our bones, just like the rest of the living tissues in our body, regenerate throughout our lives. As we age, our bodies no longer produce all of the natural building blocks for healthy bones. This is why maintaining a calcium-rich diet is important for the health of our skeleton. According to the National Osteoporosis Foundation 54 million people in the United States are living with or at high risk for osteoporosis and it causes many of the cases of hip pain in the elderly. Post-menopausal women are at the highest risk with Caucasian and Asian women leading the statistics for the U.S.
Early bone loss has no notable symptoms, which is why prevention is more important than early detection of the disease. As the condition progresses, patients can develop back pain, loss of height due to spinal compression, a hunched over posture, and increased risk of fractures of the bone. It is important to note that often patients can have osteoporosis without any symptoms and may not know about the condition until they experience a fall or other injury that results in a break.
When osteoporosis affects the hip, it can cause a great strain on a person’s ability to walk. This can be exacerbated by being overweight or having other chronic pain conditions that affect other areas of the body.
While hip replacement surgery may be necessary in the final or chronic stages of this condition, there are better ways to treat it earlier.
The best way to treat or avoid osteoporosis all together is to maintain a diet rich in calcium and vitamin D. Regular exercise and an overall healthy lifestyle will help older adults avoid the negative results of osteoporosis long-term.
Some women may be able to mitigate the effects of osteoporosis with hormone therapy. There are also several medications on the market that can help reduce or eliminate the risk of osteoporosis. Talk with your pain doctor about a bone density test to determine if you’re at risk for osteoporosis and what treatments can work best for you.
What is hip osteoarthritis?
There are many forms of arthritis—a condition that causes inflammation in joints. Osteoarthritis is considered to be caused by long-term wear and tear of the body. Hip osteoarthritis occurs when the protective cartilage between bones in the hip begins to wear down, causing the bones to rub uncomfortably together. This leads to inflammation and long-term pain problems. It can affect any joint but due to the way we move our bodies regularly it is most likely to be found in the hands, neck, lower back, knees, and hips. According to the Centers for Disease Control (CDC), over 13% of adults over the age of 25 have been diagnosed with the condition. Over 33% of adults in the U.S. over the age of 65 experience the effects of osteoarthritis.
Because osteoarthritis is degenerative, symptoms develop slowly and get worse over time. Common symptoms include:
- Pain in the joint after movement
- Tenderness in the area when pressure is applied
- Joint stiffness after periods of inactivity
- A loss of flexibility in the joints
- A grating sensation of the bones during movement
- The development of bone spurs
Osteoarthritis in the hip may cause difficulty standing or walking. It also can cause cases of hip pain in the elderly population. Patients may experience more pain when waking up in the morning after sleeping on the hip. Like most conditions related to aging, additional body weight can affect pain levels.
Treating hip osteoarthritis
Because osteoporosis is degenerative and caused by the natural wear and tear on the cartilage between joints, it can be difficult to prevent. Before attempting hip replacement surgery, there are less invasive options to consider.
For less severe cases, non-steroidal anti-inflammatory drugs (NSAIDs) can provide temporary relief of the pain. Physical therapy can help restore full range of motion in the affected joints and occupational therapy can help patients suffering from osteoporosis of the hip restore their regular daily functions. Another helpful treatment includes orthotics for the shoes that change the posture to relieve some of the stress on the damaged joints.
Finally, hip injections can help prevent pain in the hip. With a combined injection of anesthetic and steroids, they can reduce inflammation in the area. Find out more about this treatment option here.
What is hip replacement surgery?
In the U.S. alone more than one million hip and knee replacement surgeries are performed annually. While the sheer number of replacements has made the surgery more commonplace and the techniques more advanced, hip and knee replacement is not for everyone. So how do you know if it’s right for you?
If a patient has hip joint damage that inhibits their ability to function normally, hip replacement surgery may be recommended. This is only after other options have been tried to no effect. This surgery uses metal, plastic, or ceramic materials to replace the ball and socket joint that allows the hip to have normal motion. This surgery is complex. It requires extensive recovery time and physical therapy but can help some patients return to their normal daily lives once they are fully healed.
However, hip replacement surgery can sometimes result in additional long-term hip pain in the elderly especially. Chronic pain resulting from a surgical procedure is more delicate and needs specialized treatment. Some factors could influence whether hip replacement surgery is right for you.
1. You are a woman
At the 2015 annual meeting of the American Academy of Orthopaedic Surgeons a new study revealed that women have much better outcomes following a total joint replacement (TJR) of the hip or the knee. In the study of over 97,000 total hip and knee replacement surgeries at an Ontario hospital, researchers found that men:
- Were more likely to return to the emergency room within 30 days of surgery
- Suffered from more heart attacks
- Needed a revision of their surgery more often
- Were more likely to be admitted to the hospital or suffer a serious infection following surgery
Lead study author Bheeshma Ravi, MD, PhD, an orthopaedic surgery resident at the University of Toronto debunked the previous myths that women suffered more after total hip or knee replacement:
“Despite the fact that women have a higher prevalence of advanced hip and knee arthritis, prior research indicates that North American women with arthritis are less likely to receive joint replacement than men. In this study, we found that while overall rates of serious complications were low for both groups, they were lower for women than for men for both hip and knee replacement, particularly the latter. Thus, the previously documented sex difference utilization of TJR cannot be explained by differential risks of complications following surgery.”
2. You are under 35 with juvenile arthritis
Another study presented at this year’s annual meeting of the American Academy of Orthopaedic Surgeons found that for those patients 35 and under with juvenile arthritis that is unresponsive to more conservative treatments, total hip replacement might be the answer. While total hip replacement at such a young age is not often recommended, for those patients with debilitating immobilizing hip pain, total hip replacement can be a lifesaver.
Mark P. Figgie, M.D., senior author of the study and chief of the Surgical Arthritis Service at Hospital for Special Surgery highlighted the benefits of the surgery:
“The surgery in this patient population, although performed by only a small number of specialized orthopedic surgeons, is life-changing for JIA patients. Joint replacement can free patients from a life of unrelenting pain. It can enable those in a wheel chair to walk again. Patients can go back to school or work and get their lives back.”
The study found that hip replacement was indicated for most patients sometime between ten and 20 years later.
3. Your insurance has kicked in and can help defray the cost
Researchers at Boston Medical Center (BMC) found that due to increased rates of insurance, the rate of knee and hip replacement has increased by 4.7% overall. The largest increases are in Hispanics (37.9%) and African Americans (11.4%). This is good news for these populations. It means conditions necessitating these surgeries do not discriminate, affecting people equally across race and income.
Amresh Hanchate, PhD, of the section of general internal medicine at BMC and the healthcare disparities research program in the department of medicine at Boston University School of Medicine, and the first author of the study, highlighted the fact that the need has always been there, even if the insurance coverage has not:
“The need for knee and hip replacements is fairly universal among various ethnic groups. However, access to care has not been universal. Our findings suggest that there may have been a pent-up demand for these procedures among racial/ethnic minorities, and once these patient populations received insurance, they were able to move forward with the procedures.”
4. You have pain that is unresolved with other treatment methods
Perhaps the most telling indicator that a hip replacement surgery might be right for you is the one you need to discuss with your doctor: your current treatments aren’t working. Moreso, you’ve tried multiple treatments that haven’t worked.
If you have pain and stiffness that is not relieved by movement, medication, or hip injections, a hip replacement may be your best option. This pain (and accompanying X-rays) could indicate that there is irreversible bone damage to the joint. Deformity or swelling in the joint that does not change with any interventions may also indicate a need for a hip replacement. Hip replacement shouldn’t be the first line of defense against pain. It should be considered only when other options have been exhausted.
Quality of life that is limited and made poor by pain, stiffness, swelling, and deformity can lead to mood disorders and more severe issues down the road. Before you suffer from any long-term consequences of hip pain, consult a pain specialist. They can help to determine corrective actions for you to maintain a healthy lifestyle. Click the button below to find a pain doctor in your area who can help.