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Bill Klaproth (Host): Having a painful hip can severely affect your independence, your lifestyle, your job, and more, so what are your options? Here to talk with us about common causes of hip pain and treatment options is Dr. Bryan Whitfield, an orthopedic surgeon at Emory Healthcare. Dr. Whitfield, thank you for your time. So what are the most common hip conditions you treat on a regular basis?

Dr. Bryan Whitfield, MD (Guest): Sure, Bill, and thank you for having me. There are a lot of different things throughout the body that can cause pain in the hip. One of the major things that we try to immediately differentiate between is it actually a hip condition or is it coming from the back? Things that are coming from the hip can be anything from something called impingement, or labral tear, or bursitis, or pain coming from the gluteal tendon, all the way to osteoarthritis.

Bill: So some of this sounds like it's normal wear and tear, and some of this may be from injury. Is that right?

Dr. Whitfield: That is right. You can have the shape of the bones that leads itself to impinging, or really the socket and the ball essentially running into each other and tearing some of the cartilage around the rim. It can happen from a fall, and it can happen for reasons that we don't always know. Sometimes falling results in spraining the hip, or one of the ligaments of the hip, and damaging the labrum, or even falling and tearing one of the tendons on the outside of the hip.

Bill: So what are some of the common symptoms of someone with a hip condition?

Dr. Whitfield: Most of the people think that their hip is kind of on the back and on the side, the lower part of the abdomen really, what we would call the flank. Well it turns out that conditions within the ball and socket are usually felt in the groin, more on the front than the back. The buttock pain can certainly be part of it.

And usually what patients describe to me if I'm seeing them is that it hurts for awhile when they sit, and then they go to stand up, it will often hurt with certain activities. Over-stretching it such as in yoga or trying to sit with their legs crossed, and sometimes just even with every step that they take.

Bill: So at what point should someone with any of these symptoms go to see the doctor?

Dr. Whitfield: Generally there's mild aches and pains that people can have that can last for a week or two and go away and don't reoccur soon or ever at all. Anything that's really holding on in two to six weeks is probably worth getting checked out because most normal aches and pains should go away pretty readily within about a two-week period if there's nothing else going on.

Bill: So Dr. Whitfield, how do you diagnose various hip conditions?

Dr. Whitfield: That's a good question, and there's not always an easy answer. We take what the patient describes, and where they describe the pain certainly into account. There's plenty of physical exam maneuvers, moving the hip in certain positions, and asking the patient where it hurts, and what is recreating the pain. Looking at an x-ray. We put all of that together, and sometimes even then the answer is not clear and we do like cortisone injections in and around certain areas to see if that takes away the pain. We really take the whole- the history, the physical, the imaging, and the response to treatment into account when we determine, "Okay, where exactly is the pain coming from, and what condition is the most relevant?"

Bill: And you mentioned cortisone. Are there other treatment options for someone with a hip condition? We hear about hip replacement surgery all the time, but I would imagine that's kind of the last step in the process. Take us through the treatment options for someone with a hip condition.

Dr. Whitfield: Sure, and I always tailor this to kind of how aggressive or how passive patients want to be. Sometimes patients really just want to be reassured that there's nothing major going on, and there's nothing more that they need to do, and that's okay. There's nothing more that necessarily needs to happen if the pain is not limiting.

On the other hand, injections in a location that I think is symptomatic is helpful. The other thing that I do routinely is physical therapy. A lot of the pain that people can have are from muscle imbalances. If we improve the biomechanics by improving the strength in the muscle, or even just take away some of the pressure from the joint by working through therapy, it can make a very big difference whether they actually have a physical condition or whether they're just having pain coming from the joint.

Then we talk about using medications such as anti-inflammatories like Tylenol and avoiding certain activities that exacerbate the pain is another option. And then certainly if there's different surgical options if we've tried any or all of these things, and the patient continues to have significant pain over a long period of time.

Bill: So medications, physical therapy, and then you said there are surgical options, so repairs. Can you go into those for us?

Dr. Whitfield: Sure. When a patient has arthritis, what arthritis is, is the wearing away of the cartilage that coats the bones. We have it both on the ball side and the socket side. The only reliable good answer is to remove that cartilage in the underlying bone and replace it with different material such as metal and plastic, which is of course what I'm describing is the hip replacement.

Sometimes that's not what is causing the pain. Patients can have a tear in their labrum, and the labrum is the cartilage ring that goes around the socket, and that can tear from either a sprain or from the bones impinging, or running into each, as I mentioned earlier. And sometimes they can have pain because they've torn, either in a degenerative fashion or from an injury, the tendons on the outside. So if there's no significant arthritis in the hip, I can go in, I can remove some of the bone that is impinging, or running into itself, repair the labrum, and that can often be very effective in taking away their pain, and sometimes that requires also repairing the tendon on the outside if the tendon is involved in the process.

Bill: That's really interesting. So can you also talk to us then about total hip replacement and the advancements in hip replacement surgery?

Dr. Whitfield: Certainly. It's a great operation. It is considered to be for risk versus reward, one of the most successful surgeries that's done not only in orthopedics but in other surgical specialties as well. And it is very effective in taking away the majority of the pain with osteoarthritis.

Some of the newer things that people are doing is we're changing the approach, we're doing what is called the direct anterior approach, where it is supposed to be more minimally invasive, more muscle sparing. We're not detaching any muscles, just moving them out of the way to do the operation. It does require a little bit of special instruments and some special tools, but most major companies are providing those. And it's really allowing for a bit of a quicker recovery.

The long-term results have always been reasonably well, I guess the mid-term, but the short-term results are doing much better and we certainly hope that the materials that we use today are going to last even longer than they did before.

Bill: So hip replacement surgery sounds like it's becoming more commonplace. And how long can you expect a new hip to last now? You kind of alluded to that. What's the- how many years out can someone expect their new hip to last?

Dr. Whitfield: It depends, and the analogy I kind of give to people is that if you're young, active, and using and abusing the hip, which to some extent we replace it so people can be active, keep their heart healthy, we want that to some extent. But the more you use it, it can wear out. For somebody who is maybe in their fifties, very active, wants to continue a very active lifestyle, we still hope at the very least that we get fifteen to twenty years out of it. Somebody that is maybe a little bit older and more sedentary, hopefully twenty to thirty. It's not always the same for everybody, and it's not always just activity level. There's other things that go into it. Part of when it wears out, we don't always understand why.

So the analogy, as I was alluding to, is I tell people it's kind of like a car. If you're just driving slowly on Sundays, the tires will never wear out. However, if it's a sports car and you're kind of going off the line quickly and going around corners fast, those tires are probably not going to last the life of the car.

And I make the analogy because we talk about the wearing out of the plastics that is in between the components that are fixed to the bone. So I generally would tell people that if it doesn't last a good fifteen to twenty years, I'm disappointed, and my hope is that it can last up to thirty years or more.

Bill: Well that's a great analogy, Dr. Whitfield. Love that, that's a great way to put it in perspective, and thank you so much for your time today. For more information about hip pain and treatment, please visit www.EmoryHealthcare.org. That's www.EmoryHealthcare.org. You're listening to Advancing Your Health with Emory Healthcare. I'm Bill Klaproth, thanks for listening.