Anywhere people fancy high technology—South Korea is a good example—MRI units are humming, and hip surgery is booming.
The most recent data available, published in JAMA Internal Medicine in 2013, assessed how often advanced imaging was ordered in nearly twenty-five thousand physician visits. The proportion of patients who left their doctors’ appointments with orders for MRIs increased from 7.2 percent in 1999 to 11.3 percent in 2010. As a result of this increase in imaging, the percentage of patients who were directed to hip specialists for interventional procedures and surgery more than doubled, rising from 6.9 percent to 14 percent in the same period.
In 2015, the British Medical Journal researchers found, yet again, that hip osteoarthritis was a normal part of aging and that hip pain was not present in many patients with osteoarthritis of the hip, and many patients with hip pain did not show hip osteoarthritis. Yet hip replacements have increased by 30 percent from 2000 to 2015.
The number one reason a surgeon recommends a hip replacement is hip pain combined with an image that indicates osteoarthritis. Don’t be fooled by this simplistic assessment. Following a hip replacement, nearly 20 percent of patients state that they DO NOT have hip pain relief. This is mainly because the biomechanical problem that is causing hip pain was not addressed. The problem is a biomechanical dysfunction in the soft tissue surrounding the joint, which can be addressed by physical therapy.
A study published in the Journal of the American Medical Association in May of 2018 concluded that quarterly corticosteroid injections for knee osteoarthritis increased cartilage loss over the course of 2 years without providing any clinical benefit, according to a randomized controlled trial.
“Although the cartilage loss was not associated with worsening of symptom outcomes, rates of cartilage loss have been associated with higher rates of arthroplasty, raising the possibility of potential for longer-term adverse consequences on the health of the joint,” writes Timothy E. McAlindon, MD.
To translate that quote, it means that injections into the joint lead to higher rates of joint replacement. Even though this study focuses on the knee, there is no difference in the outcomes of injections into the hip. Though not the best treatment option, it is commonly performed and can lead to a higher cost of care and higher risk procedures (surgery).
Hip surgeons, who are typically trained as orthopedic surgeons, do essential things. They repair traumatic injuries. They excise tumors. They fix congenital abnormalities. But, except for top-tier physicians who usually work at academic medical centers, such procedures are not their main-stay. About 60 percent of patients who walk into a hip surgeon’s clinic want hip pain relief for hip pain that will be diagnosed as “ordinary,” “mechanical,” “degenerative,” “functional,” or “nonspecific.” Those terms describe joint space narrowing, osteoarthritis, cartilage loss, and the bony outgrowths known as osteophytes. Too often, surgeons point to these commonplace artifacts on an MRI and diagnose “Bone on Bone,” recommending hip replacement surgery as the best option.
But there’s a problem with this very common procedure in which the joint is removed and replaced with screws, plates, rods, and other medical devices. Studies show that hip replacements succeed in hip pain relief in 80 percent of patients. This is one of the highest success rates for joint replacements; however, it comes with risk. According to the British Medical Journal in 2012, 23 percent of patients reported an unfavorable long-term hip pain relief outcome.
A study in the journal of bone and joint surgery in January of 2003 indicated that, of the patients who had a total hip replacement, 3.9 percent had a dislocation, 0.9 percent had a pulmonary embolism, and 0.2 percent had a deep infection in the first twenty-six weeks after surgery. These rates are not high by any means, but they are real. Avoid the risks by relieving hip pain with conservative treatments.
It is important when getting care for a painful hip to seek help from an expert who understands the complexity of the hip and its relationship to the rest of the body. The source of hip pain is often tied to a biomechanical problem in the areas above and below the hip, which causes a stress response in the hip itself. The most common areas that are overlooked are the foot/ankle complex and the opposite side hip. These areas often show a reduction in movement ability and create stress and pain in the hip itself.
Commonly, treatments are focused on the hip that is painful. This treatment option can often result in not getting to the root of the problem and can lead to overspending on treatments that don’t fix the problem. This is, by far, the most common rip-off when seeking hip pain treatment.
The hip pain experts at Superior Physical Therapy have an intimate understanding of how the entire body is connected and know that you must look above and below the painful hip in order to find a solution. Call one today at 231.944.6541.
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