Secondary Logo

Journal Logo

Screened & Examined: Getting Hippy

Ballard, Dustin MD

doi: 10.1097/01.EEM.0000455703.83297.ab
Screened & Examined

Dr. Ballardis an emergency physician at San Rafael Kaiser and the medical director for Marin County Emergency Medical Services.

Please indulge me in a discussion of an underrated joint: the hip. Hips may not have the stoicism of shoulders (shoulder thy load, young man) or the humility of knees (take a knee, my liege), but they do have many marvelous functions and not just on the dance floor and in the labor and delivery suite.

Hips are shakable, twistable, and deadly honest. Just ask Shakira; she knows that the “Hips Don't Lie.” They are also pretty useful in supporting the body's weight and acting as major shock absorbers when that body is running and jumping. I have enjoyed such activities for decades, and I've taken my hips for granted. Not anymore.

I recently learned that osteoarthritis has taken the hop out of my hip hop. The x-rays indicate moderate to severe degenerative changes. “Degenerative changes” is truly a depressing term; it implies that there is no fix. A broken bone can be repaired or can heal on its own. A dislocated joint can be relocated with some happy juice and a strong pull. But a degenerative joint? All that lies in its future is more degeneration.

But let's back up. Let's review the pathology of osteoarthritis. Whether it is in the knees, shoulders, or hips, osteoarthritis is a process of joint degradation and narrowing. An osteoarthritic joint develops bony stubble called osteophytes, growths as unwanted as ear hair and skin tags. In ball-and-socket joints like the hip and shoulder, the joint becomes like a mortar and pestle with bone grinding on bone as these growths progress and the joint space narrows. Symptoms of hip arthritis progress from bad to worse, starting with pain and stiffness and evolving into more pain, a limp, and an inability to perform certain useful functions such as bending over to put on your socks and tie your shoes. The latter is a feat that now gives spectators in my home much amusement.



Traditionally, the treatment for this situation has been joint replacement, taking out the old mortar and pestle and swapping in a metallic version. Sometimes the joint socket can be resurfaced and the original ball retained with a metal cap covering it (this is called hip resurfacing). These procedures generally work well for relieving pain but not as well for restoring function, at least for active athletes. Patients with total joint replacements — hip and knee — are usually advised not to play sports like squash or basketball. Patients under 50 with hip resurfacing may have a better chance of safely resuming such activities. Nonetheless, it is, of course, best to avoid a major operation if you can. For those in a boat like mine, which is moderately to severely sinking, what other options are there? Let's take a quick, quip-based look.

“Wearing hip pads when biking is not stylish, but it's more stylish than the diaper you'll be wearing if you fall and break your hip.” — A colleague

There is no quicker way to osteoarthritis than severe trauma, such as breaking your hip while biking. Sadly, I've seen a number of younger patients with badly busted hips from the same mechanism; they were clipped into their pedals, tipped over, and couldn't get their feet out of the clips in time. Direct blows to the hip, even as part of a low-speed crash, are enough to shatter it. The good news is there's an easy preventive technique: wear hip pads when biking.

“You've been limping for months, and here you are playing basketball again. Doctors make the worst patients.” — An astute guy at my gym

Indeed, it's true in this particular instance. Eventually, even doctors come around. Here are some promises I've made to be a better patient: attend physical therapy and be compliant with my program, cut back on high-impact activities, and give recommended medications a try (glucosamine may help with pain as might naproxen, a drug that shows promise in stimulating cartilage repair in some preliminary studies.

“Have you looked into stem cells?” A friend who had consulted Dr. Google

Now I have. Stem cells are becoming big business, and companies have popped up that will perform a same-day procedure in which a patient's stem cells are harvested from the bone marrow and then injected into an osteoarthritic joint. The concept is that the stem cells can help promote remodeling and repair of the injured joint, decreasing pain and increasing function. That's conceptually appealing, but the effectiveness of the procedure is still unproven and its cost is not at all trivial ($5,000 or more per procedure).

“If you mention my rebounding prowess in your article about hips, I will buy you dinner.” — Local basketball legend Tom Poser

If I am going to even think about purchasing myself a stem-cell injection, I'm going to need all the free dinners I can get. Thanks, Tom!

© 2014 by Lippincott Williams & Wilkins