Harlan Selesnick, M.D
 
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Hip

JOCK Doc's Hip Questions

Question

I am a 51 year old female and had been running consistently up until a year and a half ago when I developed severe hip pain and muscle spasms. I have recently been told by 2 orthopedic surgeons that I need a total hip replacement (due to osteoarthritis). Can I resume running after I have this done? Barbara

Answer

Unfortunately, running is discouraged after joint replacement as this increases the wear and tear on the new hip and may result in loosening. However, other aerobic activities such as swimming and biking may be safe. I recommend you discuss this with your orthopedic surgeons prior to having your hip surgery. The Jock Doc

Question

I am currently a student majoring in occupational therapy. I am doing research on total hip replacement surgery. I was wondering if you knew of any medical advancements of this procedure. Are there any less invasive procedures, is arthroplastly of the hip possible? I would greatly appreciate your reply. Amy

Answer

Total Hip replacement is the same as total hip arthroplasty. The indications for hip replacement are when the patients pain due to arthritis is so bad that they can not live with it. Hip replacement is very effective in decreasing pain and allowing the patient to regain a more "normal" lifestyle. Sports however are usually limited to walking, swimming, biking, and golf. There have been a number of advances in hip replacement that will hopefully allow the replaced hips to last longer before they wear out. New ceramics, metals, and sterilization techniques for the plastic liner should further add to longevity of the new hips. Also, arthroscopic surgery for the hip has some limited indications to decrease pain when the arthritis is not to advanced, when loose pieces are in the hip joint, or labral cartilage tears produce a catching sensation in the hip. The Jock Doc

Question

I am an 18 year old D1 basketball player. I haven't started playing yet due to a chronic ongoing groin pain/strain which occurred a year and a half ago as felt pulling sensation when going for a lay up. Have constant ache in groin area where you can feel a lump, hurts to walk and always pain even when not doing anything. Went to PCP; then local orthopedic physician and did PT 4 mo. with no relief; to NYC Dr. Jeffrey Minkoff x-ray and MRI negative and aquatic PT 5 mo. with no relief; another MRI with glycerin markings-negative; to UMASS at Worchester Dr. Wm. Meyers for evaluation of all done and felt partially avulsed muscle/tendon (fascia disruped)-suggested aggressive PT 4 mo. no relief and to do whatever want to and should break on its own no relief to date. Presently been seen since Sept. '99 by Dr. A. Curtis (Northeastern University Team physician) and referred to Dr. Camer (New England Baptist Hospital) to review MRIs, etc. and referred for corticosteroid shot into hip to r/o problem in hip area by Dr. Newburg NEPH)--no relief. Bone scan-negative; another MRI with imaging negative. To see a Dr. McKaley of Boston Ballet for his suggestions? What do you think or suggest for me? I am open to more suggestions and help. Jeanne

Answer

You have seen some of the top sports medicine specialists in the country. It is possible that you have a chronic groin strain (adductor muscle origin partial tear) that has not healed. This may not show on an MRI scan. It is also possible that you may have an obturator nerve entrapment or a hip labral tear. If a neurologist finds no neurologic abnormalities you may consider surgical release or repair of your groin injury. Although these injuries rarely require surgery it is possible that your injury if the diagnosis is correct may require such a procedure. The Jock Doc

Question

I am a 57 year old female. I have been diagnosed with trochanteric bursitis. I have had pain for almost two years. My bursitis has not responded to 2 separate 6-week sessions of physical therapy. I also had two steroid injections six weeks apart. The first time I got relief for 1 day. The second time I got relief for one week. I have been to a chiropractor and he diagnosed a psoas muscle spasm that was interfering with the nerve that goes to my bursa. I have been going to him for 2 months and have intermittant relief, but the pain always comes back. I have stopped working out and even climbing stairs. I don't know what to do next. Do you think it would be helpful to go to another orthopedic MD. My bursitis was diagnosed on a bone scan. Help. Vivian

Answer

Trochanteric bursitis is a condition caused by rubbing of a thick band of tissue (Iiotibial band) on the bursa (fluid-filled sac) on the outside part of the hip (greater trochanter). This condition does not usually involve the hip joint itself. This condition commonly occurs in cyclists, runners, and soccer players. It may be related to a lack of flexibility caused by improper stretching, conditioning, or weight training. This condition usually gets better with a rehab program involving stretching, hip abductor and adductor strengthening, massage and local treatment modalities. Occasionally a cortisone injection can decrease the rubbing and inflammation and cause the symptoms to go away. Since you have not yet recovered, it is possible there may be another cause for your symptoms. I do believe an MRI scan may be helpful in diagnosis. I recommend you see an orthopedic surgeon for further evaluation and testing. The Jock Doc

Question

I am a 22 y/o male dx. with hip flexor tendonitis, I received 4 injections of a steroidal AI with lidocaine. The injections worked however I still have some pain and recurrent weakness in the hip. Originally the pain was most severe with flex. and add. of the leg while supine, and while running. It originally occurred while diving for a ground ball and landing on that hip. It reoccurred while running. I would feel a giving sensation and then moderate weakness progressing to max weakness with pain. I would like any comments you may have concerning this problem. Thanks. Jeffery

Answer

Chronic hip flexor stains that do not get better are unusual. Your complaints of weakness that dramatic are also unusual. I recommend that you be seen by a neurologist to make certain that there is not a nerve entrapment or damage that has prevented you from getting better. Also the newer high resolution MRI scans may be helpful in determining were the hip flexor is injured and that no damage to the hip joint exists such as a labral cartilage tear or loose body. After these tests are completed your orthopedic surgeon should hopefully have an answer as to what additional treatment is necessary such as neuromuscular therapy, arthroscopic hip surgery or open repair of the hip flexor origin. The Jock Doc

Question

I have problems with my hip region and knee, this occurs while walking or sleeping. It is something that is not a constant thing, it occurs at any moment and time, while bending, standing,walking,or sitting. there is a popping noise in between my joint area of my inner hip area. sometimes it feels like my hip is dislocated or I have a pinched nerve. I recently saw a surgeon, and he stated that I had a hernia. I had the surgery needed, and am convinced that it was not a hernia cause I still have the same discomfort. I carry United Health Care insurance. What would you recommend? Marcial

Answer

As you have discovered hip problems may be difficult to diagnose. An intermittent snapping sensation or pain may be related to a labral carilage tear in the hip joint, a loose piece of bone in the joint, a tendon rubbing, or the iliotibial band rubbing on the outside part of the hip. Each of these have a different type of treatment. I recommend you see an orthopedic surgeon who may order a high resolution MRI scan to aid in the diagnosis. The Jock Doc

 
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