Symptoms and causes of weak hip flexors and how to treat them

Article featured on MedicalNewsToday, medically reviewed by Gregory Minnis, DPT — Written by Lois Zoppi on February 27, 2021

Weak hip flexors can cause the surrounding muscles to overcompensate, which can cause pain and difficulty walking. Treatment for weak hip flexors includes physical therapy and exercises.

The hip flexors are muscles that connect the lower back to the hips, groin, and thigh bone. This muscle group includes the psoas muscle, which helps push the top of the leg upward.

The hip flexors stabilize the lower spine. They play a major role in walking, postural alignment, joint mobility, flexibility, and balance.

This article explains what symptoms and risks can come with weak hip flexors and how a person can strengthen them.

Symptoms

The symptoms of weak hip flexors can affect a range of different areas in the body.

General symptoms may include:

  • changes in gait and posture
  • knee pain
  • hip pain
  • back pain

These symptoms occur because the joints try to compensate for weak hip flexors, which leads to them overworking.

Pain in the hip flexor area may be the result of a hip flexor strain. This is different from weak hip flexor muscles, although weakness can cause a strain to occur.

Difficulty when walking

The psoas muscle is responsible for swinging the leg forward while walking. If this muscle is weak, a person may have to exert more energy and rely on other muscles — the rectus femoris muscle in the thigh and the hamstrings. These muscles may overcompensate during walking, which might put excess strain on them and cause discomfort.

A person may also find climbing stairs difficult as it may be hard to lift the leg.

Gait

Stiff knee gait is when a person walks with limited knee flexion, or bend, in the knee. Weakness in the hip flexors can lead to a stiff knee gait.

A 2016 study involving 47 people with severe hip arthritis revealed a correlation between hip flexor strength and gait. Participants in the study with the strongest hip abductors and hip flexors had a better gait than those with weaker muscles in that area.

However, other factors in the study that led to better gait were lower pain levels and better quality of life. Scientists concluded that muscle strength does play a moderate role in improving gait.

Posture

A person may experience lower back pain if they have a weak hip flexor, as the hip flexor is an important spinal stabilizer.

According to a recent article weakness in the hip flexors can make it difficult for a person to maintain a straight posture. Weak hip flexors can also cause the pelvis to tilt, which can affect posture and cause lower back pain.

Risks

Weakness in the hip flexors could result in injury, as well as the symptoms above. An injury could occur to the spine, legs, and knees if they have to overcompensate for weakness in the hip flexor muscles.

What causes weak hip flexors?

There are many different possible causes of weak hip flexors. These include:

Lack of exercise

Not partaking in regular physical activity can lead to weak hip flexors. Underuse of the hip muscles can cause the muscle to degenerate and become weak, which is known as muscle atrophy.

Sitting for long periods

Staying seated for extended periods can cause weakness in the psoas muscle. This is because the muscle does not work as hard as if the person were standing.

Osteoarthritis

Osteoarthritis in the hip can also cause weak hip flexors. It can also cause weakness in the knees, hamstrings, and buttock muscles.

Lateral transpsoas surgery

Lateral transpsoas surgery, a type of operation on the spine, can often leave a weakness in some hip flexor muscles.

Cerebral palsy

According to an article in the Journal of Ultrasound Medicine, people with cerebral palsy may experience weakness in the hip muscles. Cerebral palsy can also increase the risk of hips coming out of joint during childhood.

Tight or weak hip flexors?

Weak hip flexors are not the same as tight hip flexors. Sitting for prolonged periods could cause the hip flexors to become tight, as well as weak. Symptoms that come with tight hip flexors include lower back pain and hip pain.

How to test for weak hip flexors

A person can see whether they have weak hip flexors using resistance tests and simple exercises.

Seated knee raise

a person is performing a seated knee raise
  1. Sit in a chair and lift one leg, keeping it bent.
  2. A second person must push down on the knee while the seated person pushes against them.

A person with weak hip flexors will not be able to resist the added pressure on the leg.

Lying knee raise

a person is performing a lying knee raise

Lie down flat on the back, bringing one leg to the chest, using the hands.

If it is difficult to keep the leg up close to the chest after letting go of it, a weak hip flexor may be the culprit.

How to strengthen weak hip flexors

Exercises can be useful to prevent or strengthen weakness in the hip flexor muscles. Some people also find stretching useful for tight hip flexors.

The following exercises could help reduce weakness in the hip flexors:

Ankle weights

  1. While sitting down in a chair, attach ankle weights to the ankles.
  2. Slowly lift and lower the leg to strengthen the psoas muscle.

Doing this exercise from a standing position can also be effective.

Mountain climbers with floor sliders

This exercise uses sliders, which are small discs that a person can place underneath the feet to slide them across the floor without friction.

The mountain climber pose involves the following:

  1. Assume a plank position.
  2. Place a slider underneath the ball of each foot.
  3. Bring the knees up to the chest one by one, moving the slider along the floor.
  4. Repeat.
a person is performing sliding mountain climbers

Lunges

a person is performing a lunge
  1. Stand with the legs hip-width apart.
  2. Step forward with one leg.
  3. Slowly bend the knee until it reaches a 90-degree angle. The rear knee should be parallel to the floor.
  4. Return to a standing position by lifting the front knee
  5. Repeat.

Wall psoas hold

  1. Stand with the legs hip-width apart.
  2. Bend the knee and lift the leg so that it is level with the hips.
  3. Balance on the other foot and hold for 30 seconds.
  4. Slowly lower the leg.
  5. Repeat on the other side.
a person is performing a wall psoas hold

Skater squats

  1. Stand with the legs hip-width apart.
  2. Bend at the knees and keep the buttocks parallel to the ground, with the back straight.
  3. Come back up to a standing position and stand on one leg.
  4. Lift the opposite leg to the side with the foot pointed forward.
  5. Repeat on alternate sides.
a person is performing a skater squat

Resistance band training

A 2016 study on 33 people involved one group carrying out strengthening exercises using an elastic resistance band for three 10-minute periods each week for 6 weeks. They progressed the repetitions of the exercises they were doing over the 6 weeks. The control group did not carry out these strength exercises.

The scientists concluded that using exercise bands in this context can significantly strengthen the hip flexors.

a person is exercising with a resistance band

The following is an example of an exercise that uses an elastic exercise band to strengthen the hip flexors:

  1. Place the band around both ankles.
  2. Stand with the feet hip-width apart, and the knees slightly bent.
  3. Take a diagonal step, about 2 or 3 feet long.
  4. Continue for 20 steps.

Summary

Underuse of the muscles or sitting down for extended periods can cause weak hip flexors. Conditions such as and osteoarthritis can also cause weakness in this muscle group.

A person with weak hip flexors may experience lower back or hip pain and may have difficulty doing certain activities, such as walking or climbing stairs.

Weak hip flexors can affect a person’s posture and the way they walk.

To remedy weak hip flexors, a person can try a range of strengthening exercises that target the hip flexors.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Hip Pain: Causes and Treatment

Article on WebMD, reviewed by Tyler Wheeler, MD on March 15, 2020

The hip joint can withstand repeated motion and a fair amount of wear and tear. This ball-and-socket joint — the body’s largest — fits together in a way that allows for fluid movement.

Whenever you use the hip (for example, by going for a run), a cushion of cartilage helps prevent friction as the hip bone moves in its socket. Despite its durability, the hip joint isn’t indestructible. With age and use, the cartilage can wear down or become damaged. Muscles and tendons in the hip can get overused. Bones in the hip can break during a fall or other injury. Any of these conditions can lead to hip pain. If your hips are sore, here is a rundown of what might be causing your discomfort and how to get hip pain relief.

Causes of Hip Pain

These are some of the conditions that commonly cause hip pain:

Arthritis. Osteoarthritis and rheumatoid arthritis are among the most common causes of hip pain, especially in older adults. Arthritis leads to inflammation of the hip joint and the breakdown of the cartilage that cushions your hip bones. The pain gradually gets worse. People with arthritis also feel stiffness and have reduced range of motion in the hip. Learn more about hip osteoarthritis.

Hip fractures. With age, the bones can become weak and brittle. Weakened bones are more likely to break during a fall. Learn more about hip fracture symptoms.

Bursitis. Bursae are sacs of liquid found between tissues such as bone, muscles, and tendons. They ease the friction from these tissues rubbing together. When bursae get inflamed, they can cause pain. Inflammation of bursae is usually due to repetitive activities that overwork or irritate the hip joint. Learn more about bursitis of the hip.

Tendinitis. Tendons are the thick bands of tissue that attach bones to muscles. Tendinitis is inflammation or irritation of the tendons. It’s usually caused by repetitive stress from overuse. Learn more about tendinitis symptoms.

Muscle or tendon strain. Repeated activities can put strain on the muscles, tendons, and ligaments that support the hips. When they become inflamed due to overuse, they can cause pain and prevent the hip from working normally. Learn about the best stretches for tight hip muscles.

Hip labral tear. This is a rip in the ring of cartilage (called the labrum) that follows the outside rim of the socket of your hip joint. Along with cushioning your hip joint, your labrum acts like a rubber seal or gasket to help hold the ball at the top of your thighbone securely within your hip socket. Athletes and people who perform repetitive twisting movements are at higher risk of developing this problem. Learn more about hip labral tears.

Cancers. Tumors that start in the bone or that spread to the bone can cause pain in the hips, as well as in other bones of the body. Learn more about bone tumors​​​​​​​.

Avascular necrosis (also called osteonecrosis). This condition happens when blood flow to the hip bone slows and the bone tissue dies. Although it can affect other bones, avascular necrosis most often happens in the hip. It can be caused by a hip fracture or dislocation, or from the long-term use of high-dose steroids (such as prednisone), among other causes.

Symptoms of Hip Pain

Depending on the condition that’s causing your hip pain, you might feel the discomfort in your:

  • Thigh
  • Inside of the hip joint
  • Groin
  • Outside of the hip joint
  • Buttocks

Sometimes pain from other areas of the body, such as the back or groin (from a hernia), can radiate to the hip.You might notice that your pain gets worse with activity, especially if it’s caused by arthritis. Along with the pain, you might have reduced range of motion. Some people develop a limp from persistent hip pain.

Hip Pain Relief

If your hip pain is caused by a muscle or tendon strain, osteoarthritis, or tendinitis, you can usually relieve it with an over-the-counter pain medication.

Another way to relieve hip pain is by holding ice to the area for about 15 minutes a few times a day. Try to rest the affected joint as much as possible until you feel better. You may also try heating the area. A warm bath or shower can help ready your muscle for stretching exercises that can lessen pain.

If you have arthritis, exercising the hip joint with low-impact exercises, stretching, and resistance training can reduce pain and improve joint mobility. For example, swimming is a good non-impact exercise for arthritis. Physical therapy can also help increase your range of motion.

When osteoarthritis becomes so severe that the pain is intense or the hip joint becomes deformed, a total hip replacement (arthroplasty) may be a consideration. People who fracture their hip sometimes need surgery to fix the fracture or replace the hip.

Call your health care provider if your pain doesn’t go away, or if you notice swelling, redness, or warmth around the joint. Also call if you have hip pain at night or when you are resting.

Get medical help right away if:

  • The hip pain came on suddenly.
  • A fall or other injury triggered the hip pain.
  • Your joint looks deformed or is bleeding.
  • You heard a popping noise in the joint when you injured it.
  • The pain is intense.
  • You can’t put any weight on your hip.
  • You can’t move your leg or hip.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Exercises and Stretches For Hip Pain

Exercises and Stretches for Hip Pain

From Versus Arthritis

Here are some exercises designed to stretch, strengthen and stabilize the structures that support your hip.

It’s important to keep active – you should try to do the exercises that are suitable for you every day. Repeat each exercise between 5–10 times and try to do the whole set of exercises 2-3 times a day.

Start by exercising gradually and build up over time. Remember to carry on even when your hip is better to prevent your symptoms returning.

If you have any questions about exercising, ask your doctor.

It’s also a good idea to try to increase your general fitness by going for a regular walk or swim, this will strengthen your whole body – which helps support your hip. It can also improve your general health, fitness and outlook.

Simple stretching, strengthening and stabilising exercises

The following exercises are designed to stretch, strengthen and stabilise the structures that support your hip. These exercises for hip pain (PDF, 983 KB) are also available to download and keep.

It’s important not to overstretch yourself if you’re in pain. It’s normal to feel some aching in the muscles after exercising, but you should stop and seek advice if you have joint pain that lasts more than a few days.

If you’ve had a hip replacement you will probably be advised to take it easy for the first six weeks and not to push yourself too much. Ask your physiotherapist what exercises they recommend you should start with and how to do them.

You may feel slightly uncomfortable during or after exercise, but this should settle within 24 hours. It shouldn’t be painful. If you feel any sudden pain stop exercising and seek medical advice.

An illustration of someone marching on the spot.

Hip flexion (strengthening)

Hold onto a work surface and march on the spot to bring your knees up towards your chest alternately. Don’t bring your thigh above 90 degrees.

An illustration of someone standing whilst holding onto a table, moving their leg backwards and keeping it straight.

Hip extension (strengthening)

Move your leg backwards, keeping your knee straight. Clench your buttock tightly and hold for five seconds. Don’t lean forwards. Hold onto a chair or work surface for support.

An illustration of someone standing and holding onto a chair, lifting their leg sideways.

Hip abduction (strengthening)

Lift your leg sideways, being careful not to rotate the leg outwards. Hold for five seconds and bring it back slowly, keeping your body straight throughout. Hold onto a chair or work surface for support.

An illustration of someone standing whilst holding onto a table, bending their knee towards their bottom.

Heel to buttock exercise (strengthening)

Bend your knee to pull your heel up towards your bottom. Keep your knees in line and your kneecap pointing towards the floor.

An illustration of someone squatting down, bringing their knees towards their toes.

Mini squat (strengthening)

Squat down until your knees are above your toes. Hold for a count of five if possible. Hold on to a work surface for support if you need to.

An illustration of someone laying on their back with one bent leg and one straight leg with a towel under it's knee. They're raising their foot off the floor.

Short arc quadriceps exercise (strengthening)

Roll up a towel and place it under your knee. Keep the back of your thigh on the towel and straighten your knee to raise your foot off the floor. Hold for five seconds and then lower slowly.

An illustration of someone laying down with their legs straight, pulling their toes and ankles towards them whilst pushing their knees to the floor.

Quadriceps exercise (strengthening)

Pull your toes and ankles towards you, while keeping your leg straight and pushing your knee firmly against the floor. You should feel the tightness in the front of your leg. Hold for five seconds and relax. This exercise can be done from a sitting position as well if you find this more comfortable.

An illustration of someone laying on their back with their knees bent and hands under the small of their back. They're pulling their belly towards the floor.

Stomach exercise (strengthening/ stabilising)

Lie on your back with your knees bent. Put your hands under the small of your back and pull your belly button down towards the floor. Hold for 20.

An illustration of someone laying on their back with their feet to standing, lifting their pelvis and lower back off the floor.

Bridging

Lie on your back with your knees bent and feet flat on the floor. Lift your pelvis and lower back off the floor. Hold the position for five seconds and then lower down slowly.

An illustration of someone laying on their back and pulling their knee toward their chest.

Knee lift (stretch)

Lie on your back. Pull each knee to your chest in turn, keeping the other leg straight. Take the movement up to the point you feel a stretch, hold for around 10 seconds and relax. Repeat 5-10 times. If this is difficult, try sliding your heel along the floor towards your bottom to begin with, and when this feels comfortable try lifting your knee.

An illustration of someone sitting with their knees bent and feet together, pressing their knees downwards.

External hip rotation (stretch)

Site you your knees bent and feet together. Press your knees down towards the floor using your hands as needed. Alternatively, lie on your back and part your knees, keeping your feet together. Take the movement up to the point you feel a stretch, hold for around 10 seconds and relax. Repeat 5-10 times.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Total Hip Replacement Exercise Guide

From OrthoInfo &  the American Academy of Orthopaedic Surgeons

Regular exercise to restore strength and mobility to your hip and a gradual return to everyday activities are important for your full recovery after hip replacement. Your orthopaedic surgeon and physical therapist may recommend that you exercise for 20 to 30 minutes, 2 or 3 times a day during your early recovery. They may suggest some of the exercises shown below.

This guide can help you better understand your exercise and activity program, supervised by your physical therapist and orthopaedic surgeon. To ensure your safe recovery, be sure to check with your therapist or surgeon before performing any of the exercises shown.

Early Postoperative Exercises

The following exercises will help increase circulation to your legs and feet, which is important for preventing blood clots. They will also help strengthen your muscles and improve hip movement.

Start the exercises as soon as you are able. You can begin them in the recovery room shortly after surgery. You may feel uncomfortable at first, but these exercises will help speed your recovery and actually diminish your postoperative pain.

Ankle Pumps

Slowly push your foot up and down. Repeat this exercise several times, as often as every 5 or 10 minutes. Begin this exercise immediately after surgery and continue it until you are fully recovered.

Illustration of ankle pumps

Ankle pumps

Ankle Rotations

Move your ankle inward toward your other foot and then outward away from your other foot.

Repeat 5 times in each direction.

Do 3 or 4 sessions a day.

Illustration of ankle rotations

Ankle rotatations

Bed-Supported Knee Bends

Slide your foot toward your buttocks, bending your knee and keeping your heel on the bed. Do not let your knee roll inward. Hold your knee in a maximally bent position for 5 to 10 seconds and then straighten.

Repeat 10 times.

Do 3 or 4 sessions a day.

Illustration of bed-supported knee bend

Bed-supported knee bends

Buttock Contractions

Tighten your buttock muscles and hold to a count of 5.

Repeat 10 times.

Do 3 or 4 sessions a day.

Illustration of buttock contractions

Buttock contractions

Abduction Exercise

Slide your leg out to the side as far as you can and then back.

Repeat 10 times.

Do 3 or 4 sessions a day

Illustration of abduction exercise

Abduction exercise

Quadriceps Set

Tighten your thigh muscle. Try to straighten your knee. Hold for 5 to 10 seconds.

Repeat this exercise 10 times during a 10-minute period, rest one minute and repeat.

Continue until your thigh feels fatigued.

Illustration of quadriceps set

Quadriceps set

Straight Leg Raises

Tighten your thigh muscle with your knee fully straightened on the bed. Lift your leg several inches. Hold for 5 to 10 seconds. Slowly lower.

Repeat until your thigh feels fatigued.

Illustration of straight leg raise

Straight leg raises

Standing Exercises

Soon after your surgery, you will be out of bed and able to stand. You will require help at first but, as you regain your strength, you will be able to stand independently. While doing these standing exercises, make sure you are holding on to a firm surface such as a bar attached to your bed or a wall.

Standing Knee Raises

Lift your operated leg toward your chest. Do not lift your knee higher than your waist. Hold for 2 or 3 counts and put your leg down.

Repeat 10 times.

Do 3 or 4 sessions a day.

Illustration of standing knee raise

Standing knee raises

Standing Hip Abduction

Be sure your hip, knee and foot are pointing straight forward. Keep your body straight. With your knee straight, lift your leg out to the side. Slowly lower your leg so your foot is back on the floor.

Repeat 10 times.

Do 3 or 4 sessions a day.

Illustration of standing hip abduction

Standing hip abduction

Standing Hip Extensions

Lift your operated leg backward slowly. Try to keep your back straight. Hold for 2 or 3 counts. Return your foot to the floor.

Repeat 10 times.

Do 3 or 4 sessions a day.

Illustration of standing hip extension

Standing hip extensions

Early Activity

Soon after surgery, you will begin to walk short distances in your hospital room and perform light everyday activities. This early activity aids your recovery and helps your hip regain its strength and movement.

Walking

Proper walking is the best way to help your hip recover. At first, you will walk with a walker or crutches. Your surgeon or therapist will tell you how much weight to put on your leg.

Illustration of woman using a walker after hip replacement

Early on, walking will help you regain movement in your hip.

Stand comfortably and erect with your weight evenly balanced on your walker or crutches. Advance your walker or crutches a short distance; then reach forward with your operated leg with your knee straightened so the heel of your foot touches the floor first. As you move forward, your knee and ankle will bend and your entire foot will rest evenly on the floor. As you complete the step, your toe will lift off the floor and your and knee and hip will bend so that you can reach forward for your next step. Remember, touch your heel first, then flatten your foot, then lift your toes off the floor.

Walk as rhythmically and smoothly as you can. Don’t hurry. Adjust the length of your step and speed as necessary to walk with an even pattern. As your muscle strength and endurance improve, you may spend more time walking. You will gradually put more weight on your leg. You may use a cane in the hand opposite your surgery and, eventually, walk without an aid.When you can walk and stand for more than 10 minutes and your leg is strong enough so that you are not carrying any weight on your walker or crutches, you can begin using a single crutch or cane. Hold the aid in the hand opposite the side of your surgery.

Stair Climbing and Descending

The ability to go up and down stairs requires both strength and flexibility. At first, you will need a handrail for support and will be able to go only one step at a time. Always lead up the stairs with your good leg and down the stairs with your operated leg. Remember, “up with the good” and “down with the bad.” You may want to have someone help you until you have regained most of your strength and mobility.

Stair climbing is an excellent strengthening and endurance activity. Do not try to climb steps higher than the standard height (7 inches) and always use a handrail for balance. As you become stronger and more mobile, you can begin to climb stairs foot over foot.

Illustration of woman climbing and descending stairs using a crutch

Stair climbing and descending using a crutch

Advanced Exercises and Activities

The pain from your hip problems before your surgery and the pain and swelling after surgery have weakened your hip muscles. A full recovery will take many months. The following exercises and activities will help your hip muscles recover fully.

These exercises should be done in 10 repetitions, 4 times a day. Place one end of the tubing around the ankle of your operated leg and attach the opposite end of the tubing to a stationary object such as a locked door or heavy furniture. Hold on to a chair or bar for balance.

Elastic Tube Exercises

Resistive Hip Flexion

Stand with your feet slightly apart. Bring your operated leg forward keeping the knee straight. Allow your leg to return to its previous position.

Illustration of resistive hip flexion

 Resistive hip flexion

Resistive Hip Abduction

Stand sideways from the door to which the tubing is attached and extend your operated leg out to the side. Allow your leg to return to its previous position.

Illustration of resistive hip abduction

Resistive hip abduction

Resistive Hip Extensions

Face the door to which the tubing is attached and pull your leg straight back. Allow your leg to return to its previous position.

Illustration of resistive hip extensions

Resistive hip extensions

Exercycling

Exercycling is an excellent activity to help you regain muscle strength and hip mobility.

At first, adjust the seat height so that the bottom of your foot just touches the pedal with your knee almost straight. Pedal backwards at first. Ride forward only after a comfortable cycling motion is possible backwards.

As you become stronger (at about 4 to 6 weeks) slowly increase the tension on the exercycle. Exercycle for 10 to 15 minutes twice a day, gradually building up to 20 to 30 minutes, 3 or 4 times a week.

Walking

Walk with a cane until you have regained your balance skills. In the beginning, walk for 5 or 10 minutes, 3 or 4 times a day. As your strength and endurance improve, you can walk for 20 to 30 minutes, 2 or 3 times a day. Once you have fully recovered, regular walks of 20 to 30 minutes, 3 or 4 times a week, will help maintain your strength.

 


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

A New Hip May Mean a Longer, Better Life

A New Hip May Mean a Longer, Better Life

A hip replacement may help seniors live longer — for at least a decade anyway, a new study from Sweden suggests. “Our study suggests that hip replacement can add years to life as well as adding ‘life to years’ — increasing the chances of longer survival as well as improving the quality of life,” said study author Dr. Peter Cnudde. He’s an orthopedic surgeon with the Swedish Hip Arthroplasty Register in Gothenburg.

Read more

What to Expect After a Hip Replacement

What to Expect After a Hip Replacement

Article Featured on Home Care Assistance

Have You Decided it is Time for Hip Replacement Surgery?

That aching, painful and stiff hip has reduced your quality of life. You can’t enjoy the activities you used to love, like a good golf game, a walk around the block or even playing with the grandkids, without constant pain.

Over 300,000 people have hip replacement surgery each year in the United States. Before you decide to join this group, it is important to know what to expect following surgery. What will you experience after your hip replacement? When will you feel back to normal? What can you do to speed your recovery?

Pain After a Hip Replacement

First things first, hip replacement surgery will hurt. All surgery does! Be prepared that you will experience a significant amount of discomfort in the first three days following surgery. Your mobility will be limited, and you will need to depend on others to help you with your regular activities of daily living. Even simple things like going to the bathroom will require assistance.

On the first day, a significant amount of surgical pain medication will be in your system. You may feel groggy but not as uncomfortable. On the second day, you will likely be able to get out of bed and start moving with assistance. Although you had surgery on the largest joint in your body, you will be walking on it in only one or two days.

Be ready for the third day after surgery. You will probably feel like you got hit by a truck. After surgery, your body sends a large number of inflammatory cells to the injured area in order to help with the healing process. These levels will be at the highest on day three. Inflammation means swelling and swelling means pain. Talk to your doctor their recommendations for using ice and taking an anti-inflammatory medication starting on the day of surgery. But remember, typically, once you get through day three the swelling and pain will get better.

Walking After Hip Replacement Surgery

Most likely, you will be up and walking the day after your surgery. Take it slow and don’t push yourself beyond what you can handle. Getting up and active following surgery is vital to speeding up your recovery after a hip replacement. Try to exercise for 20-30 minutes at a time. The first day that might just mean getting out of bed and to the hallway. Don’t feel discouraged by this!

Moving around will not only speed up your recovery but will also increase the circulation to your legs and feet which will reduce your chance of getting a blood clot. Blood clots are a serious risk following all types of surgery but can be prevented by early movement and exercise.

Getting out of bed will also help to maintain and increase your muscle strength while preventing your new hip from getting stiff. You’ll want to take full advantage of that new level of hip movement. Don’t forget that getting out of bed and being able to walk with a walker or cane is one of the goals you need to accomplish before going home from the hospital.

Your Hip Replacement Recovery Checklist

Typically, after two to four days you will be discharged from the hospital to either your home or to a rehabilitation facility. Here are some goals to use as a checklist when transitioning back to your home. Make sure that:

  • You can get out of bed by yourself.
  • Your pain is adequately under control. This doesn’t mean you’re pain-free but it should be manageable.
  • You can eat, drink, sleep and go to the bathroom.
  • You can walk with a cane, walker or crutches.
  • You’re ready to do home exercises on your own.
  • You know what you need to do to protect your new hip from an injury.

Before you go home, you will need to have someone available to help you at home. This can be a friend, family member or a caregiver. At home, you will want to make sure that your furniture is set up so that you can get around your house easily.

What Will Hip Replacement Recovery be Like?

It’s normal to have questions about what the healing process will look like after surgery. So we’ve gathered the answer to common questions.

When Can I Shower?

You will not be showering until you get the go-ahead from your surgeon because you need to keep the incision dry. But a sponge bath will feel heavenly when you get home! The first two weeks you will be at your highest risk of infection, so report any signs of redness, drainage or fever. Your surgical staples will usually come out on day 10-14 and then you can bathe or shower again.

When Can I Start Walking?

After your surgical staples are removed, you’ll be able to start to work on walking without a walker or cane. Don’t forget to move around as much as you can while at home. Make sure you do the physical therapy exercises you have set up, go for light walks and remember to rotate your ankles, bend your knees and practice leg raises while sitting up or lying down.

When Can I Drive?

You can usually start driving within three to six weeks following hip replacement surgery. However, you will need to make sure that you are no longer taking any pain medication that affects your response time or makes you groggy. Initially, you will likely find that an automatic transmission is easier to drive. Also, make sure you can tip your foot up and down without pain prior to driving. This can depend on which hip is operated on. If you had surgery on the side you use to drive, it may take longer to get behind the wheel.

When Can I Have Sex?

Yes, it is a question every patient has but often hesitates to ask. This can be especially awkward if it is your parent that has had a hip replacement and you are accompanying them to a doctor’s appointment. Check with your doctor to be sure, but it is usually safe to resume sexual activity six weeks to two months following a hip replacement. Remember, as with all activities, to listen to your body! Do not attempt to do more than you feel capable of and to stop or slow down if you notice increased pain.

Dr. Mehran, an orthopedic surgeon, shares this rule of thumb, “If you are still needing to use a walker, you are probably not ready for sex yet.” Still using a walker usually means that you have not yet regained enough strength and balance.

What Should I Eat After Hip Replacement Surgery?

The healthier you eat, the better you heal! The food that you put into your body will provide you with the energy and nutrition needed to fight off infections, accelerate healing, increase your strength and energy and build up your nutrition stores. Speed up the recovery process by eating healing foods like berries and dark leafy greens.

6 Tips for a Successful Hip Replacement Recovery

Along with following your surgeon’s discharge plan for exercise and physical therapy, it’s important to make a few changes to your home.

“Preparing your home with the same care shown to your physical recovery will set you up for success,” says Barbara Bergin, M.D. of Texas Orthopedics, Sports and Rehabilitation Associates. She suggests starting with the following six steps.

1. Remove Tripping Hazards

Slips and falls are common reasons for hip replacement surgeries in the first place. To avoid hospital re-admission with an injury to your other hip, or damaging the replacement, Bergin suggests removing all throw rugs, floor mats, etc. from your home.

“You’ll be shuffling your feet for a while,” says Bergin. As a result, you can trip on throw rugs, including those you use in the bathroom or kitchen. If you prefer to keep the rug where it is, Bergen suggests “fastening them using carpet tape to keep the edges down.” However, she says that the best bet is removing the tripping hazard to eliminate any concerns about a fall.

2. Upgrade the Bathroom

Installing a handicap or comfort height toilet is a better option than a temporary elevated toilets apparatus, says Bergen. “Not only do the temporary appliances get dirty easily, but it’s also recommended to use a comfort height toilet permanently after a total joint replacement.” Doing so, she says, will improve the quality of your life, along with that new joint.

You should also use a shower chair. Make sure that you have a sturdy chair that is higher than average and firm. You will find this easier to get up from. To get in and out of the shower easily, you also might want to consider having a grab bar installed in the bathroom.

3. Raise ‘em up

“Elevating the legs helps get that swelling down,” Bergin says. Swelling can limit your ability to get your life back to normal. She suggests, “Using big pillows or wedges to elevate your legs if recommended.” This includes having a pillow to place in between your legs while sleeping. “A nice, fat body pillow provides comfort and helps promote restful sleep.”

4. Gather the Right Tools

Bergin says over time, you may easily perform many daily activities once again. But in the first days and weeks at home, some of life’s little tasks like getting dressed or feeling steady while retrieving something from a cabinet might be challenging. She encourages people to have a few handy gadgets to make these tasks as stress-free—and safe—as possible.

“Sock donners and handy grabbers that extend your reach are absolute musts,” she says. Other helping hands include leg lifters, bendable bath sponges and a long-handled shoe horn. Many companies sell these items together as a “hip kit” package.

5. Raise Your Seat

If you can afford it, Bergen suggests asking your doctor for a prescription for a lift chair. She says, “Your knees, hips and arms will appreciate it, and that your other bad hip will really appreciate it!” Although insurance doesn’t cover the cost of the chair, having a prescription can avoid the need to pay sales tax in some areas.

6. Borrow, Don’t Buy

Many of the items you’ll need to speed down the road to recovery post hip replacement will only be required for a few weeks or so. Instead of paying the full price out-of-pocket (medical equipment is frequently not covered by many insurance plans) or even your deductible’s portion of these items, check in your area for free or low-cost community resources. These can alleviate the sting of having to outfit your home with several new tools and medical equipment.

“Family members and/or patients may borrow this equipment for little or no cost from community medical equipment lending programs, also known as medical equipment reuse programs or loan closets,” says Janice Selden, Director of Great Lakes Loan Closets.

These organizations accept medical equipment from community members who no longer need it. “They clean the equipment, check to make sure it is safe, and lend it back out to members of the community who need it. Typical equipment includes wheelchairs, walkers, shower aids, and dressing aids,” explains Selden.

Organizations like these usually provide an online directory of locations that provide these services throughout the country and can be very helpful for patients.

Do’s and Don’ts After a Hip Replacement

The dos and don’ts might be different depending on what type of surgical technique your doctor used. Your doctor and physical therapist can give you a specific list to remember. These precautions are pretty standard to prevent your new hip from dislocating and to help with a quick and thorough recovery.

Do

  • Keep your operated leg facing forward.
  • Make sure your operated leg is in front of you as you sit or stand.
  • Use chairs that are high enough that your knee is lower than your hip when bent.
  • Use ice to reduce swelling.
  • Use heat before exercising to warm up the muscles for 15-20 minutes. This will help you to have better movement.
  • Reduce the amount of exercise you do if you are in pain but continue to stay active and resume your exercises as soon as possible.
  • Ask your doctor about safe sleep positions.
  • Limit the amount of weight you carry.

Don’t

  • Cross your legs for six to eight weeks.
  • Allow your knees to sit higher than your hips.
  • Lean forward while sitting, especially to pick something up off the floor.
  • Turn your foot in or out when you bend down.
  • Bend at the waist beyond 90 degrees.
  • Twist your hips.

How Long Until You Feel Good Again After a Hip Replacement

It will take time before you are out dancing again! Hip replacement is an excellent option to increase your health and quality of life. The American Academy of Orthopedic Surgeons report that 95% of patients who undergo a hip replacement stated the procedure was successful. They reported relief from hip pain and were able to be more active and connected with their loved ones following the surgery.

These results are encouraging but it is not an overnight cure. You can expect it to take 10-12 weeks before you are able to return to all your favorite activities. At some point, you are going to feel like your recovery is taking too long. It’s important to remind yourself that feeling frustrated and limitations to physical ability are a normal part of the healing process.

Take a break and relax from pushing yourself. Do something you can enjoy. Get help if you need it, think about how far you have already come, then get back up, keep on moving and eating healthy. 10-12 weeks will feel like a long time, but once you are enjoying a pain-free stroll or game of golf, that time will be just a memory.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Hip Pointers in Contact Sports

Hip Pointers in Contact Sports

Article Featured on Nationwide Children’s Hospital

Hip Pointers

Bumps and falls are all a part of everyday life as an athlete, and can often result in bruising and injury. The majority of these types of injuries are seen in contact sports. The term “hip pointer” is often used as a catch all phrase for any injury resulting in pain to the front of the hip. However, this is not always the case.

What is a Hip Pointer?

A hip pointer is bruising caused by a fall or a direct blow to the iliac crest, or front and top of the pelvis. This bruising is not always visible and may actually occur deep below the skin. Bruising may also occur in the abdominal muscles which attach to the pelvis. Most often hip pointers are seen in contact sports such as football and soccer. Hip pointers are extremely painful and may be aggravated by walking, running, laughing, coughing, or deep breathing.

Treatment

Hip pointers are treated immediately with rest and ice. Resting the injured hip from extremely painful movements will help to reduce swelling and speed the healing process. It may take 1 to 2 weeks before the injured hip is pain free with movement. During this time the athlete should be allowed to stretch the hip in all directions to avoid stiffness. The rule here is to stretch in the pain free range. Any pain will only slow the healing process and delay their return to sport.

It is important to consult your physician if your pain last more than two weeks or worsens overtime. This may be a sign of a more severe injury. Ice should be applied directly to the hip for 30 minutes of every 1-2 hours for the first 72 hours. A regimen of gentle stretching for 20-30 seconds can help to loosen the muscles around the injured hip and reduce pain. For more information on strains please see the article “The Sprains and Strains of Sporting Injuries” located on the Nationwide Children’s Hospital website.

Prevention

Hip pointers can be prevented by wearing appropriate protective equipment. For example, football and hockey wear protective hip pads to help prevent this injury. In other sports where padding is not worn, such as soccer, certain skills and techniques can be taught to avoid this injury. Padding can also be worn to prevent further injury to the hip.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

5 Common Causes of Hip Pain in Women

5 Common Causes of Hip Pain in Women

Article Featured on EverydayHealth | By Beth W. Orenstein, Medically Reviewed by Justin Laube, MD

Hip pain in women can result from wear and tear, overuse, and a few other causes. Here are the most common culprits.

Does your hip hurt? As with other types of chronic pain, women tend to experience it more than men. But because hip pain can have a number of different causes, determining the correct one is the key to getting the best treatment.

The Diagnosis: Is It Your Hip?

When you tell your doctor your hip hurts, the first thing she should do is confirm that your hip is actually the problem. Women might say they have hip pain, but what they may mean is that they have pain in the side of the upper thigh or upper buttock, or they may be experiencing lower back pain, says Stephanie E. Siegrist, MD, an orthopedic surgeon in Rochester, New York, and a spokeswoman for the American Academy of Orthopaedic Surgeons. Hip pain is often felt in the groin or on the outside of the hip directly over where the hip joint (a ball-and-socket joint) is located.

Causes of Hip Pain in Women

When a female patient comes to Dr. Siegrist complaining of hip pain, she considers the patient’s age, build, and activity level. If the patient is a thin 20-year-old runner or a heavy, sedentary 80-year-old grandmother, “the possibilities at the top of my list will be different,” she says.

Among the most common causes of hip pain in women are:

1. Arthritis Chronic hip pain in women is often due to arthritis, particularly osteoarthritis, the wear-and-tear kind that affects many people as they age. “The ball-and-socket joint starts to wear out,” Siegrist says. Arthritis pain is often felt in the front of your thigh or in the groin, because of stiffness or swelling in the joint.

2. Hip fractures Hip fractures are common in older women, especially those with osteoporosis (decreased bone density). Symptoms of a hip fracture include pain when you straighten, lift, or stand on your leg. Also, the toes on your injured side will appear to turn out, a sign that can aid your doctor’s preliminary diagnosis.

3. Tendinitis and bursitis Many tendons around the hip connect the muscles to the joint. These tendons can easily become inflamed if you overuse them or participate in strenuous activities. One of the most common causes of tendinitis at the hip joint, especially in runners, is iliotibial band syndrome — the iliotibial band is the thick span of tissue that runs from the outer rim of your pelvis to the outside of your knee.

Another common cause of hip pain in women is bursitis, says Marc Philippon, MD, an orthopedic surgeon in Vail, Colorado. Fluid-filled sacs called bursae cushion the bony part of the hip that is close to the surface. Like the tendons, these sacs can become inflamed from irritation or overuse and cause pain whenever you move the hip joint.

4. Hernia In the groin area, femoral and inguinal hernias — sometimes referred to as sports hernias — can cause anterior (frontal) hip pain in women. Pregnant women can be susceptible to inguinal hernias because of the added pressure on the wall of their abdomen.

5. Gynecological and back issues “Hip pain in women can have gynecological causes,” Siegrist says. “It’s important not to just assume that the pain is caused by arthritis, bursitis, or tendinitis. Depending on your age and other health issues, the pain in your hip could be coming from some other system.”

Endometriosis (when tissue similar to the uterus lining tissue grows outside the uterus) can cause pelvic tenderness, which some women describe as hip pain. Pain from the back and spine also can be felt around the buttocks and hip, Siegrist says. Sciatica, a pinched nerve, typically affects one side of the body and can cause pain in the back of the right or left hip — the pain from sciatica can start in your lower back and travel down to your buttocks and legs.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Developmental Dislocation (Dysplasia) of the Hip (DDH)

Article Featured on AAOS

The hip is a “ball-and-socket” joint. In a normal hip, the ball at the upper end of the thighbone (femur) fits firmly into the socket, which is part of the large pelvis bone. In babies and children with developmental dysplasia (dislocation) of the hip (DDH), the hip joint has not formed normally. The ball is loose in the socket and may be easy to dislocate.Although DDH is most often present at birth, it may also develop during a child’s first year of life. Recent research shows that babies whose legs are swaddled tightly with the hips and knees straight are at a notably higher risk for developing DDH after birth. As swaddling becomes increasingly popular, it is important for parents to learn how to swaddle their infants safely, and to understand that when done improperly, swaddling may lead to problems like DDH.

Description

In all cases of DDH, the socket (acetabulum) is shallow, meaning that the ball of the thighbone (femur) cannot firmly fit into the socket. Sometimes, the ligaments that help to hold the joint in place are stretched. The degree of hip looseness, or instability, varies among children with DDH.

  • Dislocated. In the most severe cases of DDH, the head of the femur is completely out of the socket.
  • Dislocatable. In these cases, the head of the femur lies within the acetabulum, but can easily be pushed out of the socket during a physical examination.
  • Subluxatable. In mild cases of DDH, the head of the femur is simply loose in the socket. During a physical examination, the bone can be moved within the socket, but it will not dislocate.

Illustrations of a normal hip and a dislocated hip

(Left) In a normal hip, the head of the femur fits firmly inside the hip socket. (Right) In severe cases of DDH, the thighbone is completely out of the hip socket (dislocated).

In the United States, approximately 1 to 2 babies per 1,000 are born with DDH. Pediatricians screen for DDH at a newborn’s first examination and at every well-baby checkup thereafter.

Cause

DDH tends to run in families. It can be present in either hip and in any individual. It usually affects the left hip and is predominant in:

  • Girls
  • Firstborn children
  • Babies born in the breech position (especially with feet up by the shoulders). The American Academy of Pediatrics now recommends ultrasound DDH screening of all female breech babies.
  • Family history of DDH (parents or siblings)
  • Oligohydramnios (low levels of amniotic fluid)

Symptoms

Some babies born with a dislocated hip will show no outward signs.

Contact your pediatrician if your baby has:

  • Legs of different lengths
  • Uneven skin folds on the thigh
  • Less mobility or flexibility on one side
  • Limping, toe walking, or a waddling gait

Doctor Examination

In addition to visual clues, your doctor will perform a careful physical examination to check for DDH, such as listening and feeling for “clunks” as the hip is put in different positions. Your doctor will use specific maneuvers to determine if the hip can be dislocated and/or put back into proper position.

During the exam, your doctor will maneuver your baby’s legs and hips in certain ways to detect hip instability.

Newborns identified as at higher risk for DDH are often tested using ultrasound, which can create images of the hip bones. For older infants and children, x-rays of the hip may be taken to provide detailed pictures of the hip joint.

Treatment

When DDH is detected at birth, it can usually be corrected with the use of a harness or brace. If the hip is not dislocated at birth, the condition may not be noticed until the child begins walking. At this time, treatment is more complicated, with less predictable results.

Nonsurgical Treatment

Treatment methods depend on a child’s age.

Newborns. The baby is placed in a soft positioning device, called a Pavlik harness, for 1 to 2 months to keep the thighbone in the socket. This special brace is designed to hold the hip in the proper position while allowing free movement of the legs and easy diaper care. The Pavlik harness helps tighten the ligaments around the hip joint and promotes normal hip socket formation.

Baby in Pavlik harness

Newborns are placed in a Pavlik harness for 1 to 2 months to treat DDH.

Parents play an essential role in ensuring the harness is effective. Your doctor and healthcare team will teach you how to safely perform daily care tasks, such as diapering, bathing, feeding, and dressing.

1 month to 6 months. Similar to newborn treatment, a baby’s thighbone is repositioned in the socket using a harness or similar device. This method is usually successful, even with hips that are initially dislocated.

How long the baby will require the harness varies. It is usually worn full-time for at least 6 weeks, and then part-time for an additional 6 weeks.

If the hip will not stay in position using a harness, your doctor may try an abduction brace made of firmer material that will keep your baby’s legs in position.

In some cases, a closed reduction procedure is required. Your doctor will gently move your baby’s thighbone into proper position, and then apply a body cast (spica cast) to hold the bones in place. This procedure is done while the baby is under anesthesia.

Caring for a baby in a spica cast requires specific instruction. Your doctor and healthcare team will teach you how to perform daily activities, maintain the cast, and identify any problems.

6 months to 2 years. Older babies are also treated with closed reduction and spica casting. In most cases, skin traction may be used for a few weeks prior to repositioning the thighbone. Skin traction prepares the soft tissues around the hip for the change in bone positioning. It may be done at home or in the hospital.

Surgical Treatment

6 months to 2 years. If a closed reduction procedure is not successful in putting the thighbone is proper position, open surgery is necessary. In this procedure, an incision is made at the baby’s hip that allows the surgeon to clearly see the bones and soft tissues.

In some cases, the thighbone will be shortened in order to properly fit the bone into the socket. X-rays are taken during the operation to confirm that the bones are in position. Afterwards, the child is placed in a spica cast to maintain the proper hip position.

Older than 2 years. In some children, the looseness worsens as the child grows and becomes more active. Open surgery is typically necessary to realign the hip. A spica cast is usually applied to maintain the hip in the socket.

Recovery

In many children with DDH, a body cast and/or brace is required to keep the hip bone in the joint during healing. The cast may be needed for 2 to 3 months. Your doctor may change the cast during this time period.

X-rays and other regular follow-up monitoring are needed after DDH treatment until the child’s growth is complete.

Complications

Children treated with spica casting may have a delay in walking. However, when the cast is removed, walking development proceeds normally.

The Pavlik harness and other positioning devices may cause skin irritation around the straps, and a difference in leg length may remain. Growth disturbances of the upper thighbone are rare, but may occur due to a disturbance in the blood supply to the growth area in the thighbone.

Even after proper treatment, a shallow hip socket may still persist, and surgery may be necessary in early childhood to restore the normal anatomy of the hip joint.

Outcomes

If diagnosed early and treated successfully, children are able to develop a normal hip joint and should have no limitation in function. Left untreated, DDH can lead to pain and osteoarthritis by early adulthood. It may produce a difference in leg length or decreased agility.

Even with appropriate treatment, hip deformity and osteoarthritis may develop later in life. This is especially true when treatment begins after the age of 2 years.

Questions and Answers About Metal-on-Metal Hip Implants

Questions and Answers About Metal-on-Metal Hip Implants

Article Featured on AAOS

If your hip has been damaged by arthritis, a fracture, or other condition, common activities such as walking or getting in and out of a chair may be painful and difficult. You may be considering hip replacement surgery. By replacing your diseased hip joint with an artificial joint, hip replacement surgery can relieve your pain, increase motion, and help you get back to enjoying many normal, everyday activities.

How Your Hip Works

The hip is one of the body’s largest weight-bearing joints. It is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone). Bands of tissue called ligaments (hip capsule) connect the ball to the socket and provide stability to the joint.

normal hip anatomy

Normal anatomy of the hip. In a healthy hip, the ball at the upper end of the thighbone (femur) fits firmly into the socket, which is part of the large pelvis bone.

Hip Replacement Devices

After you and your orthopaedic surgeon have determined you are a candidate for hip replacement surgery, your surgeon will select a hip replacement device for you based on your body structure, medical history, and lifestyle.

Many different types of designs and materials are currently used in artificial hip joints. All of them consist of two basic components: the ball component (made of a highly polished strong metal or ceramic material) and the socket component (a durable cup of plastic/polyethylene, ceramic, or metal). Sometimes, the socket is made of a different material than the ball, or is lined with a different material, and sometimes the ball and socket are made of the same material. Your orthopaedic surgeon will recommend the best combination for you.

Implant Complications

All hip implant devices — no matter what type — can have complications. The most common complications include implant dislocation and device wear.

Bone loss, or osteolysis, is also a known complication. When the ball component moves against the cup, the surface begins to wear away and small debris particles are given off. The debris remains around the joint and over time can cause the bone around the implant to thin and weaken. As a result, the implant components can loosen and additional surgery may be necessary.

Researchers are continuing to study different device surfaces in order to address the problems of wear debris and osteolysis.

Metal-on-Metal (MoM) Devices

In metal-on-metal devices both the ball and socket components are made of metal. These metal implants have been used in total hip replacement surgeries and hip resurfacing procedures.

Because of metal’s durability, metal-on-metal devices were expected to last longer than other hip implants. In addition, the ball in a metal-on-metal device is larger, making the hip joint more stable and less likely to dislocate.

MoM implants have also been used because they avoid the complication of debris wear from implants made of plastic/polyethylene. However, recent information about the wear of certain metal-on-metal devices has raised concerns about their use. Like polyethylene, metal surfaces give off small particles of debris. In addition, metal surfaces can corrode, giving off metal ions. Metal debris (ions and particles) can enter the space around the implant, as well as enter the bloodstream. This can cause a reaction in some patients, such as pain or swelling around the hip, osteolysis, and very rarely symptoms in other parts of the body.

Although the vast majority of patients have not had any problems with MoM implants, orthopaedic surgeons and the U.S. Food and Drug Administration (FDA) are concerned because cases have been reported in the peer-reviewed literature and through a British database in which patients have local hip symptoms (pain and swelling). In addition, there have been a very small number of cases that have had other medical concerns seemingly unrelated to the hip.

Updates on Metal-on-Metal Devices from the FDA

On January 17, 2013, the U.S. Food and Drug Administration (FDA) issued an updated public health communication about hip replacement components that have both a metal ball and a metal socket (metal-on-metal hip devices).To read their notification:

On May 6, 2011, the Food and Drug Administration (FDA) issued a postmarket surveillance study of total metal-on-metal hip replacement devices. Metal-on-metal (MoM) hip devices consist of a ball, stem, and shell, all made of metal parts. A postmarket surveillance study monitors adverse events after a device has been approved or cleared by the FDA. Manufacturers of metal-on-metal hip implants have orders from the FDA to further study the safety of metal-on-metal devices . As a result, if you have a metal-on-metal hip replacement device, your surgeon may be contacting you to find out how your device is functioning.

In February 2011, the FDA issued their initial public safety communication about metal-on-metal hip devices.

If after a joint replacement surgery you experience pain or have other, new medical concerns or issues, please talk to your doctor or orthopaedic surgeon.

The Importance of Physician-Patient Communication

The American Academy of Orthopaedic Surgeons (AAOS) believes that physician and patient joint decision making leads to the best surgical outcomes. Share your concerns, voice your questions, and offer a complete medical history so that you and your surgeon can together develop the best plan for you.

There are many issues to discuss with your orthopaedic surgeon when you are considering total hip replacement surgery. It is helpful to make a list of the questions you would like to ask. In addition to the questions featured in this article, the AAOS provides the following suggestions: Total Joint Replacement: Questions Patients Should Ask Their Surgeon

Your surgeon will also talk with you about hip implant devices. To help you with this discussion, here are examples of questions you may want to ask your surgeon:

  • What are your experiences with specific hip implant devices and how often do you use one over the other?
  • What are the risks and benefits of different devices (metal-on-metal, metal-on-polyethylene, ceramic-on-polyethylene, and ceramic-on-ceramic devices)?
  • If applicable, what is the surgeon’s personal experience and outcomes with metal-on-metal hip devices?
  • If your surgeon recommends a metal-on-metal device, ask why a metal-on-metal hip implant is the best for your situation.

Frequently Asked Questions About Metal-on-Metal Hip Implants

What kind of recovery should I expect after hip replacement surgery?

After undergoing hip replacement, you may expect your lifestyle to be a lot like the way it was before, but without the pain. In many ways, you are right, but it will take time. You need to be a partner in the healing process to ensure a successful outcome.

What personal health information should I share with my orthopaedic surgeon if I am considering a metal-on-metal hip implant?

It is critical that your orthopaedic surgeon know your complete medical history including any problems you may have with your kidneys and any known sensitivities or allergies to metal — for example, if you have allergic reactions from wearing certain jewelry.

Is there a way to determine ahead of time if I might have a reaction to the metal in the metal-on-metal hip implant system?

Currently there is no widely accepted test to predict if you will develop a reaction to the metal from a hip system, and there is insufficient evidence to support using a skin patch test to determine your sensitivity to a metal-on-metal hip implant. If, however, you have a known sensitivity to metal, it is important to share that information with your surgeon.

Are there any ways to prevent the metal from reaching the joint and bloodstream if I get a metal-on-metal hip implant?

No. All artificial hips require one component to slide against another component and it is inevitable that material at the surfaces will wear as they interact. In metal-on-metal hip implants, some tiny metal particles and metal ions are released into the joint space and metal ions can potentially enter the bloodstream. Certain characteristics may place patients at risk for increased wear and metal ion production, and these patients will need closer follow-up after implantation. However, how a patient reacts to the metal is variable.

Which patients should not have a metal-on-metal hip implant system implanted?

Each type of hip implant system has its own set of benefits and risks. Metal-on-metal hip implant systems are not for everyone. You should discuss your situation with your orthopaedic surgeon to determine whether you are a candidate or not. In general, metal-on-metal hip systems are not meant to be implanted in patients:

  • Who have kidney problems
  • Who have a known allergy or sensitivity to metals
  • Who have a suppressed immune system
  • Who are currently receiving high doses of corticosteroids such as prednisone
  • Who are women of childbearing age

In addition, people with smaller body frames may be at increased risk for adverse events and device failure.

Why are women of child-bearing age not good candidates for metal-on-metal hip implants?

As discussed above, recent information shows that metal ions can leave the artificial joint and enter the bloodstream. It is not known how long they remain in blood or other organs of the body.

Some metallic ions may cross the barrier from mother to fetus through the placenta. It is not known if the amount of ions is great enough to have any effect on the growing fetus or if the presence of metal ions in the mother’s bloodstream will have any effect on future pregnancies.

For this reason, it is recommended that younger women who need hip replacement surgery consider implant options other than metal-on-metal.

With the risk of adverse reactions to metal-on-metal hip implant systems, why are these devices still being offered to patients?

It is known that every different type of hip implant system has its own set of risks as well as its own set of benefits. FDA’s assessment of medical devices such as metal-on-metal (MoM) hip implants is based on a risk-benefit ratio with the data available. MoM hip implants overall have been shown to provide significant benefits (e.g., high survivorship) in certain patient populations. Although the exact prevalence of adverse reactions to metal debris is not known, current experience leads us to consider the adverse outcomes to be relatively low or equal (with some designs) to other types of hip implants. Thus, for many patients, currently available information supports a favorable risk-benefit ratio.

The orthopaedic surgeon should assess the patient’s individual needs and should avoid using metal-on-metal hip implants in patients where the risks outweigh the benefits.

Information for Patients Who Have Metal-on-Metal Hip Implants

How do I know if I have a metal-on-metal hip system?

Patients are usually told about the type of implant they are receiving prior to the surgery. If you are uncertain about which type you have, you should contact the orthopaedic surgeon who performed your procedure.

How often should I follow-up with my orthopaedic surgeon?

Based on your individual circumstances, your orthopaedic surgeon will determine how frequently you need to follow-up. There are some cases where your orthopaedic surgeon may recommend more frequent follow-up based on the type of hip implant, the outcome of the surgery and your recovery, and the results of blood tests or imaging procedures.

If you develop new or significantly worsening symptoms or problems with your hip, including pain, swelling, numbness and/or a change in ability to walk, contact your orthopaedic surgeon right away.

What should I discuss with my orthopaedic surgeon at each follow-up appointment?

It is critical that you talk to your surgeon about any new or worsening symptoms related to your hip, groin, or legs since your last visit. This may include pain, swelling, numbness, and change in ability to walk. It is also important that you discuss:

  • Changes in your general health
  • Whether you are being seen or treated by another physician for a new condition since receiving your metal-on-metal hip implant

What symptoms might a metal-on-metal hip implant cause?

Symptoms may include hip/groin pain, local swelling, numbness or changes in your ability to walk. There are many reasons a patient with a metal-on-metal hip implant may experience such symptoms and it is important that you contact your surgeon to help determine why you are having them.

Are there other medical effects that can occur with my metal-on-metal hip implant system?

Metal-on-metal hip implants, like other types of hip implants, are known to have adverse events, including infection and joint dislocation. There are some case reports of the metal particles causing a reaction around the joint, leading to deterioration of the tissue around the joint, loosening of the implant, and failure of the device, as well as some of the symptoms described above. In addition, some metal ions from the implant may enter into the bloodstream. There have been a few recent case reports of patients with metal-on-metal hip implants developing a reaction to these ions and experiencing medical problems that might have been related to their implants, including effects on the nervous system, heart, and thyroid gland.

What are my chances of developing a reaction to my metal-on-metal hip implant and having these types of medical problems?

Although current data suggests that these events are rare, it is currently unknown how often they occur in patients with metal-on-metal hip implants.

Part of the difficulty in answering this question is that individuals vary in how they react to metal ions in their bodies. For example, a reaction may develop in Patient A in response to a very small amount of metal, whereas Patient B may be able to tolerate a much larger amount before a reaction develops.

What should I do if I am experiencing adverse events associated with my metal-on-metal hip implant?

  1. If you are experiencing hip/groin pain, difficulty walking or a worsening of your previous symptoms, you should make an appointment to see your orthopaedic surgeon for further evaluation of your implant. Your orthopaedic surgeon may wish to perform a physical exam and an evaluation based on your symptoms.
  2. If you experience any new symptoms or medical conditions in your body other than at your hip, you should report these to your primary physician and remind them that you have a metal-on-metal hip implant system during their evaluation.

What should I do if I am not experiencing adverse events associated with my metal-on-metal hip implant?

If you are not having any symptoms and your orthopaedic surgeon believes the metal-on-metal hip implant is functioning appropriately, there are no data to support the need for additional tests. You should continue to follow-up with your orthopaedic surgeon for periodic examinations.

What should I discuss with my other healthcare providers including my general internist or family practice doctor?

There are rare case reports of patients with metal-on-metal hip implants who experienced medical problems in areas of the body away from their hip implant. This may have resulted from the metal ions released by the metal-on-metal hip implant.

If you see a healthcare provider for the evaluation of any new or worsening symptoms outside the hip/groin area, including symptoms related to your heart, nervous system, or thyroid gland, it is important that you tell that clinician of your metal-on-metal hip implant. This information may affect the types of tests that are ordered to further evaluate the cause of your symptoms.

When would a hip revision surgery be needed?

There are multiple reasons why a surgeon may recommend a device revision (a surgical procedure where your implant is removed and another put in its place). Many of these reasons, including infection, dislocation, and device fracture, apply to any type of hip implant. Your surgeon might also consider revision if you develop evidence of local or systemic reactions to the metal from your hip implant. In that case, the surgeon will take several factors into account in considering if and when a revision surgery is advisable.

What are the risks of revision surgery?

Any surgical procedure, including revision surgery, has risks associated with it, including reaction to the anesthesia, infection, bleeding, and blood clots. The revision surgery may be more difficult if you had a local reaction to the implant that may have affected your soft tissue and/or bone quality.

What does it mean when I see that a hip implant system has been “recalled?”

A hip system may be recalled by the manufacturer for a number of reasons. If your device is recalled, this does not necessarily mean that the device needs to be removed and replaced. In some cases, the recall just calls for different or more frequent monitoring. It is important to discuss the reason for the recall with your surgeon to determine the most appropriate course of action. If you are unsure if your hip implant was recalled, consult with your orthopaedic surgeon. Additional information on the recall can be obtained from the manufacturer.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.