Osteonecrosis of the femoral head most frequently affects 30 to 50 year olds. Although the actual pathology behind femoral osteonecrosis is not yet understood, the disease typically follows a progression to eventual femoral head collapse, which results in the need for a total hip replacement. Osteonecrosis literally translates to bone death. There are several reasons why this can occur. Ischemia, or lack of blood flow, is one. This can happen from trauma, (like a hip dislocation or fracture)...

Consider these statistics: 202,500 total hip replacements were done in 2003. In that same year, 36,000 total hip replacements were operated on again to revise, remove, or replace the first implant. The number of between the ages of 30 and 65 who will develop osteoarthritis is expected to increase two to 10 times the current rate.With the rising problem of obesity in the United States and the aging population, it is predicted that these figures will increase. For example, it is estimated that by ...

Femoroacetabular impingement, otherwise known as FAI, does not have one symptom or one clinical test that tells the physician, "Yes, this person has femoroacetabular impingement FAI)". Instead, the diagnosis is one of exclusion based on patient history, clinical symptoms, physical examination, and the results of imaging studies (X-rays, MRIs).We say the diagnosis is one of exclusion because there are other hip problems with similar presentation. The examining physician formulates the diagnosis b...

Surgeons (and patients) will find this review article on current treatment concepts for femoroacetabular impingement (FAI) of interest. Studies show that the anatomic abnormalities associated with this disorder are more complex than originally thought. Understanding the bony deformity and subsequent changes in how the hip moves is important when planning treatment for this problem.Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroace...

Big Question: Do Cemented Implants Hold Up Better Than Cementless? When joint replacements are put in place, they can be cemented in place or the surgeon can use a cementless type that fills in with bone. Both are still commonly in use but many surgeons have switched to all cementless. They made this switch to avoid implant loosening that is more common with cemented implants. Loosening aside, the question of whether cemented survive longer (and better) than cementless has come up many times. T...

Just like families with multiple generations (great-grandparents, grandparents, parents, children), objects like hip replacements have generations. The first group of hip implants designed in the 1960s are now referred to as first-generation products. Eventually, they gave way to second generation implants in the 1970s and 80s.Better technology and improved materials led to the switch from cobalt-chromium-molybdenum (CoCrMo) for the bearings used to create motion to cast alloy in the second gene...

It is not uncommon for adults 65 and older to develop hip and spine problems at the same time. Degenerative osteoarthritis of the hip along with degenerative lumbar spinal stenosis (DLSS) is referred to as the hip-spine syndrome. In this article surgeons from the Vanderbilt Orthopaedic Institute in Nashville, Tennessee review this condition.Starting with the diagnostic process, the authors walk us through the history, physical exam, and diagnostic tests needed to make a differential diagnosis. D...

Surgery for femoroacetabular impingement (FAI) has been reported "successful" but results are only available for the early or short-term postoperative period. This study from Switzerland followed a group of 185 patients treated with open hip surgery for this problem. The follow-up period was at least five years. The measures of "success" included hip range-of-motion, X-ray results, patient satisfaction, and activity level. The need for further surgery (and especially conversion to a total hip re...

If you like to run but you've worn your hip joint out and you need a hip replacement, your running days may not be over. According to the results of this study from France, running after hip resurfacing is possible. But if this describes you, before you put those running shoes on, let's clarify a few things.First of all, what is hip resurfacing? Hip resurfacing arthroplasty is a type of hip replacement that replaces the arthritic surface of the joint but removes far less bone than the traditiona...

More than ever before, adults are seeking and receiving hip replacements at a younger age and with the intent of remaining active in recreational and sports activities. In this report, a team of surgeons describe their success using short-stem hip replacements for adults who were very active before surgery. The majority of patients in this group of patients returned to sports afterwards as well.Short-stem implants are just as the name implies. The long part of the implant referred to as the "ste...

In this study, surgeons from the Mayo Clinic (Rochester, Minnesota) evaluate the long-term results for patients who were treated for slipped capital femoral epiphysis (SCFE) with a treatment approach that was new 30 years ago. The treatment is called in situ pinning. In situ means "in position." In situ pinning has become an acceptable way to treat this hip problem but should be reviewed for success before continuing to use it.Slipped capital femoral epiphysis (SCFE) is a condition that affects ...

In this article, Dr. James W. Pritchett, orthopedic surgeon from Orthopaedics International in Seattle, Washington provides us with an in-depth review of a condition known as metallosis. Metallosis following metal-on-metal hip resurfacing is the focus of this report.Metallosis is defined as the body's reaction to the presence of wear debris in the joint from metallic corrosion. This metallic corrosion occurs as a result of two metal surfaces rubbing against each other. In the case of hip resurfa...

You finally get some pain relief from that hip or knee arthritis with a joint replacement and then the bone around the implant or the implant itself fractures. Why does this happen and what can be done about it? These are the main points covered in this review article. The focus is on fractures of the femur (thigh bone) around hip and knee joint replacements.The medical term for a femoral fracture around the joint implant is a periprosthetic fracture. Peri means "around" and prosthetic refers to...

Many older adults sustain a hip fracture every year. Increasing age combined with certain risk factors such as osteoporosis (decreased bone density) makes it more and more likely that an older adult will end up in the hospital with an acetabular fracture.What's an acetabular fracture? The acetabulum is the socket side of the hip joint. It is made of cartilage over bone just like every other joint. The reason it breaks is because the person falls (and lands) in such a way that the head of the fem...

Despite all efforts to prevent hip fractures, this injury remains a major problem among adults 65 and older. And with the aging Baby Boom population (born between 1946 and 1964) now entering Medicare, this problem isn't expected to go away.In fact, estimates are that there will be half a million hip fractures per year in the next 30 years. That amounts to a big chunk of change for Medicare and an even bigger inconvenience (even disability or death) for our seniors. Loss of mobility and independe...

All intertrochanteric hip fractures are not alike. And because of that, each one must be evaluated and treated depending on the specific subtype of fracture present. The intertrochanteric region of the hip is just below the femoral neck. The femoral neck is the short column of bone between the main (long) shaft of the femur (thigh bone) and the round head at the top that fits into the hip socket.About 40 per cent of all hip fractures in older adults are intertrochanteric fractures. A fall from a...

That's a long title but it reflects a long journey from childhood into adult years with a condition called Legg-Calvé-Perthes (LCP) disease. What happens to these children with and without treatment? How does the disease affect them as adults? These are the questions addressed in this review article on the natural history of LCP.Legg-Calvé-Perthes disease affects the hip (or hips) of children between the ages of four and eight most often. But the disease can show up later in the te...

Hip and/or groin pain in a young athlete is often a signal that something's not quite right. And one of the most common causes of hip pain in this group is a condition known as femoroacetabular impingement or FAI. Early detection is the key to preventing serious hip problems later in life.You might think that young athletes don't have to worry about things like osteoarthritis. They are active and rarely overweight. They excel beyond anything the rest of us would ever dream of accomplishing. But ...

Surgeons Take a Closer Look at a Hip Replacement Implant Hip replacement surgery has been around long enough now that there are numerous implants to choose from. Size, design, type of material, and cemented versus cementless are some of the key features that differ from one system to another.In this study, the CementLess Spotorno System (CLS) was investigated for long-term (10 year or more) results. Like all other hip implant systems, the CLS has two basic components: the acetabular cup (socket...

Diagnosing and Treating Complications of Hip Dislocation Hip dislocation in young adults is usually the result of a sports injury or high-speed traumatic event (e.g., car accident). This report on traumatic posterior hip dislocations in 17 adults (men and women, but mostly men) gives us an idea of the problems that can develop later.The authors show how getting to the emergency department as soon as possible with an injury like this is very important. Waiting more than six hours to get treatmen...

Athletes At All Levels Can Return to Sports After Surgery for Femoroacetabular Impingement Femoroacetabular impingement, otherwise known as FAI has become a household name in the world of sports and athletics. That's because this problem is becoming recognized as present in many more people than ever before. Is it really a new problem? Probably not -- we are just getting better at identifying it when it's there.What exactly is femoroacetabular impingement (FAI)? And why does it affect athletes?...

Is Hip Bursitis Still Around?Pain along the side of the hip is still a common spot for bursitis (also known as greater trochanter pain syndrome. A large tendon passes over the bony bump on the side of the hip called the greater trochanter.Inflammation in the bursa (a protective gel sac) between the tendon and the greater trochanter is called trochanteric bursitis or lateral hip bursitis. You can see there are many names for this problem.Hip bursitis is common in older individuals. Women seem aff...

Antiinflammatory medications are used after a total hip replacement to prevent a complication called heterotopic ossification (HO). HO is the formation of bone in the soft tissues around the joint. This postoperative problem causes pain and stiffness -- the very symptoms a joint replacement is supposed to eliminate!No one knows for sure why some patients (quite a few actually) end up with heterotopic ossification after a hip replacement. Some experts think that trauma to the muscles or bone sets...

Just because you've never knowingly injured your hip doesn't mean you don't have a hip problem. That's one conclusion from this review article on the topic of hip instability.Hip instability can include subluxation (partial dislocation), complete dislocation, and microinstability. The last classification (microinstability) is just what it sounds like -- too much looseness in the joint but without a big enough shift in hip position to cause a subluxation.Many people with hip instability have a kn...

Hip Replacement in Adults Who Had Perthes Disease As a Child Hip replacement in adults who had Perthes disease as a child is technically challenging and difficult but entirely possible and with good results. That's the report from Italian orthopedic surgeons on 32 hip replacements.Legg-Calvé-Perthes disease (Perthes) is a rare disease that most often affects boys between the ages of 2 and 12. Girls can have LPD. The hips are the main problem. Sometimes both hips are involved, but usually...

It's no surprise that a hip replacement reduces pain, increases hip motion, and restores movement and function. After all, that's why people have the procedure done. The real question now is how long does it take to recover? More than ever, today's active seniors are asking this question long before they even get the new hip.After surgery, the most common question patients have is: "How am I doing compared to everyone else?" With information from a new study on recovery following a total hip rep...

In this update on osteonecrosis of the hip, two orthopedic surgeons on opposite sides of the globe team up to review diagnosis, causes, and treatment. Dr. G. C. Babis from the University of Athens and Dr. J. Parvizi from Thomas Jefferson University in Philadelphia explore this condition as it affects the head of the femur (thigh bone). They remind us of the many classifications and treatment options (nonoperative as well as surgical).Osteonecrosis of the femoral head refers to death of the round...

Fractures of the femur (thigh bone) in young children often require a special hip-to-toe cast called a hip spica cast. In this study, the rate of skin problems caused by hip spica casts is investigated.The authors are a group of nurses from Children's Hospital in Boston. They did a chart review of 297 children who were patients at their hospital between 2003 and 2009. The children all had a hip spica cast for a femoral fracture. They divided the children into two groups and compared them.Group o...

Did you know that two-thirds of all adults who have a total hip replacement also have high blood pressure? And many patients getting a hip replacement have what's called multiple comorbidities -- in other words, lots of other medical problems.Besides hypertension, heart disease, high levels of cholesterol, and a past bout with cancer head the list of comorbidities. And the list goes on: heart arrhythmias, lung disease, urinary tract infection, diabetes, obesity, anemia, rheumatoid arthritis, dep...

It doesn't happen very often but sometimes patients who have a total hip replacement end up having a second or revision surgery because of a failed implant. Even more rare is the occasional revision surgery that fails. In this series of six cases, the stem of the femoral implant broke in half. The implant fractures occurred early on (within the first six years). The surgeons in charge of the cases wanted to know why this happened in hopes of preventing such problems in the future.Previous studie...

In Finland, almost all patients who receive a total hip replacement are enrolled in a data registry called the Finnish Arthroplasty Registry. Information on the patient's age, sex (male or female), diagnosis, type of implant, and surgical approach is entered into a computer database.The information is confidential as to the individual patient names. Having this type of information makes it possible for researchers to examine trends in treatment over time. Changes in surgical techniques, implant ...

The 13 co-authors of this article sat on a committee together to come up with Clinical Practice Guidelines (CPGs) for the diagnosis of infections in joint replacements. The proposed guidelines were approved by the American Academy of Orthopaedic Surgeons (AAOS) in June of 2010 and published here for all to see.Clinical Practice Guidelines (CPGs) are an important tool in helping physicians keep up-to-date with what the evidence says about treatment of various problems and conditions. The goal is ...

In this study, treatment of Legg-Calvé-Perthes Disease (also known as Perthes disease) with triple pelvic osteotomy is evaluated for its effectiveness. That statement will make a lot more sense once we describe Legg-Calvé-Perthes Disease and describe what is a triple pelvic osteotomy.Perthes disease is a condition that affects the hip in children between the ages of four and eight. The condition three names to honor the three physicians who each separately described the disease.In ...

The title of this article will catch the eye of any surgeon because it includes the phrase: Systematic Review. The statistical significance of any conclusions from a systematic review is worth noting. That's because such a review combines the results of many smaller studies to give an overall view of the results of treatment like surgery for femoroacetabular impingement (FAI) of the hip.Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Fem...

Treatment of holes in the articular cartilage of the knee has taken a decided turn in the last 15 years. Surgeons have found ways to either repair or replace the cartilage. Results have steadily improved so the question now is: which method works best?In this systematic review, surgeons from the Sports Medicine Center at Ohio State University compare autologous chondrocyte implantation (ACI) against other surgical treatment techniques for this problem.Here's a little more background information ...

Many seniors put off having a total hip replacement despite the pain and loss of function that the arthritic joint is causing. They are afraid that it will hurt even more after the surgery and that it will take a long time to recover. At least right now, they can walk without a walker. After surgery, the thought of using a walker or cane is enough to keep them away.Yet every year there are nearly one million adults who do have a total hip or total knee replacement. And that figure is expected to...

There isn't one part of the body (no matter how small) that doesn't have a specific function -- and often more than one job to do. That's also the case with the labrum, a horseshoe-shaped bit of fibrous cartilage lining the hip and shoulder sockets.In this review article on the hip labrum, orthopedic surgeon Marc R. Safran, MD from Stanford University provides a detailed description of the labrum anatomy. Advanced technology including light microscopy has made it possible to take pictures and st...

Hip dysplasia is a condition where the head of the femur (thigh bone) does not fit properly into the acetabelum (the cup-like area of the pelvis where the femur sits). For several years, a procedure called the Ganz (Bernese) periacetabular osteotomy was used in adults who had hip dysplasia, but recently, surgeons have been using this procedure on teens. However, there is not much research on how effective the procedure is on teens over the short term, nor is there any reliable information regar...

Hip Resurfacing is a new way to manage painful joint destruction at an age too young for a total hip replacement. Active adults thinking about having this procedure done want to know -- how active can I be after recovery? Can I run? Play tennis? Join a soccer team? Go skiing?Hip resurfacing arthroplasty is a type of hip replacement that replaces the arthritic surface of the joint but removes far less bone than the traditional total hip replacement. Because the hip resurfacing removes less bone, ...

If you've ever had squeaky shoes while trying to sneak into a movie theatre, church, synagogue, or down a quiet hallway, you know how annoying it can be. Imagine if that noise was coming from your hip replacement! At least with a squeaky pair of shoes, you can take them off. Squeaky hip replacements are not so easy to correct.The problem of squeaking hips after joint replacement has increased in the last 10 years with the increased use of hard-on-hard bearings. What do we mean by hard-on-hard be...

Pain along the back of the hip can be a very complex and puzzling condition to figure out. It's a fairly rare problem and affects athletes involved in golf, dance, or soccer most often. This article was written to help physicians diagnose with accuracy the problem and the cause.

We hear a lot about knee arthroscopy but hip arthroscopy is a reality in the orthopedic world, too. Placing a scope in the hip joint and performing procedures like removing tissue or loose bits of cartilage inside the joint is also a common procedure. Hip arthroscopy is probably used most often among sports athletes.

Groin pain is serious business for athletes trying to stay in the game. Hockey and soccer players are at greatest risk for adductor muscle strain but any athlete in any sport can be affected. The adductor muscles are located along the inner thigh. Adductor strain is a major cause of groin pain in athletes. The temptation to play through the pain can lead to worse problems later. How can these injuries be prevented?

Sports medicine physicians and orthopedic surgeons see all kinds of injuries in the athletic population. One of the less common but very challenging areas of injury to evaluate is the hip. More specifically, the lateral hip (along the side of the upper thigh/buttock area) gets our attention today.

The American Academy of Orthopaedic Surgeons (AAOS or Academy) asked a panel of nine surgeons from around the United States to review the status of metal-on-metal hip resurfacing and give us a summary. The panel addressed four specific questions:

Have you ever heard of coxa sultans? Sounds like a member of the Arabian royalty. But it's really an annoying hip condition that results in a snapping sound and feeling that occurs in some people whenever they bend or flex their hip. Coxa sultans is better known by a more descriptive term: snapping hip.In this article, physiotherapist and professor at Boston University, Dr. C. L. Lewis presents a review of the snapping hip condition. She used a search engine to find all the articles published on...

Is Total Hip Surgery marked on your calendar? It is recommended to speak to your doctor and a physiotherapist to discuss post-operative activity restrictions. It important that you know that this article relates to the post-operative outcome of Total Hip Surgery when the anterolateral surgical approach is used.

The Charnley hip replacement has been around since the 1960s, when it was pioneered as a low-friction hip replacement. Hip replacements (arthroplasties) are, in general, one of the most carefully watched and followed surgeries in the United States, including the Charnley replacement. The authors of this article wanted to update the results of hip replacement recipients 35 years or more after they received their replacement.

There's one good way to find out if something new is working. Try it on a group of people and compare it to a second group who didn't get the same thing. That's what senior orthopedic surgeon W. Thomas, MD from Rome, Italy did. He used a special osteoconductive gel over the surface of cementless hip replacement implants in 60 patients and compared results with 60 patients who got the same implant without the gel.Osteoinductive means fosters bone growth. And that's exactly what this gel does -- i...

Health care for seniors is taking a decided turn in other countries. In Italy, for example, hospitals that focus on the care of older adults are being developed. With the special needs of this population being addressed, problems like hip fracture can be treated with a geriatric-orthopedic multidisciplinary approach. This article reports on efforts to use an immediate weight-bearing early ambulation (IWB-EA) program after surgery to repair a hip fracture.Immediate weight-bearing after surgery fo...

This is the first study reported to look at the benefit of aquatic therapy in the early days after joint replacement. Physiotherapists in Australia randomly placed patients getting a hip or knee replacement into one of three different treatment groups. The goal was to find out what kind of treatment is best in the early days after orthopedic surgery.

Your knee creaks and hurts and it gets worse going up or down stairs, getting up after sitting a while, and when keeping the knee bent. Don't even bother trying to squat. Sound familiar? You could be experiencing a condition called patellofemoral arthritis. Never heard of it? The authors of this article provide an in-depth review -- everything you ever wanted to know about patellofemoral arthritis.

Can a healthy and normally aligned patella (kneecap) dislocate? Many experts have debated this question. Certainly, anatomic variations from the norm are linked with both acute (sudden) and chronic (repeated) dislocations. But there is some evidence that no amount of force will pop the patella off the knee unless there is an underlying reason.

Everything seems faster these days -- including rehab and recovery from total hip and total knee replacements. In this study from Denmark, a group of researchers compared patients in a standard rehab program for joint replacements compared with an accelerated program. They looked at two things: cost and effectiveness. They found a big cost savings with the accelerated approach for both hip and knee replacements. The accelerated approach was more effective with hip replacements.

There's a move in the medical world to help health care professionals get on the same page. What does that mean? Well, if you have a health problem, condition, illness, disease, or injury -- no matter where you live, you should get the same top quality treatment based on the best evidence currently available.

Here are a few facts to consider. A quarter of a million people in the United States will fracture their hips this year. One-fourth of those adults die within the first 12 months after that fracture. And only half of those who survive will be able to return home and resume a normal life. Those are very sobering statistics.

In some countries with universal or nationalized health care, a joint replacement is considered an elective procedure. That means the person chooses to have the operation but it's not an emergency procedure. So despite pain and loss of motion or function, that individual must wait in a queue (line) until the resources are available to them. This could take weeks to months. In the meantime, they are advised to stay active. What's the best way to do that? Should patients exercise on land or in a p...

In this study, researchers from the Gait and Posture Lab at the University of Montreal in Canada compare walking patterns between patients who had a total hip replacement versus a surface replacement arthroplasty. An earlier study by Mont et al comparing these two groups reported a slower walking speed and decreased muscle force in the hip abductor muscle of the hip.

Imagine going from having a painful arthritic hip to a squeaking but pain free hip. That can happen after a total hip replacement (THR). What causes this problem? And what can be done about it? Those are the two questions answered in this article.

Doesn't it seem odd that after 30 or more years using ceramic implants for hip replacements that suddenly there is an increased number of patients reporting squeaking when they move? And this new problem only started in 2006. What's going on?

A group of orthopedic surgeons from four well-known orthopedic clinics took the time to review available studies on hip fractures. In this report, they summarize the evidence around treating femoral hip fractures. The information was gathered from the Cochrane database and the Scottish Intercollegiate Guidelines Network (SIGN) database. Both of these organizations are well respected for their critical reviews of the literature.

There are high costs associated with a hip dislocation after a total hip replacement (THR). And they are not all financial. The psychologic distress of a hip dislocation and fear of recurring dislocations can be very traumatic.

There are many, many possible causes of hip pain. An accurate diagnosis is needed to direct treatment. But this can be elusive and take a long time to make. In this first part of a two-part series, hip pain is examined in detail. Dfferential diagnosis is the focus of part-one. Treatment approaches are discussed in part-two.