(upbeat music)
- Let's take a look at the symptoms of hip arthritis
and how they affect your daily life.
- The symptoms of hip osteoarthritis are pain,
primarily pain which can be associated
with getting up from a seated position.
Pain associated with getting up out of bed
and starting to walk in the morning.
And a lot of times you'll have pain
going up and down stairs.
And then secondarily you can start to have
limitations in motion of the hip.
It gets harder to get up from a seated position.
And sometimes you can wind up with some shortening
of the leg of the extremity as a result
of the joint wearing down.
And then you can start to walk with a limp sometimes.
As the hip socket continues to wear down
and there's not much cartilage left in the hip socket,
even if you're not weight bearing on the hip
you can still have pain.
Because the bones are rubbing against each other.
And just changing position, whether it's in bed
or changing position to get out of bed
or sitting in a chair, getting up from a seated position
can be rather uncomfortable.
When the hip starts to wear down
a lot of the pain is generated in the groin.
In the front of the hip.
As opposed to the side or on the back.
And sometimes because of how
the nervous system is set up you can have some pain
that's referred to the inside of the knee.
So every now and then we'll see someone
come in and say they have pain in the knee
and it actually turns out to be a bad hip socket.
As a rule, the pain generated from a bad hip socket
is gonna be in the front.
We're looking for the degree
that there may be a loss of motion.
That the more arthritic the hip becomes
the more loss of motion they have.
The tissues around the sockets start
to contract from disuse.
And that limits the function and the movement of the hip.
We look to see if there's shortening of the leg
associated with loss of cartilage in the hip joint.
Are they limping?
Are they having back problems
which have developed secondarily
to try to keep limping on a bad hip socket.
And how easy is it to reproduce the pain
in the hip socket if we rotate the leg inwards
and it gives them excruciating pain.
We know that we have a problem that's not
going to easily be dealt with with pills
or injections or therapy.
How far you can walk.
What intensifies the pain?
What kind of things aren't you able to do anymore?
Are you tired of the pain?
Because that's a big determinant in what you do.
Can you continue to tolerate what you're experiencing
on a daily basis
or is the problem big enough to do something about it?
Terry has come into the office
for evaluation of pain he's experiencing in the hip.
And one of the first things that we're gonna do
is check the motion in the hip joint.
See if there's any limitation that we're seeing.
Which may be associated
with the development of osteoarthritis.
And one of the first things that we can check
is the range of motion in your hip socket here.
And one of the first things that we assess
is the ability of the leg to rotate inwards.
Which is often limited in the osteoarthritic hip.
We check the ability to rotate outwards as well.
And then we check the ability to extend the knee here
and if there's any reproduction of pain
going down the leg or in the hip region when we do that.
We also can check the strength in the musculature
which may be an indication of if the muscles
around the hip joint are properly working.
If you could push out against my hand Terry.
And the press back down.
There you go.
And why don't you lie down here for a second Terry.
The other thing that we want to check here
is the range of motion in a different fashion here.
We bring the hip up to 90 degrees
and then internally rotate the leg
to see if that generates pain in the hip socket.
Oftentimes with an arthritic hip that will.
And the ability to rotate the leg outward is also assessed.
We can assess some degree the function
of the musculature if we slightly rotate the leg out
and bring that into extension.
Sometimes we can feel muscles or tendons
popping over the bony prominences around the hip
indicating that there's a muscular problem
contributing to the patient's discomfort.
You can also palpate or feel the tissues
where some of the muscles attach to the top
of the femur bone here to see if they're
reproducing any pain around the hip.
Generally the pain from an osteoarthritic
worn down hip is gonna be more centralized in the groin.
In younger people you see people
with a osteoarthritic hip from trauma.
They may be in a car accident.
They may hit their knee against the dashboard,
cause some damage to the cartilage on the end of the bone,
which then develops into an arthritic hip.
Later on in life in your 60s, and your 70s,
and your 80s you can have wear and tear
that's associated with progressive degenerative
changes progressive osteoarthritis.
The most common scenario would be the slow progression
of deterioration of the hip socket from osteoarthritis.
Next thing that we would want to do
with Terry is check x-rays.
Cause on the x-rays we'll see if there's a loss
of joint space associated with wear and tear.
We'll see if there's bone spurs forming around the hip.
We'll see if there's any calcification
in the tissues around the hip socket.
We'll make sure there aren't any type of lesions
within the bone that can be a reason
or an explanation for the pain.
And see how much if this
may be attributed to osteoarthritis.
- [Male] Here we have the front view of a gentleman
who is having pain in his right hip.
This is his right hip.
This is his left hip.
Here we see on his normal left hip,
this is the middle of the ball.
And this is the outer surface of the ball.
This is the surface of the socket.
So here we see a good space
between the ball and the socket.
This space in here.
On his painful arthritic hip,
here is the middle of the ball.
And here is the periphery of the collapsed
surface of the ball.
It's all worn down with bone spurs like this.
And the socket, that's also all worn down
and collapsed on the ball.
This is the same gentleman who's now undergone
a hip replacement.
Again on the left side,
middle of the ball.
A normal ball.
And a normal socket.
On the right side where he has undergone a hip replacement
we have this metal ball
that's connected to a metal stem
that is inside the bone.
The metal stem connected to the metal ball
that is then sitting inside this metal socket.
(upbeat music)