Atul F. Kamath, MD
Think of your favorite activity. You’ve done it for years either recreationally or professionally, but lately the nagging pain in your hip is making it difficult. You switch to something less intense—from singles tennis to doubles or from full-court basketball to half-court.
Soon, the pain grows so bad that you give up your activity and take up swimming or walking to ease strain on your joints. You dread seeing an orthopedic specialist because you are concerned they will say you need a hip replacement. And that will take you out of the game completely, right?
Atul Kamath, MD, Director of the Penn Medicine Center for Hip Preservation, addresses three myths about severe hip pain.
Myth #1: Joint replacement is the only treatment option for hip pain.
Part of this myth is rooted in history. “In the ’90s and even into the early 2000s, young patients with hip pain would be told by doctors, ‘Well, we’re only seeing mild degenerative changes on X-ray, so you’ll have to deal with the pain and get a hip replacement later on if the arthritis worsens,’” recalls Dr. Kamath.
Now, instead of joint replacement, non-surgical and minimally invasive procedures can be done to preserve the hip joint.
Non-surgical options include things like physical therapy, acupuncture, and manual massage. “These are all good adjunctive therapies that help recover, but in isolation may not help relieve pain and improve function on a long-term basis,” he advises.
Surgical procedures to address the root cause of the hip pain include:
- Hip arthroscopy: A minimally invasive surgery to repair damage, such as cartilage injury, deep inside the hip joint.
- Core decompression: A minimally invasive technique to decompress dead bone tissue in the hip socket. Pelvic bone stem cells can be re-injected to stimulate the growth of new, healthy bone tissue.
- Osteotomy: An open surgery to form a more normal or stable hip socket, particularly for patients with dysplasia.
- Surgical hip dislocation: An open surgery that dislocates the hip joint from the socket—without reducing blood supply—to correct severe deformities and cartilage damage.
Myth #2: Treatment for hip pain only applies to older people.
Sure, age can be a factor, but the health of your cartilage is really the key.
Dr. Kamath sees young patients who have had childhood diseases like Perthes disease or dysplasia. They may have had treatments as a young child, and now they’re experiencing hip pain or dysfunction related to abnormal bone structure.
Dr. Kamath also sees other patients like 20- and 30-year-old elite athletes or performers who routinely twist their hips into extreme positions, causing hip injury. Then, there’s the 30- to 50-year-olds who are very active, but now have some wear and tear at the hip joint.
These groups aren’t eligible for hip replacement, but they may be candidates for hip preservation because of their healthy cartilage.
Hip replacement is reserved for patients with poor cartilage, arthritis and joint damage that is too far gone to save.
Myth #3: Hip pain always feels like hip pain.
Not necessarily. Sometimes, it can feel more like you pulled a muscle in your groin, which makes it harder to identify.
“With groin pain, it may be vague and often deep-seated in the joint,” Dr. Kamath explains. “And there’s a whole confluence of muscles, nerves and other tissues right around the hip, as well as, pain that may come from the low back or pelvis.”
“With true hip joint pain, you can’t often literally put your finger on the pain, so it can be challenging for the patient,” he adds.
This is because most people think their hip joint sits at the side of the upper thigh. “The hip joint is actually more in the groin,” Dr. Kamath explains. “If you put one finger in front of the groin and one finger in back and meet them in the middle, that’s actually where the hip joint is located.”
Surprisingly, hip pain can also feel like back pain, especially when there is a component of buttock pain or pain that wraps around the side or front of the hip. A skilled clinician can tease out these subtleties.
Whatever type of hip pain you’re experiencing, you do have options.
“In orthopaedics, the beauty is that most things are elective,” Dr. Kamath adds. “Just reaching a correct diagnosis, getting some information, and understanding the treatment options goes a long way in helping decide—even if surgery isn’t an option.”
Don’t put off addressing your hip pain.