Loading the player...Key Decisions of Hip Replacement Surgery Dr. Bassam Masri, MD, FRCSC, discusses diagnosis and treatment of key decisions in hip replacement.
Loading the player...Diagnosing Who Needs Hip Replacement Dr. Bassam Masri, MD, FRCSC, discusses diagnosis and treatment of hip replacement.
Loading the player...Causes of Hip Pain and Referred Pain Dr. Bassam Masri, MD, FRCSC, discusses diagnosis and treatment of hip pain from referred pain causes.
A typical patient with osteoarthritis of the hip would be somebody in their late ‘50s, and sometimes older, sometimes younger. But let’s take somebody in their late ‘50s with hip osteoarthritis. They would start to feel some hip pain that would gradually get worse and worse, to the point that they might think that they need to see an orthopedic surgeon. A very common question is when should someone have a hip replacement? Should they wait? Should they have it right away? Is it better to wait? Surgery is not without risk, even though a hip replacement is one of the most successful operations that we do.
And therefore, the recommendation is to always wait as long as possible, as long as there’s not a huge interference with the activities of daily living and the patient’s ability to work and function in a family unit or a social unit, or whatever it is.
So there is never, is it necessary to have a hip replacement. It is, is it desirable by the patient to have a hip replacement? And there’s where you have to weigh out the risks and the benefits, and the patient and their surgeon can then decide this is the right time to do it, or I’m better off waiting for the surgery.
If a patient is diagnosed with significant osteoarthritis of the hip with significant pain that is not responding to non-operative treatment, which includes medications, the use of a cane and staying active and fit, then the consideration is that of a hip replacement.
There are different ways of doing a hip replacement. There are not only fixation options. In other words, cementless versus cemented hip replacement, but there are also different bearing surfaces such as metal on plastic, ceramic on plastic, ceramic on ceramic, and metal on metal. And then there’s also the option of hip resurfacing. Local orthopedic Surgeon
For patients who have pain who might think that they require surgery, what they will be experiencing is that the pain they have been having for some time is gradually getting worse to the point that they may have some significant limitations in walking tolerance, they can only walk a few blocks now, they have some rest pain and in particular they might have some night pain.
If a patient has any of that progression of symptoms then the first thing that should happen is they should get an X-ray. Preferably the X-ray should be of the pelvis. In that way we have a comparison view of one hip versus the other hip, to see what the joint space looks like because that's an indicator of the severity of the arthritis.
n mild arthitis you may not see complete obliteration of the joint and just a subtle irregularity of the joint may be an indicator of the beginnings of arthritis, and that would be the diagnostic test for osteoarthritis of the hip.
Many patients feel that an MRI is a really important test and the recommendation is that if an X-ray's abnormal and shows arthritis, an MRI is not indicated, then money should not be wasted on an MRI if the diagnosis is obvious on a regular X-ray.
So once the diagnosis of osteoarthritis has been made and a patient might be considering surgery and they're waiting to either see an orthopedic surgeon or they're waiting for surgery, they need to continue with non-operative treatment usch as the anti-inflammatories, Tylenol, and sometimes a cane used in the opposite hand would be of great benefit to offload the affected side. It's a common misconception that the cane should be on the affected side but in reality it should be in the hand on the opposite side of the arthritic hip. Patients ask what is the role of physical therapy while you're waiting for a joint replacement or a hip replacement.
There's really no strong evidence to support physical therapy apart from a patient remaining as active as possible, so formal physical therapy is not really necessary while someone is awaiting a joint replacement. Once the diagnosis of osteoarthritis has been made and the pain is significantly interfering with the patient's day-to-day activities and causing significant pain,then a referral to an orthopedic surgeon may be necessary.
And of course if a patient has any questions about the diagnosis of osteoarthritis of the hip they should talk to their primary care doctor. Often seeing a local family physician or a physiotherapist in conjunction with a registered dietitian and athletic therapist is a great option to take control of this condition. Smart Food Now and exercise is also optominal for overall health. Presenter: Dr. Bassam Masri, Orthopaedic Surgeon, Vancouver, BC
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Hip pain or pain in the hip area may be related to things that are completely unrelated to the hip joint. So you can have referred pain. Commonly we see it in elderly patients referred from the spine. So conditions such as spinal stenosis or nerve root impingement coming out of the spine can give hip area and thigh pain that can masquerade as osteoarthritis. And the really difficult cases are where you have both osteoarthritis and spinal stenosis, and the doctor needs to sort out what is the cause of pain, how to best treat it.
There are other referred pains. You can have referred pain from abdominal structures, such as ovarian cysts. You can have pain in the groin from a hernia. You can have pain from tendonitis. So there’s a whole host of referred pain that are not related to the hip joint. And only a careful examination and investigation by a doctor can tell you what the real cause of the pain is. Presenter: Dr. Bassam Masri, Orthopaedic Surgeon, Vancouver, BC