Hip Pain: Hip Pain in Younger Adults
Guest: Dr. Langdon Hartsock – Orthopedic Surgery
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Langdon Hartsock who is Associate Professor and Chairman in the Department of Orthopedics, Medical University of South Carolina. Dr. Hartsock, one of your areas of interest, I understand, is in hip pain in younger adults. How is this different from hip pain in older adults?
Dr. Langdon Hartsock: Linda, we frequently see young people, and by that I mean people in the range of 20 years old up to 50, who come in complaining of pain around their hip. Often times, that’s in their groin area or in the back of their hip. They’ll occasionally have a limp. We do an evaluation of these individuals and most of the time they don’t have what we think of, traditionally, as arthritis that needs a hip replacement like we might see in someone who’s a bit older. And we’ve got some exciting techniques that we can offer these patients that often times will help relieve their symptoms.
Dr. Linda Austin: Now, when you talk about pain that could be in the groin or all the way to the back of the hip, I mean, that covers a pretty wide swath, so to speak. I would think that there could be a number of different causes of a hip pain like that, right?
Dr. Langdon Hartsock: You’re exactly right. There are a variety of causes of hip pain in young people and we have to work through that as part of an evaluation when they come in to see us. We usually take some time to ask the patient about how it got started, what kinds of symptoms they’re having, what makes it worse or better, have they ever had any kind of injuries, any kind of hip problems as they were growing up, and then we go ahead with a physical exam. All of this is designed to try to figure out or pinpoint what is causing the pain.
Dr. Linda Austin: Can you give some guidelines for someone listening to this as to at what point they should take hip pain seriously enough to seek an evaluation?
Dr. Langdon Hartsock: Sure. In our active society today, we have a lot of patients who will experience temporary hip pain, maybe they’ve overdone it, started a new exercise program, had a busy weekend, maybe even a minor injury at home or at work. Those things, usually, will go away in about four to eight weeks. So, somebody that needs to come in is someone who has had persistent hip pain. It hasn’t responded to the usual things we think of trying to do at home, like some Tylenol, or some anti-inflammatories, maybe some general stretching at home. It just keeps going. A lot of times it’s activity-related. Many times some of these folks are very athletic and they find, during sports or right after sports, it’s very bothersome to them and it just doesn’t go away.
Dr. Linda Austin: What are some of the common causes of significant hip pain?
Dr. Langdon Hartsock: The things that we’re seeing are the early stages of arthritis. And these are people who come in and have an examination and have an x-ray done, and often times they’re told by their primary care physician, or through the interpretation of radiologists, their x-rays are normal. And what we found out through research over the last, say, 20 years is there are some very subtle findings on the x-ray that can often times indicate that there’s a problem with the hip that’s causing the pain, and if left untreated, say, over the course of the next 15 or 20 years, will lead to arthritis. It’s progressive and potentially might need a hip replacement.
So, what we’re trying to do is identify those patients at a younger age and offer them some less invasive types of treatment that may actually stop the progression of any kind of early arthritis and save them from ever needing a hip replacement.
Dr. Linda Austin: What kind of pain is characteristic of what you’re describing? I’m thinking, for example, sciatica is a very common hip pain, but you’re not speaking of that, correct?
Dr. Langdon Hartsock: Correct. Sciatica has many meanings to many different people. True sciatica is a neurologic type pain. It’s a shooting pain that goes down below the knee, into the leg and foot, and that often times can indicate a herniated disc. The kind of pain I’m referring to is usually activity related. In other words, it’s after sports or long walks, or going up and down the steps. These patients will have a limp and they’ll have pain in their groin, which is really where the hip joint is. Sometimes it will radiate through into the back of the hip, and that can indicate one of these problems in the hip joint itself. The other frequent area of hip pain is on the side of the hip, and patients will say it goes down towards their knee. That, often times, is a fairly straightforward problem with bursitis around the hip, which can be treated quite easily with an injection into the bursa and some physical therapy for stretching and strengthening.
But this groin pain or pain in the back of the hip that just doesn’t go away, it makes them limp, it doesn’t really respond very well to tradition over-the-counter type medications, could be an indication of what we call hip impingement, which is where the bones of the ball and the bone of the socket actually repetitively hit each other as we walk or move, and it becomes painful over time. And if it’s left untreated for many years duration, eventually leads to arthritis.
Dr. Linda Austin: And, how do you treat that?
Dr. Langdon Hartsock: Well, first, we have to make a diagnosis, and that can be a little bit involved. We need to see the patient, do an examination, take some x-rays. And if we’re suspicious of hip impingement, usually we’ll go ahead and order a special kind of MRI in which the radiologist places a special kind of MRI dye into the hip joint itself and then goes ahead with the MRI. That allows us to see all the structures around the hip, the bone, the cartilage, the ligaments, the lining that goes around the socket. We can diagnose tears. We can diagnose bone chips or fragments of cartilage in the joint. And we can look at the shape of the socket and the shape of the ball. And if the shape is not quite right, that might indicate impingement. As the hip goes through its range of motion and the ball is not quite round or the hip socket itself is a little too deep then, as the hip moves through the range of motion, those structures will impinge or hit against each other, which, over a long period of time, can cause tears of the special lining, called the labrum, around the socket and that’s what causes it to be painful. We can go in, through some minimally invasive techniques and actually remove some of those problem areas and relieve their symptoms.
Dr. Linda Austin: How long of a procedure is that?
Dr. Langdon Hartsock: Well, it depends a little bit on how extensive a procedure we need to do. There are really kind of two large classes of patients that we’ve categorized. When the ball of the hip socket is not quite round, we can treat that, often times, with arthroscopic surgery of the hip and trim away the extra bone. That’s an outpatient procedure. It lasts for a couple of hours. The advantage to that is a very quick recovery. You can bear weight right away. You just need crutches for a little while you’re getting over the procedure. Sometimes we have to do a more extensive traditional type surgery with an incision and general anesthesia, and in the hospital, and that takes a little bit longer to get over.
But the whole idea is that we’re going to evaluate the hip and find out if there’s some sort of abnormal shape to the ball or the socket that’s causing the trouble, and we can relieve that. And, hopefully, for these people who are in their, say, 30s or 40s, maybe early 50s, we can save them from ever having to have a hip replacement.
Dr. Linda Austin: Very interesting. Thank you so much for talking with us today.
Dr. Langdon Hartsock: You’re welcome.
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