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Injuries, Symptoms & Treatments
Let's keep those hips swiveling !
The hip plays an integral role in the function of walking, sitting, standing and bending. It is one of the largest weight-bearing joints in the body. This ball-and-socket joint allows the leg to move and rotate while keeping the body stable and balanced.
Technologies and procedures for care and repair of the hip have evolved significantly in recent years, and our practice provides state-of-the-art therapies and surgery across the broad spectrum of hip treatments. From minimally invasive surgical techniques to total hip replacement, Dr. Bellapianta diagnoses and treats patients with compassion and the right approach at the right time.
Dr. B's goal is to first explain to patients every available treatment option and then customize a treatment plan specific to the patient’s need. Factors he considers include the injury, activity goals, job requirements and recovery timeline. If conservative treatment options are not effective, he may offer patients the latest advancements in hip surgery, including total hip replacement.
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Use the convenient search tool to find information on orthpedic conditions and treatments offered by our practice.. his assures that the information you are researching has been confirmed by Dr. Bellapianta as well as The American Academy of Orthpaedic Surgeons.
Diseases/Conditions of the hip
Conditions of the Hip
Problems with our hips can be caused by diseases such as osteoarthritis or avascular necrosis. Other hip problems are attributed to injuries such as sprains, bursitis, dislocations and fractures. Treatments for hip problems range from basic pain management techniques to sophisticated medical treatments to cure disease and repair injuries. Dr. Bellapianta has extensive expereince in Advanced Minimally Invasive Arthroscopic techniques of hip surgery to repair tears and correct pathology with reduced pain and "down time" for the patient.
Hip pain is a common complaint that can be brought on for a variety of reasons. The location of your hip pain can provide clues about the cause. Problems within the hip joint tend to result in pain on the inside of your hip or your groin. Hip pain on the outside of your hip, upper thigh or buttock is usually caused by problems with muscles, ligaments, tendons and other soft tissues that surround your hip joint.
Your hip is a ball-and-socket joint that allows you to move and provides the stability needed to bear the weight of your body. The “ball” part of your hip is located at the top of your femur or thighbone, and the “socket” is the cup in your pelvis called the acetabulum.
Many people experience hip pain caused by osteoarthritis, the gradual wearing down of the cushioning surfaces in the hip. Hip pain can also be the result of disease or injury to the components of the hip or surrounding nerves. Additionally, hip pain can sometimes be caused by diseases and conditions in other areas of the body, such as the lower back or knees. This type of pain is called referred pain. Some types of hip pain can be controlled with self-care at home, while others may require medical or surgical treatment.
Hip problems due to Arthritis
Arthritis is the most common cause of hip tissue degeneration and joint pain. There are three types of arthritis that commonly affect hips:
Osteoarthritis: often called “wear and tear arthritis” it is the most common type of arthritis and can occur in one or both hips after years of use and bearing the weight of the body. It results in deterioration of the cartilage that normally acts as a cushion between the bones that come together within a joint. In your hip it would be where the top of the femur (ball) comes together with the acetabulum (socket). When the cartilage at this juncture wears, it allows the bones to come into direct contact causing varying degrees of pain depending upon the amount of deterioration that has occurred. Arthritis in its early and mid stages can be treated with pain relievers and light exercise, while more advanced cases may require surgery such as total hip replacement.
More about Hip Osteoarthritis
Rheumatoid Arthritis: is a systemic or body wide disease that causes the immune system to attack the synovial membrane. This attack causes the production of too much fluid resulting in damage and inflammation to this important structure and to the cartilage within the joint, leading to pain, stiffness, and disability. There is no cure for this disease, and treatments focus on administering inflammation reducing medication to relieve pain and prevent or slow joint damage.
Traumatic Arthritis: is largely the same as osteoarthritis, but this time caused by some source of trauma such as an old injury, sporting injury, or previous joint surgery. These incidents can damage the cartilage and/or the bone, changing the mechanics of the joint and making it wear out more quickly. Treatments are similar to osteoarthritis and range from non-invasive conservative methods, to surgical options such as hip arthroscopy or total hip replacement.
Other Hip Injuries and Disorders
Some of the most common hip injuries and disorders include:
Sparians and Strains: involve a stretched or torn ligament, which are tissues that connect two bones at the hip. Symptoms include soreness, bruising, burning, stabbing, throbbing, aching, swelling and stiffness, and being unable to move your hip. You might feel a pop or tear when the injury happens. Treatment usually involves rest, ice packs, wearing a bandage to compress the area, and medications.
Dislocations: are joint injuries that cause the bones of a joint to go out of position. In the case of a hip dislocation, it’s when the “ball” is forced out of the “socket” resulting in a great deal of pain and immobility. If this happens it is important to get immediate medical attention. When properly repositioned, your hip will usually function normally within a few weeks but you must take extra care to not cause another dislocation.
Fractures: are a physical break in the bone usually caused by accident, fall, or sports injury. Other causes can be due to low bone density or osteoporosis, both of which cause weakening of the bones. Fractures in the hip area include femur shaft fractures and pelvic fractures. These injuries need immediate medical attention so the bones may be realigned by a plaster cast, splint, or surgical procedure to use pins, plates or screws to secure the fracture thus allowing the bones to heal and grow back together.
Hip Pointer: is an extremely painful injury to the muscle that connects at the top of the pelvis just below the waist. It most commonly is the result of a blow, fall or a quick turn of the body and most often occurs in contact sports such as football and soccer. Given time, most hip pointers will heal on their own with conservative treatment and rest.
Snapping Hip:: is a snapping sensation or popping sound experienced in your hip when you walk, get up from sitting, or swing your leg around. It occurs when a muscle or tendon moves over a bony protrusion in your hip. It’s usually painless and harmless, but can be annoying. In some cases the snapping can lead to bursitis (see below) however.
Bursitis: occurs when one of the natural small fluid-filled sacs around the hip area becomes inflamed and painful. This is usually caused by overuse of a joint muscle but can also be caused by injury. Treatment involves rest, ice packs, and medication to reduce inflammation.
Avascular Necrosis: occurs in the head of the femur when the blood supply is interrupted by a fracture or other injury. It can also be caused by developmental disorders such as dysplasia and from use of certain drugs, in particular prednisolone (cortisone or prednisone) which has been used to treat conditions like asthma, skin complaints and other ailments. The course of treatment may only have been a short one and symptoms may surface from weeks to years later. It can also (rarely) occur as an aftermath of certain bone tumours such as bone cysts. Treatment focuses on prevention of further bone loss through medications and therapy. In advanced cases, surgical procedures are often indicated and include core decompression, bone transplant, bone reshaping, and hip replacement.
Burning Thigh Pain: can be experienced on the outer side of the thigh on one side of the body. It can be caused by compression of or damage to one of the large sensory nerves to your legs. The goal in treatment is to remove the source of pressure on the nerve. This may include avoidance of an activity that aggravates the condition, weight loss, medication to reduce inflammation, and in rare cases surgery.
With this injury, the head of your femur (which is shaped like a ball) slips out of your hip socket. It may slip forward or backward out of position. This can damage structures around the joint.
This is an irritation or swelling of the trochanteric bursa. This small, fluid-filled sac is found on the outer side of the femur. It acts as a cushion for the iliotibial band, a tendon in your leg.
This therapy treats dying bone tissue in the head of the femur. Cells from your own body are used to help the femur heal.
Osteoarthritis of the Hip
This type of arthritis, also called "degenerative joint disease," is a breakdown of the cartilage in your hip joint. As this protective cartilage wears away, bone rubs against bone.
Common Treatments of the hip
Total Hip Replacement
Whether you have just begun exploring treatment options or have already decided to undergo hip replacement surgery, this information will help you understand the benefits and limitations of total hip replacement. This article describes how a normal hip works, the causes of hip pain, what to expect from hip replacement surgery, and what exercises and activities will help restore your mobility and strength, and enable you to return to everyday activities.
If your hip has been damaged by arthritis, a fracture, or other conditions, common activities such as walking or getting in and out of a chair may be painful and difficult. Your hip may be stiff, and it may be hard to put on your shoes and socks. You may even feel uncomfortable while resting.
If medications, changes in your everyday activities, and the use of walking supports do not adequately help your symptoms, you may consider hip replacement surgery. Hip replacement surgery is a safe and effective procedure that can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities.
Hip replacement surgery is one of the most successful operations in all of medicine. Since the early 1960s, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of total hip replacement. According to the Agency for Healthcare Research and Quality, more than 450,000 total hip replacements are performed each year in the United States.
The hip is one of the body's largest joints. It is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone).
The bone surfaces of the ball and socket are covered with articular cartilage, a smooth tissue that cushions the ends of the bones and enables them to move easily.
A thin tissue called the synovial membrane surrounds the hip joint. In a healthy hip, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all friction during hip movement.
Bands of tissue called ligaments (the hip capsule) connect the ball to the socket and provide stability to the joint.
Common Causes of Hip Pain
The most common cause of chronic hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease.
Osteoarthritis. This is an age-related "wear and tear" type of arthritis. It usually occurs in people 50 years of age and older and often in individuals with a family history of arthritis. The cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness. Osteoarthritis may also be caused or accelerated by subtle irregularities in how the hip developed in childhood.
Rheumatoid arthritis. This is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage the cartilage, leading to pain and stiffness. Rheumatoid arthritis is the most common type of a group of disorders termed "inflammatory arthritis."
Post-traumatic arthritis. This can follow a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.
Osteonecrosis. An injury to the hip, such as a dislocation or fracture, may limit the blood supply to the femoral head. This is called osteonecrosis (also sometimes referred to as "avascular necrosis"). The lack of blood may cause the surface of the bone to collapse, and arthritis will result. Some diseases can also cause osteonecrosis.
Childhood hip disease. Some infants and children have hip problems. Even though the problems are successfully treated during childhood, they may still cause arthritis later on in life. This happens because the hip may not grow normally, and the joint surfaces are affected.
In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components.
Is Hip Replacement Surgery for You?
The decision to have hip replacement surgery should be a cooperative one made by you, your family, your primary care doctor, and your orthopaedic surgeon. The process of making this decision typically begins with a referral by your doctor to an orthopaedic surgeon for an initial evaluation.
When Surgery Is Recommended
There are several reasons why your doctor may recommend hip replacement surgery. People who benefit from hip replacement surgery often have:
Candidates for Surgery
There are no absolute age or weight restrictions for total hip replacements.
Recommendations for surgery are based on a patient's pain and disability, not age. Most patients who undergo total hip replacement are age 50 to 80, but orthopaedic surgeons evaluate patients individually. Total hip replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.
The Orthopaedic Evaluation
An evaluation with an orthopaedic surgeon consists of several components:
Deciding to Have Hip Replacement Surgery
Talk With Your Doctor
Your orthopaedic surgeon will review the results of your evaluation with you and discuss whether hip replacement surgery is the best method to relieve your pain and improve your mobility. Other treatment options — such as medications, physical therapy, or other types of surgery — also may be considered.
In addition, your orthopaedic surgeon will explain the potential risks and complications of hip replacement surgery, including those related to the surgery itself and those that can occur over time after your surgery.
Never hesitate to ask your doctor questions when you do not understand. The more you know, the better you will be able to manage the changes that hip replacement surgery will make in your life.
An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and cannot do. Most people who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living.
With normal use and activity, the material between the head and the socket of every hip replacement implant begins to wear. Excessive activity or being overweight may speed up this normal wear and cause the hip replacement to loosen and become painful. Therefore, most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports.
Realistic activities following total hip replacement include unlimited walking, swimming, golf, driving, hiking, biking, dancing, and other low-impact sports.
With appropriate activity modification, hip replacements can last for many years.
If you decide to have hip replacement surgery, your orthopaedic surgeon may ask you to have a complete physical examination by your primary care doctor before your surgical procedure. This is needed to make sure you are healthy enough to have the surgery and complete the recovery process. Many patients with chronic medical conditions, like heart disease, may also be evaluated by a specialist, such a cardiologist, before the surgery.
Several tests, such as blood and urine samples, an electrocardiogram (EKG), and chest x-rays, may be needed to help plan your surgery.
Preparing Your Skin
Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for treatment to improve your skin before surgery.
Tell your orthopaedic surgeon about the medications you are taking. He or she or your primary care doctor will advise you which medications you should stop taking and which you can continue to take before surgery.
If you are overweight, your doctor may ask you to lose some weight before surgery to minimize the stress on your new hip and possibly decrease the risks of surgery.
Although infections after hip replacement are not common, an infection can occur if bacteria enter your bloodstream. Because bacteria can enter the bloodstream during dental procedures, major dental procedures (such as tooth extractions and periodontal work) should be completed before your hip replacement surgery. Routine cleaning of your teeth should be delayed for several weeks after surgery.
Individuals with a history of recent or frequent urinary infections should have a urological evaluation before surgery. Older men with prostate disease should consider completing required treatment before having surgery.
Although you will be able to walk with a cane, crutches or a walker soon after surgery, you may need some help for several weeks with such tasks as cooking, shopping, bathing, and laundry.
If you live alone, a social worker or a discharge planner at the hospital can help you make advance arrangements to have someone assist you at your home. A short stay in an extended care facility during your recovery after surgery also may be arranged.
Several modifications can make your home easier to navigate during your recovery. The following items may help with daily activities:
You will either be admitted to the hospital on the day of your surgery or you will go home the same day. The plan to either be admitted or to go home should be discussed with your surgeon prior to your operation.
Upon arrival at the hospital or surgery center, you will be evaluated by a member of the anesthesia team. The most common types of anesthesia are general anesthesia (you are put to sleep) or spinal, epidural, or regional nerve block anesthesia (you are awake but your body is numb from the waist down). The anesthesia team, with your input, will determine which type of anesthesia will be best for you.
Many different types of designs and materials are currently used in artificial hip joints. All of them consist of two basic components: the ball component (made of highly polished strong metal or ceramic material) and the socket component (a durable cup of plastic, ceramic, or metal, which may have an outer metal shell).
The prosthetic components may be "press fit" into the bone to allow your bone to grow onto the components or they may be cemented into place. The decision to press fit or to cement the components is based on several factors, such as the quality and strength of your bone. A combination of a cemented stem and a non-cemented socket may also be used.
Your orthopaedic surgeon will choose the type of prosthesis that best meets your needs.
The surgical procedure usually takes from 1 to 2 hours. Your orthopaedic surgeon will remove the damaged cartilage and bone and then position new metal, plastic, or ceramic implants to restore the alignment and function of your hip.
After surgery, you will be moved to the recovery room where you will remain for several hours while your recovery from anesthesia is monitored. After you wake up, you will be taken to your hospital room or discharged to home.
The success of your surgery will depend in large measure on how well you follow your orthopaedic surgeon's instructions regarding home care during the first few weeks after surgery.
Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.
Be aware that, although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose have become critical public health issues in the U.S. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.
You may have stitches or staples running along your wound or a suture beneath your skin. The stitches or staples will be removed approximately 2 weeks after surgery.
Avoid getting the wound wet until it has thoroughly sealed and dried. You may continue to bandage the wound to prevent irritation from clothing or support stockings.
Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength. Be sure to drink plenty of fluids.
Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal light activities of daily living within 3 to 6 weeks following surgery. Some discomfort with activity and at night is common for several weeks.
Your activity program should include:
Possible Complications of Surgery
The complication rate following hip replacement surgery is low. Serious complications, such as joint infection, occur in less than 2% of patients. Major medical complications, such as heart attack or stroke, occur even less frequently. However, chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur they can prolong or limit full recovery.
Infection may occur superficially in the wound or deep around the prosthesis. It may happen within days or weeks of surgery. It may even occur years later.
Minor infections of the wound are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement.
Blood clots in the leg veins or pelvis are one of the most common complications of hip replacement surgery. These clots can be life-threatening if they break free and travel to your lungs. Your orthopaedic surgeon will outline a prevention program which may include blood thinning medications, support hose, inflatable leg coverings, ankle pump exercises, and early mobilization.
Blood clots may form in one of the deep veins of the body. While blood clots can occur in any deep vein, they most commonly form in the veins of the pelvis, calf, or thigh.
Sometimes after a hip replacement, one leg may feel longer or shorter than the other. Your orthopaedic surgeon will make every effort to make your leg lengths even, but may lengthen or shorten your leg slightly in order to maximize the stability and biomechanics of the hip. Some patients may feel more comfortable with a shoe lift after surgery.
This occurs when the ball comes out of the socket. The risk for dislocation is greatest in the first few months after surgery while the tissues are healing. Dislocation is uncommon. If the ball does come out of the socket, a closed reduction usually can put it back into place without the need for more surgery. In situations in which the hip continues to dislocate, further surgery may be necessary.
Loosening and Implant Wear
Over years, the hip prosthesis may wear out or loosen. This is most often due to everyday activity. It can also result from a biologic thinning of the bone called osteolysis. If loosening is painful, a second surgery called a revision may be necessary.
Nerve and blood vessel injury, bleeding, fracture, and stiffness can occur. A small number of patients continue to experience pain after surgery.
Avoiding Problems After Surgery
Recognizing the Signs of a Blood Clot
Follow your orthopaedic surgeon's instructions carefully to reduce the risk of blood clots developing during the first several weeks of your recovery. He or she may recommend that you continue taking the blood thinning medication you started in the hospital. Notify your doctor immediately if you develop any of the following warning signs.
Warning signs of blood clots. The warning signs of possible blood clot in your leg include:
Warning signs of pulmonary embolism. The warning signs that a blood clot has traveled to your lung include:
A common cause of infection following hip replacement surgery is from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections.
Following surgery, patients with certain risk factors may need to take antibiotics prior to dental work, including dental cleanings, or before any surgical procedure that could allow bacteria to enter your bloodstream. Your orthopaedic surgeon will discuss with you whether taking preventive antibiotics before dental procedures is needed in your situation.
Warning signs of infection. Notify your doctor immediately if you develop any of the following signs of a possible hip replacement infection:
A fall during the first few weeks after surgery can damage your new hip and may result in a need for more surgery. Stairs are a particular hazard until your hip is strong and mobile. You should use a cane, crutches, a walker, or handrails or have someone help you until you improve your balance, flexibility, and strength.
Your orthopaedic surgeon and physical therapist will help you decide which assistive aides will be required following surgery, and when those aides can safely be discontinued.
To assure proper recovery and prevent dislocation of the prosthesis, you may be asked to take special precautions when sitting, bending, or sleeping — usually for the first 6 weeks after surgery. These precautions will vary from patient to patient, depending on the surgical approach your surgeon used to perform your hip replacement.
Your surgeon and physical therapist will provide you with any specific precautions you should follow.
How Your New Hip Is Different
You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending. These differences often diminish with time, and most patients find these are minor compared with the pain and limited function they experienced prior to surgery.
Your new hip may activate metal detectors required for security in airports and some buildings. Tell the security agent about your hip replacement if the alarm is activated.
Protecting Your Hip Replacement
There are many things you can do to protect your hip replacement and extend the life of your hip implant.
Participate in a regular light exercise program to maintain proper strength and mobility of your new hip.
Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may require more surgery.
Make sure your dentist knows that you have a hip replacement. Talk with your orthopaedic surgeon about whether you need to take antibiotics prior to dental procedures.
See your orthopaedic surgeon periodically for routine follow-up examinations and x-rays, even if your hip replacement seems to be doing fine.
This outpatient procedure is an examination of the inside of the hip joint. The surgeon uses miniature instruments and a small camera (called an arthroscope) to see inside the joint.
Total Hip Replacement
During this procedure, your damaged hip joint is replaced with implants that recreate the ball and socket of a healthy hip. This can reduce pain and restore your hip function.
Stem Cell Therapy for Avascular Necrosis/Hip
This therapy treats dying bone tissue in the head of the femur. Cells from your own body are used to help the femur heal.
Total Hip Replacement Minimally-Invasive
This method uses a smaller incision than the one used in traditional hip replacement surgeries. This helps speed your recovery.
Experience the latest in orthopedic care
We offer the latest in non-invasive treatments including Regenerative Cell and Platelet Rich Injections.
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