“A few months ago, I found out that what I thought was just a strained muscle was actually a symptom of something a lot more serious. In a couple of days, I will have to have my entire right hip replaced. It was a shock to hear and a decision that took me quite some time to accept.”
Spencer, says that she has a life-long condition called developmental hip dysplasia which has contributed to the problem. Lara has always lead a very active lifestyle, saying “I was a jock growing up from the time I could walk.” She was a competitive diver at Penn State and now plays tennis whenever she can, calling it “therapy”.
For a while now, Spencer has been having pain in her right hip. She thought that the pain was just due to muscle strain, and continued to exercise through the pain. But the pain persisted and became nearly constant. Her physician Dr. Peter Moley, did an x-ray on her which showed that the cartilage in her right hip has been worn down to the point where it is just about “bone on bone.” The only treatment at this point would be to totally replace the hip joint. If she did not, she could start to experience problems with her back and knee as well.
“There is no ignoring it at this point,” she said of the pain. “I just want to say anybody out there who suffers with chronic pain, I feel you. It takes over your life. It affects you emotionally, mentally, physically. You cannot sleep. It’s hard to think about. It’s gnawing at you all the time. What I wish I would have done is just taken care of this sooner and spoken up.”
Developmental Hip Dysplasia (DDH) is a dislocation of the hip joint, frequently found at birth or shortly thereafter. It can affect about 1 in 20 children. To understand DDH, we need to review the anatomy of the hip joint:
The hip socket joint in a newborn is formed from cartilage, making it malleable, or moldable. It becomes bony and sturdier as the child grows. It is the fit of the thigh bone into the socket that ultimately shapes the hip joint into its proper adult shape. If the hip joint is too shallow, or the ligaments that hold the thigh bone in the socket too loose, then the thigh bone will not sit properly in the socket, and the hip joint will not develop properly as the child ages.
The cause is unknown, but genetic factors may play a role. Low levels of amniotic fluid in the womb during pregnancy can increase a baby’s risk of DDH. Other risk factors include:
There may be no symptoms. Symptoms that may occur can include:
After 3 months of age, the affected leg may turn outward or be shorter than the other leg.
Over time, a joint that is out of place or shallow will wear out faster than one that has a more normal shape. For adults with DDH, this may eventually lead to pain in the hip, as it did in Spencer’s case. Dr. Moley says that around 10 percent of all hip replacements are done on patients under 50 years old.
Pediatric health care providers routinely screen all newborns and infants for hip dysplasia. There are several methods to detect a dislocated hip or a hip that is able to be dislocated.
The most common method of identifying the condition is a physical exam of the hips, which involves applying pressure while moving the hips. The health care provider listens for any clicks, clunks, or pops.
Ultrasound of the hip is used to confirm the problem. An x-ray of the hip joint may help diagnose the condition in older infants and children.
Hip replacement has been available since 1960, and with a series of surgical and technological improvements has become an increasingly effective treatment for hip pain. The most common cause of hip pain leading to replacement is osteoarthritis, which is caused by wear and tear on the cartilage which lines the joint surface. Over time, this causes joint pain and stiffness. Initial treatment consists of anti-inflammatory pain relievers and physical therapy. However, when these measures are insufficient, hip replacement may be considered.
According to a 2015 study by the U.S. National Center for Health Statistics (NCHS), over the 10 years of the study, the number of procedures more than doubled, from 138,700 in 2000 to 310,800 in 2010. The number grew by 92 percent, to 80,000, among those age 75 and older. It jumped by 205 percent in those aged 45 to 54, to 51,900.
Dr. Mark Pagnano, chairman of the department of orthopedic surgery at the Mayo Clinic in Rochester, Minn says that most hip replacements in middle-aged patients are due to degenerative arthritis caused by wear-and-tear- the more active people, the more patients who are candidates for hip replacement at a younger age. He goes on to say, “Recovery is dramatically easier for patients, the durability of hip replacements has improved, and the baby boomer generation is less willing to accept the limitations that accompany arthritis,”
In hip replacement, the ball-shaped head of the thigh bone (femur) is removed,and replaced with an metal stem, and a new hip ball. The joint in the hip is also replaced with a cup-shaped socket. This socket is lined with a smooth plastic surface to allow the joint to move smoothly. The replacement parts can be made of a number of different materials, including ceramics, metal,or plastic. The materials used is dependent on the age of the patient and amount of physical activity the patient expects to do postoperatively.