What is my diagnosis?
Your hip has x-ray and examination that shows us it is a “loose” fit between the ball and socket. Some hips are this way because they develop abnormally and either the ball is not round or the socket formed too shallowly or both. Other hips have a more normal socket depth and the ligaments (soft tissues that connect bones of the joint together) or cartilage (labrum cartilage) are damaged or too elastic (stretchy).
Why do I hurt?
Dr. Kerns believes that the muscles around your hip (buttocks, thighs, flexors) have to work extra hard to “hold” your hip in the socket like a walk or play sports. This can create feelings of aching, burning or pain in those muscles, especially after standing still for long periods or after running or yoga. As time goes on and patients live with instability, they begin to wear out the cushion cartilage on the surface of the bones (arthritis) and then the hip may become more painful or even feel stiff.
If you experience sharp pain in the groin area, or trouble after prolonged sitting, you may already have developed arthritis. Even if you are quite active and may have been told your symptoms have not been going on long enough, or you are too young, you may well be suffering from hip arthritis.
What happens in the long run?
No medical provider or patient can look into the future with completely accuracy. Over time, it seems that many patients with shallow hips or instability for other reasons develop severe osteoarthritis (loss of cushion cartilage) and require hip replacements. ALL PATIENTS WITH INSTABILITY WILL NOT NEED A HIP REPLACEMENT! Most continue to experience pain with activities that exceed the stability of the hip.
What are my conservative options?
Since the basic problem in instability is at there is not enough bone in the socket to support your weight, or that the ligaments and cartilage are not supportive enough to hold the joint stable, it is important to maintain ideal body weight. Even five pounds of extra weight can create worsening of symptoms for many patients with instability.
Maintaining a strong torso (core muscles) through Pilates based exercise will help you maintain control of your body during gait.
Avoiding high impact plyometric exercises (jumping, leaping, distance running, etc.) can reduce strain placed on the muscles working to “hold the ball in the socket.”
Avoiding prolonged or frequent extreme stretching regimens like yoga or ballet can protect the limited stability in your hip. Gentle stretching and meditation are, of course, OK!
Diet control and guidance are important. If you have not had counseling regarding weight loss, contact her primary doctor or health plan for support.
Smoking cessation is also important to allow tissues to recover optimally.
No evidence currently exists that dietary supplements will address the problem.
What about surgery?
There are open incision procedures available for certain patients with instability of the hip. These procedures alter the socket by cutting the pelvis and rotating it in order to deepen the socket. Dr. Kerns does not perform this operation, though he has special training and identifying candidates for this procedure. In general this is not an option for patient's older than 40 years of age. As most patients with this type (and all types) of instability are women, childbearing is possible after this surgery.
The role for camera based (arthroscopic) surgery in instability of the hip is somewhat controversial. Some surgeons have reported that arthroscopic procedures where the labrum cartilage is removed caused rapid arthritis to develop.
Labrum preserving (repair) surgery has not been linked with such rapid joint breakdown.
Capsular plication (tightening) of the ligaments arthroscopically is a temporary means of treating certain types of instability (when the socket is not too shallow).
Patient with instability must understand that surgery to repair the damaged labrum or surface cartilage is NOT fixing their main problem (instability). They can think of their surgery as “change a tire on a car with a bent axle.” This means that the labrum are cartilage was torn or worn away due to OVERLOAD of the unstable hip, fixing those surface tissues will not eliminate the OVERLOAD. Therefore return of aches, pains and tearing in the surfaces is expected after repair.
What cardio exercise IS good for me?
First, you must clear aerobic fitness exercise with your primary doctor. Dr. Kerns advocates elliptical trainer, stationary bike, recumbent bike, swimming and Pilates for patients with instability.
When about “pops” “snaps” and “clicks”?
Hips with instability will frequently pop as tendons crossing the shallow socket move from one place to another. These are normal and effort to avoid “relieving” the hip there popping it is best.
What about back pain, numbness/tingling and my legs, or other personal/sexually related symptoms?
Typically hip instability without a structural tear in the labrum or arthritis will not create these issues. Back pain, numbness/tingling in the legs, buttock pain, or pain during sex (dyspareunia) require evaluation by provide areas with expert training in these areas.
Some information about hip instability can be found at this web site: www.americanhipinstitute.org