hip surgery

Spinal Anesthesia Associated with More Pain, Prescription Analgesic Use After Hip Surgery Compared with General Anesthesia

Abstract: https://www.acpjournals.org/doi/10.7326/M22-0320

Editorial: https://www.acpjournals.org/doi/10.7326/M22-1391

A randomized controlled trial (RCT) comparing spinal versus general anesthesia for hip surgery found that spinal anesthesia was associated with worse pain immediately after surgery and higher rates of pain reliever prescriptions at 60 days. However, differences in pain, satisfaction, or mental status between the two interventions seemed to diminish at 60, 180, or 365 days after surgery. The findings are published in Annals of Internal Medicine.

More than 250,000 older adults experience a hip fracture every year and nearly all are repaired through surgery. Patient recovery of ambulation and survival at 60 days, delirium, and hospital length of stay are similar whether patients have spinal or general anesthesia during surgery. Not much is known about which type of anesthesia demonstrates better outcomes, though previous studies suggest that patients may have less pain in the first few hours after hip fracture surgery with spinal anesthesia.

Researchers from the University of Pennsylvania Perelman School of Medicine conducted a preplanned secondary analysis of a RCT comparing spinal versus general anesthesia in 1,600 patients aged 50 years or older who were having hip fracture surgery. Trial participants were randomly assigned to general or spinal anesthesia and the researchers collected data on pain on days 1 to 3 after surgery. Pain and use of prescription pain relievers, mental status, and patient satisfaction were assessed at 60, 180, and 365 days after surgery. They authors found that patients who received spinal anesthesia reported worse pain in the 24 hours after surgery but reported similar pain at all other time points. The authors also found that 25 percent of patients in the spinal anesthesia group were using prescription pain relievers at 60 days compared to 18.8 percent of patients in the general anesthesia group. However, the authors note that they did not find differences in pain, satisfaction, or mental status at 60, 180, or 365 days.

In an accompanying editorial, authors from Harvard Medical School argue that this study challenges a dominant narrative about the risks and outcomes of general anesthesia in older adults. The authors also add that this study highlights that surgical repair of hip fractures in older adults carries the risk for severe postoperative pain, regardless of whether the surgery is done with regional or general anesthesia. They suggest that future research investigate the differences in reported pain as presented in this study and the RAGA (Regional Anesthesia vs General Anesthesia) trial but note that participants in the RAGA trial may have experienced more extensive postoperative care.

Originally Appeared Here

Robotic hip surgery to be trialled on NHS for first time

Robotic hip replacement surgery is being trialled on the NHS for the very first time after the National Institute for Health and Care Research (NIHR) announced they would be providing researchers with £1m of funding.

The RACER-Hip study aims to determine whether the clinical precision of robots is a match to the proficiency and ingenuity of humans.

Hip replacement surgery is one of the most common operations performed by the NHS, with the prevalence of hip and knee surgery increasing rapidly over the last three years.

In said hip surgeries, a robotic arm prepares the bone and inserts the components to a pre-programmed three-dimensional plan. It is theorised that a robot is able to input more precise and consistent surgical techniques, which may help reduce the risk of variation and prevent poor health comes that subsequently require further corrective surgery – there is little evidence in support of this however.

This new study is a joint venture between Warwick Medical School at the University of Warwick, University Hospitals Coventry and Warwickshire, and the Royal Orthopaedic Hospital (ROH) in Birmingham. It is being led by two surgeons: Peter Wall and Professor Ed Davis from ROH.

Peter Wall said: “The RACER-Hip study is a significant investment by the NHS to examine the effectiveness of robotic hip replacement surgery.

“Robotic technology has the potential to revolutionise hip replacement surgery, however the first step to this is understanding whether it can help enhance the care surgeons provide.

“We are really excited that some centres such as Northumbria Healthcare NHS Foundation Trust have been provided with a robot specifically to take part in this research.”

An equal numbers of participants will be randomly deployed into both the human trial and the robotic one; after the surgery participants will be asked a series of questions about their ability to complete certain activities and their quality of life in the long-term, further informing the study.

The researchers will recruit patients from at least six NHS hospitals over the coming months, with the first site at ROH having already opened and Northumbria Healthcare NHS Foundation Trust receiving delivery of one of the robots designated for the trial.

Professor Ed Davis said: “The research will help orthopaedic surgeons across the world to better understand the most effective tools for performing hip replacement surgery and ensure the very best outcomes for their patients.

“This study will also include an in-depth health economic analysis to inform the NHS if this technology should be widely adopted.”

This study joins the RACER-Knee study which started recruitment around 12 months ago and is looking to answer the same questions but from a knee replacement surgery perspective.

For more information about the RACER studies, click here.

Also, if you want to know more about the latest digital advancements and innovations across the NHS, don’t forget to register for our Digital Health virtual event on the 21st of July.

###
Originally Appeared Here

Stephenson facing hip surgery after “reckless action” following drinking session

North Melbourne young gun Jaidyn Stephenson has suffered a fractured hip after falling from a bike at his home on Friday.

Stephenson was admitted to hospital after the incident and will see a surgeon on Saturday to determine the next course of action.

North Melbourne’s football manager Brady Rawlings Stephenson was trying to perform a trick after drinking at home.

“After having had drinks at home with his housemates, he attempted to perform a trick on his mountain bike off the back deck. He lost balance and fell onto a concrete paver,” he said in a club statement.

“Initially, after the accident, Jaidyn was able to walk but the pain progressed to a point that an ambulance was called.

“He was kept in overnight and he looks like he might be laid up for a while. At this stage he’ll have a stay in hospital while his surgeon decides whether he’ll need surgery.

“It puts a dampener on what was a promising season for Jaidyn. We’re disappointed with his poor judgment and his reckless action has resulted in quite a painful injury for him.”

2021 was Stephenson’s first year with the Roos after being traded from Collingwood at the end of 2020.

###
Originally Appeared Here

Hints From Heloise: Making the house ready for hip-surgery recovery

Dear Heloise: My elderly mother recently had hip surgery, and we insisted she stay with us as she recovered. Of course, this meant there had to be some changes and preparations for her stay at our home. First, I attached sleigh bells to her walker at night and made sure it was always within arm’s reach. This way, if she needed me, she could reach over and shake the walker. We had to prop one leg up for a couple of hours a day for a while, so when the doctor said something soft but firm, I put a towel around a six pack of toilet paper and slipped it into a pillowcase. It worked better than a pillow. We put night lights in her room so she could see her way to the bathroom. There were more changes, but these were her favorites and made her life easier, which resulted in a speedy recovery.

###
Originally Appeared Here

MedWatch Today: Why Physical Therapy is So Important After an Orthopedic Surgery

After a surgery, having a personalized physical therapy plan can help ensure your body heals properly.

At Community Health System, patients who undergo orthopedic surgery are encouraged to move within the first day after their procedure. Our physical therapists help patients strengthen their muscles around their new joint and help regain motion.

Fresno resident Michael Yamane spends lots of time at the outpatient physical therapy facility at Clovis Community Medical Center. He’s a FedEx employee and had shoulder surgery last November, and hip surgery this past Spring.

“We do a lot of heavy lifting, so I was loading trucks before all this happen, so I was loading the trucks… TV’s and furniture and swimming pools and all those big heavy things,” described Michael.

Michael explains, after his total hip replacement surgery on his left hip, “The next morning they tried to get you propped up and standing and see if you can step you know I did that slowly,”

Michael works with physical therapist Erika McFarland.

“At Community we have a total joint replacement program, and that’s where the patient is informed prior to going into the surgery they’re informed about what to expect for the surgery and then as far as what to expect afterward as far as rehabilitation goes,” stated Erika.

Erika said when post-surgery patients are in the hospital, a team of physical therapists will help them start to slowly move. Patients walk at first with the help of a walker or crutches.

She continued, “After you’re done at the hospital, then we are able to determine if you need to go home for a little bit more therapy at home, or if you’re high enough functioning, then you can transition into an outpatient physical therapy program.”

In the outpatient physical therapy facility, Erika works with Michael on strengthening and endurance.

“I did a lot of stretching and balancing and just getting my normal rhythm back,” said Michael.

Erika explained, “For balance in particular, we worked on single leg balance, so I have him stand at a counter so he can hold on if he needs to… And that not only helps the hip joint but also his ankle his knee even his core… For his strengthening, we did some squatting, we did some work on the machines, we did like the leg press for him, we had him do hamstring curls.”

Erika said it’s crucial that post-surgery patients stick to their rehabilitation plan because it will help them heal safer and faster. It’s also important to practice what they learn here at home.

“We can help give you the tools to specifically help the muscles that are weak, or the muscles that are tight, or the different joints that need that better movement,” said Erika.

“It helped me gain confidence and I can feel more strength in my legs and before I couldn’t even push myself,” ended Michael.

###
Originally Appeared Here

How to bounce back after a successful hip replacement at Nuffield Health, Tunbridge Wells

Sponsored Editorial

Clare Roche started participating in triathlon five years ago, but feared she may have to stop training when sudden pain on a run heralded the start of a hip problem.

Clare, who is in her 60s and lives near Wadhurst, has enjoyed a variety of sports from childhood. More recently she started to compete in triathlons and has represented Great Britain in international competitions.

Clare Roche started participating in triathlon five years ago, but feared she may have to stop training after a problem with her hip

Out on a run, she developed severe pain and was unable to put weight on her right leg. After hobbling home, things deteriorated quickly.

She was unable to walk comfortably for any length of time and the pain that radiated down the leg into the shin and ankle made sleeping difficult.

Having to cancel her plans for a walking trip to the Himalayas, Clare made an appointment with her GP.

As a physiotherapist with more than 40 years experience she already knew that the problem was related to her hip. When x-rays showed she had no articular cartilage left in the joint, it was clear the only option was a hip replacement.

Apart from her competitive sports, Clare has a very busy family life with three children and an increasing number of grandchildren. She wanted to proceed quickly to prevent her muscle strength from deteriorating too dramatically so decided to go private.

She had witnessed great results in patients and friends following hip surgery performed by Senthil Velayudham, Orthopaedic Hip Surgeon at Nuffield Health, Tunbridge Wells.

Following a consultation with Mr Velayudham, he confirmed a minimally invasive total hip replacement with ceramic on ceramic bearing surfaces was the way forward. A ‘total replacement’ means both parts of the joint are replaced – the ball and the socket.

The operation went well with no complications. For the first 10 days Clare used crutches, after which she walked with a stick. At two-three weeks post surgery she swam regularly and used an exercise bike. Within three-four weeks she walked unaided.

Clare feared she may have to stop training when sudden pain on a regular run heralded the start of a hip problem

Clare was religious with her exercises at home and in the gym, which helped her regain muscle strength; she is still doing them almost 18 months later.

At around 14 weeks after the operation she was slow jogging and brisk walking. Over the following weeks these exercises increased in duration and intensity. Four months after the operation, Clare went skiing with no problems and after that was soon competing in triathlons once again.

Prior to her operation Clare had gained a place to compete at the Triathlon World Championships. She was worried she wouldn’t be fit enough to compete but at the end of August was on the starting line, less than a year after surgery.

In between competitions Clare enjoys her grandchildren, hiking and bird watching, all of which are only possible with the pain free mobility that her new joint brings.

“Minimally invasive total hip replacement is a highly successful procedure helping patients return to an active lifestyle,” said Mr Velayudham.

“Using appropriate prostheses, restoring hip anatomy, preserving all the muscles controlling the hip and good rehabilitation helps patients to enjoy a long, good outcome following hip replacement.

Clare added: “ Having a surgeon who is not only technically excellent but someone who is empathetic to your situation and provides first-rate pre and post op oversight is crucial.

“Mr Velayudham more than fulfilled these criteria – as I knew he would having seen several of his patients over the years.

“Also impressive was the care I received at the Nuffield at all levels, from porters to senior medical staff. Everyone was attentive, professional yet caring. The food was something special too.

“My advice to anyone who wants to get the most out of their joint replacement is firstly don’t leave it too long before having the operation and secondly try to choose a great surgeon like Mr V.

“Finally, be serious and committed about exercises and general fitness both before your operation and for at least 12 month afterwards. We can all do more than we think we can!”

To find out how Nuffield Health in Tunbridge Wells could help you click here.

###
Originally Appeared Here

From Hip surgery to skiing and competitive Triathlon

Clare Roche started participating in Triathlons five years ago, but feared she may have to stop training when sudden pain on a regular run heralded the start of a hip problem.

Clare, who is in her 60s and lives near Wadhurst, has enjoyed a variety of sports from childhood. More recently she started to compete in Triathlons and has represented Great Britain in international competitions in her age group. One day whilst on a usual run, she developed severe pain and was unable to weight bear on her right leg. After hobbling home, things deteriorated quickly. She was unable to walk comfortably for any length of time and the night pain that radiated down the leg into the shin and ankle made sleeping difficult. Having to cancel her plans for a walking trip to the Himalayas, Clare made an appointment with her GP.

As a physiotherapist with over 40 years of experience in the Wadhurst area, she already knew that the problem was related to her hip. X-rays showed she had no articular cartilage left in the joint, and as a physiotherapist, she knew the only option was a hip replacement. Apart from her competitive sports she has a very busy family life with three children and an increasing number of grandchildren. Clare wanted to get back to training as soon as possible. She was keen to proceed quickly to prevent her muscle strength from deteriorating too dramatically. and decided to go privately.

She had witnessed great results in patients and friends following hip surgery performed by Mr Senthil Velayudham, Orthopaedic Hip Surgeon at Nuffield Health, Tunbridge Wells.

Following consultation with Mr Velayudham, he suggested a minimally invasive total hip replacement with ceramic on ceramic bearing surfaces was the way forward and her surgery was scheduled. A ‘total replacement’ means both parts of the joint are replaced – the ball and the socket.

The operation went well with no complications. For the first ten days Clare used crutches, after which she walked with a stick. At two to three weeks post-surgery she swam regularly and used an exercise bike. Within three-four weeks she walked unaided and could do about an hour of continuous walking. She was religious with her exercises, at home and in the gym, which helped her regain muscle strength; she is still doing them almost 18 months later. At around fourteen weeks after the operation, she began running and walking began, including short intervals of alternate slow jogging combined with brisk walking. Over the following weeks and months these exercises increased in duration and intensity. Four months after the operation, Clare went skiing with no problems. Seven months after her operation she was competing in a triathlon competition and nine months after came second in her first half ironman triathlon.

Prior to her operation Clare had gained a place to compete at the Triathlon World Championships in Lausanne at the beginning of September. She was worried she wouldn’t be fit enough to compete but at the end of August was on the starting line, less than a year following surgery.

In between competitions Clare enjoys her grandchildren, hiking, bird watching and conservation all of which are only possible with the pain free mobility that her new joint brings.

Mr Velayudham said: “Minimally invasive total hip replacement is a highly successful procedure helping patients return to good active lifestyle. Understanding patients’ expectation is very important. Using appropriate prostheses, restoring hip anatomy, preserving all the muscles controlling the hip and good rehabilitation helps patients to enjoy long good outcome following hip replacement.”

Claire added: “Having a surgeon who is not only technically excellent but someone who is empathetic to your situation and provides first-rate pre and post op oversight is crucial; Mr Velayudham more than fulfilled these criteria – as I knew he would having seen several of his patients over the years. Also impressive was the care I received at the Nuffield at all levels, from porters to senior medical staff. One hears horrible stories of waiting ages for a nurse when you really need them. That was not my experience; everyone was attentive and professional yet caring. The food was something special too.

“My advice to anyone who wants to get the most out of their joint replacement is firstly don’t leave it too long before having the operation, secondly try to choose a great surgeon like Mr V, and finally be serious and committed about exercises and general fitness both before your operation and for at least 12 month afterwards. We can all do more than we think we can!”

Originally Appeared Here

Is It Wise to Do Pilates Before or After Hip Replacement Surgery?

If you are scheduled to have hip surgery, now is the perfect time to start doing Pilates. Even if it seems counterintuitive to start this joint, doing so with the guidance of a skilled and experienced Pilates instructor will strengthen the joint muscles safely. This is just one of the many benefits of participating in Pilates before hip surgery.Pilates before surgery will also help strengthen the tissue surrounding the hip joint and maintain its range of motion. The exercises are gentle and have little or no impact, which means they can be performed even when there is femoral deterioration in the hip. In addition, Pilates helps to break down the compensation habits you may have formed. These are movements or adjustments that you have developed in your body while trying to avoid pain in your hip joint.

“They’re normal,” says Ron Jegadeesh, a Pilates instructor, physiotherapist and owner of Southfield’s Pilates Fitness & Physical Therapy Center, “but they also throw the body out of alignment and further exacerbate their condition.”

Another consideration is the fact that some atrophy will occur after surgery, during the postoperative rest period. By strengthening the hip area before surgery, you will begin the process from a stronger place than if you had not performed any Pilates. In addition, you will also improve your balance by strengthening the core, which will help you after surgery. Maintaining balance will be important once you start rehabilitating this joint; you will be less likely to fall and feel more confident about re-exercising as needed. This is where Pilates comes into play after surgery.

Once you start rehabilitating the hip joint, logic would rule that you will only work the affected side, but there is an imbalance between the two sides of the body that has been exacerbated by the aforementioned compensatory habits you probably developed before surgery. In addition, when it is reached, although there is a clear imbalance around the hip joint and the incision point, the whole body experiences the consequences of the surgery. For example, the brain has to recover from the effects of anesthesia and the body’s immune system is weakened. All of these factors make Pilates a unique qualification for rehabilitation after hip surgery.

Pilates largely avoids high impact, high power output, and heavy muscular and skeletal loading. With the Pilates system, individual units work together in an organized scheme or method. In other words, while working to strengthen the area around the hip joint and increase its range of motion, the rest of the body is oriented as an integrated system.

This is done with an emphasis on core strength and two-way stretching. During hip surgery rehabilitation, you will learn to use the core muscles to support every movement of your body. Under the attention of the instructor, you will perform these exercises with proper alignment to make sure that the muscles establish new fibers in the most beneficial way for the joint. Pilates largely avoids high impact, high power output, and heavy muscular and skeletal loading.

The amount of time you need to recover before participating in Pilates after surgery will depend on many factors. For some patients, particularly those involved in preoperative Pilates, it could take as little as six weeks after surgery. For others, it can take two to three months. Obviously, you first want to get permission from your surgeon.

If available, look for a center that offers both Pilates and physical therapy. Physiotherapists in these settings are also trained in Pilates and use Pilates equipment and machines to further facilitate the recovery of their patients. After the initial physical therapy sessions, patients can be effectively transferred to Pilates with the guidance of their physiotherapist. If this place does not exist near the place where you live, be sure to work only with highly trained Pilates instructors who are able to approach your mobility safely, both before and after surgery.

Benefits of Robotic Hip Surgery Using MAKO

Operating room robots aren’t just things from science fiction movies. In fact, many orthopedic surgeons already use them to increase their accuracy and precision. Total hip replacements are now being performed with the help of Mako, a robotic arm, and a three-dimensional modeling software system. Dr. David Cheong at Orthopedic Associates in West Florida, located in Clearwater, is one of the few surgeons in the state who uses MAKO to replace hip instead of just knee. Explain its benefits.

What is a macoplasty?

“Mako is the name of the robot used in makoplasty procedures. It’s basically robot-assisted arthroplasty or joint replacement surgery,” says Cheong. “Makoplastys begins with a computed tomography of the hip, which is then used to plan the placement of the implant. Not only planning, but execution can be done with significant accuracy because of this technology.” .

The procedure takes a few hours in an outpatient center. It starts with computed tomography (or CT), which becomes a 3D model of your natural anatomy, thanks to Mako software. The robotic arm is then directed by the surgeon to help place the hip implant at the correct point. Cheong says the Mako gives him auditory, visual, and tactile cues to help guide him in the right direction. Once completed, patients can leave the operation on the same day, without the need for hospitalization.

How long is the recovery time?

“Recovery lasts two to six weeks, which is also typical of traditional hip replacements,” says Cheong. “The only difference is the way the procedure is performed.”

In a matter of weeks, patients usually return to normal daily activities, but physical therapy is required to regain strength and make sure the implant is working properly. From here, follow-up appointments with the surgeon will be required. Implants can last from 10 to 25 years, depending on weight, activity level and general health.

How much does a macoplasty cost? Medicare and private insurers will cover the cost of a macoplasty because it is still considered a joint replacement surgery. Out-of-pocket costs will be the same as for traditional surgeries: $ 17,000 to $ 20,000. The cost of the robotic arm is expensive for doctors ’offices, so many hospitals don’t have it, just orthopedic practices.

Why don’t more surgeons use Mako’s robotic arms?

“A lot of doctors use this machine just for knee replacement, but the technology is a constantly evolving process. I think we’re going to start seeing more doctors implementing it,” Cheong says. “As surgeons, we are creatures of habit and it all depends on the type of doctor and the style they prefer, traditional or technological.” Cheong has been using the Mako arm for five years and believes it helps him place implants more accurately while eliminating other variables.

Who is a good candidate for a Makoplasty? According to Beaumont Health, makoplasties are for anyone suffering from non-inflammatory or inflammatory degenerative joint disease. Forms of degenerative joint disease include osteoarthritis, post-traumatic arthritis, rheumatoid arthritis, avascular necrosis, and hip dysplasia. Cheong adds that patients who prefer not to receive surgery may apply cortisone injections or anti-inflammatory medications as alternative treatments.

“Ultimately, it’s up to the patient to decide what they’d like to do,” Cheong says. “But for many, this type of surgery greatly improves their quality of life.”

Tips to Help Adults Prevent Hip Surgery or Arthroscopic Hip Replacement

Tips for Chiropractors and Care Providers to Avoid Arthroscopic Hip Surgery or Hip Replacement

In the United States, 3-7% of older adults will have some type of hip osteoarthritis during his lifetime. “Osteoarthritis” or “OA” is the appropriate term for overuse or age-related degenerative conditions. While there are other types of hip problems, such as fractures or soft tissue injuries, most people will be diagnosed and seek care for the degenerative type, eventually trying to avoid arthroscopic hip surgery.

Hip replacements and alternative methods

These degenerative hip problems result in nearly 200,000 hip replacements each year in our country. These surgeries are not only expensive, but involve intensive and time-consuming rehabilitation, as well as the potential for various post-surgical problems.

While some people may actually need arthroscopic hip surgery, many others are borderline surgical candidates or are not prepared to go under the knife without first exhausting other treatment options. In these cases, a combination of proper exercise and chiropractic care can significantly delay the need for surgery or even help prevent it altogether.

Exercise to support the muscles

Exercise and physical activity are known to have a positive effect on joint health and condition. When we look at the hip, we find a large “ball and socket” joint between the femur and pelvis that supports much of our weight when we do any “vertical” activity such as walking, running, or stopping.

Surrounding this joint and providing dynamic support is a complex arrangement of muscles, including the glutes, hip flexors, quads, hamstrings and adductors, to name just a few. Weakness in these muscle groups can cause unwanted additional load on the hips and cause excessive wear. By exercising regularly, especially in resistance exercise, we can make sure that the support muscles around the hip are strong and have the ability to support the hip during our daily activities.

Another added benefit of physical activity is that exercise can stimulate chondrocyte activity in the joints. Chondrocytes are the small cellular structures that hold and produce cushion-like connective tissue that surrounds and coats most of the joints in our body. If we can stimulate chondrocyte activity, we can aid in the physical process of repairing damaged tissue and creating new healthy tissue.

The good news is that if you don’t feel comfortable in a gym setting or your degeneration is too advanced to participate in “traditional” weight lifting, even the simplest bodyweight exercises can be extremely effective. Movements such as aerial positions, lunges, hip pushes / bridges, etc., are safe and efficient methods to improve endurance and muscle strength. If patients have the strength and ability to perform even more demanding exercises, encourage them to do so.

Strength exercises vs. cardio

If endurance exercise is good, what about cardio? Do you like walking or running? The answer is a bit complex.

Many studies show that, in the context of hip health, it is possible to overdo certain types of cardiovascular activity. A 2015 study, which measured the amount of load our hips experience when moving, showed that when walking, an average adult will experience hip contact forces approximately 4 to 5.5 times their body weight. This load can increase our body weight by up to 10 times when running 12 km / h (approximately the rate of one mile in 8 minutes).

For example, a 180-pound individual will experience hip contact forces of nearly 1,000 pounds when walking and more than 1,800 pounds when running. Does this mean that cardiovascular exercise is necessarily bad for the hip? No, but we must understand that these forces of contact with the hips create a cumulative effect over time. Several studies show a positive relationship between a runner’s age, running pace, total mileage, and degenerative hip disease, probably due to the increased hip contact forces that occur during the race. .

What does this mean for patients? While we can’t make specific recommendations for cardiovascular exercise, we know that extremely high mileage combined with a fast running pace can lead to an increased risk of degenerative hip problems, and the more degeneration there is, the more likely you are to encounter problems. . In the context of hip health, this means that a regular walking routine can greatly benefit patients, while running should be carefully monitored.

If you want to practice more vigorous cardiovascular exercise, try something like swimming or an elliptical shape that removes some of the load from the joints.

When adding exercise to a “surgical prevention routine,” the chiropractor or physiotherapist should determine what types of movements and loads are appropriate and make sure patients follow a proper and safe manner. When used correctly, exercise can play a valuable role in delaying the need for hip arthroscopic surgery or other surgery.

Research and the role of the chiropractor

Numerous studies have focused on the relationship between chiropractic / manual therapy and degenerative hip disease, but one highlights the benefits very well.

A 2004 study compared “manual therapy” with “exercise therapy” in 109 individuals who had previously been diagnosed with hip osteoarthritis. The exercise group focused on active exercises to improve muscle function and joint movement. Manual treatments (also known as chiropractic care) include: identification and stretching of short / tense muscles within the hip complex, traction of the hip joint, and manipulation of the joint in “each appropriate limited position.”

Participants were divided into two groups and treated for a period of five weeks, and the results were very impressive:

Success rates of primary outcomes were 81% for manual therapy, compared with only 50% for exercise therapy;
The manual therapy group had significantly better outcomes to improve range of motion, hip function, stiffness, and pain;
The positive results experienced by the manual therapy group lasted after 29 weeks.

In addition to manipulating the hip joint, another consideration should be the difference in leg length (LLD), a sign of biomechanical problems with the pelvis, SI joints, and / or lumbar spine. Interestingly, research shows a potentially strong relationship between LLD and the onset of degenerative hip disorders, probably because weight alteration in a joint could be a contributing factor to osteoarthritis. Although there are other methods for analyzing pelvic / lower back function and alignment, research focuses on LLD because it is easily quantifiable and reliable.

LLD and stressful

The researchers propose that pelvic tilt or torsion, visible through the measured difference in leg length, puts uneven load and tension on the hips and can reduce the area of contact of cartilage in the joint.

The combination of these tensions can increase the pressure on the cartilage and bone of the joint, causing degenerative hip conditions. We see evidence of this in a survey of 100 patients who were diagnosed with hip osteoarthritis. The researchers measured each person’s LLD just before hip surgery and found that their hip osteoarthritis was next to the longest limb 84% of the time. Other studies have shown very similar findings regarding knee osteoarthritis.

For chiropractors treating patients with degenerative hip problems, the focus is on restoring normal movement of the joints to the hips, as well as eliminating or reducing the amount of measured difference in leg length. Regardless of what methods or techniques are used to achieve this, attending to these areas can significantly reduce the need for surgery and have a positive impact on patients ’overall function and pain levels.

Arthroscopic hip surgery and variable options

While some patients really need surgery or arthroscopic hip replacement to protect their quality of life, many others have options when it comes to degenerative hip problems.

Proper exercise scheduling, combined with specific chiropractic care, can dramatically improve an individual’s function and mobility, significantly reduce their pain levels, and delay or avoid the need for surgery.