Hip

expandcollapseArthroscopy of the hip

Arthroscopy of the hip is in many cases an alternative to hip arthroplasty, resulting in many benefits such as:

  • Complete pain relief,
  • minimally invasive treatment (one day surgery),
  • 2-3 small (5 mm) cuts,
  • fast full fitness recovery,
  • the possibility of further sports activity,
  • prevention of degenerative changes in the hip joint.

Nowadays, many doctors who diagnose their patients with hip joint problems, start off with pharmaceutical treatment, leaving an open option for serious surgery in the form of joint replacement in the near future. Such surgery, as well as hip implants, is connected with a 7-14 day hospital stay. The solution to this medical condition is minimally invasive arthroscopic hip surgery (one day surgery). Performing hip arthroscopy is recommended to all patients whose clinical examinations and imaging had proven:

  • damage to the labrum,
  • femoral impingement conflict,
  • damage to the ligament of the femoral head,
  • damage to the articular cartilage,
  • synovitis disease,
  • loose bodies,
  • Pipkin fracture type,
  • inflammation of the hip with effusion,
  • internal hip popping ligament pathology,
  • lumbar hip,
  • pain present for more than 6 months.

Tomasz Piontek, MD, PhD, is one of few surgeons in Poland, who performs arthroscopic hip surgery. Many years of experience, and scientific knowledge, of the  Rehasport Clinic specialist ensures that this technically difficult procedure is performed successfully with utmost precision, using the latest surgical techniques. For the past ten years such procedures have been popular in  the United States and Western Europe, whereas they are just gaining popularity in Poland.

By undergoing hip arthroscopy patients save their hip joint. Additionally, pain and problems related to movement are forgotten and full sport activity is regained.

expandcollapseSnapping Hip Syndrome

External and Internal snapping hip

External snapping hip, otherwise known as dancer’s hip is a medical condition of the hip where a band of connective tissue known as the iliotibial band passes over part of the thigh bone, called the greater trochanter. This may be accompanied by an audible snapping or popping noise, at times resulting in pain, however more often causing a feeling of discomfort.

Internal snapping hip is caused by the iliopsoas tendon snapping over a bony prominence of the pelvis.

Causes of Injury

The most frequent group experiencing snapping hip syndrome are athletes practicing disciplines of intensive hip load and requiring twisting, e.g. ballet. The most frequent causes of injury are:

  • Dysfunction of the knee, e.g. lopsided knees,
  • Anterior hip tilt
  • hip flexion contracture,
  • frequent intramuscular injections in the hip.

What are the symptoms

  • A characteristic noise in certain situations.
  • Every third patient experiences pain.

How to diagnose snapping hip syndrome?

The diagnosis is based on three following elements:

  • I Doctor-Patient interview focusing on ailment, pain and function
  • II Examinations – clinical tests performed by a doctor in the office
  • III Additional examinations such as ultrasound, MRI or X-ray

Treatment

Typically, snapping hip does not require surgical treatment. This method of treatment is used only in case of bursitis among people complaining about walking disorders, and also in cases where conservative treatment had not been satisfactory. In Rehasport Clinic, snapping hip surgery is performed by a minimally-invasive arthroscopic technique that guarantees fastest recovery.

People suffering from snapping hip are most often treated conservatively. Rehabilitation is aimed at stretching and making structures of high contracture more flexible, restoring proper body posture and proper positioning of the pelvis. Pharmaceutical and physical therapy are used supportively.

expandcollapseArthroplasty of the hip joint

Arthroplasty is considered one of the greatest medical achievements of the last century. It is a surgical procedure in which the damaged hip tissue and joint is replaced by a prosthetic implant. The hip is a ball and socket joint, which may be replaced with prosthetic implants. The femoral head is replaced with a metal or ceramic ball, whereas the socket (acetabulum) with polyethylene, ceramic or metal inserts.

Currently, endoprosthesis of the hip joint can be divided into:

  • Cement use (mostly among elderly patients over 75 years)
  • Non-cemented,
  • hybrid use, where one element (usually the acetabulum) is attached without cement, and the other element by use of cement.

Endoprosthesis used in Rehasport Clinic are products of renowned orthopedic manufacturers, proving a record of the best mechanical and tribological properties:

  • e.g. cemented Exeter (Stryker)
  • non-cemented
    • resurfacing – BHR (Smith & Naphew)
    • neck – BMHR (Smith & Naphew)
    • metaphyseal – Proxima TriLock (De Puy), SMF (Smith & Naphew), Fitmore (Zimmer)
    • standard Corail (De Puy), Alloclassic (Zimmer)

During pre-operative planning an implant is selected, which meets all the expectations of its activity after surgery, based on X-ray images and the degree of destruction of the hip joint.

In Rehasport Clinic we also perform endoprosthesis replacement surgery (complications of aseptic loosening of the implant components). A highly specialized and experienced medical team guarantees high quality of procedures

Surgery

Hip replacement surgery is performed most often in epidural anesthesia and lasts from 1 to 2 hours. On the day of treatment the patient receives antibiotic protection and thrombotic prophylaxis in the form of low molecular weight heparin. Due to blood loss during surgery, and in the perioperative period, blood transfusion is sometimes neccessary. It is possible to use one’s own blood taken 2 weeks prior to surgery (1j.) or a device for automatic blood transfer (blood use from postoperative drainage). Such a procedure allows patients to avoid transfusion of other blood.

1 day after surgery isometric exercises in the form of breathing, upright posture walking with a slight weight bearing on the operated lower limb are used. Exercises are gradually expanded, so that in the 3rd  -4th day after surgery, the patient may move independently using one or two elbow crutches.

Antibiotics are used as protection for 2-3 days after surgery, whereas prophylaxis against thromboembolism (elastic stockings or low molecular weight heparin and oral formulations) for six weeks after surgery. In 3 to 7 days after surgery, after having learnt to walk, the patient is discharged from hospital, with the recommendation of further continuation of rehabilitation. After 4-6 weeks of progressive rehabilitation, proper radiographic pictures and the appropriate use of implants, the patient is allowed to start walking without crutch support. Such recommendations are applied to each patient individually, and depend on factors such as overall efficiency and patient age, remaining joint disease process, body weight, and others.

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