[Donnah (OP)]

My boyfriend injured his right hip while waterskiing many years ago.  It healed and was fine until about three years ago, when he experienced a great deal of stress.  It has been painful since then and has gotten much worse within the last year[].  We can't hike or even go for long walks.  X-rays showed nothing and he has been on anti-inflammatory drugs for months, so they are obviously not working.  He is planning to go for an ultrasound.  Is there anything he should be looking for, or anything more he can do to recover?

[chris]

Donnah

The obvious thing to exclude is a structural problem with the hip which is a common cause for groin pain. It sounds as though you've already done this with X-rays, which are a sufficiently sensitive measure to exclude anything obvious. Then you need to exclude a structural problem with the spine, including disc disease and osteoarthritis (wear and tear).

What is most noticeable about the history is the fact that the hip was fine for a long time after the accident, but only became painful when your partner became 'stressed', arguing that this might be a form of neuropathic pain (see Peter McNaughton's article on pain : http://www.thenakedscientists.com/HTML/articles/article/petermcnaughtoncolumn1.htm).

I've seen several patients with debilitating symptoms like this, all arising in different ways and all with normal scans.

The good news is that if it is neuropathic pain there are some drugs that can make the condition better including one called GABAPENTIN, or alternatively very low (sub-depression) doses of the antidepressant amitriptyline. Both of these agents are also used in people with phantom limb pain following amputation and are moderately-to-very effective.

Naturally it is very difficult to comment on the case without seeing the patient, but I doubt you'll see much on the ultrasound. I'll be interested to hear the results though, please keep us informed.

Best

Chris

[Exodus]

do they use titanium for hips replacements?

Essentia non sunt multiplicanda praeter necessitatem...

[Donnah (OP)]

Chris,

Thank you for the additional information.  The article is very good and leads me to a new theory.  Three years ago, during the high stress time, my sweetie also switched to a fat-free diet.  Recently (within the last few months) he read The Shcwarzbein Principle by Dr. Diana Schwarzbein and learned the importance of fat in the diet.  At that point he reintroduced fat into his diet.  Within the last few days his hip has been feeling better (too short a time to be conclusive yet).  Maybe the myelin sheath (comprised of a semisolid, fatlike substance) that normally protects nerve fibres was unable to function properly, due to a lack of proper building materials, after he removed fat from his diet.  The injury created a weakness and lack of proper nutrition exacerbated the condition.  What do you think?

Donnah

[Donnah (OP)]

Chris, they have diagnosed him with osteoarthritis (as you mentioned earlier - so much for my fat theory).  He will be seeing an orthopedic surgeon.  Will you enlighten me on the process of osteoarthritis please?  Is it considered reversible?

[qazibasit]

This is not a big problem he will be fine ask him for physiotherapy and he will be fine after the recovery sometimes the arterial system the artries and veins got a bit disturbed and this cause such problems he will be fine.

[Donnah (OP)]

Qazibasit, welcome!

Can you elaborate on how the arteries and veins are involved?

[cuso4]

When using stainless steel as the material for hip replacement, a problem sometimes happens: the muscle of the patient grow away from the bone because they don't accept the material.

Material scientists have found a way to overcome this problem and it is by coating an area of the stainless steel with hydroxyaphatite (not sure about the spelling), which is the compound that bones are made of.

Angel

[chris]

Sorry Donnah - you asked about this ages ago and I overlooked your request to talk a bit about arthritis...

What we call osteoartritis should actually, more accurately, be called osteoarthrosis. It is a degenerative disease of the joints affecting 100% of people over the age of 60. Men and women differ in the distribution of joints that are affected, whilst being overweight, having a preceeding injury or surgery on a joint, or some other structural abnormality that leads to abnormal joint loading all pre-dispose to the condition.

Clinically the most common features are pain, stiffness (particularly in the morning), reduced range of movement and joint deformation.

Radiologically, arthrosed joints show 4 main features :

1) sclerosis - the bones on either side of the joint develop a characteristic white flare.

2) osteophytes - this is the development of new bone at the joint margins.

3) cysts, or geodes, in the bone substance below the joint

4) space narrowing - compared with a normal joint the bone ends are much closer together owing to loss of cartilage

Microscopically there is wear and loss of the cartilage which normally coats the bone ends to provide a low-resistence point of articulation. The bone surfaces may eventually appose leading to eburnation (polishing) of the bone surfaces where they rub on each other.

We don't know what causes dysfunction and retreat of the cartilage.

The condition is managed conservatively (medically) if possible, and surgically if necessary. Conservative management includes anti-inflammatory agents  like ibuprofen which help to minimise pain, whilst gentle exercise helps to preserve muscle tone and joint movement.

If these measures fail and the condition becomes limiting and a threat to daily living (e.g. an elderly person who can't get around safely because their hip is so bad) then surgery is an option. There are prosthetic versions of many joints including hips, knees, shoulders and even knuckles, but it is worth remembering that none of these are even half as good as what you were born with, and all carry risks of various kinds. That said many elderly people with a new hip replacement suddenly feel that they have been set free again !

Chris


"I never forget a face, but in your case I'll make an exception"
 - Groucho Marx

[Donnah (OP)]

Thanks Chris, this sounds grim!  The anti-inflammatory drugs are not helping very much.  Bruce has gone to an N.D. (the same one who helped me get well) to see if there's more answers in that avenue.