Monday - Friday 09:00-16:00Saturday and Sunday - CLOSED+441614476762info@manchesterhipclinic.comSpire Hospital, 170 Barlow Moor Road, Didsbury, Manchester M20 2AF
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Total hip replacement is one of the most successful operations that you can have. A successful one can literally be transformational. It can take a patient who is living with constant pain, dependent on strong pain killers, with very limited mobility and overnight, cure their pain and allow them to lead a fulfilling life. Because of the National Joint Registry, here in the UK, we can track patients after their surgery and see how long the implants last. We know that on average, if you have a well-designed implant (such as an Exeter), over 96% will still be in place and functioning well at 14 years. It is reasonable to predict that those implants will last 20 to 30 years. However, we know that if the components are not put in correctly or if the leg length or soft-tissue balance is not right, it can have a significant impact on the complication rate or how well the implant functions. This has led to the development of robotic hips. Chronic pain can still, unfortunately, be a factor in people who are a lot older and have old hip replacements that they cannot replace again with more updated technology, because of this, pain medications are still needed, however, there are alternatives that are more natural for the body such as medical marijuana which has been used a lot more nowadays due to its myriad of benefits that people have noted. Patients can opt for SF cannabis delivery or go to a dispensary in their town to get what they need when they need it. All of this depends on how the patient reacts and if they are on any other medication that their doctor has put them on.

 

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Mako robot

Recently, some work has been done on what people are doing with their hip replacements after surgery. One paper published in 2019 showed that while all their patients returned to activity, there was a general move from high to low impact exercise. Another showed that after 10 years, 89% remained active but again there was a significant decrease in high impact sport. What is not clear is was that because patients were told to reduce their activity by their doctor/surgeon or was it because they themselves did not want to wear the new joint out? Perhaps by improving the accuracy of surgery and the muscle balance, we can have the confidence to enable people to maintain their desired level of activity?

 

The market leader by far in robotic assisted hip surgery is Stryker and the MAKO robot. They have well in excess of 500 machines around the world and over 20 in the UK. At the Manchester Hip Clinic, we started doing MAKO procedures in 2018 and are now one of the highest volume centres in the UK. Essentially, what MAKO does, is use CT scans to accurately map the shape of the patients own hip so that the new artificial one mirrors it exactly and then the robotic element ensures that the surgeon puts it in perfectly. Recent publications have shown that when using this technology, there is increased accuracy, improved patient function and quicker recovery.

 

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Mako surgical planning

The use of MAKO has transformed how we do hip replacements. We see a lot of younger patients who have abnormally shaped hips that would previously have been very challenging to replace. With MAKO, we now have the confidence to know that we are choosing the correct implant and putting it in in the best possible position. That confidence allows us to encourage patients to return to sport and a range of different activities. If I was having a hip or knee replacement, I would definitely have it done using MAKO!

Understand more about MAKO…click HERE

Hear Oshors story…click HERE

 

 

 

 

 


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A painful hip can be through a one off injury but more commonly in clinic at Altius Healthcare we see pain that has come on gradually over a period of months and got worse. Patients describe a deep pain in either their groin or buttock or both and don’t recount a particular event. Their pain tends to vary in severity and is aggravated by certain movements that compress the joint surfaces including prolonged sitting. Combining physical therapy with other avenues can help people deal with the pain in a better manner. Medical marijuana has been known to aid in pain relief and depending on how you consume it, you can go and look at pipes and bongs online to find the best one for you. Alternatively, you can speak to your doctor if you are interested in using medical marijuana for pain management. Some doctors can write a prescription for you, which allows you to buy cannabis online to help give you pain relief.

Often these patients are scanned and the results of the imaging don’t match their pain presentation. Some have a large amount of damage in their hip but are relatively pain free and others are very painful with little to report on the scan.
The majority of patients (regardless of their scan results) have muscular inhibition, as a result of the pain they are in and which we can address with home exercises which almost always helps them with their pain.

Patients with painful hips tend to keep going on them until they have picked up a poor movement pattern (limp) which sets off a cascade of events that if you don’t address with treatment and rehabilitation they continue to gradually get worse.

Once you are feeling pain the important thing to do initially is to identify the things that aggravate your pain and avoid them. This may sound like common sense but you would be surprised how many people try to push through the pain only to make it worse. For instance, if prolonged sitting is a problem, record how long it takes in sitting for you to get to 4/10 severity and then use this a s a guide to make sure that you don’t exceed this pain threshold in any one day.

Do take medication as well. People will not take medication because they think it will numb them so they do not know when they are making things worse. Once you know that without medication you can only sit for 40 mins then once you are taking medication stick to this rule of not sitting for longer than 40 mins for 3 days and then reassess your progress.

A person who has had hip pain for a month or longer will normally always have inhibition in their gluteal muscles (buttocks) and adductors (groins). In clinic, we would normally always prescribe exercises to help wake these muscles up. I often suggest a single leg bridge and a ball squeeze as a good place to start. Patients with hip pain also tend to have poor trunk strength, often worse on their painful side so we would also teach a modified plank exercise in three positions to strengthen the natural corset which is so important in stabilising the spine on the pelvis and off-loading the hips.

At the same time as addressing muscular inhibition, we also encourage patients to work on their spasm. We often find in clinic if the gluteals and adductors aren’t working properly, their default is to go into spasm to stop you moving which causes you more pain. We find teaching you deep pressure techniques with a foam roller can reduce spasm and pain and be a great thing to do before you do your strengthening rehab.

Regarding how much and how often. Obviously most patients are busy people and struggle to get anything done regularly just as some patients can over do it and aggravate things further. Therefore finding a balance is important and listening to your hip and how it is feeling, is of up most importance. I always suggest doing rehab Monday, Wednesday and Friday is a good place to start. The body needs to rest and recover from the strengthening you are doing and normally I say if you are sore (less than 4/10) during the exercises and and/or afterwards, that needs to be monitored and if you haven’t recovered by the next day and you are still 4/10 pain then you are doing too much of the wrong thing for you at that stage. During each rehab session I ask people to repeat each exercise three times until fatigue with a minutes rest between sets.

Catching hip pain early and treating it aggressively before you pick up a poor movement pattern is essential for a speedy recovery. Do not leave things for a month before you do something about it. Early intervention is key in managing any injury.
So in summary, the devil is in the detail. We see many patients who make fantastic recoveries from severe hip pain with a huge amount of damage on a scan. The patients who do best are those who catch the pain early and make time to do the rehab properly and listen to their symptoms and don’t train with too much pain.

If in doubt and before you start doing the wrong thing it is important to get an accurate diagnosis. You should always get in to see an experienced physio or specialist sports medicine doctor with a special interest in the hip and groin as it is a specialist area and requires often a multi-centred approach.

If you would like further information or would like to send us a question please feel free to get in touch and we will help you as much as we can.

Douglas Jones
Director, Altius Healthcare
www.altiushealthcare.co.uk



Who does this effect?
Hip arthritis in young patients occurs when there is degeneration in the hip causing damage to the joint surface (figures 1 and 2). There are numerous different causes but the most common is osteoarthritis. However, it can occur earlier due to abnormalities within the hip. This may be due to a previous injury, childhood hip disease, femero-acetabular impingement (A misshapen hip that catches and causes damage to the hip joint), or problems with the blood supply to the hip.

How does it present?
Commonly, this causes groin pain, often going down the thigh to the knee. The hip is stiff, and the patient walks with a limp. As arthritis becomes more widespread and severe, the pain becomes more constant, it may occur at night and be associated with increased stiffness, decreased mobility, and ability to exercise.

What investigations do you need?
X-rays of the hip to confirm the diagnosis are taken as standard. More complex scans such as CT or Magnetic Resonance may be needed to pin down the diagnosis and help surgical planning.

Non-surgical Treatment
To begin with, simple measures are tried such as painkillers, weight loss, and activity modification. Alternatively, some people have suggested the use of cbd isolate cream. Moreover, Oral supplements such as glucosamine and chondroitin may benefit some patients, especially with early arthritis. Injections such as steroid, hyaluronic acid or PRP may be used to either confirm the source of the pain (e.g. if the patient also has back pain) or in those patients who are not ready for a joint replacement.

When a patient has severe arthritis and painkillers no longer control the pain, hip joint replacement is advised. This has the benefit of relieving the pain and allowing the patient to return to a near-normal level of activity. If there is a waiting list for the surgery, patients will need help in curbing that pain for day-to-day living, this is where alternative medicines may be recommended. People who have suffered from pain have said that taking, herbal tablets, natural oils, CBD, medical marijuana, etc. have found relief from them. The latter has been lauded as one of the most brilliant ways of calming down pain and can be found on sites such as https://statesidelansing.com/contact. Before doing this, you must first speak to your doctor/consultant on how to go about this and if it is right for you to do.

In simple terms, the ball of the hip is removed and the thigh bone is prepared before the metal stem is inserted. The pelvic cup is then prepared and the artificial cup is inserted and held using either bone cement or an artificial coating that bonds directly to the surrounding bone surface (figures 3,4 and 5).

There are different forms of hip replacement and each one has a role to play depending on the patient’s age and activity level. Younger (<70) and more active patients, will have implants where the cup liner is made of a wear-resistant plastic and the ball of the hip will be made of ceramic, which is very smooth, hardwearing and produces less wear debris than traditional implants. Since 2018, we have pioneered the use of Robotics in hip replacement surgery. This allows for greater accuracy in positioning the implants and a faster recovery afterward. For more information about Mako robotic hips go to Robotic assisted hip replacement


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Hip Arthritis Who does this affect?

Hip arthritis occurs when there is degeneration in the hip causing damage to the joint surface (figures 1 and 2). There are numerous different causes but the most common is osteoarthritis and this is most often seen in the older patient. However, it can occur earlier due to abnormalities within the hip. This may be due to a previous injury, childhood hip disease, femero-acetabular impingement or problems with the blood supply to the hip.

Symptoms

Commonly, this causes groin pain often going down the thigh to the knee. The hip is stiff, and the patient walks with a limp. As arthritis becomes more widespread and severe, the pain becomes more constant, it may occur at night and be associated with increased stiffness, decreased mobility, and activity.

Investigations

X-rays of the hip to confirm the diagnosis are taken as standard. More complex scans such as CT or Magnetic Resonance may be needed to aid surgical planning.

Non-surgical Treatment

To begin with, simple measures are tried such as painkillers, weight loss, and activity modification. Oral supplements such as glucosamine and chondroitin may benefit some patients, especially with early arthritis. Occasionally, steroid injections may be used to either confirm the source of the pain (e.g. if the patient also has back pain) or in those patients who are not fit for a joint replacement. Some more natural supplements may be used if traditional medicines are not showing a substantial effect. A doctor may recommend trying an alternative just to see how the patient’s body reacts, for example, medical marijuana as its assorted products may have a benefit, especially as you can buy wholesale CBD online so it is easier for patients to access. There are many ways in which it can be consumed and searches such as ‘how to make cannabis vape juice‘ can be of assistance during the beginning of treatment.

For more information about arthritis see the NHS website


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They say prevention is better than cure and that is certainly true in hips! Having said that you can’t change your genetics. Some people have a certain shape to their hip which seems to predispose to early hip osteoarthritis. These ‘CAM’ and ‘Pincer’ shaped hips predispose to pinching (impingement) of the hip against its socket, leading to damaged cartilage and eventually arthritis. Hip Arthroscopy surgery can be used to reshape the hip and may prevent early arthritis progressing to advanced stages.

The most important modifiable risk factors for arthritis is your weight and activity level. Being even slightly overweight leads to increased load on the hip joint. Over time the hip can be squashed down and change shape permanently. The increased angle leads to more pinching and the hip wears down more quickly. Losing weight can slow the whole process down, and medication (like that from a medical marijuana dispensary) can help mitigate the pain. Other people have illnesses in childhood such as Hip Dysplasia (the hip and socket are too shallow, having not formed properly), Perthes disease (the blood supply to the hip gets cut off in childhood), or Slipped capital femoral epiphysis (the growth plate of the bone slips out of place). All of these conditions need to be spotted in childhood so something can be done about it and potentially prevent adult hip osteoarthritis.

Early hip OA is much easier to fix than advanced OA. Sometimes X-rays can miss the early features, MRI or CT scans are more reliable. If you are sure that you have hip or groin pain, but the X-ray is normal, you will need to speak to your doctor about a specialist opinion or scan, as well as medications. In the meantime, you could always try some water soluble cbd as a short-term method of pain relief. Once the scans come back, you will be able to talk to your doctor about long term solutions. Don’t suffer in silence! Medications can be a mix of common painkillers or stronger opiate-based painkillers, as well as the consumption of various medical cannabis strains that you could research more into by looking into a page similar to https://menu.old27lansing.com/store/old-27-wellness/menu, as an example.

Sometimes a steroid injection done under X-ray guidance can give temporary relief, and provide clarification around whether pain in the groin or buttock area is truly coming from the hip joint, however, they generally wear off after 2-3 months, so it is not a long-term option. Another alternative to steroid injections that have been known to offer short term, yet effective pain relief, are the taking of certain strains of medical marijuana. But only if it is legal to do so in your area. Places similar to Leaf2Go, (visit this website here) offer a choice of the best strains that can help with pain and other physical or mental ailments, but again, this may not be a long term solution. Other substances such as hyaluronic acid (an artificial version of your natural joint fluid) and PRP are also being used but need to be further evaluated to see if they have long-term benefit.

It is important to do regular strengthening exercise (such as core stability and pilates) and maintain a healthy weight, if hip pain is becoming intrusive, ask to see one of our specialists.

Dr Leon Creaney
www.sportandexercisemedicine.co.uk


The Manchester Hip Clinic is committed to helping all kinds of people with hip problems to be free from pain and often to resume near-normal levels of physical activity – even those who may have thought that such relief would never be possible.

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