Regular activity and exercise are important for our general health as well as our physical and mental well-being. However, any of us who enjoy sport, whether casual or competitive, are not immune to the potential damage to our bodies of undertaking such pastimes. A recent high-profile example can be found in tennis star and former Wimbledon & US Open champion Andy Murray, who’s recent hip problems threatened to end his career prematurely.
Not just for the older generation
When we think of hip problems, many of us will have a mental image of helping an ageing grandparent into an easy chair. This cliché is not only somewhat politically incorrect it is also sadly inaccurate in most cases, as arthritis and hip related injuries are becoming ever more common in the young. A full hip replacement was often the default solution for such problems in the elderly, but for the more youthful amongst us intervention at an earlier stage provides the opportunity for alternative solutions to be considered.
The most common cause of hip problems is osteoarthritis which is essentially pain and stiffness in the joints. A pioneer in this field, Reinholt Gantz, has asserted that this condition is caused by the shape that the hip of the hip resulting in dysphasia Dysplasia or Impingement.
Dysplasia – Without getting too technical, this is essentially a ball and socket problem, whereby the hip socket is more shallow and doesn’t fully cover the ball portion of the upper thighbone. This condition is normally present from birth and may lead to premature wear of the joint. At worst the hip may be partially or completely dislocated.
Impingement – This, on the other hand, is becoming increasingly recognised and is where there is abnormal contact between the ball and socket, resulting in increased friction and potential damage to the joint. Unfortunately, misdiagnosis of impingement is quite common as standard X rays of the affected area often look normal. Patients are subsequently treated for less onerous complaints such as muscle strains, leading to no improvement in the overall condition. As a result, correct diagnosis can often take up to 2 years.
Types of Impingement
Impingement is pain caused by the neck of the femur bumps on the rim of the socket. Eventually cartilage damage and arthritis occur. There are essentially two types, CAM and Pincer, the former more common in men and the latter in women.
CAM Impingement – With CAM impingement the problem is caused by a bony bump ( or CAM ) on the front of the neck of the femur. Internal rotation of the leg is often reduced and can cause great discomfort and distress when carrying out everyday tasks such as getting into a car, bending down to sit on a low chair or even putting on one’s shoes.
Pincer Impingement – This is where impingement is caused by a prominent rim of the socket. Symptoms are not as acute, with often a generalised ache or dull pain in the hip region. Highly active women with a slender body shape will often experience such symptoms due to the extremes of movement they can be produce, especially when undergoing sport or any other physical activity.
Diagnosis is key, not just for literal big hitters like Andy Murray, but for all of us engaging in athletic pursuits.
Physiotherapy – Hip injuries due to sporting endeavour are all too common (e.g the aforementioned Scottish tennis ace) and physio is often the most recommended option to identify the extent of the problem. However, should there be little or no improvement within six weeks, more in-depth investigation is required.
X-rays – Not a French dish but actually a popular diagnostic tool, the frog leg lateral view X ray can help identify a CAM bump. Alternatively, a specialist MRI scan known as an arthrogram, which involves a dye being injected into the hip joint, can pinpoint cartilage tears, bony abnormalities and Impingement.
With the specific cause identified, treatment methodology depends upon a variety of factors including age, pain levels and the amount of structural damage involved.
Injections – Cortisone injections which are a shot of steroids targeted at a specific area can offer fast-acting relief from the pain caused by inflamed muscles, joint and tendons.
Surgery – For more severe symptoms, keyhole surgery may be the best way forward. With hip injuries or defects, it is designed to have a twin benefit. Firstly, to repair or remove damaged tissue from the hip joint, and secondly to curtail or eliminate the impingement so stopping or slowing the progression of arthritis in the affected area.
Rehabilitation & Recovery
Following surgery, the good news is that over 80% of patients can throw away their crutches after a few short weeks and regular physiotherapy is then all that is required for a full recovery.
However, if arthritis has already taken hold, the option of replacing the hip joint is unfortunately the only route available. Metal on metal hip resurfacing can produce excellent results, as evidenced by Mr Murray’s return to form and prominence in the tennis world. For many people though, this is not a viable option due to the sensitivity to metal that can result in.
Therefore, for arthritis at least, a total hip replacement remains the most popular and effective solution as the following key data shows:
Full functionality following surgery
85% of replacements last over 15 years
60% of replacements last over 20 years
In summary, we may not all be destined to be tennis titans, but whatever our age or experience, a hip injury need not be a roadblock to healthy physical exercise and the pursuit of sporting excellence.