March 24, 2006 (Chicago) -- While most of us assume that hip osteoarthritis (OA) and other diseases of the hip happen primarily to seniors, that's not necessarily true, say orthopaedic surgeons speaking at the 73rd annual meeting of the American Academy of Orthopaedic Surgeons in Chicago.
But the good news is that doctors are getting much better at detecting and treating hip conditions in young and active people.
"We are seeing an increasing patient base of adults in their 20s and 30s as well as those in their 40s, 50s, and 60s who lead extremely active lifestyles and put very high demands on their hip joints," said Joseph C. McCarthy, MD, during a news conference. McCarthy is a clinical professor of orthopaedic surgery at the New England Baptist Hospital in Boston and president of the American Academy of Hip and Knee Surgeons.
Diagnosing Hip Problems in the Young
"With conventional MRIs, we don't see a lot of cartilage injury, but the gadolinimum-arthrogram MRI has a bit more contrast [which allows for better viewing]," explains E. Anthony Rankin, MD, a professor of surgery at Howard University and chief of orthopaedics at Providence Hospital, both in Washington. The new MRI technology is the most accurate nonsurgical way to evaluate hip pain that cannot be seen on standard X-rays, conventional MRIs, and computerized tomography (CT) scans.
Surgically, doctors tend to rely on arthroscopy to diagnose hip problems, Rankin says. Arthroscopy involves the use of special instruments that are inserted into tiny incisions to allow a surgeon to view the inside of the body to identify changes in the hip and surrounding tissue that can cause disease.
"This is done more and more for the hips today," Rankin says.
Treatment Looks Better and Better
With improved methods of detection also come improved ways to treat hip disease in younger people. "The real trend is in what we have to offer these patients," he tells WebMD.
"Hip disease in younger people typically results from congenital disorders, trauma, or developmental issues," Rankin explains.
And "we haven't really had the ability to address this surgically in the past as earlier hip replacements were reserved primarily for elderly people who are not especially active, don't place a high demand on their joints, and did not have a long life expectancy," he says. But "today's replacement hips are more durable and increasingly being done in younger populations."
Today, "advances include longer-lasting implants that won't take as much of the bone during the initial operation," he says. "We are preserving bone stock, so if you do have to have another replacement surgery, we have more to work with."
Though hip replacements are highly successful operations, they don't last forever, and if a person undergoes one at a young age, there is a high likelihood he or she will have to undergo more replacement surgery in the future.
What's more, some younger people may also be candidates for a less-invasive joint replacement-type procedure known as hip resurfacing. During this procedure, surgeons smooth out the hip to repair a cartilage tear. "These less-invasive procedures offer less risk, a faster rehabilitation to return to work and an active lifestyle, and less long-term activity restrictions in selected patients," McCarthy explains.
Thomas P. Schmalzried, MD, an orthopaedic surgeon and associate medical director of the Joint Replacement Institute in Los Angeles, says resurfacing is best used among people who are at risk for failure of a total hip replacement. "In general, these are young and active patients with good bone in the proximal femur, or the tip of the thigh bone," he explained during a news briefing.
Rankin says osteotomy is still used frequently to treat hip disease. Osteotomy or "bone cutting" is a procedure in which a surgeon removes a wedge of bone near a damaged joint to shift weight from an area where there is damaged cartilage to an area where there is more or healthier cartilage.
Prevention Still Gold Standard
"Most joint surgeons would like to preserve the native joint for as long as possible," Rankin says.
"We still don't know exactly what causes OA, but "athletes and active people do tend to develop joint wear and tear."
The best ways to preserve joint health and function are to keep weight down and stay active, he says. "Exercise is important, but exercise that involves pounding on the joint may make a person more likely to develop hip problems."