Hips Archive

An ailing knee or a hip can make life miserable. Even if your doctor recommends it be replaced, you need to carefully weigh the risks and benefits before agreeing to this major surgery and understand that it will require significant rehabilitation to get back on your feet.

The most important factor in choosing to have a knee or hip replaced is how much it hurts and how much it is affecting your life. Here are six signals that it's time to have a knee or hip replaced:

The first line of treatment for many knee and hip problems includes taking over-the-counter pain medications. Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are the most common pain medication options. However, these pain medications have a variety of side effects, so it's important to discuss your personal health risks with your doctor when considering long-term use for chronic conditions such as osteoarthritis.

Acetaminophen (Tylenol and other brands) is usually effective for mild pain and is easy on the stomach. However, it is toxic to the liver at high doses. The recommended maximum per day is generally set at 4 grams (4,000 milligrams), which is the equivalent of eight extra-strength Tylenol tablets. But that dosage can still cause liver problems for some people. To be safe, aim for 3,000 milligrams or less, and be cautious of mixing multiple products containing acetaminophen, such as a pain reliever and a cold medication or a prescribed narcotic.

Bring this article to your doctor appointment.

You've run out of options for hip pain and you're facing a possible hip replacement (see "Anatomy of a hip replacement"). Once your doctor has determined that you're a good candidate for surgery — based on your medical history, images of your hip, steps you've taken to reduce pain (such as weight loss and low-impact exercise programs), and how pain has affected your daily function — you'll need to ask lots of questions.

"This is not a time to be shy. Be aggressive and get answers. The doctor expects that," says Dr. Scott Martin, an associate professor of orthopedic surgery at Harvard Medical School and medical editor of the Harvard Medical School Guide Total Hip Replacement.

These painful flare-ups can occur suddenly and for no apparent reason. Here's what you can do about them.

Have you ever woken up with a mysterious egg-shaped swelling on your elbow or knee and have no clue what caused it? There is a good chance you have bursitis.

"Bursitis is definitely more common as you get older and just comes with the territory of living a longer and more active life," says Dr. Robert Shmerling, senior faculty editor at Harvard Health Publishing and Corresponding Member of the Faculty of Medicine at Harvard Medical School.

In the journals

If you are ever hospitalized for a hip fracture, using an anti-osteoporosis medication may protect you from another bone fracture. A study in the September 2020 issue of Bone examined data on almost 78,000 people ages 50 and older hospitalized with hip fractures. About 10,000 were given anti-osteoporosis medication — usually alendronate (Fosamax) — within one year.

People who began treatment 15 to 84 days after their fracture were less likely to be hospitalized for another kind of fracture in the future compared with people who began treatment later. Those who first took medication after 252 days had the highest risk. The researchers were not able to measure the participants' bone density, so it's possible some people had especially strong or weak bones, which may have influenced the outcome.

If you're having the occasional twinge of joint pain when you go for a walk or climb stairs, or you're worried about arthritis because a parent had it, one step toward prevention is to check your weight.

There are two ways that being overweight raises your risk for developing osteoarthritis (the most common joint disorder, which is due to wear and tear on a joint). First, excess weight puts additional stress on weight-bearing joints (the knee, for example). Second, inflammatory factors associated with weight gain might contribute to trouble in other joints (for example, the hands).

Hip and knee pain can keep you from the activities you love, as well as make routine tasks difficult. But there are many ways to get you moving again pain-free, without surgery. Here are some of the treatments that can help relieve hip and knee pain.

Ultrasound, phonophoresis, and iontophoresis

Therapeutic ultrasound is a simple procedure that uses sound waves to increase blood flow, relax muscle spasms, and aid healing that leads to faster hip pain relief and knee pain relief. The therapist applies gel to your skin and moves an ultrasound wand over your skin around the painful area. In a special ultrasound technique called phonophoresis, medication (often hydrocortisone) is added to the gel. In a survey of orthopedic physical therapists, more than half said they would use ultrasound and phonophoresis to reduce soft-tissue inflammation (in tendinitis or bursitis, for example). These techniques are also used to manage pain, heal tissue, and help muscles stretch.

A desire to stay active and a natural aversion to pain send nearly 800,000 Americans to orthopedic surgeons each year for a hip or knee replacement. And we're seeking these operations much earlier in life. According to Dr. Scott Martin, associate professor of orthopedic surgery at Harvard Medical School, this isn't a healthy trend. "A lot of joint replacements are being done because they can be," says Dr. Martin.

Every surgical procedure carries the risk of complications — or even death. Because the average joint that's replaced only lasts 10 to 15 years, having the procedure done at age 50 instead of 70 means there's a good chance you'll need a second procedure when you're older and at higher risk for complications.

On call

 Image: © Ridofranz/Thinkstock

Q. I was an active runner before my hip replacement. Is it okay to return to jogging several times a week?

A. Hip replacements help relieve pain and improve function for people with worn-out hip joints. However, replacement joints also can wear out over time and require what's called a revision surgery. Therefore, activities that may increase stress or wear on the joint are often discouraged.