Hip Health

Dr. Charles Lawrie from Washington University Orthopedics discusses hip health, both surgical and nonsurgical options for patients, and expectations for reclaiming a pain-free life.

What are the main areas and conditions that you work with and treat?

I primarily focus on the degenerative conditions of the hip and knee with a focus on minimally invasive, rapid recovery techniques. Our goal in my practice is to get people back on their feet as quickly as possible with the use of new technologies in hip replacement and knee replacement.  

What are some of the more common hip conditions that maybe tend to come up over someone’s so course of their lifetime?

Just about everyone at some point in their life will experience some hip pain to some degree. Common conditions that affect all ages include things like bursitis and tendonitis which are conditions that typically cause pain related to soft tissue or muscles. Other conditions that can be present from birth like hip dysplasia can either show up early on as an infant, in childhood or even later on in life and arthritis caused by dysplasia.

Young athletes now are more and more experiencing hip impingement which can lead to things like labral tears, avascular necrosis which is a common condition where part of the hip actually dies and causes arthritis and then degeneration or just wear and tear osteoarthritis which is extremely common as we are getting more and more active in our younger years. We see a little more arthritis in our younger years and finally hip fractures are increasingly common as well and especially in the older population and those always require surgical treatment in most cases.

We hear a lot about hip replacements and at what point does that come into play?

Hip replacement is really kind of a last resort for conditions that cause hip pain and it is indicated in patients who have degeneration of their hip which can be due to a variety of conditions. The one thing about hip replacement is it is really a personal decision that patients need to make with the help of their surgeon to decide when to do it. There are a lot of options that we have for treatment leading up to the point where someone would get the surgery but once that decision is made it is a very good operation with excellent results.

As far as some things that maybe we should look for, what are some signs, symptoms, some things that might indicate that something is going on and we need to take it to the next level and have a surgeon take a look?

Like I mentioned before, hip conditions affect patients of all ages and just because you are having pain somewhere around the hip doesn’t necessarily mean that it is from the hip and it certainly doesn’t mean that you need surgery right away. As with any aches or pains anywhere in the body most patients tend to start with managing it themselves at home with things like over the counter anti-inflammatories. Aches or pains that don’t go away with more conservative home treatments after 3 or 4 weeks usually should be evaluated by a physician  and those patients initially end up being treated by their primary care physician where they will voice their complaints. Then they get an x-ray and that will show whether it’s hip arthritis or something else causing pain. Certainly if someone’s had a fall and they are experiencing severe pain or they are unable to walk that is the point they should go to the ER right away. Most of the conditions that I treat that are caused by a problem in the hip usually are more nagging pains that slowly get worse over time and that is what brings the patient to the attention of  the doctor.

Now we talked about the extreme, the hip replacement. What are some of the other treatments?

We have a lot of good treatments available to us before we get to hip replacement. Like I mentioned before, most patients should start with things like non-steroidal anti-inflammatories that can be purchased over the counter at pharmacies or things like Tylenol. Beyond that when the pain continues to gets worse and doesn’t respond to those, we typically prescribe physical therapy to  the patients to work on strengthening and stretching of certain muscle groups that can help off load the hip and help some of the patient’s pain and can also keep them active.  Beyond that, injections with corticoid steroids or cortisone injections can be very helpful for the hip and those are typically done with the use of ultrasound or x-ray guidance as the hip is pretty deep underneath a lot of muscles and techniques can be used to ensure that the injection is going into the right place as the medicine goes in. After that it is really a discussion with the patient and the surgeon as to whether or not they feel surgery is an appropriate next step. Like I said that is really a situation that should be discussed between the patient and the surgeon and there is never really any urgency in doing that.

When we talk about issues with the hip we usually talk about the elderly. I am curious, what age patients do you see?

We actually see patients of all ages. Like I mentioned hip dysplasia malformed hips is a condition that can be present from birth and it can cause patients to need hip replacements even when they are very young. We know hip replacements done with modern materials and modern techniques will probably last the patient 20 or 25 plus years or maybe even longer.  The current generation of implants that we have we have a date on them of about 20 years and we know that about 90% of them survive at least 20 years and we are still waiting every year to get the data back to show us that they continue to survive at that high point.

We are a little bit more willing to do hip replacements on younger patients who are having hip problems that can’t be treated with other surgeries.  Beyond that, we have good options for patients in their twenties and thirties and forties who want to remain very active. Patients who want to continue things like hockey and soccer or basketball with arthritis which is called hip resurfacing which is a unique procedure that not many surgeons around the country perform. We have a fairly high volume center at Washington University where we do those and beyond that we treat patients in their elderly years with hip replacements who just developed arthritis.

As you indicated about 20 to 25 years is about how long you can expect a replacement to last? 

The most recent data that we have on implants that were developed about 19 years ago indicates that those replacement are lasting approximately that amount of time with 90% of them. Depending on what group of patients you are looking at a lot of the countries around the world keep that keep registries of all the hip replacements that have been done in the country. We look at all the hip replacement that have been done and roughly 90% of them are at 20 years so. It is our hope to see those hip replacement last even longer than 25 to 30 years plus. We can’t definitively say that at this point because there is no data to support it.

I know that talking to patients who have had it done several years ago even the types of materials being used is constantly evolving and changing so this really is a fascinating thing to look at from your standpoint of orthopedics because there are constant advances being made in this whole area.

Hip replacement is really a great surgery and a patient who has a good reason to do it for most patients they are up and walking the same day and by four to six weeks after surgery they usually are back to most of their normal daily activities. By three months most of them are back to normal activities golfing and hiking without much difficulty and most of them wake up after surgery saying their pain feels better than before and it is a really incredible thing to see in the right patient.

Dr. Charles Lawrie is an Assistant Professor, Orthopaedic Surgery with Washington University Orthopedics.  Schedule an appointment with Dr. Lawrie or any of the other specialists at the Progress West Hospital location.