Preventing arthroscopic hip surgery or replacement

Tips for chiropractors and nurses on avoiding arthroscopic hip surgery or hip replacement

In the United States, 3-7% of older adults have some form of hip osteoarthritis in her lifetime. “Osteoarthritis” or “OA” is the correct term for overuse or age-related degenerative joint disease. While there are other types of hip problems such as fractures or soft tissue injuries, most people are diagnosed and treated for the degenerative type in order to ultimately avoid hip arthroscopic surgery.

Hip replacement and alternative methods

These degenerative hip problems result in almost 200,000 hip replacements in our country every year. In addition to being expensive, these surgeries involve intensive and time-consuming rehabilitation and the potential for a wide variety of post-operative problems.

While some people really need hip arthroscopic surgery, many others are either borderline surgical candidates or unwilling to go under the knife without first exploring other treatment options. In these cases, a combination of adequate exercise and chiropractic treatment can significantly delay or even avoid the need for surgery.

Exercise for supporting muscles

Exercise and physical activity are known to have a positive effect on the health and condition of our joints. Looking at the hips, we find a large “ball joint” between the thighbone and the pelvis, which carries a large part of our weight during any “vertical” activity such as walking, running or standing.

This joint surrounds and provides dynamic support from a complex array of muscles, including the glutes, hip flexors, quadriceps, hamstrings, and adductors, to name a few. A weakness in these muscle groups can unintentionally put additional strain on the hips and lead to excessive wear and tear. By exercising regularly, especially resistance training, we can ensure that the support muscles around the hips are strong and can support the hips in our daily activities.

Another added benefit of physical activity is that exercise can stimulate chondrocyte activity in the joints. Chondrocytes are the small, cellular structures that maintain and produce the cushion-like connective tissue that surrounds and lines most of the joints in our body. If we can stimulate chondrocyte activity, we can support the physical process of repairing damaged tissue and building new, healthy tissue.

The good news is that even the simplest of bodyweight exercises can be extremely effective if you are uncomfortable in a gym or if your degeneration is too far advanced to participate in “traditional” weightlifting. Movements like squats, lunges, hip kicks / bridges, etc. are safe and efficient ways to improve muscle strength and endurance. When patients have the strength and ability to practice more demanding sports, encourage them to do so.

Strength exercises vs. cardio

If resistance training is good, what about cardio? Walk or run The answer is a bit complex.

Many studies show that related to hip health, it may be possible to overdo certain types of cardiovascular activity. A 2015 study that measured the amount of stress placed on our hips when moving showed that the average adult experiences hip contact forces of around 4 to 5.5 times their body weight while walking. This load can increase up to 10 times our body weight when running 12 km / h (roughly the pace of an 8-minute mile).

For example, a 180 pound person experiences hip contact forces close to 1,000 pounds while walking and greater than 1,800 pounds while running. Does that mean cardiovascular exercise is necessarily bad for the hip? No, but we need to understand that these hip contact forces have a cumulative effect over time. Several studies show a positive association between a runner’s age, running speed, total mileage, and degenerative hip disease, likely due to the increased hip contact forces that occur while running.

What does this mean for patients? While we can’t make specific recommendations for cardiovascular exercise, we do know that extremely high mileage combined with fast running pace can increase your risk of degenerative hip problems, and the more degenerative there is, the more likely it is that problems will arise bump. In the context of hip health, this means that a regular walking routine can be of great benefit to patients, while running needs to be carefully controlled.

If you want a more vigorous cardio workout, try something like swimming or an elliptical trainer that will take the strain off your joints.

When adding exercise to a “surgical prevention routine”, the chiropractor or physical therapist should determine what types of movements and loads are appropriate, while ensuring that patients are following the correct and safe form. When used correctly, exercise can play a valuable role in delaying the need for hip arthroscopic or other surgical intervention.

Research and the role of the chiropractor

Numerous studies have looked at the relationship between chiropractic / manual therapy and degenerative hip disease, but one highlights the benefits very well.

A 2004 study compared “manual therapy” with “exercise therapy” in 109 people who had previously been diagnosed with osteoarthritis of the hip. The exercise group focused on active exercises to improve muscle function and joint movement. The manual treatments (also known as chiropractic) included: identifying and stretching the short / tight muscles within the hip complex, traction of the hip joint, and manipulation of the joint in “any convenient limited position”.

The participants were divided into two groups and treated over a period of five weeks, and the results were very impressive:

  • The success rates of the primary endpoint were 81% for manual therapy compared to only 50% for exercise therapy;
  • The manual therapy group had significantly better results for improved mobility, hip function, stiffness, and pain;
  • The positive results of the manual therapy group persisted after 29 weeks.

In addition to hip joint manipulation, leg length discrepancy (LLD) should also be considered, a sign of biomechanical problems with the pelvis, SI joints, and / or lumbar spine. Interestingly, research shows a potentially strong link between LLD and the incidence of degenerative hip disease, likely because an altered weight load on a joint could be a contributing factor to osteoarthritis. While there are other methods of analyzing pelvic and lower back function and alignment, research has focused on LLD because it is easily quantifiable and reliable.

LLD and stressors

Researchers suggest that pelvic tilt or torsion, visible from the measured difference in leg length, puts uneven loading / stress on the hips and possibly reduces the contact area of ​​the cartilage within the joint.

The combination of these loads can increase pressure on cartilage and bones in the joint and lead to degenerative hip disease. We see evidence of this in a survey of 100 patients who were diagnosed with hip osteoarthritis. The researchers measured each person’s LLD shortly before hip replacement surgery and found that their hip osteoarthritis was on the side of the longer limb 84% of the time. Other studies have shown very similar findings in knee osteoarthritis.

For chiropractors treating patients with degenerative hip problems, the focus is on restoring normal joint movement of the hips, as well as eliminating or reducing the measured leg length difference. Regardless of the methods or techniques used to achieve this, treating these areas can significantly reduce the need for surgical intervention and have a positive effect on the overall function and pain level of patients.

Arthroscopic hip surgery and variable options

While some patients really need hip arthroscopic surgery or replacement to protect their quality of life, many have other options when it comes to degenerative hip problems.

Appropriate exercise programming, combined with specific chiropractic treatment, can dramatically improve a person’s function and mobility, significantly reduce their pain level, and either delay or avoid the need for surgery.

DANIEL KEADLE, DC, originally from Raleigh, NC, was introduced to chiropractic at a young age and was drawn to the positive changes chiropractic made to his family’s health. He prefers a proactive approach to health, combining a variety of adaptation techniques and hands-on therapies while drawing on his fitness and nutrition background to deliver a holistic health experience. Visit for more information.

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