At Home with Chris Jessen 2018 - 170
irtually all patients that go to
see surgeon Tom Pollard are
amazed that the cause of their
pain is their hip joint. It's a
misconception that hips only cause
problems in older people who need a
hip replacement - and Tom's patients
prove this. Many lead active lives,
whether taking yoga and pilates classes,
whizzing kids around on the school run,
horse-riding, playing sports, or just
going on walks with the family.
In many cases, the problem develops
so that even simple things, like driving,
sitting behind the desk at work, or even
relaxing on the sofa, brings on pain.
'There are lots of possible causes of
hip pain, so it's very important that we
see our patients in a team environment,
with physiotherapists and sports
physicians, for diagnosis and to
formulate a specific treatment plan,'
explains Tom. 'Some patients may just
have soft-tissue problems, which are
best managed by physiotherapy, but
my main role is to identify patients
where there is damage in the hip joint.
'This might be best treated with
keyhole surgery so it's really important
that we explain clearly what the cause
of the symptoms is, what the options
are, and what the rehabilitation of all
treatments would involve, so that a
Opening up about
Busting the myth that hip surgery is just for people of a certain 'vintage'
patient can plan their treatment to fit
in with their busy schedules.'
Help for younger hips
Hip joint pain in young adults has always
been common, but it is only recently
that the mechanisms involved have
been understood, and most importantly,
effective treatment options - with low
risks - been developed. The hip joint
consists of a ball (the femoral head),
sitting inside a socket (the acetabulum).
Shock-absorbing cartilage covers the
surface of the head and lines the inside
of the socket and a different cartilage,
called the labrum, runs around the rim
of the socket (see diagram, right).
Hip pain that persists beyond three
months will frequently be caused by a
problem within the joint, which arises
because of subtle variations in joint
shape (and consequently mechanics),
in combination with activity profile.
This results in the overwhelming of
natural repair mechanisms of the
cartilage and soft-tissue structures
(essentially fatigue failure). The end
result can be severe osteoarthritis,
where the cartilage wears away
completely, and this is usually best
treated with a hip replacement.
In young patients, there is a spectrum
of damage to the cartilage, which results
in pain. Many already have significant
damage to the acetabular labrum and
articular cartilage, which rarely heals and
will usually progress if not treated. It's
now known that 90% of cases of severe
osteoarthritis are in fact caused by the
same abnormal joint mechanics that