Treatment of Premature Osteoarthritis of the Hip:

The traditional medical approach to premature osteoarthritis: The typical approaches by traditional doctors for the various causes of premature osteoarthritis of the hip are nonsteroidal anti-inflammatory medications (NSAIDs) or cortisone shots. Sometimes physical therapy may be tried, often with limited success. Since NSAIDs or cortisone shots do nothing to reverse the actual cause of the premature osteoarthritis, they have no long term benefits and could even cause the osteoarthritis to worsen. A much better approach is a monitored exercise program with Hackett-Hemwall Prolotherapy. 

How Prolotherapy at Caring Medical helps premature osteoarthritis:

Dextrose Prolotherapy: As you know a degenerated structure needs regeneration. Prolotherapy is also known as regenerative injection therapy. Prolotherapy doctors use a variety of substances to stimulate regeneration. The most common and most studied proliferant substance (and the one which has shown the best success in studies) is simple dextrose. This is also known as Hackett-Hemwall dextrose Prolotherapy. Some studies just call this “proliferative injections of hyperosmolar dextrose.” The point we want to make here is that this solution is very effective, yet very safe. I have published numerous articles on using dextrose and have studied hundreds upon thousands of patients using dextrose Prolotherapy. You can read our studies at www.prolotherapy.org and read about Caring Medical’s research here.

Other Prolotherapy solutions: At Caring Medical, we may also include human growth hormone and platelet rich plasma (also known as PRP Prolotherapy or PRPP) in our treatment regimes. The bottom line is that various proliferative solutions need to be injected into the joint itself, but also into the surrounding soft tissue structures such as ligaments and tendons that stabilize the hip and are responsible for a lot of the patients’ pain. This is why this type of Prolotherapy is called Hackett-Hemwall Prolotherapy and is why just one shot of PRP does not work for joint instability. PRP alone only into the joint does not treat the ligaments and give the patient a full treatment for their joint instability. 

What to do if you are diagnosed with premature osteoarthritis? We recommend that you come to see us here at Caring Medical where an experienced Hackett-Hemwall dextrose Prolotherapy doctor such as myself (Dr. Hauser treats the patients). I typically inject Prolotherapy solution directly into the actual hip joint, as well as the ligamentous support in the front, side, and back of the hip(s). The other structures around the hip joint such as the gluteus medius bony attachments are often injected as well. The patient under our care is often seen monthly and for approximately 3-9 visits, depending on stage of the arthritis. Of course there are times where surgical correction is needed, but typically patients just need Prolotherapy.

How does Prolotherapy help cases of coxa profunda (deep acetabulum) or femoroacetabular  impingement (FAI).  Sometimes the hip has an acebular deformity that can get complicated. In other words the femoral head may have an odd shape. For example, it may have a non-spherical head or the orientation of the acetabulum may be off;  ie retroverted or have some other “weird angle” compared to the femur bone.

What do you mean?  Take myself as an example. If you examined me, you would note that I only have about 50% of normal motion in my right hip with regard to external rotation compared to my left hip. I have always had this phenomenon and currently have no pain in my right hip. With my “premature osteoarthritis” I have completed 5 ironman triathlons and numerous marathons and ultramarathons and long distance cycling events. In other words, my deficiencies in motion do not limit me. I was born that way. But if my right hip starts to hurt, I address the situation. Of course, I do not take NSAIDs or get cortisone shots, I get regenerative treatments.  If you saw me in a yoga class you might make fun of me because of my limitations in right hip motion, but that is your problem, not mine. I am just there to work on my fitness, not look like a yoga guru!

Do congenital hip abnormalities require surgery? Many patients ask me if a congenital (genetic) problem with their hips require surgical correction. The answer is - sometimes.  Sometimes pelvic osteotomy, femoral osteotomy, or joint replacement surgeries are needed.  If someone has avascular necrosis of the hip, sometimes surgery is needed.  If the patient has some reasonable range of motion remaining, ie 50% or greater normal range of motion, then Prolotherapy works great at helping with the pain and exercises like cycling and swimming will  slowly allow the patient to regain some of the lost range of motion.

Sometimes the patient will only achieve pain relief, which, of course, the patient is excited about. However, some sports like martial arts require not only improved pain levels, but also improved range of motion. So sometimes, even though the patient is a good Prolotherapy candidate for decreasing pain levels, the patient may still need arthroscopy or some other surgical procedure to help with range of motion. It is surprising to me, however, the number of patients I have seen over the years who do not really get much improved range of motion with surgical procedures! I would encourage those of you who are inquiring about a surgical procedure for premature osteoarthritis of the hip to have a frank discussion not just with your Prolotherapy doctor, but also with your orthopedic surgeon. If you end up choosing surgery, you can always get Prolotherapy after the surgical procedure. Better yet, if Prolotherapy does not fully meet your expectations, you can always then choose surgery. Our philosophy is always to go the least invasive, most potentially successful route first.   

Treatment of femoroacetabular impingement syndrome (FAI):  Many patients ask if a structure is impringed, doesn’t someone have to un-impinge it?  Again, the answer is sometimes. Let’s say, for instance, a patient has FAI and his main symptom is groin pain. The patient is a cyclist and is experiencing pain with cycling. In seeing this particular patient, I would try and determine if he truly has FAI on physical examination. I look for whether he has a positive impingement sign on physical examination and then determine the cause of it. If the cause is some tremendous structural problem with the hip like a dysmorphic problem or orientation problem of the femur, then surgical correction may be needed.  However, remember, the most common cause of FAI and other premature osteoarthritic conditions is simply some type of soft tissue injury such as a ligament injury, so thus Prolotherapy is the best treatment!  What ligament?  Well it could be the iliofemoral or ischiofemoral ligament. These two ligament injuries as well as a hip labral tear cause hip joint instability. Given enough time this will and can cause premature osteoarthritis and eventually FAI.

Two different types of FAI:  Potential patients will email at drhauser@caringmedical.com and frequently discuss two different types of FAI. The “cam-type” FAI is where the femoral head-neck junction is abnormal and the “pincher-type” FAI is where the acetabulum shape or its configuration within the pelvis is abnormal. Some people have both types of FAI.  Both types of femoroacetabular impingement cause injuries to the labral area because of repetitive impingement stress. They either cause labrum degeneration or labrum tears. How do I tell the difference and does it make a difference?  In pincher femoroacetabular impingement when the hip is in full flexion, the femoral head-neck junction hits or abuts the anterosuperior aspect of the acetabulum. It is commonly caused by two deep of an acebular socket as in coxa profunda or protrusion acetabuli. One can easily imagine that if the socket portion of the hip is too deep that when the patient flexes the femur bone (thigh), it will pinch structures like the labrum between the acetabulum and the femur neck, so it pinches the labrum. In cam femoroacetabular impingement, there is abnormal contact between the head and socket of the hip because of a loss of roundness of the femoral head.  Cam comes from the Dutch word meaning “cog” because the femoral head is not round. This loss of roundness causes an abnormal contact between the head and the socket of the hip.  In cam FAI, the impingement typically occurs when the hip is flexed, but also internally rotated.  As already mentioned, patients often have “mixed” FAI, meaning they have a combination of both. 

Both types of FAI can cause premature osteoarthritis of the hip because both types progress to hip labral and cartilage damage. For the person who desires a more conservative approach, Prolotherapy is recommended. Prolotherapy inside the joint, as well as around the structures of the joint causing some or all of the pain is what I typically do. What most patients may not realize is the cartilage has no nerve endings, so pain in a joint originates from some other structure(s) than cartilage. This is another reason that just getting injections inside the joint does not make much sense. Hackett-Hemwall dextrose Prolotherapy, along with other proliferants, addresses all the pain-producing structures. It typically works well with FAI, along with the other conditions causing premature hip osteoarthritis. Again I use this along with an exercise program that I individually prescribe geared at stimulating joint health. Like other causes of premature hip osteoarthritis, sometimes surgical procedures are needed. The operative procedures are designed to address the adverse mechanical effects of impingement and hopefully address the reasons for it. Sometimes a combination of Prolotherapy and surgery is required. 

Pros and Cons of Prolotherapy vs Surgery for premature osteoarthritis of the hip:

Pros:

• Almost no down time. Small business owners such as carpenters, handyman, professional service people, and other business owners cannot afford the down time or expense of surgical procedures. After Prolotherapy of the hip, patients can return the same day to work!  No lost time or vacation from work is required!
• Cost!  Who is not concerned with cost? Prolotherapy does not require general anesthesia, post operative rehabilitation (with Prolotherapy the exercises you can do at home), so the cost is typically 1/10th to 1/30th of surgery. 
• Risk.  Most patients at Caring Medical do extremely well with Prolotherapy, but Prolotherapy, like surgery, has some risks. Because Prolotherapy is an outpatient procedure and requires no general anesthesia, it is a much safer procedure than surgery.
• Not as radical!  You might find this odd, but Prolotherapy gradually helps the body get stronger. In other words, the results are gradual and the person works alongside his/her body to get the hip in the best possible shape. Surgery is radical and you know there is no turning back after surgery. Once bone is removed, it is removed!  Once the joint is replaced, it is replaced!  Sometimes you need radical, but I think radical should be used as a last resort!
• Time. In our office, Prolotherapy only takes a few minutes to perform, whereas surgery might take hours. I would rather have a doctor working on me for a few minutes rather than a few hours!

Cons:

• Waste of time and money. Sometimes patients receive Prolotherapy by inexperienced Prolotherapy doctors and end up wasting time and money. The bottom line to prevent this is to go to a place where the doctor has seen the condition before and has had success treating it such as Caring Medical.
• Pain of the injections. As you know, surgery causes more pain than injections, so this may not be a down side, because surgery is much more painful than Prolotherapy. Prolotherapy is also painful – it involves giving injections! In our office, we apply an anesthetic cream to the skin to decrease the pain and, of course, we can give some pain medications as needed to get through the treatment. We also offer conscious sedation if a person has a huge fear of needles/injections. But realize 90% of patients in our office receive the Prolotherapy treatments with no pain meds or conscious sedation.
• Multiple treatments required.  With surgery comes extensive rehabilitation and physiotherapy after surgery. Generally the number of Prolotherapy visits is a lot less than the number of doctor and physical therapy visits required with surgery. This might not be a down side compared to surgery, but just realize Prolotherapy involves a series of treatment sessions typically performed at one-month intervals.  In our experience, generally after a patient completes a series of Prolotherapy treatments, no follow-up Prolotherapy treatments are needed unless the patient reinjures himself. We see patients with very physical jobs or who participate in physical sports that may require “touch up” treatments on occasion.

Think Prolotherapy may be for you? Call us!

To experience the Caring Medical difference for yourself, schedule a consultation via email or call us at 708-848-7789.

Caring Medical is a full time Prolotherapy doctor’s office. We have successfully treated all of the conditions we write about. This is why patients travel from across the country and internationally to be treated by our Prolotherapy physician Dr. Ross Hauser. The difference is in the care, technique, and experience you get with Dr. Hauser and team at Caring Medical.