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DESCRIPTION:
It is a relatively common occurrence in my Prolotherapy practice to see patients under the age of 50 with premature osteoarthritis. Patients typically complain of significant hip and groin pain, especially with exercise. What regularly brings them into our office is the fact that they cannot play their sport or exercise with any zealousness anymore. Sometimes by the time they come in, they are limping, but typically they look totally normal except when attempting to move their hips. Generally the affected hip has lost 25% or more of its motion compared to the other hip. Sometimes even tying their shoes on the affected side is a problem. What I want to tell these patients is that Prolotherapy is a great treatment for their premature osteoarthritis of the hip and can often get the patient back to playing the sports they love. There are many causes of premature osteoarthritis of the hip. The most common causes that I see in my practice here in Oak Park, IL are listed below.
Common Causes of Osteoarthritis of the Hip
- Coxa Profunda
- Femoroacetabular Impingement
- Perthes Disease
- Slipped Capital Femoral Epiphysis
- Acetabular Dysplasia
- Avascular Necrosis
- Hip Instability From Hip Ligament Injury
- Labral Tear
- Joint Subluxation
As most of us know the hip joint is typically a very deep joint. It is known as a ball and socket joint and generally produces a lot of stability because of the deep hip joint socket. In acetabular dysplasia, generally the hip joint is not so stable because the acetabular component (socket portion) of the hip joint is not so deep. This, along with hip joint subluxation, hip ligament injuries, and hip labral tears, cause the hip joint to be unstable. This instability often leads to development of muscle spasms around the hip, as well as a clicking or popping sound in the hip or groin. Sometimes you can’t hear this sound, but can feel it, or for example, the doctor can feel it during physical examination when palpating the hip during external rotation and extension of the leg. The bottom line is that an unstable joint needs a way to stabilize. Will the body find a way to stabilize it? How does the body do that?
How does the body stabilize an unstable joint? To stabilize an unstable joint the body will first force the muscles around the joint to spasm. This has the temporary effect of causing pain which alerts the patient to get medical treatment for the problem. If the underlying joint instability is not dealt with, then the muscles will fatigue and this causes increased pressure within the joint because of the instability which leads to articular cartilage breakdown and further ligament and labral injury, which just makes the joint instability worse. As the pressures on the hip joint increase, an increased mechanical load or pressure on the joint with normal activities is seen with increasing joint instability, with eventual changes within the joint such as articular cartilage breakdown and bony overgrowths called bone spurs, which are another common occurrence with osteoarthritis or degenerative arthritis. These changes will subsequently decrease hip range of motion. Eventually the pain and hip range of motion will both deteriorate to the point where the patient cannot perform activities they love, such as running, playing tennis, basketball, or taking long walks. They will seek out medical care.
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