Hip Replacement Surgery Alternatives
Ross Hauser, MD
A 2006 article in Pain Physician Journal featured a case study of successful cartilage regeneration using a bone marrow therapy1. This case involved a 64-year-old man with a 20-year history of hip pain. He was a candidate for hip replacement as his MRI showed severe degeneration, decreased joint space, bone spurs and cysts
The researchers in this study were aware of the use of bone marrow and stem cells in animals but were curious about its success on human cartilage. This man underwent a stem call transfer in an effort to regenerate cartilage in his hip. Bone marrow was extracted from this patient, processed and injected into the affected hip. After the first bone marrow treatment the patient reported some improvements in his hip although the MRI showed no change. One month later a second treatment was done and resulted in increased joint space and increased range of motion. The patient reported that he was able to stand for longer periods of time, enjoyed travel and recreation and was able to walk further and sit with less pain. The researchers concluded that this man did in fact have cartilage regeneration and that bone marrow therapies hold great promise for joint degeneration.
Stem Cell Therapy for Chronic Hip Pain
We are discovering study after study that proves the benefit of bone marrow in treating chronic pain. In our experience, we have seen excellent results using bone marrow as a proliferant for Prolotherapy. Stem cell injection therapy is just one treatment option that we offer sports injuries, chronic pain and arthritis of the hip. You can also contact us for questions on your specific case.
Recent research including that appearing in the British Medical Journal, found that 7 to 23% of patients who had hip replacement continued to have long term unresolved pain.
In studying both hip and knee replacements, they concluded: “The proportion of people with an unfavorable long-term pain outcome in studies ranged from about 7% to 23% after hip and 10% to 34% after knee replacement. . . After hip and knee replacement, a significant proportion of people have painful joints. There is an urgent need to improve general awareness of this possibility and to address determinants of good and bad outcomes.” 2
Doctors warn each other that they must make the patients aware of hip replacement complications
In another study, doctors warned each other that they must make the patients aware of complications that could include “fracture, neurovascular damage, leg length discrepancy, (surgery) failure, premature loosening, death, medical complications, ongoing pain, stiffness, wound healing problems.”3
Prolotherapy or Hip Replacement?
What makes a very good, good, and poor candidate for Prolotherapy to the hip?
Often patients seek a Prolotherapist’s opinion after having had a hip arthroscopy. While some have experienced temporary relief of pain and symptoms, others continue to experience the same problems following surgery. It is unfortunate that these individuals were not offered Prolotherapy first, instead of surgery. The unfavorable long-term results of joint arthroscopy should not be surprising. Removing tissue from joints may provide a temporary pain-relieving benefit, but long-term, the patient is left with a weaker joint, more susceptible to degeneration.
In our research published in the Journal of Prolotherapy we sought to show how Prolotherapy could provide high levels of patient satisfaction while avoiding hip surgery. Here is what was reported:
We examined sixty-one patients, representing 94 hips, who had been in pain an average of 63 months. We treated these patients quarterly with Prolotherapy. Includied in this patient group was twenty patients who were told by their doctors that there were no other treatment options for their pain and eight patients who were told by their doctor that surgery was their only option.
Patients were contacted an average of 19 months following their last Prolotherapy session and asked questions regarding their levels of pain, physical and psychological symptoms and activities of daily living, before and after their last Prolotherapy treatment.
Results: In these 94 hips, pain levels decreased from 7.0 to 2.4 after Prolotherapy; 89% experienced more than 50% of pain relief with Prolotherapy; more than 84% showed improvements in walking and exercise ability, anxiety, depression and overall disability; 54% were able to completely stop taking pain medications.
We concluded: “The Hackett-Hemwall technique of dextrose Prolotherapy used on patients who presented with over five years of unresolved hip pain were shown in this retrospective pilot study to improve their quality of life even 19 months subsequent from their last Prolotherapy session. The 61 patients with 94 hips treated reported significantly less pain, stiffness, crunching sensation, disability, depressed and anxious thoughts, medication and other pain therapy usage, as well as improved walking ability, range of motion, sleep, exercise ability, and activities of daily living. This included patients who were told there were no other treatment options for their pain or that surgery was their only option. The results confirm that Prolotherapy is a treatment that should be highly considered for people suffering with chronic hip pain.”4
Bilateral hip pain treatment
Our patient came into the clinic with a two year history of bilateral hip pain, right hip worse than the left. The pain started two years prior during a run. The patient typically ran 28-30 miles per week, but had not run for about two years, since the hip pain started.
At 51-years-old, he was getting discouraged because he had tried physiotherapy, chiropractic care, electrical stimulation, laser treatments, and all the recommendations given to him pointed him toward bilateral hip replacement. The last treatment he tried was a fluoroscopically guided steroid injection into his severely degenerated hip. The net result was almost no pain relief and an expense of $2,700.
In my opinion, this steroid injection was absolutely not indicated and should not have been performed. Another interesting part of his medical chart was the Pain Diary that he completed post-steroid injection. He reported a 7/10 pain level prior to the injection.
Prolotherapy and Hip Pain
In the hours post-procedure, this is what happened:
1 hour = 0/10;
2 hours= 2/10;
You can interpret that for yourself!
Please see his X-ray report below:
Examination: Xray Hip (RIGHT)
Perf: 3/19/2009 10:35:00 AM
Indication: Right hip pain
Impression: Moderate changes of osteoarthritis, with joint space narrowing, subchondral sclerosis, subchondral cysts and marginal osteophytes are noted in the right and left hip, right greater than left. Otherwise, no abnormalities are identified. There is evidence of fracture dislocation.
From the above report, the patient basically has extensive osteoarthritis, with the right hip worse than the left hip. On my physical examination with his hip flexed 90 degrees, he only had 17 degrees of external rotation on his left hip and even less on his right (less than 10 degrees). In other words, this is extremely bad osteoarthritis. The only treatment that can keep someone from a hip replacement is Prolotherapy. But I first want you to hear some more about the treatment that the patient had received prior to coming in to see me.
The patient brought some of his medical records with accompanying billing for me to review at his initial consultation. You can clearly see the following charges: initial consultation and the initial steroid shot: $2689.00 of which he had to pay $2019.60 out of pocket.
In my opinion, this was a total waste of money, not to mention a treatment that would worsen his condition. I believe that the science of steroids on cartilage is that steroids degenerate it, while Prolotherapy regenerates it.
At Caring Medical, the patient received a considerably less expensive Prolotherapy treatment to his right hip and the procedure went well. We received this email from him in response to our post-Prolotherapy follow-up call:
Hello Dr. Hauser,
Just a few lines regarding the 1st treatment. You and your staff are a pleasure to interact with. The injections were not without pain, however, after a few hours the injection pains subsided and to my pleasant surprise, my hip pain also was reduced. The mobility of the hip was noticeably improved and I am looking forward to my next treatment. Thank you. M.K.
You might be thinking, “How could the mobility in his hip be better one day after Prolotherapy?” The answer: it provided pain relief! With less pain, you obviously are able to more freely move your joints! What will be the patient’s ultimate outcome? While I cannot predict the future, there is a good chance he will get out of pain. Whether he will run again is yet to be determined, but I am sure he will be an avid cyclist!
The bottom line here is that Prolotherapy has a chance to get him better – I would give it a 90% chance. Steroids have a 0% chance to get him better.
x-ray hip guided injections
Here are a few of my objections to performing injections under X-ray:
- No study anywhere in the world that I know of reports that injections under X-ray actually give better results compared to injections given without X-ray guidance.
- Insurance companies pay billions of dollars for these injections under X-ray, yet no documentation exists showing improvement in patient care.
- Steroids are the typical solutions physicians use for these injections under X-ray (called fluoroscopic guidance)yet steroids have been shown to cause cartilage deterioration.
- Injections under X-ray guidance cost 10 times the amount as normal Prolotherapy injections.
- Only one injection is typically given when performed under fluoroscopic guidance, so what is the likelihood that the injection is going to give long-term pain relief? I would say the answer to that is “very low.”
Prolotherapy after Hip Replacement
Question: I have several friends who have had a hip replacement (THR) or a hip resurfacing. That has helped with the walking and getting around, but my friends still complain about groin pain. Is it possible to have Prolotherapy following hip surgery?
Answer: Many people who have continued pain after a surgery benefit from Prolotherapy. The reasoning is simple, the surgery did not address whatever pain remains. In other words, something besides the hip is causing the continued groin pain. This could be a referral pain pattern from the pubis, lower back or tendon/ligaments that go to the greater trochanter (side of the hip). My advice, tell her orthopedic of course and get an opinion from a Prolotherapy doctor.
1. Centeno CJ, Kisiday J, Freeman M, Schultz JR. Partial Regeneration of the Human Hip Via Autologous Bone Marrow Nucleated Cell Transfer: A Case Study. Pain Physician. 2006;9:253-256
2. Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. 2012 Feb 22;2(1):e000435.Print 2012.
3. Isherwood J, Dean B, Pandit H. Documenting informed consent in elective hip replacement surgery: a simple change in practice. Br J Hosp Med (Lond). 2013 Apr;74(4):224-7.
4. Hauser R, Hauser M. A retrospective study on Hackett-Hemwall dextrose Prolotherapy for chronic hip pain at an outpatient charity clinic in rural Illinois. Journal of Prolotherapy. 2009;2:76-88.