Hip pain from hip injuries is difficult to deal with and traditionally requires long-term pain management.
Patients are often told that surgery is the only medical option. Sometimes patients are told they need a hip replacement or hip resurfacing to deal with the pain. Though surgery is the best option in some cases, often times minimally invasive regenerative therapy is all that is needed.
Doctors use non-surgical regenerative therapies like stem cell and platelet-rich plasma (PRP) treatments for hip injury patients. Regenerative therapy is different from other non-surgical treatments that only focus on relieving pain and do not repair the hip injury. Stem cell and PRP treatments help the body heal itself naturally.
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), osteoarthritis is a primary cause of hip joint damage requiring hip replacement surgery. Both stem cell and PRP therapies help alleviate hip problems like arthritis and similar degenerative hip joint problems.
Traditional hip surgeries are traumatic, often requiring follow-up physical therapy to redevelop strength and mobility. Surgery also requires the patient to endure months of pain and discomfort while recovering. In contrast, patients undergoing regenerative therapies usually walk the same day and have a shorter recovery period than surgery patients.
In This Article:
- Surgical Methods of Treating Hip Injuries
- Regenerative Therapy for Hip Injuries
- The Option to Choose an Alternative
- The Journey to Hip Surgery
- The Journey to Regenerative Therapy
- Novus Spine & Pain Center
- Regenerative Therapies for Hip Injuries Resources
Surgical Methods of Treating Hip Injuries
When the protective cartilage on the “ball” of the hip joint (the femoral head) wears away, there can be direct contact with the pelvic acetabulum (the hip socket). The patient may experience a “crunching” or “grinding” of bone on bone from advanced osteoarthritis or avascular necrosis (bone death). Traditional methods of treating hip injuries are invasive surgical procedures. Not all patients are good candidates for the surgery; however, patients who undergo surgery face an extended recovery time as well as physical therapy.
Hip replacement surgery replaces the femoral head with a prosthesis by removing the top portion of the femur bone (total hip arthroplasty). Doctors generally do not perform hip replacement surgery on patients under the age of 50. Hip prosthetics usually last less than 20 years, which means younger patients will likely require a second hip replacement. Surgery to replace a worn prosthetic hip joint is complex, and there is a higher risk of infection. A second surgery is also likely to cause more damage to surrounding bone and tissue.
Another traditional surgical method is to “patch” hip defects and injuries by bone grafting. A procedure that cuts some of the patient’s bone to create a “patch.” The hope is the patch will take root and grow. However, the amount of available bone for grafting is limited, and the procedure is not appropriate for all patients.
Because of the pain and recovery time, not all patients want to undergo hip replacement surgery. Other patients are ineligible for hip replacement surgery for a variety of reasons, and some have a greater than average risk of post-surgical complications. Some of the reasons for surgical complications include:
- Infection. Patients who are prone to infection or have an existing infection may not be eligible for hip replacement surgery. A post-surgical infection can require the patient to return to the hospital for treatment that may include an extended course of intravenous antibiotics. In cases of a serious infection, the doctor might need to remove the artificial hip.
- Nicotine. Smokers and other tobacco users face a higher rate of medical complications. There is a higher risk of follow-up surgery or revision hip replacement surgery for nicotine users. To lower post-surgical risks, total hip replacement candidates are encouraged to stop, or at least cut back on, tobacco use.
- Osteoporosis. Severe osteoporosis can cause bones to be too brittle to support and adhere to the new joint prostheses properly. Mild to moderate osteoporosis may affect how a surgeon plans to do the surgery. It may be necessary to improve bone density before performing surgery, and continue building up bone density after surgery to improve the outcome.
- Weight. Obese patients are more prone to medical complications, post-surgical infections, and wound healing complications. Being overweight can also decrease the lifespan of a joint implant.
- Other factors. Patients who have type 2 diabetes or heart disease have an increased risk of post-operative medical complications.
Regenerative Therapy for Hip Injuries
Regenerating bone and cartilage is an alternative to surgery for hip injury patients. The treatment does not require the long recovery time of invasive surgery. Most patients resume normal activities the same day of the procedure.
Regenerative therapy uses the patient’s own stem cells and PRP to heal bone and cartilage defects. Injecting stem cells into the affected hip joint is all it takes to initiate a healing environment. The treatment can even help spur the regrowth of bone in cases of osteonecrosis (bone death), which is often the result of chemotherapy treatments.
Stem Cell Therapy
Stem cell studies uniformly show improvements in osteogenesis (bone growth) and angiogenesis (blood vessel formation). In clinical studies, groups treated with stem cells show significant improvements in patient-reported outcomes.
Researchers at the University of Paris East Department of Orthopaedic Surgery made an exciting discovery. Despite advanced hip disease, they found stem cell therapy can repair bone damage in hip osteonecrosis over the long-term. The study followed 116 patients for 5-10 years after receiving stem cell therapy. A majority of the study participants had improved pain scores and were able to avoid hip replacement surgery.
Research at Washington University School of Medicine in St. Louis, MO found it is possible for the newly grown cartilage to release anti-inflammatory molecules. These molecules can help prevent the return of arthritis, the most common cause of hip pain.
Platelet-Rich Plasma (PRP) Treatment
Like stem cells, PRP offers patients a long-lasting, permanent solution that does not wear off over time as do traditional pain injections. Injecting a patient’s own PRP helps stimulate the healing of cartilage and reduce the pain and disability. Overall, PRP is a safe treatment. There is no risk of allergic reactions because the PRP is the patient’s own blood.
The entire process takes about an hour. The platelet-rich plasma is collected from the patient’s blood and processed. The doctor then injects the PRP into the injured joint using image guidance to assure precise placement. The number of injections varies depending on the patient, but typically range from two to six over time.
Patients typically report a significant reduction in pain and/or increased function after the first or second injection. The timeframe for experiencing results depends on the extent of the hip injury; however, on average, patients experience results in four to six weeks. The benefit of PRP therapy is that it has a sustained outcome and is categorized as a permanent fix.
The Option to Choose an Alternative
Many patients who had hip replacement surgery say they continue to have hip pain. Some report feeling pressured into having surgery. Others say they were told alternative treatments would not work, or surgery was the only option. Many surgery patients say they did not know there were other options.
Research bears out that patients with hip osteoarthritis are too often told only about hip replacement surgery as a treatment. Most simply do not know about nonsurgical therapies available to them. A combined research team from the Universities of Montreal, Ottawa, Toronto, and Chicago found when given the information, patients opt to have fewer hip replacement surgeries.
The Journey to Hip Surgery
Patients with hip osteoarthritis need information both at the time of diagnosis and further throughout the disease development and care continuum. There are six typical phases a patient experiences on the journey to deciding on hip surgery.
- Phase 1 – Hip pain begins with a diagnosis of hip osteoarthritis. The patient has pain and goes to the doctor.
- Phase 2 – Hip pain symptoms increasingly interfere with physical activity. A patient expresses concern about becoming hooked on painkillers.
- Phase 3 – Symptoms significantly decreases the quality of life. The patient may ask, “I can´t stand the pain. Is it time for surgery?”
- Phase 4 – Orthopedic evaluation and surgical decision-making. The patient may be given one of three responses to needing surgery.
- Phase 4a – Timing of surgery. The patient may be told the joint is worn out, but “not enough to require surgery.” The patient is told to wait until “it gets bad enough.”
- Phase 4b – Waiting for surgery. The patient prepares for surgery by doing strengthening exercises over a 3-to-4-month period before surgery.
- Phase 4c – Denial of surgery. A patient may not medically fit for surgery, or the patient prefers a non-surgical option.
- Phase 5 – The pre-operative period. The patient prepares for the surgery, recovery, and physical therapy.
- Phase 6 – The recovery period. The patient undergoes a period of physical therapy before returning to normal activities.
The Journey to Regenerative Therapy
Patients with hip osteoarthritis looking for alternatives to surgery have fewer steps to recovery
- Phase 1 – Hip pain begins with a diagnosis of hip osteoarthritis. The patient has pain and goes to the doctor.
- Phase 2 – Hip pain symptoms increase and interfere with physical activity. The doctor and patient discuss treatment options.
- Phase 3 – Orthopedic evaluation and decision-making. The doctor and patient discuss options from surgery to regenerative therapy.
- Phase 4 – Decision to undergo regenerative therapy. The patient schedules the procedure.
- Phase 4a – The procedure. The patient goes to the doctor’s office for treatment.
- Phase 4b – The follow-up. Additional treatment appointments may be scheduled depending on the extent of the osteoarthritis.
- Phase 5 – Recovery period. The patient begins noticing a reduction in pain while continuing normal activities.
- Phase 6 – Discharge and follow-up. After a couple of months, the patient schedules a yearly follow-up exam while enjoying reduced pain and increased function.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in regenerative therapies like stem cell and PRP for hip injuries. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.
Regenerative Therapies for Hip Injuries Resources
Mesenchymal stem cell therapy in the treatment of hip osteoarthritis (PubMed)
Is Stem Cell Therapy for Arthritis Safe and Effective? (Arthritis Health)
Stem Cells Get Hip (Mayo Clinic)
‘Living’ cartilage grown using stem cells could prevent hip replacement surgery (Medical News Today)
Hip Injuries And Pain (MedRebels)
Helping Patients Across The US (SpineMD)
Is Stem Cell Therapy A Realistic Option For Hip Replacement? (Stem Cell Institute Los Angeles)
Hip Replacement vs. Stem Cell Therapy (Regenexx)
Hip Replacement Surgery (National Institute of Arthritis and Musculoskeletal and Skin Diseases)
Indications and Eligibility for Total Hip Replacement Surgery (Arthritis Health)
Stem cell treatment for avascular necrosis of the femoral head: current perspectives (PubMed)
Treatment of osteonecrosis with autologous bone marrow grafting (PubMed)
Update on Biomaterials (PubMed)