Non-Operative and Alternative Treatments

Delaying or Preventing Hip Pain

Sometimes pain can be tolerated, but pain is usually a signal that something needs to be corrected rather than endured. When pain from hip dysplasia is severe, you should consult your doctor about definitive treatment by PAO surgery or a total hip replacement (THR). Ignoring pain too long as a young adult can cause more damage to your hip and eliminate the possibility of corrective surgery to restore your hip function.

The type of arthritis caused by hip dysplasia is called osteoarthritis. This means the smooth joint surface is wearing out like the tread of a tire wears out on a car. If the tire is out of balance, then the wear is faster than a well-balanced tire. Once the tread is gone, then it’s time to replace the tire. Tire treads often wear out with an uneven pattern and rotating the tires helps move the good tread into a better position so the tires last longer. For dysplastic hips it’s often possible to correct the imbalance with surgery and move the good cartilage into a better position to prolong the life of the hip surface and delay the onset of osteoarthritis.

When hip preservations surgery is not an option, there are a few steps you can take to help delay total hip replacement or to relieve pain until surgery is performed. Unfortunately, there aren’t any long-term cures for hip dysplasia other than surgical management.

Medications

Medications and cortisone injections can decrease the inflammatory component of your hip pain. Hip dysplasia causes swelling and irritation of the joint lining in addition to the pain from the thin joint surface or torn labrum. Medications may decrease the inflammation and help relieve pain, especially the nighttime pain that occurs when the hip is at rest. Some herbal remedies also act like medicines and these will be presented as Alternative Treatments.

If you have hip pain but do not currently need surgery, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) include over-the-counter medicines like ibuprofen (Advil) and naproxyn (Aleve) can relieve inflammation and provide pain relief. While these medicines can provide short term relief, the anti-inflammatory effect may need three or four days of steady medication to have full effect. The instructions on the Aleve website say that you can take one or two tablets every 12 hours for a maximum of 10 days, but you should see a doctor if you plan to continue longer than that. There are also prescription anti-inflammatory medicines that your doctor can prescribe if you need more time or if you have side effects from over-the-counter medications.  Your doctor can explain these medications to you and discuss recommended dosages.

Narcotic medications are not recommended for chronic hip pain because of the risk of dependency or addiction. This is especially true for hip dysplasia because current surgical techniques can produce long-term relief and return to activities.

Injections

Injections into the hip joint are often used to relieve pain and delay surgery. Recent developments include injections that may preserve or restore the hip cartilage. At this time, none of these techniques has been shown to provide long-term relief. While these advances may be useful for other causes of arthritis, there is little likelihood that people with hip dysplasia will benefit because the socket and ball will still be inadequate to support hip forces during walking.

Injections into the hip joint may be done by experienced physicians who are familiar with anatomical landmarks, but some physicians prefer to use ultrasound or fluoroscopy to guide the needle into the hip joint.

Cortisone Injections: These are the most commonly recommended injections to provide temporary relief that lasts from three to six months in most cases. Cortisone is a type of steroid that has strong anti-inflammatory effects. One problem is that multiple cortisone injections may soften the cartilage and increase the rate of deterioration. For that reason, most doctors try to avoid more than three hip injections of cortisone a year. There is a slight risk of infection with any injection but cortisone shots do not increase the risk of infection when a total hip replacement is eventually performed. However, it’s generally recommended to avoid cortisone shots in the months prior to total hip replacement surgery.

Hyaluronic Acid Injections: Hyaluronic Acid (HA) is a joint lubricant that’s found in normal joint fluid. Some benefits from HA injections have been reported for other joints, but hip joint studies have compared HA injections to cortisone injections. In almost all these studies, the cortisone injections gave better relief that lasted longer than HA injections.

Prolotherapy: Prolotherapy consists of injection of highly concentrated dextrose sugar water into a joint, tendon, or ligament to stimulate the healing process or to decrease pain. Platelet rich plasma or stem cells are occasionally added but generally, the sugar water alone is used. Prolotherapy causes inflammation that “jump starts” the healing process. This is thought to stimulate growth factors that are necessary for healing of ligaments, tendons and cartilage. Some success has been noted for tendon and ligament damage, and some studies of osteoarthritis have shown improvement in symptoms. No studies for labral tears have been published. Like other injections, prolotherapy does nothing to correct the underlying cause of joint deterioration from inadequate bone support of hip dysplasia.

Platelet Rich Plasma Injections: Platelet Rich Plasma (PRP) is a concentration of growth factors from a person’s whole blood. A sample of blood is taken and put into a centrifuge to isolate these growth factors and then the blood is returned to the patient while the PRP is injected into a site that needs additional stimulation. There is no evidence that this helps osteoarthritis caused by hip dysplasia. In one study PRP was used for patients undergoing arthroscopic labral repair but the authors found no benefit from this additional stimulation.

Stem Cell Injections: Bone Marrow Mesenchymal Stem Cells (BM-MSCs) are a person’s own bone marrow cells that can become into almost any type of cell including cartilage. These are concentrated from bone marrow and injected into the arthritic joint. Often three injections are performed one week apart. This is a generally safe procedure, but it is still experimental because results are questionable. There may be some benefit for joints with small segments of cartilage damage, but BM-MSC will not restore the bone alignment that causes arthritis from hip dysplasia.  

Lifestyle Modifications

Lifestyle modifications can help delay surgery or recover from surgery. These include weight management, moderate exercise, adequate sleep, avoidance of harmful substances, stress management, proper nutrition, and heat therapy. Many books have been written about this subject, but here are some that may be specific to those with hip dysplasia.

Body weight management: Losing a few pounds is the most beneficial lifestyle modification you can make. Even five pounds can damage to the hip joint and make a big difference in comfort. The reason is that muscle leverage on the hip increases the force pressing the ball into the socket. One pound of body weight magnifies the joint pressure by three to five pounds. So, losing five pounds can decrease the painful forces by an equivalent of 15 to 25 pounds.

Another way to think about it is that body weight acts like a nutcracker and increases the pressure on your him a lot more than you think because the hip joint is not directly under the center of your body. The hip muscles work hard to keep your pelvis level when walking. When your hip is in pain, the pelvis may dip so the pressure on the hip joint decreases.

Sports activities and exercise: Running, stair climbing, and impact sports are not recommended for people with hip dysplasia. Print

Moderate exercise and strengthening is preferred to maintain muscle balance long as there isn’t too much load put on the hip joint. Swimming is an excellent activity that maintains cardiovascular fitness and upper body strength in addition to low impact hip exercise.  Other activities like rowing, cycling, or tennis may be possible in moderation, but these can be difficult for arthritic hips because of stiffness and stress across the hip joints. Sports like golf and bowling are unlikely to damage the hip but there may be pain in certain positions.

Movements of the hip and gentle stretching exercises are recommended because motion may help lubricate and nourish the joint surfaces. Tai Chi is excellent for flexibility and balance. Walking with a cane in the hand opposite the sore hip can also provide some physical activity in later stages of painful hip dysplasia.

Depending on the level of dysplasia, you may benefit from one or two visits with a local Physical Therapist to teach you the correct way to exercise without causing damage to your hip.

Adequate sleep: This may be difficult if you’re having pain at night. Acetaminophen (Tylenol) is least likely to interfere with normal sleep patterns compared to NSAIDs such as aspirin, ibuprofen (Advil) or naproxen (Aleve). Regular bed time with adequate time for sleep is important for repair processes and for stress relief. More time in bed may be needed along with an occasional daytime nap to make up for lost sleep due to pain.

Exposure to daytime light during the day and avoiding blue light prior to bedtime have been shown to help people fall asleep and have better sleep patterns. You can read about this in the Harvard Health Letter. Computer screens, TV screens and hand-held digital devices emit blue light that can be decreased by adjusting some of these devices. Blue-blocking glasses, screen filters, and special light bulbs can also decrease blue-light exposure to help restore natural sleep patterns.

Avoidance of harmful substances. This applies most often to cessation of cigarette smoking. Any tobacco products or nicotine in any form, causes serious health consequences to your entire body including joints, ligaments, bones and muscles. Cigarette smokers have more complications after surgery than non-smokers. Cessation of smoking prior to surgery helps avoid complications, but the minimum time required isn’t known. At least two months seems to be the minimum in some studies, but longer is better, including no smoking after surgery too.

Alcohol in excess is also harmful to joints and interferes with successful surgery. Three or more servings of alcohol per day increases the risk of infections, bleeding and heart problems after surgery.

Stress management and proper nutrition are healthy practices regardless of hip dysplasia. Mindfulness training and medication techniques can help decrease stress and help muscle relaxation.

There is growing interest in the role of Vitamin D supplementation and anti-inflammatory diets in the management of joint pain. However, the benefits for osteoarthritis caused by hip dysplasia is uncertain compared to inflammatory joint problems such as Rheumatoid Arthritis. The Arthritis Foundation has provided some tips for an anti-inflammatory diet that may help decrease pain.

Heat therapy: Heating pads can help tense muscles relax. Surface heat may also help relieve pain temporarily by providing skin sensations that are more pleasant than joint pain. However, there is little likelihood that surface heat can improve deep circulation to the hip or change the underlying problem of the bone alignment.

Summary of Lifestyle Modifications. Except for weight loss and activity restriction, there are few lifestyle modifications that can slow the process of joint deterioration that results from hip dysplasia. Unfortunately, the underlying problem of hip dysplasia is that the bones are not supporting the joint surface adequately. This causes excessive pressure in areas that wear out faster unless the bones are re-aligned or replaced surgically.

Complementary and Alternative Treatments

There are no known alternative treatments to prevent or cure osteoarthritis. Some people do experience temporary pain relief from symptoms when using alternative treatments, though studies have not shown evidence that this changes the long-term outcome of osteoarthritis.

Acupuncture

Acupuncture is sometimes tried for pain relief. Acupuncture is a traditional Asian practice in which small needles are inserted into the patient and manipulated by the practitioner. The theory of treatment is to improve the flow of energy throughout the body however there is no evidence to support this mechanism.

In 2009, the British Medical Journal published a review of thirteen studies of acupuncture that concluded there was little difference between real, sham, or no acupuncture for relief of pain. [1] Those who report pain relief may be experiencing a placebo effect.

Avocado-Soybean Unsaponifiables (ASUs)

ASUs are supplements made from a specific type of oil from avocados and soybeans. ASU supplements are thought to slow down cartilage wear and to encourage the growth of healthy cartilage in hip and knee joints.

The oil in the supplements is more concentrated than what is consumed when eating avocados and soybeans. There is some evidence that ASUs may relieve symptoms of arthritis, but the effect may be short term. [2]

Ginger

Ginger is an edible root often used in cooking as a seasoning. In the context of alternative medicine, ginger is sometimes recommended to settle an upset stomach or to reduce inflammation and its resulting pain. Ginger can be purchased as a supplement, or ginger can be made into a tea.

Ginger contains compounds called gingerols that have anti-inflammatory properties. There is some evidence that ginger has a moderate pain relieving effect for osteoarthritis. [3]

(Caution) Ginger might interfere with some blood-thinning medications. So if you are taking a blood thinner, check with your doctor before taking ginger supplements. Side effects from ginger supplements can include heartburn or diarrhea. (Caution)

Glucosamine and Chondroitin

Randomized controlled studies have shown that these supplements do not promote the growth of cartilage or improve joint health. It is still possible to buy these supplements, but they will not improve the health of your hip joint.

(Caution) People who are allergic to shellfish should not take glucosamine. Glucosamine and chondroitin can interfere with blood-thinning medicines. (Caution)

Tai Chi and Yoga

Tai Chi and yoga are traditional disciplines with movements than can help promote strength, flexibility, and balance. Staying active is good for you as long as you do not push your joints to the point that you are in pain or you get injured.

Look for teachers who are willing to work with any limitations that you may have. Some experienced teachers can suggest ways to modify exercises so that they are less strenuous.

(Caution) Though these exercises can improve your muscle strength, posture, and overall health, they cannot change the bone structure of your hip joint. (Caution)

Other Herbal Remedies

Numerous herbal remedies have shown anti-inflammatory properties including Curcumin, Boswellia Extract, Fish Oils, UC-II, Resveratrol, and more. For more information about alternative medicines, including studies, see the National Center for Complementary and Alternative Medicine at the National Institutes of Health or the Cochrane Reviews. The Cochrane Collaboration is an independent organization that reviews primary research in health care.

 

 

  • Call to Action Buttons

  • Email Sign Up

    Email Sign Up
  • Social Media Links

  • Translate Link

    Para ver en Español Click Aquí

  • SubNav Menu

  • Latest News

    Latest News

    view all

    NYU Langone Health - Hip Symposium

    Jun 06

    This symposium will highlight the major challenges facing providers wh...

    PAO vs THR - What to do and when to do it?

    Apr 09

    A staggering number of adults are suffering with chronic hip pain due ...

    Can I play sports after my PAO?

    Feb 21

    Hip dysplasia in young adults is becoming increasingly recognized. Man...

  • Latest Stories

    Latest Stories

    view all

    Phil

    Jun 29

    Hello my name is Phil, I am a 32 year old male who lives in Oregon, US...

    Kiley

    Jun 25

    As a parent the last thing you want to hear after your child is born i...

    Malia

    Jun 14

    Malia was diagnosed with hip dysplasia and placed in a Pavlic harness ...