<img class="alignright wp-image-5862" src="https://www.drfields.com/wp-content/uploads/2023/08/hip-replacement-alternative-1-500x422.png" alt="Hip Replacement Alternative" width="300" height="253" />We see a lot of people in our office trying to avoid hip replacement surgery. These patients have usually already tried all kinds of treatments in an effort to "preserve their hip" and avoid surgery. Oftentimes, just the mention of surgery sends people searching for an alternative, and Regenerative Orthopedic options are effective hip replacement alternatives.

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<strong>Why Look for An Alternative to Hip Replacement?</strong>

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Hip replacement can be a successful means of improving quality of life, especially when the hip has become severely degenerated. But there are issues to be considered prior to choosing hip replacement.

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Hip replacements do not last forever, they wear out. So if the patient is younger, it is important to keep in mind that the replacement will wear out in 15-plus years.

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Also, some people have continued pain after hip replacement.The surgery just doesn't go as well as planned! But there are alternatives. And Regenerative Orthopedics is a non-surgical option.

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Debris can leak from the replacement causing an inflammatory response that leads to further destruction of the hip joint. Researchers in the journal <em>Orthopaedic Surgery</em> say, “Inflammatory responses to polyethylene wear debris can lead to severe bone resorption and aseptic loosening in the long-term following total hip replacement.” (1)

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And I always say, "remember, once the surgery is done, it cannot be undone." Surgery is permanent. There is no going back!

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<strong>But My Doctor Says My Hip Is Bone-On-Bone?</strong>

Hip replacement is often chosen because the patient has been told they have bone-on-bone arthritis, and hip replacement is the only option. The hip replacement is chosen because the patient thinks there is no other choice. But hip replacement is not the only option for bone-on-bone arthritis. Regenerative Orthopedics is a practical option in many arthritis cases.

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<em>How do you get to bone-on-bone in the first place?</em>

Bone-on-bone refers to the a condition of arthritis where the smooth cartilage that lines the hip bones wears away, leaving the joint without its cushion, allowing bone to rub against bone. The bones no longer glide normally.

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Bone-on-bone doesn't happen suddenly. That bone-on-bone condition began when the soft tissue, like tendons, ligaments, and even the hip labrum, became injured, worn, and/or weakened, and allowed for the hip joint to become unstable. Eventually, the person with this worn-out hip will experience loss of motion. Over time, the hip instability causes further joint injury, the wearing away of the cartilage lining of the hip joint, the development of bone spurs, and the “bumping” of bones into one another. The eventual degenerative changes can be seen on an x-ray, and bone-on-bone arthritis is diagnosed.

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But what's really interesting is that cartilage has no nerve endings. Where is the pain coming from then if it's not from the worn cartilage? It's likely the ligaments! All of the abnormal motion from the unstable hip changes the balance in the hip joint and distributes forces differently, injuring other joint structures like the ligaments. Ligaments are highly innervated. They do have nerves. And when injured, can elicit pain. The injured soft tissue needs to be addressed and repaired. What repairs joint soft tissue? Regenerative Orthopedics!

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<strong>Which Treatments Can Help Me Avoid Surgery?</strong>

Injury to soft tissue, like the ligaments, tendons, and cartilage, causes the joint to become unstable. It is important to address the cause and not just the effect of the wearing out hip. Regenerative Orthopedics, such as Dextrose Prolotherapy, Platelet Rich Plasma, and Stem Cell Prolotherapy, are all non-surgical treatment options that get to the root of the problem. They actually stimulate ligament, tendon, and cartilage repair. And most people have pain because of injury to one or all of these structures.

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<strong>But I Have Already Tried Conservative Care</strong>

Have you already tried pain medications, cortisone injections, hyaluronic injections, or even massage and PT? But you still have pain? Pains medications, NSAIDs, and cortisone injections may help with the pain, but they do not repair the soft tissue of the joint. It's also very possible massage and physical therapy helped for a time. These treatments are great to resolve and repair muscle issues. However, if the problem involves ligaments, tendons, and cartilage, that need repair, then a treatment needs to be sought that addresses these soft tissue injuries. Regenerative Orthopedics does just that!

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<strong>The Ligaments of the Hip Need to Be Repaired!</strong>

When your hip is unstable it destroys supporting tissue of the hip. The ball starts to rub the socket the wrong way and it moves abnormally. This is what's often referred to as “wear and tear” degeneration. This abnormal motion must be fixed.

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The ligaments of the hip need to be repaired in order to stop the degenerative effect of the injured ligaments. Surgery often cuts through ligaments but it does not repair them! The Journal of Biomechanics says this, “Laboratory data indicate the hip capsular ligaments prevent excessive range of motion, may protect the joint against adverse edge loading, and contribute to synovial fluid replenishment at the cartilage surfaces of the joint. However, <strong>their repair after joint preserving (hip arthroscopy) or arthroplasty (hip replacement) surgery is not routine.</strong>"(2)

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The hip ligaments need to be repaired. Many people continue to have pain even after hip replacement. It is quite possible the problem is related to the lack of repair of these soft tissue structures. You can’t save the hip without saving and repairing the hip ligaments.

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<strong>Why Is Hip Ligament Repair Important?</strong>
<ul>
 	<li>Hip ligaments prevent an excessive range of motion and contribute to the natural lubrication process of joints preventing friction and wear and tear.</li>
 	<li>The repair of ligaments after hip replacement surgery is not routine, and often leads to the need for hip revision surgery.</li>
 	<li>Failing to restore hip ligament function may increase the risk joint</li>
</ul>
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<strong>Regenerative Repair of the Ligaments Is an Effective Treatment Option</strong>

Regenerative Orthopedics offer an alternative for the repair of hip ligaments which can reduce the need for hip replacement. The journal <em>International Orthopaedics says, </em>"Newer, regenerative approaches have the potential to effectively delay or reduce the requirement for such invasive procedures.”(3)

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Regenerative Orthopedics are an effective alternative to hip replacement surgery. Researchers in the <em>Journal of Prolotherapy</em> demonstrated that Prolotherapy helps decrease pain and improve the quality of life of patients with chronic hip pain. Ninety-five percent of patients stated their pain was better after Prolotherapy. (4)

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Another medical journal reported, “According to our study, Prolotherapy is superior to exercise. Prolotherapy could provide significant improvement for clinical outcomes in developmental dysplasia of the hip and might delay surgery." (5)

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In many cases, Prolotherapy alone is sufficient to repair the hip. But in cases of more advanced degeneration, the addition of PRP and Stem Cells may be needed. At OrthoRegen®, we use the Gold Standard in Stem Cell Repair, which includes Prolotherapy, PRP, adipose stem cells, and bone marrow stem cells. This combination is extremely effective for advanced cases of hip arthritis. The stem cells and PRP address the cartilage problem and the Prolotherapy addresses ligament repair, stabilizing the hip, and restoring joint stability. The repair is comprehensive treatment of the entire hip.

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In the <em>American Journal of Sports Medicine, researchers say,</em> “Results indicated that intra-articular PRP injections offer a significant clinical improvement in patients with hip osteoarthritis without relevant side effects.”(6)

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And in the journal <em>Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders</em>, researchers show that stem cells regenerate tissue damage within the osteoarthritic joint, and when combined with Prolotherapy injections, were able to restore hip stability. (7)

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Hip surgeries are going through the roof with close to 10 million hip surgeries performed annually. If you would prefer to avoid surgery, please give us a call to see if you are a good candidate for Regenerative Orthopedics.

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<strong>References</strong>
<ul>
 	<li>Xing D, Li R, Li JJ, Tao K, Lin J, Yan T, Zhou D. Catastrophic Periprosthetic Osteolysis in Total Hip Arthroplasty at 20 Years: A Case Report and Literature Review. Orthopaedic Surgery. 2022 Aug.</li>
 	<li>van Arkel RJ, Amis AA, Jeffers JR. The envelope of passive motion allowed by the capsular ligaments of the hip. Journal of biomechanics. 2015 Nov 5;48(14):3803-9</li>
 	<li>Hevesi M, Jacob G, Shimomura K, Ando W, Nakamura N, Krych AJ. Current hip cartilage regeneration/repair modalities: a scoping review of biologics and surgery. International Orthopaedics. 2020 Sep 10:1-5.</li>
 	<li>Hauser RA, Hauser MA. 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.</li>
 	<li>Gül D, Orsçelik A, Akpancar S. Treatment of Osteoarthritis Secondary to Developmental Dysplasia of the Hip with Prolotherapy Injection versus a Supervised Progressive Exercise Control. <em>Med Sci Monit</em>. 2020;26:e919166. Published 2020 Feb 11. doi:10.12659/MSM.919166</li>
 	<li>Dallari D, Stagni C, Rani N, Sabbioni G, Pelotti P, Torricelli P, Tschon M, Giavaresi G.Ultrasound-Guided Injection of Platelet-Rich Plasma and Hyaluronic Acid, Separately and in Combination, for Hip Osteoarthritis: A Randomized Controlled Study. <em>Am J Sports Med</em>. 2016 Mar;44(3):664-71. doi: 10.1177/0363546515620383. Epub 2016 Jan 21.</li>
</ul>
Hauser RA, Orlofsky A. Regenerative injection therapy with whole bone marrow aspirate for degenerative joint disease: a case series. <em>Clin Med Insights Arthritis Musculoskelet Disord</em>. 2013 Sep 4;6:65-72. doi: 10.4137/CMAMD.S10951. eCollection 2013.