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You’re tired of living with chronic hip pain, but you want to avoid any unnecessary procedures. With access to the country’s best hip experts, you can be on your way back to doing the activities you love.

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Feel completely confident in your journey toward hip health

Whether you need a second opinion or you’re just starting out, it’s time to work with a hip specialist at Best In Class MD. Find your condition or recommended treatment below and see how we can help.

What is hip osteoarthritis?

Hip osteoarthritis is often called “wear-and-tear” arthritis. Osteoarthritis is a common degenerative joint disease and is more likely to affect individuals as they age. Hip osteoarthritis occurs when the injury and inflammation in the joint cause a breakdown of the cartilage that covers the bone. This cartilage, called articular cartilage is often compared to the shiny “gristle” at the ends of chicken bones. The articular cartilage allows for smooth movement of the hip joint and keeps the bones from rubbing together. When the articular cartilage breaks down, the shock absorbing quality is lost and leads to bone-on-bone apposition. This creates inflammation, pain and stiffness. Advanced hip osteoarthritis can make it difficult to walk, rise from a chair or bend over to tie one’s shoes. The experts at BICMD have extensive experience with hip osteoarthritis and can help you via their orthopedic telemedicine platform.

What causes osteoarthritis of the hip?

Osteoarthritis usually occurs in older individuals and is a by-product of joint use and repetitive motion. This can cause the wear and tear and subsequent breakdown of the articular cartilage. Other factors that may contribute to hip osteoarthritis are:

  • Excessive weight
  • Genetic defects in the articular cartilage
  • Improperly formed hip joint
  • Family history of osteoarthritis
  • Previous hip injury

What are the symptoms of osteoarthritis in the hip?

Pain within the hip joint is the most common symptom of hip osteoarthritis. Often pain develops over time and can worsen with activity. Other symptoms of hip osteoarthritis include:

  • Stiffness in the joint and trouble walking
  • Pain that increases with activity
  • Groin pain or pain that radiates to the buttocks or knee
  • Crepitus – or a crunching, popping or grinding noise in the hip
  • Locking of the hip joint
  • Decreased range of motion

How is hip osteoarthritis diagnosed?

Our experts at BICMD can diagnose hip osteoarthritis and provide recommendations using our virtual orthopedic telemedicine platform. An x-ray and MRI, along with a complete patient history, are often used to reach the proper diagnosis. An x-ray can show abnormal bone characteristics while an MRI can show the health and condition of the articular cartilage in the hip, as well as other hip structures. We can help you develop the best plan of action for your hip osteoarthritis and let you know what treatments we recommend.

How is osteoarthritis in the hip treated?

Non-Surgical Treatment:

Conservative measures should be the first line of treatment for osteoarthritis in the hip. The goal of treatment is to alleviate pain and improve mobility. Treatments may include:

  • Rest, ice, elevation
  • Discontinuation of activities that may contribute to painful hip symptoms such as running or climbing the stairs
  • NSAIDs (non-steroidal anti-inflammatory drugs)
  • Exercise and physical therapy
  • Weight loss
  • Using a cane, crutches or a walker to take pressure off the affected hip joint
  • Hip injections

Surgical Treatment:

Surgical intervention should be considered when conservative methods fail to alleviate pain and restore mobility. Surgery for hip osteoarthritis can include:

  • Osteotomy – The head of the femur (thigh bone), the acetabulum (hip socket) or both may be cut to realign the joint and take pressure off of the hip surfaces.
  • Hip Resurfacing (link to treatment) – Similar to a hip replacement, but more conservative. During hip resurfacing, the damaged bone and cartilage are removed and the surfaces of the femur and the acetabulum are capped with a smooth metal covering that moves smoothly together and eliminates bone-on-bone friction.
  • Hip Replacement (link to treatment) – Also called hip arthroplasty the hip joint is replaced by metal, ceramic or plastic parts. During this procedure, the head of the femur is replaced with a smooth metal ball. The acetabulum is replaced with a new joint surface and the two act together to form a new hip joint.

For more information on hip osteoarthritis and the possible treatment options you should consider, or to  have your hip condition evaluated by one of our experts, please click on “Get Started”. to reach one of our orthopedic telemedicine experts.

The Hip Joint – An Overview:

The hip is a ball and socket joint that is formed by the head of the femur (thigh bone) fitting securely into the acetabulum (socket) which is part of the large pelvis bone. The joint surface is covered with a slippery tissue called articular cartilage. This helps the ball and socket move smoothly together, without friction during movement. The acetabulum has a rim of strong fibrocartilage that helps hold the femur securely within the socket, forming a gasket and creating a tight seal which offers hip stability. If you have been diagnosed with a hip condition, like a hip labrum tear and are looking for a second opinion, our doctors at BICMD are experts in orthopedic hip conditions and can provide you with an on-demand virtual consultation.

What is FAI?

FAI is the acronym for Femoroacetabular Impingement, it occurs in the hip when additional bone grown occurs on one or both of the bones that form the ball and socket joint. The additional bone growth, sometimes called bone spurs, cause an abnormal or irregular shape which allows the bones to rub against each other during movement. When the extra bone forms on the femoral head/neck this is referred to as a CAM deformity. The result of this extra bone growth is the pinching, or impingement of the joint. Over time, this will cause the articular cartilage to become worn and damaged, resulting in pain, catching within the joint, and limited range of motion. This condition may begin early in childhood and is a major contributing cause of early degenerative joint disease of the hip in young, active patients.

What is a Hip Labrum Tear?

The hip labrum is made up of strong, flexible fibrocartilage that sits on the acetabulum (socket) of the hip joint. The job of the hip labrum is to hold the ball of the femur (thigh bone) securely within the acetabulum. It acts as a gasket, creating a tight seal that offers hip stability while the joint moves through its full range of motion.

A hip labrum tear occurs when this strong fibrocartilage tears away from the acetabulum, either partially or completely. Femoral acetabular impingement can be one of the causes of a torn hip labrum when the misshaped bone damages the hip labrum.  This condition may begin in childhood and is a major contributing cause of early degenerative joint disease of the hip in young, active patients.

Are there different types of hip impingement or FAI?

Femoroacetabular impingement is classified by two distinct types. Patients may have one or the other type, or they may have a combination. These types of impingement are:

  • Cam Impingement: A Cam hip impingement occurs when the femoral head is misshaped. If the head of the femur is not smooth or round, it cannot move or rotate correctly inside the acetabulum (socket). The result of a misshapen femoral head can cause excessive grinding and wear against the cartilage inside the joint, which can tear the labrum.
  • Pincer Impingement: This type of hip impingement can be caused when the socket of the hip is too deep. Pincer Impingement can also occur when extra bone on the acetabulum (socket) extends further than it should, over the edge of the femoral head. This can cause the labrum to pinch, or crush and the articular cartilage can be damaged.
  • Combined Impingement: Combined hip impingement is when both a misshaped femoral head and extra bone on the acetabulum, causes the uneven wear and tear of the cartilage. Both Pincer and Cam impingement will cause pain and excessive wear within the joint capsule.

What are the symptoms of femoroacetabular impingement?

Typical symptoms experienced in patients with FAI are:

  • Hip pain; can be stabbing or a dull ache
  • Stiffness in the hip with decreased range of motion
  • Deep groin pain with certain activities
  • A locking sensation in the hip
  • A catching sensation in the hip or groin
  • Pain after sitting for a long period of time
  • Pinching, felt in the hip when flexing the joint beyond 90 degrees
  • Hip pain with exercise or sports
  • Hip pain that radiates to the thigh, buttock or knee
  • A limp when standing to walk

How is FAI or Hip Labrum Tear diagnosed?

The specialists at BICMD have extensive training and experience in diagnosing FAI, Hip Labrum Tear, Cam Impingement, Pincer Impingement or a combination. Typically, femoroacetabular impingement can be seen on x-ray and in an MRI. As part of your consultation, BICMD experts can review your x-ray or MRI to evaluate the bone and soft tissue. Through our telemedicine platform you can consult with your selected expert to discuss your diagnosis and treatment options – without the need for special travel. A correct diagnosis and appropriate treatment plan or second opinion by our orthopedic experts who are “best in class,” can make the difference between a fair recovery and a great recovery.

What is the treatment for femoroacetabular impingement?

If you’ve tried non-surgical treatments and they have failed to alleviate pain, surgical intervention may be needed. Our physicians will only recommend surgery for FAI when conservative treatment has not helped, or if the condition has worsened. FAI impingement can typically be treated arthroscopically, using small incisions and a small camera called an arthroscope. Small, specialized instruments help the doctors to operate inside the hip joint, offering less bleeding, less chance of infection and a quicker recovery time.

Would you like more information on FAI, Femoroacetabular Hip Impingement or labrum tears? Are you experiencing hip pain or have you been diagnosed with hip impingement, FAI or a torn labrum? Please click on "Get Started” to reach one of our orthopedic telemedicine experts and to use our state-of-the-art telehealth platform.

A gluteus medius tear is a condition characterized by severe strain on the gluteus medius muscle that results in partial or complete rupture of the muscle.

 

Would you like more information on Gluteus Medius & Minimus Tears?  Are you experiencing hip pain or have you been diagnosed with Gluteus Medius & Minimus Tears?  Please click on "Get Started” to reach one of our orthopedic telemedicine experts and to use our state-of-the-art telehealth platform.

A common type of chronic hip pain that may affect the hip's outer area, or the outside part of the upper leg, from the hip to the knee along the thigh.

 

Would you like more information on trochanteric pain syndrome?  Are you experiencing hip pain or have you been diagnosed with trochanteric pain syndrome?  Please click on "Get Started” to reach one of our orthopedic telemedicine experts and to use our state-of-the-art telehealth platform.

A hip fracture is a break in the upper part of the thigh bone near the hip socket. Surgery is almost always the treatment for a hip fracture. Fractures of the hip can be caused by trauma such as a car accident, but they are often common in older people with osteoporosis, as well. Some patients with previous conditions that make them prone to hip fractures may feel pain in the hip region before the actual break.

 

What is hip replacement surgery?

Hip replacement surgery, also called a total hip replacement or hip arthroplasty, is a surgical procedure that replaces a damaged hip joint. The surgeon uses an artificial implant made of metal, ceramic or plastic materials, called a prosthesis, to replace and recreate the hip joint. The orthopedic telemedicine hip specialists at BICMD can evaluate your hip condition and give you a second opinion if you are thinking of hip replacement surgery.

Why would I need a new hip?

Hip damage caused by hip osteoarthritis can cause debilitating pain limited range of motion. Damage to the bones in the hip joint, caused by hip osteoarthritis is not repairable and in older patients, requires hip replacement surgery. Hip arthroplasty or hip replacement surgery is recommended when conservative hip treatments have failed to improve mobility and alleviate pain. Hip replacement surgery is reserved for individuals with severe hip damage.

How is hip replacement surgery performed?

Hip replacement surgery should be performed by an orthopedic surgeon who has an excellent track record and repeated success in performing hip arthroplasty. The procedure is done with a standard technique using a slightly larger incision, or series of smaller incisions to perform the operation.

The procedure begins with the old, damaged femoral head being removed from the joint. It is replaced with a metal stem, inserted into a hollowed-out center of the femur. A ceramic or metal ball is then placed on the upper portion of the stem, replacing the removed femoral head.

Next, the damaged cartilage surface of the acetabulum (socket) is removed and replaced with a metal socket. The socket is held in place by screws or medical cement.

A synthetic spacer is then inserted between the new ball and the new socket. The spacer allows a smooth, gliding motion within the joint, mimicking the articular cartilage. This creates a pain-free surface that allows the new hip components to move together without pain.

What are the risks of hip replacement?

As with any joint replacement surgery, hip replacement has certain risks patients should understand before they commit to arthroplasty. Your surgeon can go over risk factors with you, and the likelihood (if any) of experiencing any of the following:

  • Blood clots
  • Infection
  • Dislocation
  • Fracture
  • Change in leg length
  • Loosening of the joint
  • Nerve damage

What is the recovery like following a hip replacement?

Many skilled hip replacement surgeons will tell you their surgery is only as good as their patient’s willingness to follow post-surgical protocols. It is important to understand the recovery process following hip arthroplasty is a team event which includes you, your doctor and the post-operative team. Patients undergoing a hip replacement can expect the following:

  • Pain medication will be prescribed and should be taken as directed
  • Hip replacement surgery usually requires an over-night stay in the hospital
  • Passive motion exercises will begin after surgery to help restore motion
  • A walker or crutches are needed until weight bearing can be tolerated
  • Patients are given a detailed list of precautions
  • Physical therapy is started right away and will continue until full strength and range of motion are restored.

Complete recovery following a hip replacement, on average, can take 6 to 12 months. Modern hip replacements last 20 or more years.

For more information on hip replacement or hip arthroplasty, or for a second opinion on recommended hip surgery for your hip osteoarthritis, please contact our experts, by clicking on “Get Started” to reach one of our orthopedic telemedicine experts.

What is hip resurfacing?

Active and younger individuals can suffer from hip osteoarthritis.  Hip osteoarthritis occurs when the articular cartilage on the end of the hip bone and on the socket wears away. This leaves an uncomfortable bone-on-bone condition which is painful and can be debilitating. The resulting inflammation causes hip osteoarthritis. Hip resurfacing is a type of hip replacement; however, instead of replacing the entire hip joint, hip resurfacing involves the shaving of the surface of the femur and the acetabulum (hip socket), and then capping it with a new joint surface. This approach preserves more of the patient’s natural bone and reduces the risk for postoperative dislocation and inaccurate leg length. The experts at BICMD can diagnose your hip condition through their orthopedic telemedicine platform and can advise you of your best treatment options and if you are a candidate for hip resurfacing.

What is the difference between hip resurfacing and a hip replacement?

In a conventional hip replacement, the portion of the hip with osteoarthritis is removed and replaced by a new ball and socket. The original ball of the femur is cut and removed to allow a stemmed prosthesis to be placed in the marrow cavity of the thigh bone. A ball is affixed to the top and is then inserted into a new acetabulum, or socket which is fitted into the pelvis. The joint moves easily with the help of a spacer and osteoarthritis joint pain is eliminated.

Hip resurfacing is a surgical technique that differs completely in the way the thigh bone is treated. Instead of removing the ball at the top of the femur, it is shaved down in millimeters, to a peg. The process is often compared to how a dentist prepares a tooth for a new crown. The femoral “peg” is then fitted to a metal ball that is placed around it, capping the top. The acetabulum is treated in a similar manner to the hip replacement, in that an artificial “cap” is fixed to the socket on the preserved bone.

Why would I choose hip resurfacing surgery?

Hip resurfacing surgery is not suitable for all patients. Younger candidates have better post-operative outcomes (younger than 60) as well as men with strong healthy bone. Larger-framed patients also do better with hip resurfacing than with a traditional hip replacement. The benefit of resurfacing is that it preserves more of your bone and delays the need for a total hip replacement. Our specialists at BICMD have extensive experience with hip resurfacing and can tell you if you would be an ideal candidate. If not, they can help you decide on the best hip treatment for your condition through a telemedicine visit. Younger patients enjoy other benefits of hip resurfacing, such as:

  • Quicker return to normal activities and lifestyle
  • Resurfaced hips do not have the limitations of a new hip
  • Hip resurfacing can last longer than a traditional hip replacement
  • More of the bone is retained
  • It is very unlikely for the resurfacing material to “pop out” or dislocate
  • Post-operative hip functions at a higher level than a complete hip replacement

How is a hip resurfacing surgery performed?

Under general anesthesia, the orthopedic surgeon makes an incision in the thigh to access the hip joint. The femoral head is brought out of the socket and trimmed with specialized equipment. A carefully fitted metal cap is then cemented over the femoral head. Next, the cartilage that lines the acetabulum, or the socket is removed, and a metal cup is placed into the socket. Finally, the femoral head is relocated back into the socket and the incision is closed.

What are the risks of hip resurfacing?

  • There is a slight risk (1-2%) of fracturing the femoral neck.
  • Surgery is more exacting and technically challenging, making it more difficult to find a qualified surgeon.
  • Not recommended for older individuals.
  • Although rare, injury to nerves or vessels can occur.

How long does the resurfacing of a hip last?

The materials used in hip resurfacing have improved drastically in the last 10-15 years. Two metal implant surfaces eliminate concerns about the plastic portion of a hip replacement wearing out. The most recent data shows hip resurfacing to last as long, if not longer than a hip replacement. Some hip resurfacings have survived up until the 15 to 20 year-mark.

How long is the recovery following hip resurfacing surgery?

Hip resurfacing is done on an in-patient basis. Patients can go home in 1 to 3 days, depending on your surgeon’s recommendations. In general, patients can expect the following:

  • Weight bearing as tolerated, immediately after surgery.
  • Expect to use a walker, cane or crutches until full weight bearing is possible.
  • Pain and discomfort are normal after surgery and can be controlled with medication, taken as directed.
  • Exercises will be needed to regain full range of motion and strength.
  • Physical therapy is also recommended.

Most patients can expect a shorter recovery time than hip arthroplasty, or replacement. Hip resurfacing patients can expect to return to normal activities in about 1-2 months.

For more information on hip resurfacing, or the correct treatment for your hip condition, and to receive a second opinion for your hip osteoarthritis, please contact our experts, by clicking on “Get Started.” You will be connected to one of our orthopedic telemedicine experts through our state-of-the-art telemedicine platform.

What is a hip arthroscopy?

Hip arthroscopy, also referred to as keyhole surgery, a hip scope, or a minimally invasive procedure all refer to a method of surgery that examines the inside of the hip joint with a small surgical camera called an arthroscope. Hip arthroscopy uses a small surgical camera that is inserted through a small incision in the hip. The camera projects the image within the hip to a screen, allowing the orthopedic surgeon to see inside the hip joint. Small, specialized instruments are then inserted through additional small incisions to operate within the joint. Hip arthroscopy can be used for a wide variety of hip conditions and is the preferred method of hip surgery for our physicians at BICMD. Hip arthroscopy offers patients quicker healing time, less pain and less chance of infection.

What hip conditions can be treated with hip arthroscopy?

The orthopedic surgeons at BICMD are extremely skilled at diagnosing hip conditions. Their expert second opinions can offer you treatment options and a plan for the best recovery possible and can be done via orthopedic telemedicine. A wide number of conditions can be treated with this minimally invasive technique including:

  • FAI – Femoroacetabular Impingement
  • Hip labrum tear
  • Hip abductor tear – Trochanteric pain syndrome
  • Hamstring repair
  • Gluteus repair

What is a hip labrum tear?

The hip labrum is a is a ring of fibrocartilage that sits on the outside rim of the hip socket (called the acetabulum). The hip labrum is responsible for holding the ball of the femur (thigh bone) securely within the hip joint while allowing full range of motion. The hip labrum can become damaged from repetitive pivoting or twisting motions that cause wear on the labrum. Hockey, golf, soccer, ballet and football all involve motions that can tear or fray the labrum. Hip abnormalities, such as a hip impingement can also cause a hip labrum to tear or fray. A hip labrum tear occurs when the labrum is pulled from the attachment site on the acetabulum.

What is a hip labral repair?

A torn hip labrum that requires surgery, can be repaired arthroscopically. The goal of an arthroscopic hip labral repair is to reattach the labrum to the acetabulum. This specialized surgery will improve hip stability and function, improve diminished range-of-motion and decrease hip pain. A properly repaired hip labrum will also help prevent additional damage to the hip joint and surrounding soft tissue.

How is an arthroscopic hip labral repair done?

The hip labrum has a limited blood supply and cannot heal itself once it is torn from the bone. Surgical intervention is needed to restore the torn labrum and to stabilize the hip joint. The type of labral repair surgery will vary, depending on the type and severity of the tear. During a hip labral repair, our surgeons may do one or more of the following:

  • Labral tear repair – The surgeon reattaches the labrum to the acetabulum using small surgical anchors and surgical thread called sutures.
  • Debridement – If the hip labrum is frayed it can cause pain and additional damage. During debridement, the surgeon trims away or smooths out the damaged portion of labrum.
  • Impingement treatment – If the torn labrum was caused by hip impingement, the surgeon will correct any bone abnormalities using a special tool to resurface the area causing impingement
  • Hip labrum reconstruction – Sometimes the labrum is too damaged, and the surgeon is unable to complete a repair. A hip labrum reconstruction uses a graft to reconstruct the labrum. The graft is secured to the bone with sutures and restores the function of the original labrum.

How long is the recovery after arthroscopic hip surgery?

Arthroscopic hip surgery offers patients a quicker healing time and many procedures can be done out-patient. The time for recovery will vary, depending upon the procedure needed to correct your hip problem. In general, a full recovery after hip labrum repair or reconstruction can take up to twelve months. Once your condition is diagnosed, your orthopedic specialist will be able to give you a more accurate estimate of recovery time.

For more information hip arthroscopy, hip labral repair or to be evaluated for your hip pain, or to receive a second opinion from one of our orthopedic telemedicine experts, please click on “Get Started” to reach one of our Best in Class physicians.

An acetabular fracture is a break in the socket of the hip joint. Usually, they are caused by trauma such as a car accident. But they often occur in older people with weakened bone structures, as well. Pelvic and acetabular fractures usually require surgery to repair and stabilize the structure of the hip joint.

 

For more information Pelvic and Acetabular Fractures, to be evaluated for your hip pain, or to receive a second opinion from one of our orthopedic telemedicine experts, please click on “Get Started” to reach one of our Best in Class physicians.

The hip joint is a “ball and socket” joint. In a young patient with hip dysplasia, the hip joint has not developed normally, and the socket of the hip joint is too shallow to adequately support and cover the head of the femur. Hip dysplasia, left untreated, can cause pain and premature development of osteoarthritis. Adolescent hip dysplasia is often present at birth as developmental dysplasia of the hip, but it goes undetected and develops into adolescent hip dysplasia. Some hip dysplasia cases can be treated with non-surgical methods.

This list contains some of our most commonly seen conditions, but it is by no means exhaustive. Our hip doctors handle the same wide variety of conditions that an in-person physician would.

If a hip condition or injury is keeping you from enjoying the freedom of a pain-free life, our physicians are committed to helping you feel better.

Click on “Get Started” to reach one of our orthopedic telemedicine experts.

Best in Class Hip Specialist

  • Edwin Su, MD
    • Orthopedic surgeon, top-ranked Hospital for Special Surgery
    • Associate professor of Orthopedic Surgery
  • Benedict Nwachukwu, MD MBA
    • Orthopedic surgeon, top-ranked Hospital for Special Surgery
    • Consultant for the NBA Player’s Association, Team Physician for the WNBA and MLS

I've now made a decision about my next steps and the BICMD platform truly fulfilled its promise to provide expert second opinions.

-Alex Miller

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