Podcast: Tips for bad hips

Podcast Transcript

Hello and welcome to The Bone and Joint Playbook with Dr. John Urse, Tips for Pain-Free Aging. Today’s topic is, Tips for Bad Hips. Let’s listen in.

Terry: Hey there Dr. Urse, welcome!

Dr. Urse: Hi Terry, thanks for having me.

Terry: I’m happy to do that. By the way we should make to the listeners that it’s the middle of February and we’re in the middle of a pandemic, but yet we’re doing a topic here today, the topic is what?

Dr. Urse: Tips for bad hips.

Terry: Tips for bad hips. What made you pick that topic?

Dr. Urse: Well, I do a lot of hips in my practice in orthopedic surgery and it’s a confusing problem for patients to figure out and likewise for doctors. So, I think a lot of people are wondering why their hips bother them and what they can do about them, and I think we will talk about some of those things today.

Terry: Ok, so what qualifies you on being a hip expert?

Dr. Urse: Well, I started off with my training, I did a clinical fellowship in total joint replacement up at Harvard. I have 34 years of practice as a board-certified orthopedic surgeon. I teach hip arthroscopy which is looking into the hip with a light to people all around the world that come to Chicago for an association called AANA, which is the Arthroscopy Association of North America. I have been teaching that for years and so I think I have a pretty good background for hip problems.

Terry: Do you do a lot of hip surgeries?

Dr. Urse: I do.

Terry: Just roughly, how many hip surgeries do you do a year, a week or month?

Dr. Urse: I probably do over 300 a year, probably two thirds of those would be scopes where we look in with a light to try and preserve the hip and then maybe 100 or more are joint replacements which we will talk more about later which are called a hip replacement or total joint replacement.

Terry: So why are we talking about hips today? What’s making this the kinda interesting topic?

Dr. Urse: Well, I think we want to get across to the listeners a couple of different things. One is that hip problems can start very young, and they can become problems really quickly and they can make your hip wear out quickly and at an earlier age than you would like. Then we are dealt dealing with a hip problem in someone’s middle of life when we’re trying to get you to age 90 with your body parts, and to do that we don’t want to start replacing hips like we replace knees and shoulders at a very early age. So, if we can recognize a problem in a hip, much like a car problem we can fix it without having to replace it which makes a lot of sense. So, our job as orthopedic surgeons and physicians is to diagnose a problem that might be related to the hip, identify it, and find a way to fix it. We try to do things as simply as possible such as non-operative therapy, things like exercises, physical therapy, chiropractic treatments, things that include anti-inflammatory or cartilage protective agents that help delay progression of arthritis. Obviously, things we will talk about later that have to do with looking into the hip with a light called a hip scope, fixing a problem that might be in there to prevent it from being a worse problem later. Then talking about whether the hip is too far gone with too much arthritis and if we should talk about replacing it and what that can do for people and how long that can last. We will also talk about the different ways we can do that with newer technologies, using robots, computers, and some of the better scientific advances.

Terry: So, what makes someone have a hip problem?

Dr. Urse: Well, I think it’s kind of like any story, we want to go back and start at the beginning. When we are born, our hips are like a deep ball and socket joint. I tell people they are much like the little ball at the base of your rearview mirror. You can go up and down, side to side or around and rotate. Our hips have a lot of freedom of motion, much like a shoulder as opposed to a knee or elbow that just bend and straighten. So, when we’re born this deep socket, called the hip ball and socket, that’s the femur and acetabulum. Those have a deep ball and socket relationship like a cup, and it fits in well, but some people when they’re born have a shallow hip and if the hip doesn’t have a deep socket to sit in, the ball slides out a little more which is called hip dysplasia. Hip dysplasia is where the hip doesn’t form a deep cup, almost like a half moon and is very shallow like a coffee plate. That hip dysplasia, you may have heard about it in some animals, dogs get hip dysplasia where their hips get into trouble at an earlier age than you would expect. So, when you’re young, a pediatric orthopedic surgeon might put your hip in a brace and we will ask people if they were ever in a hip brace as a child, because that may have been a sign that your hip is shallow. Unfortunately, some people don’t know it because they have never had an x-ray or identification of the hip problem, so the hip never deepens and never becomes a deep socket. In some early phases of life if it is very shallow, sometimes the pelvic bone must be cracked and moved over to make a shelf or a cup or coverage for the hip itself.

Terry: Let me ask a question, is that genetic because certain breeds of dogs have hip dysplasia problems?

Dr. Urse: I don’t know that I have seen that it’s genetic, I think it is more developmental. There is an interesting way when we’re in our mothers’ wombs that if the ball is facing the socket, the socket deepens and then it becomes a deep socket. If the ball is turned maybe the feet were twisted, the kid was breached, or turned, the leg was turned, maybe the ball wasn’t facing the socket. That special embryonic tissue doesn’t know to deepen, therefore it doesn’t become a deep socket and then that’s just maybe the way the body didn’t have the ball facing the socket to begin with. Thats why the braces that hold the legs out like a pillow between your legs would do, some of those hip braces you’ve seen kids wear, the body can still develop a socket until about age four. So even if you recognize it a year after someone is born, the bracing can still help the hip deepen and form better. Then as you get into the early years, there is things where the growth plate, which is the place that our bones get our length, that’s called a growth plate at the top of our thigh bone. That can slip off like a dip of ice cream on a cone and that’s called a slipped growth plate or a slipped epiphysis. That can lead to now having a mismatch of the ball and socket and we’re going to talk about this mismatch of where the ball and socket don’t form a smooth articulation, they don’t glide back and forth. So, if something makes the ball out of round or if the ball has slipped backwards, again a pediatric orthopedic surgeon at Children’s Hospital may put a pin in the ball to hold that little piece of the growth plate, like the ice cream back on the cone, or they will try to push it back on and realign it. Then other things effect blood flow to the ball. There is a thing called Perthes Disease and other things in childhood, so we may as you these things about your history as an adult having a hip problem, to see if they started earlier. Then we will say, gosh were you playing hockey, were you a goalie who did the splits all the time and you started having hip pain after that one collision with a guy trying to score a goal. Well, that may have torn something inside the hip called a labrum, you may have a problem internally that we would then identify as like a rock in your shoe as it is literally inside the joint. We would then want to do a good exam and want to say where is your pain, is it in the front, the side, the rump, or buttocks, does it go down to your knee? Hip pain is very diverse, it’s difficult for the patient to explain and difficult for the doctor to understand. So, this could be a problem we ask, do you feel pins and needle feelings down your leg because that could be your sciatic nerve. We did a podcast on you’ve got a pinched nerve and why that could be the cause of leg, neck, or arm pain. It could be a hernia problem in the front of the hip, that maybe just from lifting heavy bags of peat moss in the backyard for your wife and you’ve got a hernia, well that’s a general surgery problem where you have a weak area in the lining of the groin and it’s not in the hip at all, but it seems like it’s the front of your hip. Then there are parts of hips that pop or snap or make noise and you say, why is my hip making noise? Well, someone needs to look at it, because it could be on the outside hip bone, it could be coming from a ropey thing called a tendon, a snapping tendon across the front of the hip. We even see that after some surgery’s when scar tissues rub across that little tendon. So, what you need is a good exam from a doctor or health care provider who can look at the back, check your nerves, look at your hip, and look at the muscles. We talked about hip bursitis as an outside hip source of pain and a lot of times it’s the muscle, called the glute that lifts your leg that helps you go up and down steps. If that muscle is partially torn or completely torn you may have more weakness than pain, you may say I can’t go up steps, my leg is so weak. That is a muscle problem outside the hip, not in the joint, so an MRI or a more specific test will show that. We may say, “Terry we’ve looked at your hip today in the office and your x-rays don’t show much arthritis, but something is not right, and I think it’s in your hip although you’re feeling the pain in your buttock, I think the pain is coming from your hip. I will put an ultrasound on the front of your hip and I’m going to put a needle in the joint with some Novocain and cortisone and see if that takes your pain away”. If you said hey, I know you’re in the hip with that shot and my buttock pain is gone, guess what your problem is in the hip and it is just referring pain to your back, to the front of your thigh or outside of your thigh. A diagnostic injection may do two things, it will tell you where your problem is and if it may not be your back and may not be the groin where the hernia was, it may actually be in the hip. It will tell us that we need to look harder and do an MRI, CAT Scan or an ultrasound test to get more information as to where the problem is coming from.

Terry: So, what about what you were talking about earlier with the hockey player. Are there habits or professions that you see in your career that tend to generate hip problems down the road like cheerleading or something like that?

Dr. Urse: Well, they can. The reason they sometimes generate that is another thing called a developmental problem. I am going to use one long medical word in this whole podcast and it’s femoroacetabular impingement and mercifully it’s abbreviated to FAI. When the femur bone rubs against the socket bone, called the acetabulum it rubs or impinges, and impingement means something is rubbing against something. We see it in the shoulder, when you raise your arm your shoulder impingement may occur, we see it in your ankle when you pull the ankle up there may be a little spur on the end of the shin bone that causes ankle impingement. The hip is no different, we can get a bump, we call it like a bunion of the hip it’s a bump that may be developmental through teenage or early years. We can show soccer players over eight years where their hip looks good and overtime, they get this little bunion or bump that actually causes a mismatch where the hip impinges and tears the gasket. The gasket, called the labrum which is a lip or lining around the hip socket. All a sudden they have this hip pain, and more activity isn’t going to help that like more soccer, more hockey, more cheerleading, more jumping off pickup trucks on your farm. All those things are going to make it more damaging to your hip and for us we want to say is that a problem. Let’s fix it when you’re thirty and reshape that ball to make it round so it doesn’t cause wear on the cartilage which is the gristle that coats the joint. The things that go wrong with hips over time are when you have a square peg in a round socket, that’s like a mismatch. You’ve seen the car commercial with the four guys shoving the square thing in a round socket. If you have an out of round ball in a round socket, you have a mismatch that is going to wear the hip out earlier. There is a coach for Duke and a former coach for the Chicago Bears that both got into hip problems in their forties because they got arthritis at an earlier age than they wanted, and both had to have hip replacements. You ask yourself, why would someone that young need to have a hip replacement? The answer is they had lousy hips. They had wear and tear that was probably not recognized at an early age that wore the hip out earlier than they would like. In order for them to walk a not have pain, to get back to coaching, running restaurants and smoking cigars, they needed to have a hip replacement to resume normal activities, and we will talk a little more about that at a later point in the podcast. There is a lot of things we can do before we replace a hip, that is why we talk about hip preservation and trying to get the hip to age ninety without doing a joint replacement at an earlier age than we would like.

Terry: So, are there healthy habits to keep you hip in good shape?

Dr. Urse: Sure, there are. We know weight affects hips and knees, if someone loses twenty pounds that’s going to be two times benefit for your force across the hips, so that’s forty less pounds of force across your hip joints. You get three times benefit of the knee on that, so if you lost twenty pounds you would have sixty less pounds of force across your knee. So certainly, weight is one thing. We know that if you don’t have hip problems, there is no problem with running, jumping, or playing sports.

Terry: Do those cause hip problems?

Dr. Urse: They don’t. Now trauma does, so if you’re one of the football players, like Bo Jackson who gets tackled and it damages his hip and his hip pops out of the socket, it rips the blood flow and arteries to the hip. Now that bone does not have any blood supply and that’s called avascular necrosis or necrosis of the bone. Thats much like taking a tulip away from its stem and saying how long is that going to look good in a vase in my wife’s kitchen? The answer is not very long. So, if the ball to the hip called the femur bone doesn’t have blood flow, that can damage the hip at an early age, and you could end up with a hip replacement or a procedure to try and increase the blood flow. So, we talked about how trauma is bad, some medicines like steroids, things like excessive alcohol use can lead to this necrosis of the bone which is called AVN. So, there are lifestyle things that people can pay attention to, I think you should pay attention to your body. If you go on a walk every day and you go three miles and you feel good, I would go four and take your dog. There isn’t the saying, you only have 10,000 steps in your legs before they break down. The guy you’re talking to today is still playing baseball, I’m fortunate to have good hips and knees and so if you’re really not having problems with things, you should keep doing them. If you’re conversely not feeling right, you need to find out what’s wrong. If you feel like there is a rock in your shoe, you should check it because it’s not good to run around with a rock in your shoe, right? So, it’s a loose body in your hip, an inflamed hip, or a labrum tear that’s flipping in and out of your hip that’s causing pain, that’s a warning sign that someone should look at it.

Terry: So earlier you said that hips can be difficult to diagnose. What makes hips so hard to understand and figure out?

Dr. Urse: Well, there are a whole lot of muscles that cross the hip joint from the pelvis and from the back that go to the leg muscles and move the leg in all those directions we talked about. Every muscle that crosses the leg and the hip joint sends a sensory fiber that gives pain feedback to the body. So, a back muscle that crosses the front, we talked about the snapping hip tendon, that muscle starts in the third lumbar vertebrae that is in the upper back. So, you may have upper back pain that is hip pain problem because the pain pattern from that nerve says hip problem, but back pain to the patient or the doctor looking at you. It maybe the outside where the pain pattern is, the front, the groin, or the buttock. So maybe what you need is a way to find the source and try to narrow down if it’s in the pelvis or not. It could be a female organ, it could be a hernia. The MRI is going to show your ovaries, uterus, and your prostate along with other things in there. So, the work up for a hip problem includes a detailed study of things around the hip to make sure it’s not those. Then we pinpoint it to the hip then we say what we could do best for the hip.

Terry: How do you figure out someone has a hip problem? What are the steps? If I came to your office today and said by back and my hip are bugging me. What do you run me through? What kind of tests or diagnostics?

Dr. Urse: Well, that’s going to be a history and physical and x-ray. So, we are going to ask you all those questions about birth to now. What has happened with you with your hip and what makes it worse, what makes it better. If you’re a woman is this related to your hormone changes, maybe you get hip pain every thirty days, and it may not be your hip after all. So, we want to ask all those questions first and then we want to examine you. I am going to check your back nerves, I will have you stand on one leg, do a knee bend, I will have you walk on your tip toes, have you walk and see if you’re in-toeing or out-toeing. Some hips have a rotational problem where you see people who are pigeon toed and are trying to compensate for a hip problem to make their hip feel better by walking with their toe turning in. We are going to check you laying down and we will swivel your hips and see if this reproduces hip pain and if I lift your knee up and bend it over to the other side and you say that really hurts, well that’s called a scour test when we’re taking the ball and kind of grinding it into the hip socket. If you say, “wow what are you doing? That hurts,” well Terry that might be in your hip. I am going to do an exam with you on your side and I will check your outside glute muscles to check strength, so we check your nerves, muscle strength, we check arteries, we check your belly, we look for a hernia and then when we get done with a physical exam I go Terry, you need a good old x-ray. So an x-ray will tell us a lot, it will show if there is a normal shape to your ball and socket, you don’t have a bump or a bunion, but you hurt so let’s do an MRI, let’s do a test that uses radio waves and you just lay there and listen to music with your headset. Then about forty-five minutes later we get a detailed study of your hip, pelvis, muscles, your labrum, and your cartilage and it’s really helpful. Then I might say, “Terry let’s put a little shot in your hip today, I will use cold spray a little pin stick and some Novocain in your hip to numb it up and see how it feels”. If your pain goes away, I tell people it’s like a door with a squeaky hinge, if you pick the right hinge with WD-40 and it stops squeaking, that’s the problem, right?

Terry: How long does a shot like you said usually last?

Dr. Urse: If you use just Novocain, it will wear off in about six hours like your lip at the dentist. If you say let’s put something good in there to help with the swelling we can put a steroid called cortisone with the Novocain and then you would say wow I feel better, well then you go home and the Novocain wears off, but the cortisone may kick in for months and then you have something that might just treat the problem. So, we not only know it’s in there, but that might be all you need, just a shot since you over did it and inflamed the lining of the hip and there is nothing else that needs done.

Terry: One question I’ve always had about this is it’s the middle of February and its cold. Every bone in by body feels different during this time period, what is it about the weather that causes problems like this to kind of creep in?

Dr. Urse: Well, there certainly is a correlation between temperature, humidity, and dampness. So, when it rains those people with arthritis are going to tell you that it’s going to rain later. There is a reason there are a lot of condos selling in Tucson and Fort Lauderdale. Warmer weather and humidity make joints feel better and if you live in the north in the winter, you’re going to have more aches and pains than someone in Tucson who is sweating to the oldies down there. It is just a matter of humidity sometimes and cold and maybe rain. They always say that joints are a good barometer for weather and some of it is probably barometric pressure and things like that but is probably useful to look at what you or your animals are doing during different weather changes.

Terry: So now that we have talked about the hip and hip problems and how you diagnose hip problems, how do you treat them?

Dr. Urse: Well, that is one of the things I do quite frequently. I do this procedure called hip arthroscopy where we look into the hip with a light, but it involves a little more than a usual scope. You have probably heard of scoping a knee or shoulder when you have a meniscus tear or loose body or maybe your rotator cuff is torn in your shoulder, and we look in with a light and stitch it. We look into the hip also, it’s just that they’re harder to do and that’s why fewer doctors do them. We put you on a table and we have to put a boot, like a ski boot on your foot and literally pull your hip partway out with traction. You are asleep for this since your muscles need to be relaxed for us to pull the hip partway out. When we do this, we use x-ray to put our instruments in the joint and see what is wrong. If it is the torn labrum which is the gasket and a very important seal for the hip, we then do everything we can to repair that and put stitches in it. By repairing that it usually fixes their pain pattern, and we hear that pretty quickly from people after surgery. The most important part of the procedure is why did the labrum tear? So that is the part where we have to say is there a bone spur rubbing on it from above or below and that is where the FAI comes from. It could be that you have an overhang like an icicle that pinches when you move your hip up or it could be a bunion on the thigh bone called a cam lesion or bunion, we call it. That could be bumping when you raise your leg up and either way it impinges or rubs on that labrum. Another part of the surgery is taking a bone bur and smoothing that bump away much like a foot surgeon would fix your bunion so you could wear shoes better. That procedure is done through a scope or it could be done open, in some parts of Europe they open up your hip and pop it out of place and then reshape it, fix the labrum and put your hip back in and put a little screw through the outside and you’re in the hospital for three days and on crutches for three months. So, we do those through a scope and it’s a pretty detailed procedure, but the people that do those do a fair number of those and I think that is a way to preserve the hip and reshape it. There are other things we do in the joint that address loose bodies or cartilage wear that let us see that cartilage to know how much arthritis does this hip have. We hope we know from our imaging studies, but nothing replaces looking directly at the hip and if there is a lot of wear and tear in the hip then we really don’t like to do hip arthroscopies, because we say that you’re going to need a new hip someday. It’s kind of like that car in Cuba, you want to keep it running for as long as you can, but if it’s not getting you from point A to point B and if you can’t sleep, if you can’t enjoy your life because of your hip and your hip arthritis is too severe then we should talk about those hip replacements and what they can do for your lifestyle changes.

Terry: So, if you’re doing ten operations a week, how many would be the hip replacement versus the hip labrum repair?

Dr. Urse: Probably two or three hip replacements and probably seven labrum repairs. Most people are under 60 years old and have hip problems from ages 20-60 frequently. Those are the good times to fix the hip, just like knee scopes. Some people have their knee scoped once every ten years if they get a piece of gravel or a torn meniscus, it’s like taking your car in to keep it going so I don’t have to replace my car. When you get to a point where your hip is too worn out then I talk to you about the options of a hip replacement and what that can do for your lifestyle and how long that may help you.

Terry: So how long do hip replacements last and walk me through the process of getting one?

Dr. Urse: Well, if we did that office exam and I looked at your x-rays and said, “Terry you’re close to bone on bone in your hip” I would say you have three or four options. Some of our other podcasts talked about those some of them would be to try something other than cortisone, which is fast acting, but not very long lasting. One of them might be a PRP or stem cell injection, which use your own bodies biology, they’re called ortho-biologic’s. They have anti-inflammatory properties and cartilage growth factors in the stem cells that can help you delay a joint replacement. You may say I am in my fifties, and I don’t really want a joint replacement can I try an injection of my own bodies stem cells to delay surgery and I would say sure, it’s a great option. My wife had a bad hip five years ago and I took her to a guy, because I wasn’t going to work on it, and he said you need a new hip and she said no thanks, I don’t want one. I put stem cells in her hip five years ago and she still hasn’t had her hip replaced to this day. Her x-rays don’t look great, but she doesn’t care because she is walking around and doesn’t use a crutch or take medicines. For her this was a great option, and she knows someday she is going to have a hip replacement. If you said, what else can we do besides a stem cell injection? We can do physical therapy, we can get a lightweight hip brace, but these are not going to solve the problem in the joint. A hip replacement gets rid of the arthritis in the joint and you have a new ball and socket, and it has just been recognized as the number one lifestyle changing procedure in medicine, reconstructive hip surgery. Of all the things we do in medicine, people are more impacted by a hip replacement than any other surgery. It’s the number one satisfaction surgery in orthopedics, in fact mental health changes are second and cataract surgery is third. I tell people if you have a bad hip talk to your doctor and say tell me about a hip replacement, what is involved? It’s a big surgery and there are a couple different ways we do them, we can do them from the back with a pocket incision, some people have them done from the side and there is a newer approach anteriorly between the muscles. We do it with either imaging guidance or robotics to help us put them in more accurately. People get up and walk right away and most people have the option to go home the same day they have the hip replacement. Therapy will come to your house every day for the first few weeks, and you get up and walk on it. Most people just get up and go, they have been miserable for a long time, and you put a new joint in, and most people are pretty happy afterwards. Certainly, the surgery needs a long discussion to know about taking antibiotics to prevent infection, using some blood thinners to prevent blood clots, making sure your heart and lungs are good for the surgery and we have anesthesia see you ahead of time and in this day and age you get a Covid test two weeks ahead of time. Obviously for that reason and all the hospitalization issues, we try to avoid keeping you in the hospital. So, if we can make your pain comfortable, control your nausea, then we do the surgery, we have therapy see you right after surgery and if you’re walking that day then you can go home that day. You can do your therapy at your house with your pillow and your surroundings, and we think that’s a great way to go.

Terry: So, is there an age where you say ok, you’re probably too old to be doing a hip replacement because of the risk outweighs the benefit.

Dr. Urse: I would say that age in my book is around 90 years old. I am telling you that there are people in their eighties that if they’re healthy enough and their heart and lungs are good there is no reason you wouldn’t consider a hip replacement. I have done hip replacements on people who are ninety years old, and they were healthy, and their heart and lungs were good, and their lifestyle was miserable, and they were cleared. I tell people it’s like flying an old plane, sometimes if you take it to the hanger and they give you the green light that its running fine and that person is in good health, you can’t just say well your ninety and so I can’t fix your hip. You’ve got a limp, use a cane, and try to take Motrin that is going to burn a hole in your stomach. Honestly, I would rather you tell me it’s a lifestyle problem for you and it’s bad enough that I need this, and then I am going to have my internal medicine doctor and my anesthesia doctors look you over, check your bloodwork and tell me if this is a safe procedure. If it is, we will sometimes do a spinal where we put the legs asleep, and you don’t need to have a tube in your throat and you get up and go after the procedure. Again, I think it’s a decision that the patient and the doctor make on an individual basis.

Terry: Ok, as we near the end of this podcast, I’m sure there are things we didn’t cover that you feel are important to get out there to the listener. What are some things that they should know about hip issues, hip replacements, and hip treatments?

Dr. Urse: Well, I think they should know that there are a lot of mimickers of hip pain. The back and we talked about pinched nerves, sciatic nerve, and the sacroiliac joint. There are things that aren’t the hip so you have to say could this be my hernia, a prostate problem, my back, or some other things like hip flexor tightness from doing hurdles and it’s just a muscle strain, it isn’t in the joint and an MRI might show that. You will want to have your doctor put a shot in your hip and see if that helps, because over 90% of the time you will get a benefit from a shot in the joint and that tells you it’s in there or it isn’t in there. If it is not, then you can move on and say let’s image my back and make sure it isn’t a pinched nerve or ruptured disc or my SI joint is off from childbirth, and I just need to see my chiropractor to get my SI joint adjusted. I think you want to know what is wrong so getting an x-ray, get a good exam and get a diagnosis. I always tell people that if you get a good diagnosis, you can google what to do with the problem, but if you don’t know what it is then you don’t even know what to put in the google search box.

Terry: The family doctor is not going to be able to pick out these typical issues, or will they refer you out?

Dr. Urse: They are pretty smart. I think what family doctors are good at is they know their patients. They will say what is your problem and let’s get an x-ray. A lot of times the x-ray will tell you a lot or they will say you know your x-ray doesn’t show much, but you look like you’re hurting, and they will send us a referral and they will get a consult. A consult just means I am seeing you and will say, Terry let me look at your x-rays and I may get a couple different special x-rays and I will examine you and may put a shot in the joint. I may say, “hey, how’s that feel?”, and you might say that’s the first time the pain in my butt has been gone in three years. I would then say that it probably is something in your hip and let’s go get an MRI and go a step further and talk about your options of if a scope will help or whether you want to have a cortisone shot every six months and keep working on your house you’re building. I think you just follow a progression. I think the chiropractors that I know do a great job seeing things that they’re helping and when they’re really not getting anywhere, they’ll say I think this is a hip problem and will send it to an orthopedic surgeon for a consult. I then like to send the patient back to the chiropractor for therapy after a scope and they get their patient back and we all work together to get the patient better and that is really what medicine should do.

Terry: Well Dr. Urse I think this has been an amazing conversation and I feel much more “hip” about the topic of hips. I want to thank you for doing this and if you want to leave the listeners with a final comment feel free.

Dr. Urse: I will just say thanks for doing this Terry, we do have this podcast listed on Spotify and DrJohnUrse.com. You can see some of the podcasts and read some of the blog articles that have information about hips and hip arthroscopy and some information about the stem cells and PRP at DrJohnUrse.com.

Terry: Alright DrJohnUrse.com thanks for joining us today.

Dr. Urse: Thanks, Terry.

Thank you for joining us today on this episode of The Bone and Joint Playbook with Dr. John Urse, Tips for Pain-free Aging. Please join us again for another episode. This has been a production of Doctors Unmasked, produced by Terry O’Brien.