Managing Hip Joint Necrosis: Tips for Pain Relief and Mobility

Hip joint

Symptoms: Left hip joint necrosis, pain while walking, leg length discrepancy (limping), orthopedic surgeon recommends joint replacement.
Due to age factors, planning to endure as long as possible before undergoing replacement.
Questions: (1) Regarding the leg length discrepancy (limping), would custom shoes (or inserts) be suitable for my current condition without worsening it, and could they help prolong the use of the damaged joint? Where should I purchase them? (2) If I want to increase related muscle strength to reduce pelvic tilt, what exercises should I do? (3) Are there any methods to help me extend the time I can manage?

athe, 30~39 year old female. Ask Date: 2010/04/28

Dr. Shi Guozheng reply Orthopedics

Custom-made insoles can be beneficial and can be ordered from stores that provide crutch supports or prosthetics.
Exercises for thigh extension, adduction, abduction, and flexion can be performed to strengthen the muscles.
If the degree of joint necrosis is not severe, considering the use of the medication Fosamax may help alleviate the condition.

Reply Date: 2010/04/28

More Info

Managing hip joint necrosis, particularly when it involves pain and mobility issues, can be challenging. Here are some insights and recommendations based on your symptoms and situation.

1. Addressing Leg Length Discrepancy (Limping)
When dealing with leg length discrepancies, custom orthotics or shoe inserts can indeed be beneficial. They can help balance the pelvis and reduce the strain on the hip joint, potentially alleviating some pain and improving your walking pattern. However, it’s crucial to ensure that these orthotics are designed specifically for your condition. Consulting with a podiatrist or an orthopedic specialist who can assess your gait and provide tailored recommendations is advisable. They can help you find a reputable place to get custom orthotics made, which may include specialized shoe stores or clinics that focus on foot and ankle health.

2. Strengthening Muscles to Reduce Pelvic Tilt
To counteract the effects of hip joint necrosis and maintain mobility, strengthening the muscles around the hip and pelvis is essential. Here are some exercises that can help:
- Hip Abduction Exercises: Lying on your side, lift your top leg straight up while keeping it aligned with your body. This strengthens the gluteus medius, which helps stabilize the pelvis.

- Bridges: Lying on your back with your knees bent, lift your hips towards the ceiling while keeping your shoulders on the ground. This exercise strengthens the glutes and hamstrings.

- Clamshells: Lying on your side with your knees bent, keep your feet together and lift your top knee while keeping your feet in contact. This targets the hip abductors.

- Wall Sits: Lean against a wall and slide down into a sitting position, holding for as long as comfortable. This strengthens the quadriceps and stabilizes the knee and hip.

Always consult with a physical therapist before starting any new exercise regimen, especially given your condition. They can provide a personalized program that considers your limitations and goals.

3. Extending the Time Before Surgery
To prolong the use of your hip joint before considering surgery, consider the following strategies:
- Weight Management: Maintaining a healthy weight can reduce the load on your hip joint, potentially slowing the progression of necrosis.

- Low-Impact Activities: Engage in low-impact exercises such as swimming or cycling, which can help maintain cardiovascular fitness without putting excessive strain on your hip.

- Pain Management: Over-the-counter pain relievers like acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain. However, consult your doctor before using them regularly.

- Physical Therapy: Regular sessions with a physical therapist can help you learn how to move more efficiently and safely, which can reduce pain and improve function.

- Assistive Devices: Using a cane or walker can help offload pressure from the affected hip, making it easier to walk and reducing pain.

Conclusion
While the prospect of hip joint replacement surgery may seem daunting, there are several strategies you can employ to manage your symptoms and maintain mobility in the meantime. Custom orthotics, targeted strength training, and lifestyle modifications can all play a role in extending the functionality of your hip joint. Always work closely with your healthcare providers to ensure that your management plan is safe and effective for your specific condition. If your symptoms worsen or you experience significant changes in mobility, it may be time to reconsider surgical options.

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