Non-Surgical Treatments

Hip Injections

Hip joint injections involve injecting medicine directly into the hip joint to diagnose the source of pain or treat pain due to conditions such as arthritis, injury or mechanical stress of the hip joint. Hip pain may be experienced in the hip, buttock, leg or low back. The injection contains a combination of a numbing medicine and cortisone (an anti-inflammatory agent). Numbing medicine delivers temporary relief from pain, provided the hip joint is the source of the pain. It thus serves a diagnostic function and helps to confirm or deny whether the joint is the source of pain. Cortisone serves to reduce the inflammation in the joint providing long term pain benefit.

Procedure

If needed, a relaxation medicine is given to the patient through an IV line. The patient lies face down on an X-ray table. The small area where the injection needs to be given is numbed with an anesthetic. The patient may feel a sting for a few seconds. A small needle is then accurately placed by the doctor into the joint guided by the real-time X-ray images (fluoroscopy). Before injecting the medicine, a contrast dye is injected through this needle into the joint to confirm that the medicine will reach the joint. A combination of anesthetic and anti-inflammatory cortisone is then slowly injected into the joint. The whole procedure usually takes about 30 to 60 minutes.

After the procedure

After the injection, the patient is made to rest for 20 to 30 minutes and is then asked to move the joint, provoking pain. The patient may or may not find a decrease in pain depending on whether the injected joint is the main source of the pain. The patient is also asked to maintain a record of relief in pain during the coming week. Physical therapy may also be recommended. Even when pain relief is significant the patient should increase activities gradually over one to two weeks to avoid reappearance of pain.

Risk and complications

The possible risks of hip injections include: swelling and pain in the joint after the injection, infection, depigmentation of skin, local thinning of the skin and rupture of a tendon.

If the injected hip joint is the source of the pain, the pain may reduce two to five days after the injection. However, if no improvement is found within ten days after the injection further diagnostic tests may be required to ascertain the cause of pain.

Physiotherapy

Physiotherapy or physical therapy is an exercise program that helps you to improve movement, relieve pain, encourage blood flow for faster healing, and restore your physical function and fitness level. The main aim of physical therapy is to make your daily activities, such as walking, getting in and out of bed, or climbing stairs, easier. It can be prescribed as an individual treatment program or combined with other treatments. Physiotherapy is usually ordered to help you recover after certain surgeries, injuries and long-term health problems such as arthritis.

A physiotherapist will examine your symptoms and daily activities, and make a treatment plan, which primarily focuses on reducing your pain and swelling. The different procedures used by your therapist depend on your specific physical ailment. Physical therapy involves a combination of education, manual therapy, exercises and techniques. Some of the procedures commonly used are:

  • Stretching exercises: Surgery, age and conditions, such as arthritis and osteoporosis, can cause inflammation and stiffness in your joints and muscles, and restrict your movement. Physiotherapists guide you step by step to stretch certain areas of your body to restore flexibility, and enhance the movement of joints and muscles.
  • Core strengthening and stability exercises: Specific exercises are designed to make the core (pelvis and lower back) strong enough to support the whole body.
  • Ice and heat: Applying heat or cold treatment on muscles can stimulate the blood flow and reduce swelling. Heat treatment helps to reduce joint pain and spasm in the lower back and neck, and loosen muscles. Cooling works best for ankle sprains.
  • Ultrasound: An ultrasound sends high frequency sound waves over your body and stimulates deep body tissues. Vibrations produced by sound waves help to stimulate blood flow and facilitate the healing process. This procedure can also be used to improve metabolism and enhance the adhesiveness of bones after a fracture.
  • Electrostimulation: In this procedure, an electric current is passed through the area which requires treatment. This helps in relieving pain, stimulating muscles and nerves, and expanding blood vessels.

These treatments may cause mild soreness or swelling. You can talk to your therapist in case it is prolonged.

Platelet Rich Plasma Therapy

Our blood consists of a liquid component known as plasma. It also consists of three main solid components which include the red blood cells (RBCs), white blood cells (WBCs), and platelets. Platelets play an important role in forming blood clots. They also consist of special proteins, known as growth factors, which help with our body's healing process. Platelet-rich plasma or PRP is a high concentration of platelets and plasma. A normal blood specimen contains only 6% platelets, while platelet-rich plasma contains 94% of platelets and 5 to 10 times the concentration of growth factors found in normal blood, thus greater healing properties.

Indications

PRP is a relatively new method of treatment for several orthopedic conditions such as muscle, ligament, and tendon injuries; arthritis; and fractures. PRP injections can help alleviate painful symptoms, promote healing and delay joint replacement surgeries.

Procedure

Your doctor will first draw about 10 ccs of blood from the large vein in your elbow. The blood is then spun in a centrifuge machine for about 10 to 15 minutes to separate the platelets from the remaining blood components.

The injured part of your body is then anesthetized with a local anesthetic. The platelet-rich portion of your blood is then injected into your affected area. In some cases, your doctor may use ultrasound guidance for proper needle placement.

Post-Procedural Care

  • It is normal to feel some discomfort at the injection site for a few days after your procedure.
  • You will be prescribed pain medications by your doctor.
  • You may use cold compresses to alleviate your symptoms.
  • You will be instructed to stop any anti-inflammatory medications.
  • You may resume your normal activities but should avoid any strenuous activities such as heavy lifting or exercises.

Risks and complications

There are very minimal risks associated with PRP injections. Some of the potential risks include

  • Increased pain at the injection site
  • Infection
  • Damage to adjacent nerves or tissues
  • Formation of scar tissue
  • Calcification at the injection site

Stem Cell Therapy

Introduction

Stem cell therapy is a form of regenerative medicine that utilizes the body's natural healing mechanism to treat various conditions.

Stem cells are being used in regenerative medicine to renew and repair diseased or damaged tissues, and have shown promising results in treatments of various orthopedic, cardiovascular, neuromuscular and autoimmune conditions.

Stem cells are present in all of us acting like a repair system for the body. However, with increased age sometimes the optimum amount of stem cells is not delivered to the injured area. The goal of Stem Cell therapy is to amplify the natural repair system of the patient's body.

Types of Stem Cells

There are two major types of stem cells embryonic stem cells and adult stem cells. Embryonic stem cells (ESCs) are stem cells derived from human embryos. They are pluripotent, which means they have the ability to develop into almost any of the various cell types of the body.

As the embryo develops and forms a baby, stem cells are distributed throughout the body where they reside in specific pockets of each tissue, such as the bone marrow and blood. As we age, these cells function to renew old and worn out tissue cells. These are called adult stem cells or somatic stem cells. Like embryonic stem cells, adult stem cells can also replicate into more than one cell type, but their replication is restricted to a limited number of cell types.

Use of Stem Cells in Orthopedics

The unique self-regeneration and differentiating ability of embryonic stem cells can be used in regenerative medicine. These stem cells can be derived from eggs collected during IVF procedures with informed consent from the patient. However, many questions have been raised on the ethics of destroying a potential human life for the treatment of another.

Adult stem cells are most commonly obtained from the bone marrow, specifically the mesenchymal stem cells, which have the ability to replicate into cells that form the musculoskeletal system such as tendons, ligaments, and articular cartilage. They can be obtained from the iliac crest of the pelvic bone by inserting a needle and extracting the stem cells from the bone marrow.

Currently, stem cell therapy is used to treat various degenerative conditions of the shoulder, knees, hips, and spine. They are also being used in the treatment of various soft tissue (muscle, ligaments and tendons) as well as bone-related injuries.

Who is a Good Candidate for a Stem Cell Procedure?

You may be a good candidate for stem cell therapy if you have been suffering from joint pain and want to improve your quality of life while avoiding complications related to invasive surgical procedures.

Preparing for the Procedure

  • It is important that you stop taking any non-steroidal anti-inflammatory drugs (NSAIDs) at least two weeks before your procedure.
  • Preparing for a stem cell procedure is relatively easy and your doctor will give you specific instructions depending on your condition.

Stem Cell procedure

The procedure begins with your doctor extracting stem cells from your own bone marrow. Bone marrow is usually aspirated from your hip region. Your doctor will first clean and numb your hip area. A needle is then introduced into an area of your pelvic bone known as the iliac crest. Bone marrow is then aspirated using a special syringe and the sample obtained is sent to the laboratory. In the laboratory, the aspirate is spun in a machine for 10 to 15 minutes and a concentrated stem cell sample is separated.

Your doctor then cleans and numbs your affected area to be treated and then, under the guidance of special x-rays, injects the stem cells into the diseased region. The whole procedure usually takes less than one hour, and you may return home on the same day of the procedure.

Post-Operative Care

  • You will most likely be able to return to work the next day following your procedure.
  • You will need to take it easy and avoid any load bearing activities for at least two weeks following your procedure.
  • You will need to refrain from taking non-steroidal, anti-inflammatory medications (NSAIDS) for a while as this can affect the healing process of your body.

Advantages & Disadvantages

  • Stem cell therapy is a relatively simple procedure that avoids the complications associated with invasive surgical procedures.
  • As stem cell therapy uses the cells derived from your own body it reduces the chances of an immune rejection.

Disadvantages

  • The disadvantage of adult stem cell therapy is lack of data about its long-term effects as it is a newer evolving therapy.

Risks and complications

Stem cell therapy is generally considered a safe procedure with minimal complications, however, as with any medical procedure, complications can occur.

Some risks factors related to stem cell therapy include infection as the stem cells may become contaminated with bacteria, viruses or other pathogens that may cause disease during the preparation process.

The procedure to either remove or inject the cells also has the risk of introducing an infection to the damaged tissue into which they are injected. Rarely, an immune reaction may occur from injected stem cells.

  •  Precision Orthopedics & Sports Medicine
  • Arthroscopy Association Of North America
  • American Academy Of Orthpaedic Surgeons
  • The American Orthopaedic Society For Sports Medicine
  • International Society For Hip Arthroscopy
  • Texas Health Harris Methodist Hospital Southlake
  • Baylor Medical Center At Trophy Club
  • Baylorscott And White Medical Center Grapevine
  • Baylorscott And White Medical Fort Worth
  • Medical City Arlington
  • Precision Ortho Express