August 2022 — By Cherie Binns
As to the hip replacement question, most people will never need a hip replacement.
I see many on social media sites for people with MS asking the questions, “Is hip pain caused by MS?” or “I’ve had this pain in my hip for so long. Should I get a hip replacement?” I’d like to respond to both of these questions as both a medical professional and as a person with MS who has dealt with hip pain for the better part of the past 30 years.I was in an automobile accident in 1993 that totaled my car and injured all four of us that were in it. I was left with chronic bursitis in my left hip that lasted for years. Once I was diagnosed with MS and was sent to a physical therapist for a gait evaluation, I was told that I had foot drop on the left side and it may be contributing to my hip pain and also to the lower back discomfort that seemed to be always present. Addressing the foot drop first with Foot-Flexr and eventually with an ankle foot orthotic, the bursitis I had lived with for nearly a decade resolved. A resumption of that discomfort now tells me I need to go back to using one of the corrective measures until the discomfort resolves. Additionally, the PT gave me a series of easy exercises to strengthen the foot flexors in my leg and some stretches to keep spasticity better managed so that the muscles of my upper leg would not continually pull on the attachments of the hip and worsen that discomfort.Physical therapy is essential for those of us living with MS who have any gait issues, spasticity, pain, or a history of falls. Currently there are several hundred PTs who now are trained as MS certified specialists throughout the U.S. and Canada. These individuals are well aware of the unique issues people with MS face with exercise and rehabilitation programs and know how to prevent muscle fatigue and issues with heat intolerance that may negatively affect the individual. While we may be given handouts showing us how to do an exercise that is recommended for us, the PT will pick and choose from many such exercises to tailor a program just for you. They may switch it up adding and subtracting components of your program as you improve. Be sure and let them know if something is painful or difficult to do and they can also show you ways to achieve what is needed without that discomfort.As to the hip replacement question, most people will never need a hip replacement. If you have had regular high-dose steroids over the years (More than eight or 10 doses of 1000 mg of IV Solumedrol or 1250 mg of oral prednisone annually) you could be at risk for a condition known as hip necrosis. Steroids can cause bone thinning and deterioration over time, especially in women and those individuals who are carrying an extra 40 or 50 pounds of weight over their ideal body weight. Those who have had injuries to the hip from falls or accidents may also have a greater risk of deterioration and those with additional conditions such as rheumatoid arthritis and osteoarthritis may lose integrity in the hip joint and need replacement. Generally, in individuals living with MS, unless there are these other factors in place, we may never need a new hip.I spoke with the orthopedist who does the greatest number of hip replacements in our state. He told me his protocol for determining who needs a new hip is gradual – in steps from noninvasive to more invasive methods – to diagnose and treat prior to actually replacing a joint. He starts with a simple X-ray to determine if there are fractures present that could be causing pain. Sometimes, if the hip is deteriorating, he will see small bone fragments in the joint space and that will tell him right out of the gate the individual is a candidate for surgery. Next, he refers the person to a PT for evaluation and treatment of the hip pain. Following that, if there is no improvement, he orders an MRI of the hip with contrast that is injected into the hip space by a radiologist using fluoroscopy-guided imaging prior to the MRI. He may also give the individual the option for a steroid injection into the hip to see if that relieves pain.I have been through that entire process because of the chronic pain I have experienced. The MRI, with contrast, showed only mild, age-related degeneration of the joint that does not yet require a hip replacement. My pain is predominantly in the outer area of the hip where the joint enters the hip socket. Most pain from deterioration is actually felt most intensely in the groin and not the outer hip.If these questions are still troubling you, may I suggest you schedule an evaluation with a physical therapist and follow their guidance. If a replacement seems like a possibility, they will facilitate getting you to the appropriate doctor and you will have developed a relationship that will get you started in your post-op recovery period.
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