Hip pain: an important component in the whole decision whether to operate or not
With hip problems and increasing limitations the pain that you also experience can be estimated and compared with a known scale. Surgeons use the pain as experienced under certain conditions and activities plus any position limitations of the leg to determine the need for a possible operation. Pain and how it is experienced is very personal but we can usually imagine us a simple scale of 0-10 and grade our pain with the aid of this scale. This scale is called “VAS” or “Visual Analogue Scale, see the picture below.
Apart from the VAS scale sometimes the VRS (Verbal Rating Scale) is used,even the RWS (Red Wedge Scale), BS (Box Scale), BRS (Behavioural Rating Scale) and FAS (Functional Activity Score). Each scale has its own range and application where is most suitable. For example hip patients that can not express their our pains in the common way and can’t be graded via the VAS scale can be estimated by a surgeon using the FAS or BRS scale. In that last situation the patient is observed and the responses are noted during different activities and with the leg in different positions, showing up limitations as the pain increases. The Box Scale can be compared with the VAS scale but now each figure is placed in a square that a patient can point at to mark the experienced pain level, see the picture below.
On top of your pain even your decreased flexibility in the joint, possible limitations in your work and every day living, your leisure time, sports, plus the added information from examinations with, MRI, CT-Scan, ultrasound, DEXA-scan and possibly more will determine how the surgeon will respond.
Orthopedic surgeons have access to more methods to establish how severe the situation is. A well-known grading method is the “HHS” or “Harris Hip Score”, that tries to account for the patient’s whole life with all the daily activities and how this negatively influenced by the hip problem, hip pain is an integrated component in this system. There is an “on line” version of the Harris Hip Score <-click on the link. You can test yourself with the help of the Harris Hip Score how serious your situation is and report your surgeon the score that you found.
En variant of the “HHS” is ther “OHS” or “Oxford Hip Score”, an on-line version is found here: http://www.orthopaedicscore.com/scorepages/oxford_hip_score.html
Our neigbours in Denmark developed their own grading system: “HAGOS” (the Copenhagen Hip and Groin Outcome Score).
Hip pain and the increasing limitations in the range of movement of the hip are clear signals that something is wrong and that you should not continue in the same way. Your next step should be to contact a doctor who in turn can write a referral for an x-ray examination. This doctor does not have to be an orthopedic surgeon, who normally takes months to come in contact with. Your general practitioner is at this stage all that is required. You would be wise to order copies of the x-rays that will be taken (burned for you to a CD), so that you will have the freedom to contact several specialists with the images. If you include me as receiver of your message with images I will do my best to give you my opinion and if wished I will also contact some of the orthopedic surgeons in my network for second opnions over your case.
In any case you should realise that you do probably only have limited time on your hands if you wish a hip resurfacing prosthesis. Only patients that have come in good time and before the hip is completely worn and destroyed are candidates for hip resurfacing. There is a clear threshold and once you pass this you may be forced to accept a traditional hip prosthesis. If you feel that you already are in this grey zone you are invited to contact me without delay for an indication if this is really true.
Your hip pain should never be accepted as a normal part of your life, no one should have to live with pain!
Meanwhile in the time leading up to a possible hip operation you can test if any products like glucosamine or chondroitine can help to dampen your complaints. Glucosamine exists in different variants, like a sulphate and chloride and possible mixes with for example chondroitine and MSM. You have to expect that you need to use the specific tablet some weeks before the effects will be noticed, so don’t quit too quick! These products are almost harmless but because they may contain shellfish they can be a problem for people with an allergy. The week prior to your operation you will have to quit taking these tablets, some painkillers and other supplements. Some of them are known to interact with the anaesthetic or medication that is given during the operation. Always request the opinion of your surgeon if you wonder if the specific medicines and supplements that you commonly take may be a problem.