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FirstHealth of the Carolinas
The hip By Dick Broom

The top of the thigh bone is shaped like a ball and fits into a cup-shaped socket in the pelvis. A capsule formed of ligaments connects the ball to the socket and allows the leg to move in various directions without the joint coming apart.

The surfaces of both the ball and socket are covered with cartilage. If the cartilage weren’t there, the friction of bone rubbing against bone would cause the surrounding tissue to become painfully inflamed.

The muscles that move the leg are attached to the bones of the hip by tough, cord-like tendons.

A common misconception about the hip joint is its location. Most people think it is higher up and farther to the side than it is. So when we are told to put our hands on our hips, we usually put on hands on top of the pelvis.

The hip joint is actually deep in the groin.

Orthopaedic specialists frequently see women with hip problems who have been to their OB/ GYN physician because of pain in their groin. And men with hip pain often think they have a hernia.

On the other hand, it is common for people to go to an orthopaedic surgeon with what they are sure is a pain in their hip when it is actually the sciatic nerve on the side of their buttocks that is hurting.

Arthritis is one of the most common problems that people have with their hips, and we are more likely to develop arthritis as we get older.

“Osteoarthritis is the number one pain-producing hip problem for which people seek help in this community,” says David Casey, M.D., an orthopaedic surgeon with Pinehurst Surgical.

Articular cartilage caps the ends of bones within joints and keeps the bones from rubbing directly against each other. Arthritis is the wearing away of this cartilage. When this cushion of cartilage wears too thin, the surrounding tissue becomes inflamed. This process leads to pain, swelling, stiffness and often grinding noise when the joint is used.

There are two main types of arthritis: osteoarthritis and inflammatory arthritis. Osteoarthritis, caused by wear and tear on the joint, is by far the most common. Inflammatory arthritis, which includes rheumatoid arthritis, is the result of an inflammatory response involving the body’s immune system against soft tissues, cartilage and bone. Destruction of these tissues leads to multiple joint pains, morning stiffness, joint swelling and nodules.

David Casey, M.D.
Jason Guevara, M.D.

Orthopaedic surgeon Jason Guevara, M.D., of the Pinehurst Hip and Knee Center tells patients to think of the cartilage in their hip as the tread on a tire.

“The tread is going to wear down over time, and some people’s cartilage, like some tires, wears down faster than others,” he says. “Patients will come in with the cartilage worn away, and I tell them they’re down to the steel belt.”

Once the cartilage is completely gone, it is similar to having a blowout on the interstate, Dr. Guevara says. “It’s excruciating pain that can put you in a wheelchair,” he says.

A number of factors can cause or contribute to the development of osteoarthritis, according to Dr. Casey.

“Aside from normal wear and tear, there may be certain activities that you engage in, such as high-impact sports, that may cause your cartilage to wear out faster,” he says. “A traumatic injury to your hip or knee can increase your risk for arthritis in those joints as well. Some people appear to have a genetic predisposition toward developing osteoarthritis.”

Dr. Guevara thinks there is also a strong hereditary factor. “I sometimes see three generations of families with osteoarthritis,” he says.

Some people have so much pain and stiffness from arthritis in their hip joints that they require hip replacement surgery.

Running a close second to osteoarthritis as the most common hip problem is bursitis. Bursitis is inflammation of a bursa, one of the fluid-filled sacs that provide a cushion for tendons and muscles as they slide across a bone.

Bursitis is most often caused by overuse of the joint, repetitive motion, direct pressure or trauma, but it also can be caused by inflammatory or infectious conditions. In the hip area, the bursa that is most likely to become inflamed is high up on the outside of the thighbone.

“A lot of people say it hurts to lie on their side or when they move their leg,” Dr. Guevara says. “Sometimes they have shooting pain halfway down their leg.”

Hip bursitis rarely requires surgery. In most cases, it can be treated effectively with anti-inflammatory medications and by stopping or reducing the activity that may have triggered the flare-up.

Patients with severe bursitis pain might need a cortisone injection, which in most cases provides longlasting relief.

Ruth Cummings
Ruth Cummings was grateful that her grandson, his wife and their two young children came to stay with her while she recovered from hip replacement surgery. “They didn’t want me staying all by myself when I first came home,” she says.

Ruth Cummings suffered with severe arthritis pain for more than two years before she had hip replacement surgery late last year.

But after just a few weeks, she told them they could go back to their own home, that she would be just fine on her own.

“They’ve got two little boys, and I love them to death, but, boy, are they rowdy,” she says. “I enjoy peace and quiet.”

Cummings, 75, lives between Carthage and Vass in Moore County. She got her new right hip a couple of weeks before Christmas last year. Her surgeon was David Casey, M.D., an orthopaedic surgeon with Pinehurst Surgical.

Dr. Casey performs joint replacement and other orthopaedic procedures at FirstHealth Moore Regional Hospital in Pinehurst and FirstHealth Richmond Memorial Hospital in Rockingham.

Cummings says she had suffered with severe arthritis pain for more than two years before having her hip replacement surgery.

“My leg and hip were killing me every time I tried to get up and move around,” she says. “The pain was excruciating.”

The day after her surgery, she was up and gingerly walking around. She spent four days in the hospital, then a week at a rehabilitation facility.

“Therapists came out to my house for about a week after that,” she says, “but then they said I didn’t need them anymore.”

Six weeks after her surgery, Cummings was feeling wonderful.

“It feels so good to walk around the house and not hurt with every step,” she says. “Dr. Casey gave me some pain pills, but they are still in my pocketbook, because I didn’t hurt after he got rid of the problem.

“I tell everybody I’m so proud of my new hip. I wouldn’t take anything for it.”

Rhonda Chappell
Rhonda Chappell was born without a left hip socket. She wore braces on her leg until she was 5, when she had surgery to create a socket.

“I was fine for a long time after that, but as I got older, osteoarthritis set in and the joint started deteriorating,” she says. “I started limping terribly and was having a lot of pain.”

Rhonda Chappell enjoys a walk with her dog Millie. Within months of getting a new hip last year, Chappell was walking around New York City and Disney World.

In January 2007, Jason Guevara, M.D., of the Pinehurst Hip and Knee Center replaced her worn-out hip with a brand new one. Dr. Guevara performs joint replacement and other orthopaedic procedures at FirstHealth Moore Regional Hospital.

Six months after Chappell got her new hip, she was walking around the Big Apple.

“My daughter graduated from high school last year, and her aunt and cousin and I took her to New York, and we walked all over the place,” Chappell says. “Before the surgery, I would have been lagging behind the others, limping and dragging that leg.”

Last December, she took her two teenage children to Disney World, where they walked for hours.

“It has made a world of difference,” she says of her new hip. “I have no pain, and I don’t limp.”

Chappell, 47, lives in Moore County between Candor and Eagle Springs. Her husband raises peaches, and she tends their roadside stand. Last year’s peach crop was ruined by a late freeze, but she has high hopes for this year.

“I’m ready to work,” she says.