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