Ask Dr. Nestor: What Can I Expect During A Hip Evaluation?

Summit orthopedic surgeon Dr. Bryan Nestor specializes in arthritic hip conditions and has more than two decades of experience evaluating patients who are considering a hip replacement. He explains exactly what patients can expect during their evaluation.

A painful hip and the prospect of surgical treatment can be unsettling. Dr. Nestor takes the time to educate his patients about their condition and their treatment options during their initial evaluation.

“My practice has always been focused on people with arthritis of the hip and knee,” he explains. “Probably 60 to 70 percent of the patients I see have already been managed conservatively, and know that they are at the point where they need a joint replacement. Whenever I do an evaluation, I take my patient through a series of steps to gather information and provide education, so that we can make informed decisions together.”

  • When a patient with a hip problem comes in, Dr. Nestor’s first question is ‘How is your pain?’ “I ask them to rate their pain on a scale of 0 to 10: ‘What number would you give your pain on average, taking your level of activity into consideration?’”
  • Next, Dr. Nestor identifies the source of the pain: is it in the front, the groin, the thigh, or around the knee? “Ten to fifteen percent of patients have pre-tibial pain with hip arthritis,” he explains. “I also want to confirm that the pain is generated in the hip, and not in the back.”
  • Functional restrictions are discussed. “Can you reciprocate stairs—can you take a step with one foot, and then raise your other foot to the next step, or do you need to pause with both feet on the same step before continuing?” Dr. Nestor explains. “How far can you walk? Could you walk six city blocks? Over a mile? Do you walk with a limp? Do you use a cane or other assisting devices? What’s the severity of the limp?”
  • Nestor asks his patient to put on shoes and socks. “Some people lose flexion and internal rotation, which makes shoes and socks a struggle,” he explains.
  • A physical exam is performed, which includes watching the patient walk outside the room. “You can learn a lot by watching gait,” says Dr. Nestor. “I also examine the patient’s range of motion and leg length.”
  • X-rays are reviewed and explained. “I’ll point out the hip joint on the x-ray, and show them where the cartilage at the ends of the bone is gone,” he says. “When cartilage is gone, bone is rubbing against bone when they move, causing pain.”
  • Finally, Dr. Nestor discusses treatment choices. For patients who’ve already been managed conservatively, those choices are straightforward. “You can continue taking anti-inflammatories and perhaps using a cane,” says Dr. Nestor. “At this point, physical therapy isn’t necessarily helpful. There’s a benefit with arthritis to maintaining muscle tone and range of motion, but exercise may also aggravate the arthritis. Your other alternative is a total hip replacement. If you are ready to consider surgery, I’ll talk about what surgery involves.”

Understanding what to expect can take some of the uncertainty out of your visit, and better prepare you for your evaluation. The most successful patient-doctor collaborations are built on medical expertise, patient awareness, and informed communication about priorities and concerns.

 

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