My aching knees! Or is it actually my hip? Understanding where joint pain comes from.

Most people experience joint pain at some point in their lives but interestingly, many people don’t actually know where their joint pain comes from.

“There are times when a patient comes in with knee pain but after looking at the X-rays, the knee looks fine but hip joint is worn out. The pain is actually being referred from a hip issue – not the knee,” said Dr. Smith, Chief of Arthroplasty at Tufts Medical Center in Boston. “Pain flows downhill so to speak, meaning that in some cases, a hip injection or a hip replacement is going to solve knee pain.”

Diagnosing the cause of your joint pain

Diagnosing the cause of joint pain can be challenging, and in most cases a careful history and examination can determine where it stems from. Orthopedic surgeons can do a “diagnostic injection” of pain medicine to see if it cures the problem in a particular joint. This procedure can help determine where your pain might be coming from and is done right in the office. It’s simple, inexpensive, and minimally invasive; and the results can be powerful.

After a thorough physical examination, reviewing your xrays, and in some cases, reviewing the results of your diagnostic injection, a clear picture starts to emerge on where the pain is coming from.

If there is degeneration of the joint itself, Dr. Smith at Tufts Medical Center will work with you to really understand how your joint pain is affecting your quality of life before he recommends a particular treatment. For example, one person could have significant hip degeneration, but hardly believe it has any effect on their day to day activities. Another person, could be very physically active, and incapable of maintaining any level of fitness due to even a milder case of hip degeneration.

Understanding your treatment options

Once your orthopedic surgeon understands the cause and effects of your joint pain, they will work with you to choose the best possible treatment plan.

Hip pain is the most common condition that orthopedic surgeons treat. Studies indicate that people aged 60 years and older report having had significant hip pain on most days over the last six weeks.¹ For some, pain is increased during and after use (particularly weight-bearing activity), but improves with rest. This is usually indicative of a structural joint problem, such as osteoarthritis.

When treating hip pain at Tufts Medical Center, Dr. Smith will most often start with non-invasive treatments such as:

• Modifying aggravating activities
• Doing lower impact activity
• Using canes in the opposite side of the affected hip to balance out the burden
• Non-steroidal anti-inflammatory agents such as ibuprofen

If the hip pain continues despite these treatments, an injection can be given into the femoral acetabular articulation under x-ray guidance. This has both therapeutic and diagnostic benefits. It helps alleviate the pain, but is also an indicator that the joint is not affected and it is the surrounding musculature.

If there is severe degeneration, or if your quality of life is compromised because of moderate degeneration, a total hip replacement is likely the best bet. While not without risk, it is the most successful surgical procedure performed in the United States, with almost immediate relief and return to normal activity. Marathon running and high impact sports might be off the table, but Dr. Smith states that most patients can slightly modify their lifestyle and enjoy the same activities they did before the pain.

To learn more about joint pain, or to book an appointment with Dr. Smith please visit our website.