Groin Pain Caused by Arthritis: A Doctor’s Story

author : AMSSM

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I realized my 50 mile/week running career was over. Now what? I was only 30 years old. I did what I could to stay active – switched to biking and swimming.

By Deanne Eccles-Rotar MD

Member AMSSM 

Groin Pain has a lot of etiologies. When it happened to me I thought it was an overuse injury – a tendonitis. I was an avid runner and also liked to participate in triathlons and high impact aerobics. I dealt with it for a year, thinking it would go away eventually. Advil seemed to help, and it didn’t keep me from running, so I just waited. Then my brother asked me to run with him. He was always a little faster and I relished the competition. I ran, and he wore me out – and the pain persisted this time. Even into the next day. It became severe, to the point that I didn’t want to run.

Concerned that maybe something was really wrong – such as a stress fracture – I went in to get an x-ray. Since I was a physician I could read my own films. When they brought the x-rays back I was shocked. They showed signs of moderate arthritis of the hip, including sclerosis of the bone at the joint, subchondral cyst formation, spurring of the bone, and joint space narrowing. I realized my 50 mile/week running career was over. Now what? I was only 30 years old. I did what I could to stay active – switched to biking and swimming. I kept the muscles around the joint as strong as I could and as flexible as I could. I did all the things I tell my patients. The one thing about arthritis is that there is no cure. You can take glucosamine and chondroitin sulfate and those may help slow progression, but nothing can fix cartilage when it’s damaged other that a cartilage transplant. I wondered how it happened to me?

The two common causes of early degenerative changes in the hip are due to hip dysplasia and anterior impingement of the hip. Anterior impingement is where the femur strikes the front of the socket during flexion. These patients have trouble obtaining end range flexion of the hip without starting to rotate the leg outward. Hip dysplasia is often seen in first-born females or children who are born breech. This is where the socket of the pelvis is not deep enough to completely cover the femoral head. More severe cases can be diagnosed at birth, while mild cases present with signs of degenerative change at a young age. Another cause of hip problems is avascular necrosis of the femoral head, a condition where the bone dies and begins to collapse. This is usually seen after some type of trauma to the hip joint such as fracture or dislocation.

The treatment in the past used to be hip replacement. Now there are new treatments being done. One of these is called hip resurfacing. Hip resurfacing is similar to a hip replacement in that hardware is placed in the hip joint, but it differs because the hardware preserves the femoral neck so that forces across the pelvis are more similar to that of normal joints. The hip is dislocated during surgery and then a metal cup is placed in the patient’s hip socket. The femoral head is then prepared so that the metal cap can be placed over it and it is secured with cement. This procedure was approved by the FDA in May of 2006, and has been done in the US with success since then. This is a great option for younger more active patients because it allows them to return to a higher level of activity. It also conserves more of the bone, minimizing the problems of a leg length discrepancy after surgery and allowing for revision to a total hip replacement when the hardware wears out. Because the implant is large in diameter, there is more stability to the joint and less risk of dislocation.

The main concern with the resurfacing technique is that it is newer, and the longevity of the hardware is not known. However it was first done in 1997 and has shown great success so far, with the Birmingham Hip Resurfacing implant showing 98% survivorship at the 5 year mark. Another concern is that the load bearing surfaces are metal on metal, and there is a chance of release of metal ions into the bloodstream. With the use of chromium cobalt, wear particles have been significantly decreased; however, there is still a higher level of metal ions found in the bloodstreams of patients with the implants. Testing done so far, however, has not been able to determine negative effects.

This and other upcoming surgical options hold hope for the large number of Americans that suffer from arthritis. They allow you to regain some of the activities that you gave up long ago. For me, I chose the resurfacing and am in the midst of rehabilitation. Hopefully I will be able to return back to some running – at least enough to catch up to my two year old son!

Deanne Eccles-Rotar MD
Dean Health Systems in Madison Wisconsin

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date: April 9, 2007