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Rapamycin extends mouse lifespan 9–14%
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Hip anatomy, pain, & treatment | Peter Attia & Adam Cohen — Whalespan

Content›Video›Hip anatomy, pain, & treatme…

Hip anatomy, pain, & treatment | Peter Attia & Adam Cohen

Peter Attia60m · 2023-08-02

Claims Made

88

Claims Supported

68

Support Rate

77%

Support rate

68 of 88 claims supported

68 supported20 partial / not

Claims from this content

71

✓Well SupportedAn MRI is the gold standard for detecting stress fractures, especially when pain first begins, as X-rays are often negative and bone scans are impractical.✓Well SupportedHip and knee arthritis are more common in individuals with incongruent joint surfaces.✓Well SupportedApproximately 50% of individuals who survive a hip fracture experience a decrease in functional level.✓Well SupportedBiologic therapies are a reasonable option for symptom reduction in knee arthritis and may be safer than repeated cortisone injections.Well Supported

More from Peter Attia

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Attia walks back the clinic protocol: too aggressive for healthy adults

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A. Volkovreader

4h

Bookmarking — the dossier-vs-overview split is the right call. Most of the time I want overview; sometimes I want receipts.

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Would love a "what would change this verdict" RSS feed. Sign me up if it exists.

✓

The one-year mortality rate after a hip fracture in individuals over 65 is 30% with surgical repair and 79% without.

◐Partially SupportedThe labrum enhances shoulder stability by acting like a suction cup.

◐Partially SupportedPlatelets are injected into tendons, joints with arthritis, or muscles to promote healing.

◐Partially SupportedA combination of hyaluronic acid and PRP may be more effective than individual treatments for knee pain.

◐Partially SupportedA Pavlik harness used for nine months can effectively treat hip dysplasia in infants.

◐Partially SupportedSurgery with pins is often required for tension-sided femoral neck stress fractures to prevent displacement.

◐Partially SupportedPerforming a small amount of adductor maintenance exercises daily can significantly contribute to lower body maintenance.

◐Partially SupportedGroin pain in runners can indicate a stress fracture of the femoral neck, particularly on the tension side.

◐Partially SupportedThe development of the acetabulum (hip socket) is influenced by the shape of the object within it, and delayed treatment for hip dysplasia can lead to hypertrophied soft tissue, making correction more difficult.

◐Partially SupportedMany randomized controlled trials show excellent results for PRP, particularly for tennis elbow and knee arthritis.

◐Partially SupportedArthritis in the hip can be diagnosed with a plain X-ray by observing the absence or thinning of cartilage, even in young adults.

◐Partially SupportedEccentric loading of hip adductors can be difficult and painful even with only five repetitions.

◐Partially SupportedMaintaining strong and flexible hip flexors is important, as tightness can negatively impact antagonistic muscles.

◐Partially SupportedElderly individuals with hip fractures had significantly smaller psoas muscle volume compared to age-matched controls in a South Korean study.

◐Partially SupportedDevelopmental dysplasia of the hip occurs when the hip is not concentrically reduced in utero or early childhood, leading to improper formation of the acetabulum.

◐Partially SupportedMicronized fat injections show promise for osteoarthritis of the ankle and knee, though the regenerative outcome is not fully understood.

◐Partially SupportedPlatelet-rich plasma (PRP) injections are effective for tennis elbow and gluteus medius tears, and potentially for hamstring tendons.

◐Partially SupportedEccentric and concentric loading of the adductor muscles during a specific hip exercise can be intensely difficult.

◐Partially SupportedManaging arthritis in the future involves identifying onset before clinical symptoms and implementing preventative measures.

◐Partially SupportedWeak gluteus medius and abductors are implicated in many lower extremity injuries at the hip and knee, including ACL injuries and knee valgus.

◐Partially SupportedHip fractures in the elderly are often exacerbated by pre-existing conditions such as advanced cancer or renal disease, acting as a final stressor.

◐Partially SupportedA team approach to hip fracture care may slightly delay surgery but likely leads to better long-term outcomes and earlier discharge.

◐Partially SupportedMedical management around hip replacement surgery, including medications to decrease blood loss, has made the procedure more efficient and safer.

◐Partially SupportedAnterior approaches to hip replacement surgery spare more muscle and ligaments compared to the posterior approach, leading to less morbidity.

◐Partially SupportedStrengthening hip abductor muscles can prevent IT band pain and is a priority muscle group to work on starting from early teens.

◐Partially SupportedTendon degeneration is a normal age-related trajectory due to cellular senescence, leading to inflammation and pain.

◐Partially SupportedHospitalization following a hip fracture can be catastrophic for elderly patients.

◐Partially SupportedComplete femoral neck fractures can disrupt blood supply to the femoral head, leading to bone death and potential hip replacement.

◐Partially SupportedUmbilical cord blood derivatives, Wharton's jelly, and exosomes are not FDA-approved for injection.

◐Partially SupportedRandomized controlled trials (RCTs) are necessary to definitively answer questions about the efficacy of biologic therapies.

◐Partially SupportedThe efficacy of platelet-rich plasma and stem cell therapies is best evaluated through randomized controlled trials and systematic reviews.

◐Partially SupportedStem cell therapy is not approved in the United States for conditions other than blood disorders.

◐Partially SupportedIncreasing running frequency, distance, and speed simultaneously can contribute to stress fractures.

◐Partially SupportedOvertraining, which does not allow sufficient time for bone healing, can lead to stress fractures.

◐Partially SupportedBone strength increases in response to stress, such as from running.

◐Partially SupportedCartilage relies on diffusion for nutrition and chondrocytes have limited capacity to repair extracellular matrix under substantial load.

◐Partially SupportedArthritis is characterized by the loss and thinning of articular cartilage, which is a smooth, biologic tissue that facilitates pain-free joint movement.

◐Partially SupportedCommon sources of hip pain in individuals under 50 include bone problems, cartilage issues, connective tissue problems, muscle/tendon issues, and referred pain from the back.

◐Partially SupportedHip replacement surgery has a high patient satisfaction rate and low complication rate, making it preferred over cortisone injections for appropriate patients.

◐Partially SupportedStress fractures occur when bone is subjected to loads exceeding its normal healing capacity, leading to micro-fractures that fail to heal with insufficient recovery time.

◐Partially SupportedA stress reaction is a precursor to a stress fracture, and high-risk stress fractures can become complete fractures.

◐Partially SupportedThe location of hip pain is a crucial factor in diagnosing the underlying cause.

✕Not SupportedUmbilical cord or Wharton's jelly injections are not permitted for therapeutic use.

✕Not SupportedA study of 1000 websites found 94% of stem cell therapy promoters made inaccurate statements.

◐Partially SupportedConditions like ligamentous laxity and developmental dysplasia are more prevalent in women and can be inciting issues for hip problems.

◐Partially SupportedSenescent tendon cells degenerate and produce factors that cause tendon degeneration, inflammation, and pain.

◐Partially SupportedHip pain at age 28-29 may indicate arthritis due to undiagnosed hip dysplasia, diagnosable with an X-ray showing cartilage thinning.

◐Partially SupportedAutologous cells can be used for therapy if they are minimally manipulated, such as concentrating bone marrow without enzymatic or digestive changes.

✕Not SupportedStandardized dosing is lacking in PRP preparation, as platelet concentration and quality can vary.

◐Partially SupportedWeakness of the gluteus medius is painful, has poor healing potential, and occurs in older individuals, endurance athletes, and unstable patients.

◐Partially SupportedThe hip joint is more stable than the shoulder joint due to its deep, concentric socket.

◐Partially SupportedThe FDA has a warning page and video explaining that there are no approved stem cell therapies for general use in the United States.

◐Partially SupportedThe gluteus medius and gluteus minimus muscles are the main abductors of the hip and are considered the 'rotator cuff of the hip'.

◐Partially SupportedTreatment for compression-sided femoral neck stress fractures involves rest and crutches until pain-free weight-bearing, typically taking 6-8 weeks to heal, followed by gradual exercise resumption.

◐Partially SupportedSome patients with compression-sided stress fractures opt for surgery to facilitate mobility for daily activities.

◐Partially SupportedHyaluronic acid can be used off-label for hip injections, with some studies suggesting potential benefits.

◐Partially SupportedPlatelet-rich plasma (PRP) is derived from a patient's own blood and can be categorized as leukocyte-rich or leukocyte-poor.

✕Not SupportedA high percentage of websites promoting stem cell therapy make inaccurate statements.

✕Not SupportedAdministering an injection immediately before hip replacement surgery increases the risk of infection.

✕Not SupportedCortisone injections are not preferred for hip issues due to concerns about cartilage damage.

◐Partially SupportedAll hip fractures require surgery due to the necessity of rapid mobilization.

◐Partially SupportedFemoral acetabular impingement (FAI) is more common in men and can be exacerbated by power-type sports.

◐Partially SupportedFemoral acetabular impingement is characterized by a bone bump on the femoral neck that pinches the labrum and acetabular rim during hip movement.

◐Partially SupportedRepetitive stress from sports like hockey, football, and basketball can lead to delayed growth plate closure in the femoral neck, forming a cam lesion and increasing arthritis risk.

◐Partially SupportedIn hip instability, the ligamentum teres provides a secondary restraint by connecting the ball to the socket.

◐Partially SupportedEndurance athletes with hip pain should consider a femoral neck stress fracture.

✕Not SupportedTrue stem cell therapy for orthopedic conditions is not widely available or approved in the United States.