Read on: danhwilliams.com

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Let's start 2025
..by finishing Amanda's story.

Amanda lay  on her side on the operating table in front of me.
A 59-year-old woman about to have her hip replaced.

I looked down at the ball of her dislocated hip joint.
Precision tools at the ready..
Saw, reamer, rasps..

Hmm, her femoral head doesn’t look THAT bad..!
NOT the worst hip I’ve ever seen.


So what is going on..?

Amanda had a combination of:

• A Deep socket and
• A Cam shape femoral head

(a head that sat slightly off centre on the neck of her femur)
 
And those 2x mild deformities set the trajectory for Amanda's hip pain..

See her ‘x-ray films and scans’ in Newsletter #30.
Read ‘where injections do play a role’ for Amanda in #31 and..
Share how we made the ‘decision’ in #32.

 
That Deep socket + Cam / Loss of roundness look like this..

And won’t have mattered during most of Amanda’s everyday life.

Walking extends the hip by 10 degrees 
Flexes the hip to maybe 40 degrees.

Small 'deformities' beyond that don’t cause problems.
 
However, jobs like Amanda’s, such as..

• Cleaning
• Plumbing or
• Professional football

Require a lot of repeated deep bending / flexing of the hip.
And those repeated movements do cause problems 💥
 
At the extremes of movement the loss of roundness..
Collides with the edge of the deeper than average socket 💥

Like  trying to rotate an egg end over end into its cup..
..the misshapen ball does not easily rotate into the round socket.
 
Repeated impact on the edge of the socket leads to labral inflammation 💥
That hurts 💥


Inflammation💥

Like trauma + inflammation anywhere else in the body..

• Inflammatory cells + molecular mediators flow in..
• Leading to a red, swollen, hot, and painful labrum. 

Amanda felt that labral inflammation..

• Deep in her groin 💥
• As a burning pain 💥
• A toothachey-like discomfort 💥

 
On top of that she sometimes felt a sharp catching pain that took her breath away 💥💥

On asking when her groin pain first started, she told me..


 
She did not know what it was at the time.
So she kept on impinging her hip..
Bump, bump, bump.. 💥💥💥

It only become clear looking back..
When she understood how her..

• Deep socket and
• Off centre lollipop on a stick

..repeatedly collided 💥💥💥

What do I take away from this..?

Well, first of all it's Awareness.

Awareness that any twinge of groin pain
..could be coming form the hip. So..

💥 Dont' ignore it
🟥 See it as a red flag
👊 See it as a call to action

Second, is Movement..

I'm going to pay attention to how I move.
I'm going to avoid ANY deep hip flexion.

Happy New Year (by the way)..!

It's as good a time as any to make some changes.

And if someone forwarded this Newsletter to you..
You can sign up here to stay in touch each week.

2024 was my first full year of newsletters.
A full year that has got us to the underlying cause of most hip pain..

Taking in the evidence base AND illuminating it with stories.
My own + those of patients (always anonymised and with consent) 

Thank you for reading and staying with me.

My plan for 2025 starts by finishing Amanda's story.
Taking the lessons from her story that can help me..

And looking at the changes that she and all of us could make..

💥💥 To do more of the things we love with less pain 💥💥