The Sex and the City Reboot “And Just Like That…” has managed to gather together “old fans” of the original HBO series, as well as a new group of avid watchers who want to tune in to see how Carrie and the gang are dealing with life as fifty-somethings. One of the newest episodes “Tragically Hip” caught my attention from a medical/orthopedic standpoint.

As an orthopedic surgeon and hip specialist in “The City,” I couldn’t help but tune in to this episode to see if the writers captured Carrie’s hip problem accurately. Yes, I’m aware the show is fictional, but Carrie’s hip surgery and subsequent physical therapy prompted this blog to explain what I believe occurred and how non-fictional hip patients should proceed if faced with hip pain similar to the fictional Carrie. Let’s talk about a few of the discoveries and points made in the “Tragically Hip” episode:

WARNING: SPOILERS AHEAD!

Photo Credit: Wikimedia Commons

After consulting Dr. Google, Carrie diagnosed herself with “old lady back”

If you haven’t seen the episode, Carrie was having debilitating back pain that required her to use an umbrella as a cane to walk up the steps in her apartment and concluded she was suffering from arthritis.  She called the problem “old lady back.”  She (unsuccessfully) tried some self-healing techniques, like using pain and heat patches to help with the pain.

While these things could help alleviate certain types of back or hip pain to some degree, it is clearly important to get to the root of the problem and see an orthopedic specialist. Pain caused by hip issues can often mimic common symptoms of back problems and can occur at any age. In my practice, I see patients of all ages and stages of life that have hip issues underlying their back pain. Athletes are especially prone to pain in their back and hips caused by various defects and overuse injuries of their hips.  While it made a “cute” term for the show, “Old Lady Back” isn’t a real diagnosis.

Did Carrie have back pain or hip pain?

A lot of hip problems are often discounted as back pain as there is an overlap in hip and lumbar spine disorders. One of the biomechanical studies that I did as a resident actually helped coin the term “Spinopelvic syndrome” which is an acknowledgment that back and hip disorders are entwined. Obtaining the most accurate and correct diagnosis is key in treating back or hip pain. Not all pain is arthritis either and not everyone will need arthroscopic or open surgery to address the issue. I treat many different hip issues without surgery.

Carrie was diagnosed with a congenital birth defect of the hip.  What does that mean?

I found this part of the episode especially interesting (and nebulous). A congenital birth defect of the hip would mean this was something Carrie was born with, that began to cause pain, or problems with her hip, creating back pain. I found myself weighing in on how I would diagnose Carrie, had she been my patient. A congenital problem would be called hip dysplasia.  This occurs when the hip socket does not fully cover the ball portion of the femur. A developmental issue would be called a CAM deformity, where the femoral head is not perfectly spherical and does not fit well into the socket. Both of these conditions cause hip pain and potentially impingement – but It is most likely that Carrie has hip dysplasia. [If any of the show-writers are reading this blog please reach out to confirm or deny]. I would caution anyone however, that undergoing an arthroscopic (minimally-invasive) hip procedure for dysplasia is controversial, unless you have borderline dysplasia i.e. only a small amount of dysplasia. If Carrie had frank, or more severe, dysplasia, then she may have been considering a periacetabular osteotomy which is an open hip surgery.

It is vital that patients choose the correct procedure for their exact diagnosis. This is why patients in “The City” should find a hip specialist that is well versed in these types of hip conditions and the best treatment for hip pain.

Why couldn’t Carrie feel herself pee after her hip surgery?

I don’t want to get too graphic here, but this issue should be talked about and addressed. Perineal numbness (Carrie, not being able to feel herself urinate after surgery) is a known side effect of using a perineal post during hip surgery. Traditional hip arthroscopy uses a perineal post, a bit of an archaic piece of equipment, that I do not use in my practice. Instead, I do all hip surgeries on a specialized traction table that makes postless hip surgery possible. This specialized surgical technique eliminates the issues caused by a post during hip arthroscopy.  You can read more here, about Postless Hip Arthroscopy.

Is it really possible to get back into your four-inch Manolo Blahnik stilettos three months after surgery?

After the surgery, Carrie has her first appointment with Travis the physical therapist whom she shares her recovery goal of getting back into heels as soon as possible. He instructs her to get out of her clothes and get ready for a “deep lower body massage”. Hmmmm. She later finds out that (the very attractive) Travis wasn’t covered by her insurance and agrees to pay out of pocket to continue working with him.

While getting massaged by a good-looking PT may seem like the ideal passive way to recover from hip surgery, the reality is that – although it is essential you have a qualified therapist guiding your recovery – you are the one that has to do the hard work to get your mobility back to the level you desire. Also, my PT colleagues would rather refer to the manual part of the rehabilitation as “soft tissue therapy”.

I tell my patients all the time that the surgery is the easy part but making sure that they get good physical therapy is key. Unfortunately, some of the best therapists (regardless of their looks) may not be covered by insurance, but it can be worth the out-of-pocket cost, especially if there are no qualified hip therapists in a geographic location. After all, you want to be back in those Manolos, pain free, right?

Hip Arthroscopy is a new procedure compared to established orthopedic interventions like hip and knee replacement. As such, I was excited that hip preservation made it into the Sex and the City sphere. Arthroscopic hip labral repair is now on par as an iconic “City” symbol as Pelotons, Martinis and Manolo Blahniks.

For additional resources on managing hip pain or back pain, or to chat about similar symptoms to those that Carrie had in Sex And The City’s Reboot, please contact the office of Benedict Nwachukwu, MD, orthopedic shoulder surgeon serving Manhattan, New York City and surrounding New York boroughs.   

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