IN GOOD STANDING TREATING HIP PROBLEMS AS SOON AS POSSIBLE CAN PREVENT FURTHER DAMAGE.

Byline: Evan Henerson Staff Writer

We don't necessarily think much about hips unless, say, Ricky Martin or Madonna is shaking them provocatively or we're trying to execute a dance maneuver. Hips? Those things that keep our legs in proper alignment, right?

Uh-huh. But without healthy hips, you're either in great pain, you're not walking or both. Forget about climbing stairs, getting into a car or even bending down and tying your shoes. Diane Glatt, who runs a placement agency for nannies and companions for the elderly, agrees with her doctor's assessment that living with hip pain is ``like fitting a round peg into a square hole.''

``I remember taking the pocket out of my car so I could get in and out more easily,'' said Glatt, a Northridge resident who eventually had a hip replacement operation. ``I'd pick up my kids' toys with a reacher. My third child I didn't carry as much as my first two. She walked more on her own.''

Hip pain like Glatt's is not something to ignore, say doctors. The longer you wait to get it taken care of, the less your chance of recovering and walking properly. And the more likely your decreased mobility will lead to other health problems.

If hip pain leaves you confined to a wheelchair for six months, nothing a doctor can do - surgical or otherwise - will get you walking again, says Dr. H. Michael Mynatt, associate director of the Arthritis Institute at Centinela Hospital Medical Center and Queen of Angels - Hollywood Presbyterian Medical Center.

``Even when you get a new joint, you don't get a single new muscle fiber,'' says Mynatt. ``The biggest factor is how active and strong you were before the operation.''

Wearing thin

With osteoarthritis of the hip, the smooth covering on the end of your bones that helps the hip joint glide wears thin. As the condition worsens, the hip joint can become stiff and inflamed and bone spurs can develop at the end of the joint. As the cartilage wears away completely, you could be walking around with bone rubbing against bone. Osteoarthritis is not reversible, although early action can slow the disease's progression.

Similarly, anybody who sustains a hip fracture - more than 350,000 per year in this country, according to the American Academy of Orthopedic Surgeons - should get immediate attention, since hip injuries set up a host of other problems, such as blood clots and pneumonia. A study conducted in New York 

hospitals in 1997 and 1998 found that 14 percent of the people who were admitted for hip fractures died within six months. Twenty-five percent were dead after a year.

Dr. Joseph Zuckerman, who chairs the AAOS' council on education, predicts that the annual cost of treating and rehabilitating patients who have suffered hip fractures will climb to $17 billion in 30 years.

``We're left with a major public health problem,'' says Zuckerman who is also chair of the orthopedic surgery department at New York University's Hospital for Joint Diseases. ``Look at the demographics of the country. When you consider that the fastest-growing population is over 64, this is going to be a big problem.''

In May, the AAOS held its National Consensus Conference on Continuous Care on the subject of hip fractures. With so many health maintenance organizations trying to quickly discharge hip-fracture patients, rehabilitation takes place in nursing homes, says Zuckerman, which aren't necessarily the ideal environment for that type of recovery.

``I'm not sure incentive is there for patients to do well in a rehab setting,'' he said, adding that the Consensus Conference's recommendations are currently being prepared. ``We can do things better.''

Dr. Raymond Gritton, rehabilitation director at Glendale Memorial Hospital and Medical Center, agrees. In the long run, he believes it is more cost effective for a patient to spend 10 to 14 days rehabilitating in a hospital if he or she can go home at the end rather than being discharged to a nursing home.

``This is a big anxiety-producing issue with the elderly. A lot of them see friends who were living at home suffer a hip fracture, and go into a nursing home,'' says Gritton. ``Then they never see them again.''

That didn't happen with 87-year-old Vera Spencer of Glendale, who spent nearly a month in the hospital after surgery to repair a hip she fractured after falling on June 28.

Success story

The surgery and rehabilitation were both successful, and Spencer - who is also legally blind - returned home. A part-time caregiver helps her around the house and with her exercises.

``I've always been very independent and I've taken care of a lot of people during my life,'' says Spencer. ``I use a cane and I'm supposed to be very careful. It would be horrible to fall again.''

Osteoporosis, a loss of bone density that can cause bones to be more susceptible to fractures, is typically associated with people over the age of 60, and post-menopausal women are at especially high risk for the disease. However, a new wellness campaign undertaken by Centinela/Queen of Angels Arthritis Institute uses adults of all ages to get the message across that people with severe pain can ``take their lives back'' through a knee or hip replacement operation.

On the cover of the institute's brochure, under the words ``Life Is a Moving Experience,'' stands a fit and smiling, wetsuit-clad Jack LaLanne, holding the chain of a boat and standing in the water with the Golden Gate bridge in the background. LaLanne, who had both knees replaced following a car accident six years ago, said he was using a chin-up bar in the hospital the day after the procedure.

New knees, new man, says LaLanne, who participated in the institute's campaign with fellow knee replacement recipients wine maven Robert Mondavi and actor Ernest Borgnine.

``It's like being born again,'' says LaLanne, 86. ``People who have problems with their knees and hips should get it done. Don't put it off. These people moan and groan, 'My God, I don't have the time' or `I'm too old' or something like that. They're wasting all this time, and they're suffering.''

But joint injuries and degeneration are not exclusively a concern for seniors. Thirty-seven-year-old Jack McRae, who also appears on the campaign's video and television spots, is a vice president for Computer Services and a former martial arts competitor who had both hips replaced last December.

Diagnosed with a form of osteoarthritis of the hips (cause unknown), McRae saw several doctors, eventually ending up - like Glatt - with Dr. Lawrence Dorr at the Arthritis Institute. He resisted surgery for several years, treating his condition with medication, physical therapy and figuring out ways to compensate.

``The fear of going into surgery, going under and not waking up, was very much misplaced, but for me, very real,'' says McRae, who is back at nearly full strength. ``Now that I think about it, holy cow, I should have done this sooner.''

It wasn't easy, says McRae. He notes that people with hip pain quickly realize how difficult activities like bending over to pick up something off the floor become.

One day, McRae noticed his 3-year-old son, Andrew, walking slowly around the house, bent over with his hand on his back and making a groaning sound.

``I said, 'What the heck are you doing?' '' McRae said. ``He said, 'I'm imitating you when you pick something up.' That convinced me.''

No day at the beach

McRae's early fears are certainly understandable, say doctors, who note that hip replacement is major surgery with a painful and difficult recovery. The decision by Sulzer Orthopedics last December to recall 25,000 of its Inter-Op hip implants - 17,500 of which had already been implanted in patients - due to a manufacturing error, didn't exactly enhance the procedure's reputation.

Richard Krutosik, 38, a nurse at Northridge Hospital Medical Center, had his first hip replacement on April 18 at Sherman Oaks hospital. While still in the hospital, he dislocated the hip again and had to have the procedure repeated five days later.

``Things went from bad to worse and then got better,'' says Krutosik, who was training to run the L.A. Marathon before pain in his hips forced him to change his plans. He faces a third surgery in September. ``If you're in that much pain and it's disrupting your life, you don't really have much of an option.''

A multisport athlete, Krutosik said he might still tackle the L.A. Marathon route one day, but on a bicycle in order to spare wear and tear on his knees.

``The biggest thing is to be pain-free,'' says the Sherman Oaks resident. ``By this time next year, I'll be pain-free for the first time in two years, and that sounds really good.''

CAPTION(S):

4 photos

Photo:

(1 -- cover -- color) Joint effort

Hip replacements, increasingly common, can bring renewed quality of life after years of pain.

(2 -- 3) Richard Krutosik, 38, a multisports athlete, works with physical therapist mal Adamski following April hip replacement surgery. He faces more surgery in September. ``If you're in pain and it's disrupting your life, you don't really have much of an option.'' Above, an artificial ball-and-socket hip joint replacement.

(4) - fitness guru Jack Lalanne, 86.

Evan Yee/Staff Photographer