Hip Arthritis

Overview:  Osteoarthritis or degenerative joint disease of the hip is a condition of loss of cartilage of the hip joint.  This may be due to normal wear and tear over the course of many decades.  However, there are many other reasons that can cause it such as:

  • Prior trauma
  • Avascular necrosis (AVN) or osteonecrosis (ON) of the femoral head
  • Labral tears
  • Hip impingement
  • Arthritis ( rheumatoid arthritis, psoriatic arthritis, or septic (infection) arthritis
  • Developmental dysplasia
  • Slipped capital femoral epiphysis
  • Perthes disease
  • Genetics such as epiphyseal dysplasias
  • Idiopathic

Symptoms:

  • Pain, most commonly in the groin or front pocket.  May also have pain in the thigh that radiates to the knee or less commonly pain on the outer portion of the hip.
  • Limited range of motion/stiffness of the hip
    • Difficulty putting on shoes/socks or trimming toenails
    • Difficulty getting in/out of low cars
    • Difficulty getting off a low seat
    • Pain in bed without a pillow at the knee
    • Pain with certain sexual positions
    • Limp where it is more comfortable to lean over the painful hip while walking or while using a cane in the opposite hand
    • Pain that is limited to the outside of the hip and is worse when laying on that side in bed is often trochanteric bursitis or tendonitis which may respond to therapy and will not need surgery

Evaluation:

  • Physical Exam includes assessment of range of motion, of gait, and neurovascular status and reproduction of the pain in the front pocket distribution with seated range or motion of the hip-joint.
  • X-rays:  X-rays will be taken to assess the degree of arthritis; mild, moderate, or severe.
  • Diagnostic Hip Injection:  Injections tend not to provide long term relief of the hip.  However, your surgeon may use an injection if assistance is needed in the diagnosis particularly if there are also symptoms that could be related to low back issues.  These should be performed by a trained individual using an ultrasound machine of fluoroscopic X-ray machine to assure the injection is in the hip.

Treatment:

  • Non-operative Interventions
    • Activity Modification
    • Use of ambulatory aid (cane, walker, crutches, trekking poles)
    • Weight loss, if over ideal body weight
    • Motrin, Naprosyn or other Non Steroidal Anti inflammatory Drugs (NSAIDS)       
    • Physical Therapy—rarely beneficial for hip arthritis. It may help with gait and bursitis symptoms
  • Operative Interventions
    • Total Hip Arthroplasty (Hip Replacement)
      • This is a highly successful and durable operative procedure which replaces the femoral head (ball), neck and damaged cartilage in the acetabulum (pelvis).  There are four components that comprise the hip replacement: acetabular component (cup), liner (plastic, metal or ceramic), femoral head (metal or ceramic ball) and femoral component (typically titanium stem).
      • Risks of surgery are very rare but can include: Infection, bleeding, damage to nerves or blood vessels, soft tissue trauma, bruising, continued pain, stiffness, fracture, dislocation, limb length discrepancy, numbness or tingling, loosening or wear of prosthesis, need for further surgery.  Risks of anesthesia include heart attack, blood clot, stroke, pulmonary embolism, death.
      • There are 3 different types of bearing surfaces available for total hip arthroplasties:
        • Metal on highly crossed-linked polyethylene (metal ball on plastic liner):  This is the current recommendation for most patients.  It is highly successful and durable and has the best track record with 98% survivorship at 20 years in young active patients.
        • Ceramic on ceramic: This is more common in Europe and has potential for improved wear. There are increased risks associated with this procedure including a 4% chance of audible squeeking and need for revision if there is malposition
        • Metal on metal: This was originally popular in the 1970s with a number of patients doing well long term but many patients with complications thought to be related to manufacturing of the implants. With improved manufacturing techniques, it regained popularity between 2001 and 2008.   Metal on metal is the only articulating bearing surface available in resurfacing or “capping” types of hip replacement. We are currently not recommending or performing this procedure due to a portion of these patients presenting with problems associated with the metal debris generated.  We are currently recommending metal ion testing in those patients who already have the this type of hip replacement.
        • Education:
          • Before surgery we encourage our patients to attend a two hour class (informational session) which explains what to expect before surgery, during your hospitalization, and throughout your post-operative recovery. This provides an opportunity, even to those only considering surgery, to meet members of the health care team and ask multiple questions and even hear answers to questions that others might ask. Generally patients and their families find this opportunity very rewarding and informative.

Post-op care following total hip replacement:

  • Pain relief, especially the pain in the groin to gentle motion, can be immediate.
  • Typically weight bearing and ambulation is started immediately.
  • Discharge to home can occur as soon as the day or day after surgery.  Discharge to an extended care facility to those with limited recourses at home can occur after  three days in the hospital
  • To prevent blood clots that can occur in 5% of the patients, we encourage early activity and blood thinning medication for one month.
  • Initially use of a walker or crutches is used.  This can be quickly advanced to a cane for a couple of weeks as needed.
  • Total hip precautions (avoiding deep hip flexion and extreme twisting) for six to twelve weeks after surgery to prevent dislocations.
  • Approximately 2-3 follow up appointments within the first 3 months after surgery and then one year after surgery and then every 5 years thereafter for routine x-rays to evaluate for signs of wear.