Arthritis means “inflammation of the joint”. The most common kind of hip arthritis is osteoarthritis. This is often referred to as “wear-and-tear” arthritis of the hip or degenerative joint disease. Basically, osteoarthritis is characterized by a progressive wearing away of the joint cartilage. This results in inflammation within the joint itself. The cartilage is a protective structure of the hip and when it wears away, the bare bone is exposed within the joint. Other types of hip arthritis include rheumatoid arthritis (a systemic immune system disease), ankylosing spondylitis (an inflammatory disease of the spine and sacroiliac joint), and systemic lupus erythematosus (an autoimmune disease where the body harms its own healthy cells and tissues).
Who has Hip Arthritis?
Hip arthritis usually affects people over the age of fifty. It is seen more commonly in those who are overweight. Weight loss can reduce the symptoms that are related to hip arthritis.
Hip osteoarthritis can be cased by such mechanical issues as hip dysplasia (shallow hip socket), or hip impingement. Other factors that can lead to hip arthritis include traumatic injuries to the hip and fractures to the bone of this joint.
What are the symptoms of Hip Arthritis?
Hip arthritis symptoms worsen as the condition worsens. Patients will often report good months and bad months, as symptoms change with the weather conditions. The most common symptoms include:
Dull, aching pain in the groin, outer thigh, and/or buttocks
Limited range of motion of the hip joint
Stiffness of the hip
Pain with activities
Walking with a limp
How is Hip Arthritis diagnosed?
A person with Hip Arthritis will need a thorough physical examination, basic laboratory tests, and X-Rays. This will serve as a baseline for the orthopedic surgeon to reevaluate later examinations and determine the progression of the disease. During the examination, the doctor will have you move your hip in a variety of different positions. X-Rays will show thinning or erosion of the bones and loss of joint space. Sometimes the doctor can detect excess fluid of the joint on an X-Ray.
What is the treatment for Hip Arthritis?
It is important to note that treatment will depend on the severity of the condition, age of the patient, and activity level of the patient. Not all treatments work for every single patient and not all are appropriate for everyone, either. You should discuss your treatment options with an orthopedic specialist. Some of the current therapies include:
Activity Modification – It may be necessary for you to limit certain activities and learn new exercise methods to help you.
Weight Loss – Being a healthy weight is one of the most important treatment modalities. The less weight the joint has to carry, the less pain you will experience.
Walking Aids – The use of a cane or single crutch in the opposite hand from the affected hip will allow a decrease demand placed on the arthritic hip.
Anti-Inflammatory Medications – Your orthopedic specialist may prescribe a Non-Steroidal Anti-Inflammatory Drug (NSAID) for you to help treat the inflammation as well as the pain. Acetaminophen (in moderation) can be an effective medication for the treatment of arthritis.
Physical Therapy – By strengthening the muscles around the affected hip joint, there will be a decrease burden on the arthritic hip. It is important for you to prevent atrophy of the surrounding muscles and structures to maintain functional use of this hip.
Joint Supplements – Glucosamine is a safe and effective joint supplement used in the treatment of hip arthritis.
Hip Replacement Surgery – When non-surgical measures fail, your orthopedic specialist may recommend hip replacement surgery.
When the hip joint has reached a point where symptoms are not controlled, a hip replacement procedure is an option. The surgeon will remove the damaged joint surface and replace it with an artificial implant. These implants will wear out as time goes by, so therefore, these surgeries are not done frequently in younger patients. Please note that hip replacement is typically reserved for those people who have tried many other treatments and therapies and still have significant pain during normal daily activities. When a hip replacement procedure is performed, the bone and cartilage on the ball-and-socket hip joint is removed. This is done by using precise instruments to create surfaces that fit perfectly into the area and work well. This creates an artificial hip joint that functions as a new hip.
What are the risks of a Hip Replacement?
Over ninety percent of patients who have hip replacement surgery have positive results. While hip replacement is a common procedure, there still are risks involved. These include:
Blood loss
Blood clots
Infection
Leg length difference
Hip implant loosening
Hip dislocation
What can I expect after hip replacement surgery?
Success of this operation will depend on many factors. Hip replacement is typically a successful procedure, but a number of factors affect the outcome. Surrounding painful joints can affect hip surgery outcome. Other medical problems such as diabetes, heart and lung disease, as well as general fitness level also affect outcome after hip replacement surgery.
If you have hip joint injury or impairment that causes pain and inhibits your daily activities, you may be a candidate for hip replacement surgery. Hip replacement surgery, also known as arthroplasty, is a surgical procedure in which the damaged and diseased parts of the hip joint are removed and replaced with artificial parts, known as a prosthesis. The hip joint is a ball-and-socket type joint that can rotate in many positions. This procedure replaces both the natural socket and the rounded ball at the top of the thigh bone with duplicate parts. Hip replacement is done to increase function of the hip joint and in turn improve mobility. In the U.S., over 50,000 hip replacements are carried out each year, and most are done on adults age 65 and older. Most people who have hip replacement are women who want a better quality of life.
Hip replacement is typically reserved for those who have pain and limited mobility that interferes with the activities of daily living. One of the most common causes of hip joint damage is osteoarthritis, a condition that consequences in pain and stiffness of a joint. Rheumatoid arthritis is another cause. This disease results in joint pain, stiffness, and swelling. Osteonecrosis can cause hip damage, too. It involves avascular necrosis which is the death of bone due to insufficient blood supply. Septic arthritis, another source of hip destruction, results from a joint that becomes infected. Other reasons for a hip replacement are fracture, bone tumors, or injury that leads to collapse of the hip joint.
Not long ago, doctors would only perform arthroplasty on those people over 60 years of age. This was because older people were less active and put less stress on the replaced artificial hip than their younger counterparts. Now, doctors have found that these surgeries can be successful in younger people too. The new medical technology has improved the artificial parts and allows them to withstand more stress and strain. The overall health and activity level of the person is valued more than the person’s age.
What are the Alternatives to Hip Arthroplasty?
Your doctor may try many other methods of treatment before bringing up a hip replacement. These alternatives include exercise, physical therapy, walking aids, an exercise program, and medication. If inflammation is the root of the problem, the doctor may prescribe a nonsteroidal anti-inflammatory drug (NSAID) such as Naproxen or Motrin. It is not unheard of for people with severe hip pain to be on strong narcotic pain medication. Also, numerous nutritional supplement programs exist that combine glucosamine and chondroitin for relief of pain.
Joint injection is a common office procedure that works for some people with hip problems. This is a procedure where corticosteroids are injected directly into the hip joint. Also, doctors can inject joint lubricants such as hyaluronan that allow for increased range-of-motion. If exercise and medication do not work for you, the doctor may suggest a less complicated procedure before hip replacement. A common substitute is osteotomy. This treatment involves realigning the bone to transfer weight from the damaged, painful bone surface to one more healthy and strong area.
What all is Involved with Hip Replacement Surgery?
The area where the end of the femur (thigh bone) and the pelvis bone meet is known as the hip joint. The femoral head (a ball from the end of the femur) fits into the acetabulum (a socket) to allow a broad range-of-motion. The surgeon simply will make a six to eight inch incision over the side of the hip and remove the diseased bone tissue and cartilage from the joint region. After that, the surgeon replaces the head of the femur and acetabulum with prosthetic parts. These new artificial materials allow for a natural sliding motion of the joint.
Alternative Procedures
A new surgery that has hit the O.R.s is a surgery called minimally invasive replacement or mini-incision arthroplasty. During the last decade, this procedure has been used because it allows for smaller incisions and shorter recovery afterwards. To be a candidate, you must be less than 50 years old and have a normal body weight. Overall health is measured for this procedure. The parts for both styles of surgery, traditional or minimally invasive, come in two customary varieties. One type involves cemented parts which are fastened to existing, healthy bone with surgical glue. This procedure is referred to as a “Cemented” hip replacement. Another option involves uncemented parts and it requires biologic fixation to hold these parts in place. The “Uncemented” technique encompasses the use of parts made with a porous surface that lets the patient’s bone grow into the pores to hold the artificial parts in place. Uncemented replacements are chosen often for the older, less active person and for individuals who have weak, fragile bones from osteoporosis or Paget’s disease.
There is an advantage to the Cemented procedure. Research findings indicate that recovery time is less with this type of technique when compare to the Uncemented surgery. Experts say that it takes longer for the natural bone to grow and attach to the prosthesis with uncemented hip replacements.
What are the Complications of Hip Arthroplasty?
The American Academy of Orthopedic Surgeons conveys that there are more than 231,000 hip replacements performed each year in the United States alone. At least ninety percent of these do not require any type of revision due to new technology and innovations in surgery. However, some complications and difficulties do arise. The most common and dangerous initial complication is hip dislocation. This is when the ball becomes dislodged from the socket. The most usual later complication is inflammatory reaction to the prosthetic joint particles that may wear off the joint surface and be wedged into the neighboring tissues. This inflammatory response triggers the action of cells that wear away the bone and cause the implant to loosen. Less common problems are infection, blood clots, and joint stiffening.
References
NHS Choices. (2011). Hip Replacement. Retrieved from:
http://www.nhs.uk/Conditions/Hip-replacement/Pa…
NIAMS. (2010). Hip Replacement. Retrieved from:
http://www.niams.nih.gov/Health_Info/Hip_Replac…
