About Hip Arthritis
The hip is a major weight bearing joint and is therefore subject to extreme physical stresses which can over time result in the deterioration of the cartilage within the joint. This is the most common type of arthritis to affect the hip and is a condition called osteoarthritis or ‘wear and tear’ arthritis. Other types of arthritis include post traumatic arthritis, which is arthritis secondary to a fracture or traumatic injury to the hip, and inflammatory arthritis, which is related to connective tissue diseases such as rheumatoid arthritis.
The symptoms associates with hip arthritis are hip, thigh and/or knee pain, limping, weakness and joint stiffness. Typically there will be a progressive inability to perform routine activities such as putting on shoes and socks. Treatment for cases of minor or moderate arthritis are oral anti-inflammatory medications, steroid injections, exercise and physical therapy. In advanced cases or cases where medical treatment has not provided adequate relief, a total hip replacement is recommended.
At Regional Orthopedics, hip replacement is performed through a small 4-inch incision over the buttocks. It is typically positioned in an area where it would be covered by a bathing suit or underwear. The procedure that we employ is an advanced technique whereby natural muscle planes are utilized for accessing the joint. This allows for not only for much less postoperative pain and a more rapid recovery, but also allows for the restoration of natural joint mechanics and improved joint stability. This procedure will typically involve a 3-4 day hospital stay.
A minimally invasive procedure that involves the placement of a small camera into the hip. The inside of the hip can be visualized on a monitor. Through a separate small portal, a probe can be inserted to examine the structures within the hip. Based on direct visualization and probing, damaged tissue can be found and a diagnosis can be made. This is a useful procedure to establish a diagnosis related to hip pain, weakness or instability. In most cases, these problems can be immediately addressed at that time. The typical problems that can be addressed with this minimally invasive ambulatory procedure include removal of loose bodies in the joint, repair or removal or a torn labrum, removal of osteophytes or recontouring of bone to relieve impingement syndrome. Other extra-articular problems can also be addressed, such as removal of chronic bursitis.
The benefits of this minimally invasive procedure to the patient include a quicker recovery with less pain and less hip stiffness.
About Hip Bursitis
Hip bursitis is a common cause of pain. It is the result of bursal inflammation and often will develop over the lateral aspect of the hip. It can be the result of overuse, physical stress or muscle imbalances. Symptoms typically include pain in the hip, thigh and buttocks.
Treatment of this condition is typically an oral anti-inflammatory medication, steroid injection and exercises. In cases resistant to medical treatment, the bursa can be surgically removed.
About Hip Fractures
The hip is a common area to sustain fracture, especially under conditions of osteoporosis. The patterns of fracture are typically femoral neck, intertrochanteric and subtrochanteric. Fractures of the femoral neck that are minimally displaced and intertrochanteric/subtrochanteric fractures can be treated by surgical repair through placement of fracture implants that will hold the fragment of bone together rigidly in a reduced position and will allow for immediate mobilization, and in most cases weight bearing without restrictions. This is an important concept and a critical goal to achieve especially in the elderly, since bed rest for even seemingly short periods of time can cause permanent debilitation and can lead to other life-threatening complication such as decubitus ulcers (bed sores) and venous thrombosis (blood clots). In cases of femoral neck fracture in the elderly where the fracture is substantially displaced, a partial or total hip replacement is recommended due to the high risk of a failure of healing when surgical repair is attempted.
Partial and total hip replacement also allows for immediate mobilization with unrestricted weight bearing.
Hip impingement occurs as a result of a ‘cam’ or ‘pincer’ mechanism. In each case the problem exists because of a loss of congruity between two opposing surfaces – the proximal femur and acetabulum.
Symptoms of hip impingement are typically groin pain. Certain positions typically exacerbate the pain, often hip flexion. This condition is diagnosed with the use of clinical examination, special radiographic views and MRI.
The treatment of this condition is often oral medications to relieve inflammation and a therapy program. For athletes, an assessment of technique and modifications can help to relieve the impingement phenomenon. In cases when non-surgical treatment has failed, this condition can often be fixed arthroscopically. The procedure is ambulatory. Weight bearing can often begin immediately following the procedure. Activity limitations are temporary when they are employed and are based on individual factors.
The hip is a “ball-and-socket” joint where the “ball” at the top of the thigh bone (femur) fits inside the “socket” in the pelvis (acetabulum). A natural substance in the body called cartilage lubricates the joint. When the bone and/or cartilage of the hip becomes diseased or damaged from arthritis, hip fractures, bone death or other causes, the joint can stiffen and be very painful. A total hip replacement may be recommended for patients who experience severe hip pain and can’t do what they want or need to do in daily life.
In a total hip replacement, the diseased bone and cartilage are replaced with a metal ball and plastic cup. The artificial joint, called a prosthesis, may be cemented in place, may be cementless, or may be a hybrid of both. The surgery takes from two to four hours, followed by another few hours spent under observation in a recovery room. Patients usually enjoy immediate relief from joint pain after the surgery.
Physical therapy starts as soon as the first day after surgery with the goal of strengthening the muscles and preventing scarring (contracture). Therapy begins with the patient sitting in a chair and progresses to stepping, walking and climbing stairs, first with crutches or walkers and then without supportive devices. Occupational therapy and at-home exercises help patients learn how to use the prosthesis in everyday activities.
Total hip replacement is successful in over 95% of well-selected patients. On average, replacements last 15-20 years. Some patients enjoy full use of the prosthesis after 25 years or longer.