About Hip Arthritis and Replacement
Osteoarthritis of the hip is also called degenerative arthritis or “wear-and-tear” arthritis.
The most common symptoms of hip arthritis are groin pain, hip stiffness, and limping. Hip stiffness may make it difficult to bend forward or to reach your foot to put on a sock or shoe. Other symptoms may include catching or popping in the hip joint.
Hip pain may radiate into your thigh or knee, or it may radiate into the buttocks.
Osteoarthritis symptoms are typically at their worst first thing in the morning or after prolonged sitting. Some patients experience increased pain and stiffness with changes in weather (rainy or cold weather).
Hip osteoarthritis is a gradually progressive problem that gets worse over time.
Cause and Anatomy
The hip joint is formed by a ball (the femoral head) and a socket (the acetabulum). The femoral head is the uppermost part of the thigh bone (femur). The acetabulum is part of the pelvis. In a healthy hip joint, the surfaces of the joint are lined with firm, smooth articular cartilage. The articular cartilage allows for smooth, pain-free motion in a healthy hip joint.
Hip osteoarthritis is the gradual wear and tear of this articular cartilage surface. Osteoarthritis of the hip is a very common condition. A number of different factors contribute to the development of hip osteoarthritis. Age-related wear and tear of the joint surface is the primary mechanism that leads to hip osteoarthritis. A number of factors can accelerate the process and lead to more severe arthritis and arthritis at an earlier age. These factors include:
- Injury to the hip joint (a history of fracture or cartilage tear in the hip)
- Heavy physical labor or activities
- Congenital deformity of the hip joint resulting in a shallow hip socket (hip dysplasia) or a femoral head that is not perfectly round
While these factors increase the risk of developing osteoarthritis, many patients without these risk factors also develop osteoarthritis of the hip.
If you see a doctor for evaluation of hip pain, the doctor will ask questions about your pain, such as:
- When did the symptoms begin?
- Where is the pain located?
- Was there an injury to the hip?
- What has been tried for treatment?
- What makes the pain better or worse?
- Have you had previous hip surgery or treatment?
- Have you been diagnosed with a hip problem in the past?
The doctor will perform a physical examination of the hip to determine:
- The range of motion of the hip joint
- The location of pain when the hip joint is moved
- Areas of tenderness to touch
- Muscle strength around the hip joint
- The presence of crepitus (popping or grinding with hip motion)
- If a limp is present with walking
Radiographs (X-rays) of the hip and pelvis are usually performed as part of the hip joint evaluation.
In a healthy hip joint, there should be space between the femoral head (ball) and acetabulum (socket). This space represents the thickness of the articular cartilage in the hip joint.
If the space is completely gone, this indicates that the articular cartilage has been completely worn away.
If the X-ray of the hip does not fully reveal the problem in the hip joint, an MRI (magnetic resonance image) or CT scan (computed tomography) may be ordered to fully evaluate the condition of the hip joint and surrounding muscles and soft tissues.
What Are My Options?
Initially, the treatment for hip osteoarthritis includes:
- Activity modification - avoiding high-impact activity such as running and jumping.
- Weight loss.
- Physical therapy - to improve range of motion of the hip joint and strengthen the muscles around the hip joint.
- Over the counter medications such as acetaminophen (Tylenol) or non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil or Motrin) or naproxen (Aleve or Naprosyn). Other NSAIDs are available as prescription medications.
- Corticosteroid injections directly into the hip joint.
- Use of assistive devices such as a cane or walker to provide stability while walking and take pressure off of the painful hip joint.
If you have tried a number of non-surgical treatments without relief, your pain has become constant and severe, and your day-to-day activities are severely limited because of your hip pain, your doctor may recommend total hip replacement surgery.
Total Hip Replacement
If you have developed severe and debilitating symptoms due to hip osteoarthritis, the reason is that you have completely worn away the healthy articular cartilage from the ball (femoral head) and socket (acetabulum) of the hip joint.
A total hip replacement gives you a new ball and a new socket. Total hip replacement is the replacement of both the ball and socket with metal, plastic, or ceramic parts that allow for smooth motion of the hip joint without the pain and stiffness that usually accompany osteoarthritis.
Hip replacement surgery usually lasts one to two hours. Patients typically spend one or two nights in the hospital after surgery, but in some cases are able to go home on the day of surgery.
After the hip replacement surgery is completed, patients work with a physical therapist to get on their feet and begin walking. In most cases, full weight bearing is allowed on the operative leg.
Several different “approaches” are used for hip replacement surgery. The surgical approach describes where the incision is made and which muscles are divided or incised in order to get into the hip joint to perform the surgery.
Most surgeons have a preferred method of performing hip replacement surgery.
The names of the different approaches are posterior, direct anterior, and antero-lateral (also called direct lateral). Each approach has its own benefits and risks. Studies have shown that the recovery after hip replacement surgery is similar regardless of which approach is used.
If you are considering hip replacement surgery, you should ask your surgeon about which approach is to be used and why.
After hip replacement surgery, there will be pain associated with the surgery that lasts for several weeks. This pain usually improves week to week.
Many patients with severe hip osteoarthritis are able to say that the deep groin pain is improved (compared to the pain they had before surgery) within the first few days after surgery.
Flexibility and muscle strength gradually improve after surgery with the help of physical therapy and home exercises. This process can take a number of months.
The amount of pain experienced after hip replacement surgery and the speed of recovery vary greatly from patient to patient.
As with any surgical procedure, there are risks associated with hip replacement surgery. These risks include:
- Nerve or blood vessel injury
- Fracture (broken bone)
- Hip dislocation
- Leg length inequality
- Need for additional surgery
- Medical complications such as deep vein thrombosis (blood clot in the leg)
You should discuss any questions about the risks of surgery with your doctor if you are considering hip replacement.