Osteoarthritis & Hip Replacement

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The normal hip joint is a ball and socket joint. The socket is formed by part of the pelvis called the acetabulum. The ball is formed by the upper part of the thigh bone called the femoral head. Together, they provide good stability and range of motion, allowing a wide range of activities in most people.

A wide range of conditions can afflict the hip joint, the most common of which is osteoarthritis in the above-50 age group. Osteoarthritis causes pain and stiffness, usually progressive in nature, and this can often result in significant restriction in activity. Osteoarthritis is often predisposed to by:

• Dysplasia of the hip which is a deformity of the hip joint early in life, and
• Avascular necrosis of the femoral head, which may occur in persons on long term steroids, heavy drinking, with previous hip trauma or with certain systemic conditions.

However, often the cause of the arthritis is unclear, though occupations requiring heavy lifting, farming, and elite sports activity have been shown to be associated with increased rates of hip osteoarthritis.

Treatment of Hip Osteoarthritis


There is no known cure for osteoarthritis of the hip. However, various modalities of treatment aim to allow relief of pain and resumption of function activity.

These include weight management, since obesity and being overweight have been shown to be associated with increased incidence of development of hip osteoarthritis.

Physical therapy with strengthening and range of motion exercises has an important role in reducing pain and preserving motion and function of the joint. Hydrotherapy may also have a role to play in specific patients. Techniques to reduce strain on the joint and to protect the joint from shock and stress are also important to improve function.

So far, there has been no medical evidence in support of use of specific dietary therapies for management of osteoarthritis.

Various forms of oral medication including paracetamol, NSAIDs and cox-2 inhibitors are helpful in alleviating pain and reducing inflammation to allow painful function of the joint.

Glucosamine supplementation may be beneficial in alleviating symptoms from hip osteoarthritis.

Occasionally, intra-articular steroid injections may also be prescribed if symptoms are not brought under control by oral medication.

A total hip replacement is a surgical procedure whereby the diseased cartilage and bone of the ball and socket is surgically replaced with implants.

Hip replacement surgery is not new, with surgeries being carried out since the early 1960s.

However, much refinement and improvement of the procedure has occurred during this time.

Traditionally, the materials used to replace the surfaces of the ball and socket have been a metal ball and a polyethylene or plastic socket. While providing smooth, low friction movement, wear and tear of the plastic tended to occur over time. Also, the worn out plastic particles tended to cause a reaction in the body called ‘osteolysis’ which resulted in bone around the hip being removed by the body. The wear of the plastic, together with the resorption of bone by the body, would result in early failures of the prosthetic hip joints.

Currently, the choice of materials used to replace the joint surfaces is much wider. Newer plastic surfaces have been devised which allow much lower rates of wear. Accurately fashioned hard-wearing ceramic and metal surfaces have reduced rates of wear, while circumventing problems with osteolysis.

Along with improved surfaces, implant design has also improved to allow better integration and ingrowth of implants to the bone, allowing for a stable hip joint.

Along with advances in material technologies, surgical techniques have also improved.

New equipment has made possible minimally invasive techniques, with use of smaller incisions and less disruption of muscles around the hip joint.

The anterior approach to the hip joint is gaining popularity due to the ability to approach the hip joint through a minimally invasive fashion, with the surrounding muscle retracted aside, without the need to cut through the muscle.

The benefits of a smaller incision and less soft tissue disruption are a shorter hospital stay, with faster rehabilitation, and may allow faster return to work and daily activity.

These new advances have helped to make hip replacement surgery highly successful, with excellent pain relief and return of function.

If you are bothered by arthritis of the hip, you should seek advice from your doctor. He will be able to counsel you about whether you may be able to benefit from the many advances in hip replacement, and allow you to return to an active, pain-free lifestyle.

Such non-surgical measures are usually effective in mild to moderate arthritis, allowing pain-free function. However, in severe arthritis, hip replacement surgery is the best option in allowing for a pain-free mobile joint.

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Expert Author:
Dr David Paul Bell, Orthosports Orthopaedic Surgery & Sports Medicine.


Further Reading

 
The article above is meant to provide general information and does not replace a doctor's consultation.
Please see your doctor for professional advice.