If your hip has been damaged by arthritis, a fracture or other conditions, common activities such as walking or getting in and out of a chair may be painful and difficult. Your hip may be stiff making it hard to engage in simple activities such as putting on your shoes and socks. You may even feel uncomfortable while resting.
When medications, changes in your everyday activities, and the use of walking aids such as a cane are not helpful, a hip replacement surgery is a viable option for providing long-term pain relief and returned mobility. By replacing your diseased hip joint with an artificial joint, hip replacement surgery can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities.
A Total Hip Replacement (THR), is a surgical procedure in which the hip joint is replaced by a prosthetic implant. Replacing the hip joint consists of replacing both the acetabulum and the femoral head. Such joint replacement orthopedic surgery generally is conducted to relieve arthritis pain or fix severe physical joint damage as part of hip fracture treatment.
WHAT LEADS THE HIP JOINT TO DETERIORATE?
The most common cause of hip arthritis is osteoarthritis—the progressive loss of surface cartilage, which is age-related, genetic to some respect (Northern European Caucasian males), and is accelerated by obesity and high activity levels. This is the true “car tire arthritis” where the joint literally loses its cushioning, “tread.” Symptoms are slowly progressive over many years and account for the subtlety of onset.
Avascular necrosis (AVN) is where the bone collapses from lack of blood supply in uncommon situations of large corticosteroid doses, sickle cell anemia, HIV drugs, profound alcoholism, prior fractures around the hip joint, and many cases where we just don’t know the etiology! AVN causes sudden onset of hip pain as the bone collapses—much like the roof on a house. The onset can be quite disabling and thereby different than osteoarthritis.
Hip arthritis is also seen in patients who have fractures of the acetabulum and/or proximal femoral neck. This disturbs the normal anatomy and causes premature wear of the hip joint.
HOW DO I KNOW I NEED A TOTAL HIP REPLACEMENT?
Unlike an arthritic knee, deterioration of the hip joint is often subtle and often leads to back or knee pain second to slowly progressive decreased hip motion.
Hip arthritis produces anterior hip pain in the groin or the upper leg, whereas lumbar spine issues produce pain in the lower back and posterior hip area. 70% of hip arthritis patients also have concurrent lumbar spine issues. Lumbar spine conditions such as pinched nerves or facet joint arthritis can cause significantly perceived hip pain.
Every patient we evaluate for potential THR undergoes evaluation of the lumbar spine. By history, physical, x-rays, and sometimes an MRI, we can sort out the relative contributions of lumbar spine and hip arthritis to the patient’s reported pain and dysfunction. If lumbar spine problems prevail, they deserve attention before any THR consideration.
Many patients don’t appreciate how stiff their hips are, and in most cases, both hips are affected with arthritis so that the patient cannot feel the difference between left and right, as both hips have become restrictive!
That said, lumbar spine issues are even more difficult to judge as to their contribution to the patient’s issues. Many patients have undergone a lumbar spine MRI which indeed shows degenerative and aging changes. These may or may not have clinical relevance and often require a detailed analysis by a spine expert and/or pain management physicians. It is imperative before proceeding with a THR that the primary pain generator be ascertained—whether lumbar spine, hip, or both.
A simple physical test, however, will reveal hip arthritis. With the patient in a sitting position, the examiner rotates the hip while rolling the bent knee in and out. Restricted motion is a faithful sign of hip arthritis—which is confirmed on hip x-rays.