Arthritis is generally defined as deterioration of a joint with associated loss of the cartilage which lines the joint and acts as a cushion. As the arthritis progresses, the body’s natural processes kick in and the bone tries to reinforce itself with additional calcium. This additional calcium can form bone spurs (osteophytes) which can become painful and cause many of the symptoms associated with arthritis.
Arthritis is most commonly caused by wear and tear of the joint and is known as osteoarthritis. However, inflammatory conditions such as rheumatoid arthritis or damage to the joint from trauma can cause a form of arthritis known as post-traumatic arthritis. Some anatomic conditions, such as hip dysplasia can also predispose to arthritis of the hip. Hip dysplasia occurs when the hip socket fails to develop as deep as it should result in a smaller surface area for the hip joint to sit within.
Can Hip Arthritis Be Treated Without Surgery?
Treatment for hip arthritis depends on the degree of joint damage and the cause. In general, there are not as many treatment options for arthritis of the hip as there are for the knee.
If recognized early, hip dysplasia can be treated with a procedure known as an osteotomy. During this procedure, either the bones of the hip socket of the proximal femur (upper thigh bone) are cut and the angle of weight-bearing is changed to increase or change the surface area of the hip to prolong the lifespan of the natural joint.
Common non-operative treatments for hip arthritis consist of:
- Activity modification
- Weight loss
- Exercise in moderation and physical therapy
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen and naproxen
- Intraarticular corticosteroid injections
What are the Surgical Options for Hip Arthritis?
If these treatments have not provided relief, surgery may be indicated. Some hip conditions can be treated arthroscopically in order to preserve the hip joint. During a procedure known as hip arthroscopy, a small camera and surgical instruments are inserted into the hip joint and small bone spurs and lose pieces of cartilage can be removed.
If hip arthroscopy is not effective or not an option, then a hip replacement may be recommended. Although hip replacement has been available for over 50 years, the surgical technique and implant materials have evolved and improved drastically over time.
The most common type of hip replacement performed world-wide is a total hip replacement. This procedure involves placing a replacing both the socket of the hip as well as the ball shaped bone on the end of the femur. The goal of these implants is to mimic the natural function and anatomy of the hip. A decade ago, there was renewed interest in metal on metal joint surfaces with the promise of such highly engineered and machined surfaces lasting much longer than previous hip replacement implants. However, metal on metal bearings are common in industrial use, but unfortunately had complications in humans and are no longer used.
How Have Hip Replacements Changed in the Last 10 Years?
In recent years there has been a trend toward the use of titanium alloy metals and ceramic or ceramicized metal joint bearing surfaces. Ceramics are durable, extremely hard and make an excellent articulating surface and the modern ceramic implants do not have the brittle character of early ceramics. These ceramic joint surfaces can typically last 20 or more years.
Another recent trend in Hip Replacement has been the development (and marketing) of various “less invasive” surgical approaches to the hip, including the direct anterior approach. Other popular “minimally” invasive approaches are the mini posterior, and posterosuperior (or “Superpath”).
Each of these approaches offers a muscle and tendon sparing “intermuscular” access to the hip. All have their pros and cons, but all allow early mobility and immediate weight-bearing and walking with physical therapy the day of surgery. I always recommend to patients, choose the procedure that your surgeon does best and is most experienced with.
Total hip replacement is trending to shorter and shorter hospital stays, and many are done as an outpatient, which means patients can return home the day of their surgery. Whether your hip replacement is performed on an inpatient or outpatient basis depends on several factors related to your overall health and age.
If you are considering a hip replacement, or are not sure which hip replacement approach is best for you, contact our offices to schedule an appointment with one of our Joint Replacement Specialists. We will create a treatment plan based on your lifestyle and goals so that you can get back to doing what you love!