There are several reasons why your specialist may recommend hip replacement surgery. People who benefit from hip replacement surgery often have:
Hip pain or stiffness that limits everyday activities, such as walking or bending and getting in and out of chairs.
Hip pain continues while resting, either day or night.
Stiffness in a hip that limits the ability to move or lift the leg.
Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports.
The hip is a ‘ball and socket’ joint made of the two bones, the thigh bone and the pelvis. What people refer to as their ’hip’ when talking about clothing is actually the top part of the pelvis. The part of the thigh bone that, makes the ball up is called the femoral head which is attached to the rest of the thigh bone by a piece of bone called ‘the neck’. The part of the pelvis that makes up the socket is called the acetabulum.
The surfaces of the bones that move against each other are covered by a layer of tissue called articular cartilage, or the joint surface. In healthy joints this is smooth and the surfaces move freely against each other. In damaged or arthritic joints this layer may be rough or patchy and this can cause pain, swelling and feelings of instability.
The hip is stabilised by various structures. The strongest of these are the muscles. These include the various thigh and buttock muscles. The ball and socket joint is contained within a very important sleeve of tissue called the hip joint capsule. There are thickenings in and around the capsule that form ligaments. There is also a structure made of cartilage that runs around the rim of the socket that acts like an ‘O’ ring called the labrum. Its job is to effectively deepen the socket and make the joint more stable.
Common Hip Conditions
Arthritis is a very common condition affecting hips. There are various causes like injury, whole-body diseases like rheumatoid disease, psoriasis and lupus and the most common – wear and tear. The hip will usually cause pain in the groin and sometimes running all the way down the front of the thigh to the knee. Occasionally there is no pain in the hip at all but the stiffness often noticed as difficulty putting on shoes and socks or cutting toenails. Instability can also be a problem, There are many different ways to treat arthritis before surgery is required. These include an exercise program and weight loss, modification of activity, various walking aids, medications (both prescription and non-prescription), physiotherapy, podiatry and injections. Surgery is usually used when another treatment has failed or the disease is too advanced for it to be likely to work. If surgery is required for hip arthritis, it is usually some sort of replacement.
Trochanteric Bursitis is a term used to refer to pain and tenderness on the outer aspect of the thigh. Strictly speaking, it refers to inflammation of a small thin ‘bag’ of slippery fluid that sits on the bone on the outer aspect of the thigh. This is present to allow easy movement of the soft tissues over the bone. We have subsequently realised that this is not actually the cause and that it is in fact caused by muscle dysfunction of the large buttock muscles that usually hold the pelvis still when walking during the part of the walking movement that has all the body weight on one leg as the other leg swings through.
Walking incorrectly or limping puts a strain on the muscle insertion on to the bone and causes damage to the tendon that fails to heal because of a poor blood supply. Treatment of this is usually non-operative and concentrates on getting the act of walking correctly again. This involves physiotherapy and podiatry with a managed exercise program. Sometimes injection can be used to try and help the healing process. Surgery is rarely used as it does not have a high success rate. A hip replacement does not fix this pain.
A labral tear is a term used to describe a tear or detachment of the stabilising ring around the lip of the hip socket. This can be a very painful, frustrating and disabling condition. This condition does not show up on simple x-rays or even some MRI scans. It can often cause sharp pain with certain movements, sudden instability or a deep nagging aching groin pain. Luckily the vast majority of labral tears can be treated conservatively, and the, in fact, many people have them and don’t realise that this is what they have. In a small percentage of cases, the tear is debilitating enough to warrant surgery. Surgery can sometimes be performed via a small incision and use of a T.V camera. This procedure is called a hip arthroscopy. I do not perform hip arthroscopies but do refer appropriately when required. Unfortunately, a lot of labral tears that are symptomatic are associated with quite significant arthritic change and in those particular instances, the best way forward is usually a hip replacement.