Total Hip Replacement
By: Dr. Abe Kopolovich, DPT, MBA, JD-IP
Your Hip The hip joint is where the femur (thigh bone) and pelvis meet and consists of a ball and socket joint. The socket, called the acetabulum, is a part of the pelvis and accepts the ball, called the head of the femur (femoral head). The acetabulum and femoral head are both covered by a thick layer of articular cartilage that allows the head pivot inside the acetabulum in a nearly frictionless and pain free manner. The rim of the acetabulum is lined with a different and thicker type of cartilage called the labrum, which serves to make the socket deeper and reduces the stresses across the articular cartilage.
Many patients with arthritis of the hip complain of pain in the front of the hip (groin area), back of the hip (buttock), or on the side. An additional complaint is stiffness of the hip joint making simple activities such as donning shoes and socks quite difficult. Common Hip Problems Arthritis is the most common cause of the breakdown of hip cartilage.
Osteoarthritis: also referred to as “wear and tear” arthritis; osteoarthritis affects the cartilage that cushions the bones of the hip. As this cartilage wears away, the ends of the bones rub together causing a grinding feeling, hip pain and resulting stiffness.
Rheumatoid arthritis: a systemic disease, which affects multiple joints in the body. The synovial membrane, which lines the entire joint cavity becomes irritated and produces too much fluid. The resulting healing response damages the cartilage, leading to pain and stiffness. Rheumatoid arthritis starts in much younger patients. Avascular necrosis (or osteonecrosis) can also result in damage to the hip articular surfaces. It is caused by an interruption of the blood supply to the femoral head, resulting in death (or necrosis) of the bone tissue and collapse of the femoral head. Injuries, tumors or alcoholism may cause interruptions in the blood supply.
In most cases, non-surgical treatments are exhausted before operative measures are considered. Non-surgical treatments for arthritis of the hip include: Talk to your doctor about a referral to physical therapy (PT). Exercise can help keep your joints flexible, strengthens the muscles around the joints, reduces pain and keeps your bone and cartilage tissue strong and healthy. If you start an exercise regimen, take a balanced approach and include aerobic activities such as walking, swimming and cycling in addition to stretching/flexibility exercises and strengthening exercises. You want to avoid exercises that place excessive stress on the joints like high-impact workouts or competitive sports activities. Losing weight can have a surprising effect on reducing arthritic pain. With each step, you exert 4-7 times your body weight on your knee joints. So when you lose even a small amount of weight, your symptoms improve dramatically and you may be able to perform more activities and potentially put off surgery for six months or longer. Activity modifications include reducing high-impact and repetitive activities that place increased stresses on the hip joint. Guided yoga or pilates can also help reduce pain and improve mobility. The use of a cane, usually in the hand opposite the affected hip, can reduce the stress across the hip joint.
Total hip replacement (THR) is performed in patients with severe wear and loss of cartilage in the hip joint due to injury, trauma or for types of arthritis or other congenital or age-related changes to the hip joint. In a THR, the damaged femoral and the damaged hip socket (acetabulum) are removed and replaced with metal, plastic, or ceramic components depending upon your unique needs and condition. Revision Total Hip Replacement THR permits patients to participate in most activities of daily living in a pain-free manner for 10-20 years and sometimes longer.