What's causing your hip joint pain? Is getting relief through joint replacement an option for you? These are just some of the answers that an orthopaedic surgeon can provide. But first, it's a good idea to have information about joint replacement that will help you understand what the surgeon tells you.
Hip replacement, also hip arthroplasty, is a surgical procedure in which the hip joint is replaced by a prosthetic implant. Such joint replacement orthopaedic surgery generally is conducted to relieve arthritis pain or fix severe physical joint damage as part of the hip fracture treatment.
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The hip is one of the main weight bearing joints in your body and consists of two main parts:
- A ball (femoral head) at the top of your thigh bone (femur).
- A rounded socket (acetabulum) in your pelvis.
The ball (femoral head) on the thigh bone fits into the rounded socket (acetabulum) in the pelvis. Ligaments, which are bands of tissue, connect the ball to the socket and help keep the ball and socket steady. The surfaces of the ball and socket are covered by a smooth, tough material called articular cartilage, which cushions the bones and lets them move easily.
All the rest of the surfaces of the hip joint are covered by a thin, smooth tissue liner called synovial membrane, which makes a small amount of fluid that acts as a lubricant so that the bones in the hip joint will not rub against each other.
Reasons For Hip Pain
One of the most common causes of chronic hip pain is arthritis. The most common types of arthritis are:
- Osteoarthritis (OA) — sometimes called degenerative arthritis because it is a "wearing out" involving the breakdown of cartilage in the joints. When cartilage wears away, the bones rub against each other, causing pain and stiffness. This usually occurs in people aged 50 years and older, and frequently in individuals with a family history of osteoarthritis.
- Rheumatoid Arthritis (RA) — produces chemical changes in the synovium that cause it to become thickened and inflamed. In turn, the synovial fluid destroys cartilage. The end result is cartilage loss, pain, and stiffness. This affects women about 3 times more often than men, and may affect other organs of the body.
- Post-traumatic Arthritis — may develop after an injury to the joint in which the bone and cartilage do not heal properly. The joint is no longer smooth, and these irregularities lead to more wear on the joint surfaces.
Other causes of joint pain include avascular necrosis, which can result when bone is deprived of its normal blood supply (for example, after organ transplantation or long-term cortisone treatment), and deformity or direct injury to the joint.
Joint pain can be made worse when you avoid using a painful joint, weakening the muscles and making the joint more difficult to move.
What You Should Know About Hip Joint Replacement
"Joint replacement" is usually reserved for patients who have severe arthritic conditions. Most patients who have artificial hip joints are over 55 years of age, but the operation is being performed in greater numbers on younger patients thanks to new advances in artificial joint technology.
Circumstances vary, but generally patients are considered for total joint replacement if:
- Functional limitations restrict work, recreation and the ordinary activities of daily living.
- Pain is not relieved by medications or physical therapy or by the use of a cane, and/or by restricting activities.
- Stiffness in the joint is significant.
- X-rays show advanced arthritis or other problems.
What Is Total Joint Replacement?
Total joint replacement is a surgical procedure in which certain parts of an arthritic or damaged joint are removed and replaced with a plastic or metal device or an artificial joint. The artificial joint is designed to move just like a healthy joint. Hip replacement involves replacing the femur (head of the thigh bone) and the acetabulum (hip socket). Typically, the artificial ball is made of a strong metal or ceramic, and the artificial socket is made of polyethylene (a durable, wear-resistant plastic) backed with a metal shell. The artificial joint may be cemented in position or held securely in the bone without cement.
Are You Ready to Consider Hip Joint Replacement?
If different treatments haven't helped you get through your everyday activities comfortably, you may be ready to consider hip replacement surgery.
Today, more than 300,000 Americans a year have total hip replacement surgery. First performed in 1960, this procedure is considered one of the most important surgical advances of the past 100 years. It has amply fulfilled its promise of restoring many people to the lives they knew before their hip pain worsened.
Possible Complications of Surgery
Serious complications may occur with any surgical procedure. These include but are not limited to: problems with anesthesia, cardiovascular problems including heart attack, vascular problems including thrombus, bronchopulmonary problems including emboli, genitourinary problems, and gastrointestinal problems. Certain additional complications related to joint replacement surgery in particular may include but are not limited to: bleeding problems, blood clots in the legs and/or lungs, wound healing problems, damage to nerves and blood vessels, limb length discrepancy, bone erosion or abnormal bone formation, dislocation, infection, pain, bone fracture or non-union, component wear or fracture, component loosening. Complications may require medical intervention including additional surgery and, in rare instances, may lead to death. Your doctor should discuss these potential complications with you.
Will an Artificial Hip Joint Last Forever?
As successful as most of these procedures are, over the years, an artificial joint can become loose and unstable or wear out, requiring a revision (repeat) surgery. These issues — together with the fact that increasing numbers of younger and more active patients are receiving total joint replacement, and patients are living longer — have challenged the orthopaedic industry to try to extend the life cycle of total joint replacements.
Recent improvements in surgical techniques and instrumentation will help to further the success of your treatment. The availability of advanced materials, such as titanium and ceramic, and new plastic joint liners provides orthopaedic surgeons with options that may help to increase the longevity of the artificial joint.
Hip Replacement Surgery Techniques
There are several different incisions, defined by their relation to the gluteus medius. The approaches are posterior (Moore), lateral (Hardinge or Liverpool), antero-lateral (Watson-Jones), anterior (Smith-Petersen) and greater trochanter osteotomy. There is no compelling evidence in the literature for any particular approach, but consensus of professional opinion favours either modified anterio-lateral (Hardinge) or posterior approach.
- The posterior (Moore) approach accesses the joint through the back, taking piriformis muscle and the short external rotators off the femur. This approach gives excellent access to the acetabulum and preserves the hip abductors. Critics cite a higher dislocation rate although repair of capsule and SERs negates this risk.
- The lateral approach is also commonly used for hip replacement. The approach requires elevation of the hip abductors (gluteus medius and gluteus minimus) in order to access the joint. The abductors may be lifted up by osteotomy of the greater trochanter and reapplying it afterwards using cables (as per Charnley), or may be divided at their tendinous portion, or through the functional tendon (as per Hardinge) and repaired using sutures.
- The anterolateral approach develops the interval between the tensor fasciae latae and the gluteus medius.
- The anterior approach utilises an interval between the sartorius and tensor fascia latae.
The double incision surgery and minimally invasive surgery seeks to reduce soft tissue damage through reducing the size of the incision. However component positioning accuracy is impaired and surgeons using these approaches are advised to use computer guidance systems.
Having an Orthopaedic Evaluation
If you're ready to consider having hip joint replacement, the next important step is to talk with an orthopaedic surgeon. The medical management of arthritis and joint degeneration may be handled by a family doctor, an internist, or a rheumatologist. However, when medical management is not effective, an orthopaedic surgeon should be consulted to determine if surgery is an option. In some cases, the orthopaedic surgeon may be the first physician to see a patient and make the diagnosis of arthritis.
While every orthopaedic evaluation is different, there are many commonly used tests that an orthopaedic surgeon may consider in evaluating a patient's condition. In general, the orthopaedic evaluation usually consists of:
- A thorough review of your medical history
- A physical examination
- Additional tests as needed
The information that the orthopaedic surgeon gathers during the medical history usually suggests the possibility of several different diagnoses (causes). After the medical history is taken, the orthopaedic surgeon conducts a physical examination: If you are experiencing pain in your hip joint, your back may be examined, because hip pain may actually be the result of problems in the lower spine.
After the physical examination, X-ray evaluation is usually the next step in making the diagnosis. The X-rays help show how much joint damage or deformity exists. An abnormal X-ray may reveal:
- Narrowing of the joint space
- Cysts in the bone
- Spurs on the edge of the bone
- Areas of bony thickening called sclerosis
- Deformity or incorrect alignment
- Other abnormalities
Additional tests may include laboratory testing of blood, urine, or joint fluid and/or magnetic resonance imaging or a bone scan of the joint and surrounding soft tissue.
Following the orthopaedic evaluation, the orthopaedic surgeon will review and discuss the results with you. Based on his or her diagnosis, your treatment options may include:
- Physical therapy
- Hip joint fluid supplements (injections that provide temporary pain relief)
- Total hip joint replacement
If you and your orthopaedic surgeon decide that hip joint replacement surgery is an option to relieve your pain, he or she will provide the specific-to-you details of which type of artificial joint will be used, what you need to know to prepare for the surgery, how the surgery will be performed, and what results you can expect once you're up and moving again.