Hip Conditions

Hip Arthritis

Hip arthritis is a condition that affects the hip joint, causing pain, stiffness, and impairing the quality of life for many people. Generally, treatment of hip arthritis includes activity modification, physical therapy, and anti-inflammatory medications. If these treatments do not provide relief, surgical treatment in the form of a Total Hip Replacement may be necessary.

Anatomy

The hip is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone). The surfaces of the ball and socket are covered with articular cartilage, a smooth tissue that provides shock absorption. Ligaments connecting the ball to the socket make up the hip capsule which help to provide stability to the hip. The hip joint plays an important role in everyday movements such as sitting, twisting, and rotational movements of the leg.

What is Hip Arthritis?

Arthritis is any condition that causes degeneration of the cartilage of the joint surfaces. When the articular cartilage wears down, there is no longer a smooth surface lining the ball and socket causing pain. Some of these conditions include osteoarthritis, rheumatoid arthritis, avascular necrosis, and hip dysplasia. Trauma or other injuries to the hip may also cause arthritis.

Osteoarthritis

Also called degenerative joint disease, this is the most common type of arthritis, which occurs most often in older people. This disease affects cartilage, the tissue that cushions and protects the ends of bones in a joint. With osteoarthritis, the cartilage starts to wear away over time. In extreme cases, the cartilage can completely wear away, leaving nothing to protect the bones in a joint, causing bone-on-bone contact which can lead to painful bone spurs or osteophytes.

Rheumatoid Arthritis

This is an autoimmune disease in which the body’s immune system (the body’s way of fighting infection) attacks healthy joints, tissues, and organs. Occurring most often in women of childbearing age (15-44), this disease inflames the lining (or synovium) of joints. It can cause pain, stiffness, swelling, and loss of function in joints. When severe, rheumatoid arthritis can deform, or change a joint. For example, the joints in a person’s finger can become deformed, causing the finger to bend or curve. Rheumatoid arthritis affects mostly joints of the hands and feet and tends to be symmetrical. This means the disease affects the same joints on both sides of the body (like both hands or both feet) at the same time and with the same symptoms. No other form of arthritis is symmetrical. About two to three times as many women as men have this disease.

Avascular Necrosis (AVN)

A condition in which the bone of the femoral head dies. The unhealthy bone under the cartilage surface can collapse causing damage within the hip joint. Main causes of AVN include injury to the femoral head, heavy alcohol use, and certain medications such as high dose corticosteroids.

In the arthritic hip, despite the cause, there is thinning or complete loss of the cartilage, which causes loss of joint space and shortening of the leg. There can be osteophyte or extra bone formation, limitation of joint motion, and pain

Predisposing factors to Osteoarthritis of the hip

Some conditions may predispose the hip to osteoarthritis; it tends to affect people, as they get older and particularly affects joints that distribute force and weight throughout the body

  • A previous fracture that involved the hip
  • Growth abnormalities of the hip (such as a shallow socket) may lead to premature arthritis
  • Some childhood hip problems later cause hip arthritis (for example, a type of childhood hip fracture known as a Slipped Epiphysis; also Legg-Perthes Disease)
  • Inactive lifestyle- e.g., Obesity (overweight) Your weight is the single most important link between diet and arthritis, as being overweight puts an additional burden on your hips, knees, ankles and feet

Diagnosis

Hip arthritis can be diagnosed with a thorough history and physical examination. It must be differentiated from other conditions that may cause similar symptoms including pelvic or urologic conditions. X Rays are helpful in revealing signs of arthritis including joint space narrowing.

Treatment

Treatment of hip arthritis depends on the severity of the patient’s symptoms

Non operative treatment options include:

  • Anti-inflammatory medications
  • Physical therapy
  • Lifestyle modifications, weight loss
  • Cortisone injection if anti-inflammatory medications are unsuccessful

Surgery is considered if non operative treatment including anti-inflammatory medications, physical therapy, weight loss, and walking aids do not improve symptoms. Patients who have severe pain with activities, pain at night, loss of the ability to work and perform routine activities, are those who may benefit from surgical treatment in the form of a Total Hip Replacement.


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