Hip Arthritis: Anatomy
The hip join is made up of the pelvis and the femur. The femoral head articulates with the acetabulum like a ball and joint socket. The femoral head and acetabulum are covered in a thin layer of cartilage that acts as shock absorbers.
In an arthritic hip, decades of wear and tear the leads to the cartilage wearing down and causing pain with ambulation, and decreased range of motion such as problems putting on shoes or crossing legs. Pain is typically worse with ambulation and located in the groin.
Hip Arthritis: X-Rays
Healthy Hip
Arthritic Hip
Here are xrays of a healthy hip. The femoral head is round and there is space between the femoral head and pelvis meaning there is cartilage in between and no bone-on-bone arthritis.
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Here the femoral head and pelvis are touching each other, there are bone cysts throughout and flattening of the femoral head. The cartilage has been worn out and there is severe bone-on-bone arthritis.
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Treatment
The underlying cause of pain in arthritis is inflammation within the joint. There are many conservative treatment options to reduce the inflammation. and improve the strength of the muscles around the joint.
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Oral Medications: Oral non-steroidal anti-inflammatories such as over the counter ibuprofen can help to provide relief. There are also prescription anti-inflammatories that can can provide greater relief. These medications work well however they are not delivered directly to the hip or knee in high doses.
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Injections: Strong anti-inflammatory medications can be delivered to the joint itself with hip or knee Injections. There are various types of injections that can be performed to help reduce the inflammation and lubricate the joint.
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Physical Therapy: Physical therapy can lessen your pain by teaching better posture or “form” for your day-to-day activities, like getting in and out of a chair. Exercises also help
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Weight Management: Eating healthier and low impact exercise such as swimming, walking, elliptical and cycling can help with weight loss. This leads to reduced forces across the joints and less pain. Every 1lb of weight loss equals 4lbs less force across the joints.
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Surgery: Anti-inflammatories, band-aids to reduce pain however they don’t address the arthritis itself. If all else fails, surgery is the last option. For the right indications, joint replacement provides immediate and long lasting pain relief with the ability to return to your normal function
Total Hip Replacement (THA)
(Click video to play)
In a total hip replacement, the arthritic femoral head is removed and replaced with a metal stem. This femoral stem is placed down the femur which is hollow like a pipe.
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Next a few millimeters of bone is removed from the acetabulum and hemispherical component is fit tightly into the pelvis. A durable highly cross-linked polyethylene (plastic) is placed between. This acts as the new "cartilage" in the hip.
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A hip replacement can be done through different incisions such as anterior or posterior. Your surgeon will discuss which is the best option for you.
