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About the Hip

The hip is one of the body's largest joints. It is also called a synovial joint or a "ball-and-socket" joint: where the ball-shaped surface of one rounded bone fits into the cup-like hollow of another bone. Cushioning the surface of the ball and socket is a smooth, slippery substance called articular cartilage. This protects the bones and allows them to move easily. The surface of the hip joint is covered by a thin lining called the synovium which produces fluid that lubricates the cartilage and aids in movement.

hip-diagram-orthopedic-surgery

Total hip replacement surgery may become necessary when severe degeneration of the joint occurs due to conditions such as arthritis, avascular necrosis (poor blood flow), trauma, and infection.

Arthritis

Also called "wear-and-tear" arthritis, osteoarthritis is a very common condition. Usually, people develop it in middle age or older. It develops gradually and worsens over time. It can occur in any joint in the body, but most often develops in weight-bearing joints, such as the hip.

In osteoarthritis of the hip, the cartilage in the joint slowly degenerates (wears away). If left untreated, the cartilage can wear away completely, causing bone-on-bone rubbing. Pain and joint stiffness make it hard to do everyday things like bending down, climbing stairs, getting up from a chair, or walking. There is no cure for osteoarthritis, but the earlier you seek treatment, the better your chances for maintaining a normal, active lifestyle.

There is no single, specific cause for hip arthritis. However, your risk increases if you:

  • Are middle aged or older
  • Have a family history of arthritis
  • Have injured your hip in the past
  • Are obese
  • Suffer from hip dysplasia (a deformity present at birth)

The most common symptom is pain in the hip area which can worsen over time, and might increase due to inactivity (sitting or resting). Additional symptoms may include:

  • Pain in the groin or thigh that radiates to the buttocks or knee
  • Pain that flares up with vigorous activity
  • Stiffness in the hip joint that makes it difficult to walk or bend
  • "Locking" or "sticking" of the joint, and a grinding noise during movement caused by loose fragments of cartilage and other tissue interfering with the smooth motion of the hip
  • Decreased range of motion that affects the ability to walk and may cause a limp
  • Increased joint pain with rainy weather

Diagnosing hip arthritis begins with:

Physical Exam

Your physician will ask you a series of questions and is likely to do a physical exam. The physical exam will including examining any specific areas of concern, especially as they relate to the reason for your visit to the office.

Personal and Family Medical History: Your doctor will likely ask you a series of questions relating to your personal medical history and your family's medical history.

Your doctor will perform tests to assess:

  • Tenderness in your hip
  • Range of motion
  • If there is a "grating" sensation when you move the joint
  • Pain when pressure is placed on the hip
  • Gait (walking) issues
  • Any signs of injury to the muscles, tendons, and ligaments surrounding the hip

Imaging Tests

X-rays

A form of electromagnetic radiation with very high frequency and energy. X-rays are used to examine and make images of things such as the bones and organs inside the body.

X-rays of an arthritic hip may show a narrowing of the joint space, changes in the bone, and the formation of bone spurs (osteophytes).

On occasion, other imaging tests may be performed to better determine the condition of the bone and soft tissues of your hip. These include:

Magnetic resonance imaging (MRI)

This test uses a magnetic field, radiofrequency pulses, and a computer to produce detailed images of body structures in multiple places. You may be asked to drink a contrast solution for better imaging, and you will most likely lie on a moving table as pictures are taken. MRI is a more detailed tool than x-ray and ultrasound and for certain organs or areas of the body, it provides better images than CT. MRI may not be recommended if you have a pacemaker or other metal implant.

Computed tomography (CT) scan

CT scans use x-ray equipment and computer processing to produce 2-dimensional images of the body. The patient lies on a table and passes through a machine that looks like a large, squared-off donut. Doctors order CT scans when they want to see a two-dimensional image of the body to look for tumors and examine lymph nodes and bone abnormalities. If contrast dye is used to improve the computer image, the patient may need to avoid eating or drinking for 4 to 6 hours before the test. Patients should tell their provider before the test if they have any allergies or kidney problems.

Bone scans

Bone scans involve a low dose of radioactive material that is injected into a vein. Bone attracts this material. Concentrated areas show up on the scan and are referred to as "hot spots." Hot spots may be indicative of cancer arthritis.

Although there is no cure for arthritis, there are a number of treatment options that will help relieve pain and improve mobility.

Nonsurgical Treatment

As with other arthritic conditions, early treatment of hip arthritis is nonsurgical. Your doctor may recommend a range of treatment options.

Activity modification

Physicians may prescribe general lifestyle changes to a patient, in order to help relieve the symptoms of their condition and improve their overall physical function and well-being. Depending on the medical condition being treated, activity modification may include: decreasing or increasing one's level of physical activity; added rest; beginning a new activity or exercise program; changing sleep habits; or modifying one's physical environment at home, in their vehicle, or at work.

Some changes in your daily life can protect your hip joint and slow the progress of arthritis.

  • Minimizing activities that aggravate the condition, such as climbing stairs.
  • Switching from high-impact activities (like jogging or tennis) to lower impact activities (like swimming or cycling) will put less stress on your hip.
  • Losing weight can reduce stress on the hip joint, resulting in less pain and increased function.

Physical therapy

Sometimes referred to simply as "PT," this is a type of rehabilitative treatment that uses specially designed exercises and equipment to help patients preserve, regain, or improve their physical abilities following injury, disability, disease, or surgery. Physical therapy can include therapeutic exercise, massage, assistive devices, and patient education and training.

Specific exercises can help increase range of motion and flexibility, as well as strengthen the muscles in your hip and leg. Your doctor or physical therapist can help develop an individualized exercise program that meets your needs and lifestyle.

Walking aids

Using walking supports like a cane, crutches, or a walker can improve mobility and independence. Using assistive aids like a long-handled reacher to pick up low-lying things will help you avoid movements that may cause pain.

Medications

If your pain affects your daily routine, or is not relieved by other nonsurgical methods, your doctor may add medication to your treatment plan.

  • Over the counter medication such as acetaminophen
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): A class of medications, including but not limited to aspirin, naproxen, and ibuprofen, that are used for reducing pain and redness, swelling, and heat (inflammation) in arthritis and other painful inflammatory disorders.
  • Corticosteroids: Cortisol is a naturally-occurring hormone in the body that can affect immune cells. Corticosteroids can be given orally (as a pill) or topically (as a cream, gel, or ointment). Because topical corticosteroids are applied directly to the skin and not circulated throughout the body, patients being treated with them may experience fewer side effects.

Types of Hip Surgery

Your doctor may recommend hip surgery if your pain causes disability and is not relieved with nonsurgical treatment. There are many different types of hip surgery available. Your doctor will discuss your options with you.

hip-xray-orthopedic-surgery

X-ray image showing an artificial hip joint replacement.

Hip replacement (also called total hip arthroplasty)

During hip replacement, the doctor removes the damaged bone and cartilage, and replaces them with new pieces (an artificial joint called a prosthesis) usually made of metal and very hard plastic. In fact, there are many different materials that may make up a total joint replacement, and the best solution varies from person to person. Your surgeon will discuss the best materials that are available for you.

Hip Revision (revision total hip arthroplasty)

Hip revision surgery is performed to repair an artificial hip joint. Artificial joints, such as hips, do not last forever. They wear down over time, or they can be damaged due to an injury. This procedure is more complex and takes longer than the original hip replacement, and requires more planning and special expertise on the part of the orthopedic surgeon.

Osteotomy

The hip bones are cut, reshaped, and fixed in a new position to take pressure off of the hip joint. This procedure is used only rarely to treat osteoarthritis of the hip. It can be an option for younger patients in order to delay having to undergo a total hip replacement surgery.

Hip resurfacing

This hip replacement procedure that is an alternative to total hip replacement. The damaged bone and cartilage in the hip socket is removed and replaced with a metal shell. The head of the femur, however, is conserved and capped with a smooth metal covering.

After Surgery

After any type of hip surgery, there is a period of recovery. Your recovery time and rehabilitation will depend on the type of surgery you had. Your doctor may recommend physical therapy as well as use of walking aids such as a walker, crutches, or a cane. After a period of time, you should be able to perform simple, daily tasks again with less pain.

If you would like additional information about joint replacement surgery at BMC or wish to make an appointment, please call 617.830.3973.

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