Hip Replacement
Surgery

The hip joint is also designed to bear repeated motion and a fair amount of wear and tear. The hip joint is not easily indestructible. However, increasing age and use can cause the cartilage to wear down or become damaged.
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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).

Articular cartilage covers the surface of the ball and socket. It creates a smooth, low-friction surface that helps the bones glide easily across each other. The surface of the joint is covered by a thin lining called the synovium. In a healthy hip, the synovium produces a small amount of fluid that lubricates the cartilage and aids in movement.

Hip Arthritis

The most common form of arthritis in the hip osteoarthritis — the “wear-and-tear” arthritis that damages cartilage over time, typically causing painful symptoms in people after they reach middle age. Unlike osteoarthritis, inflammatory arthritis affects people of all ages, often showing signs in early adulthood.

Rheumatoid Arthritis

In rheumatoid arthritis, the synovium thickens, swells, and produces chemical substances that attack and destroy the articular cartilage covering the bone. Rheumatoid arthritis often involves the same joint on both sides of the body, so both hips may be affected.

Ankylosing Spondylitis

Ankylosing spondylitis is a chronic inflammation of the spine that most often causes lower back pain and stiffness. It may affect other joints, as well, including the hip.

Systemic Lupus Erythematosus

Systemic lupus erythematosus can cause inflammation in any part of the body, and most often affects the joints, skin, and nervous system. The disease occurs in young adult women in the majority of cases.

People with systemic lupus erythematosus have a higher incidence of osteonecrosis of the hip, a disease that causes bone cells to die, weakens bone structure, and leads to disabling arthritis.

Symptoms

Inflammatory arthritis may cause general symptoms throughout the body, such as fever, loss of appetite and fatigue. A hip affected by inflammatory arthritis will feel painful and stiff. There are other symptoms, as well:
  • A dull, aching pain in the groin, outer thigh, knee, or buttocks
  • Pain that is worse in the morning or after sitting or resting for a while, but lessens with activity.
  • Increased pain and stiffness with vigorous activity.
  • Pain in the joint severe enough to cause a limp or make walking difficult.

Physical Examination

During the physical examination, rangge of motion usually is restricted and painful. Most typical finding is the limp or antalgic gait.

X-rays

X-rays of an arthritic hip will show loss of joint space, thinning or erosion in the bones.
This x-ray shows a normal hip.
This x-ray shows inflammatory
arthritis with decreased joint space.

Blood Tests

Blood tests may reveal whether a rheumatoid factor—or any other antibody indicative of inflammatory arthritis—is present.

Treatment

Although there is no cure for inflammatory arthritis, there are a number of treatment options that can help prevent joint destruction. Inflammatory arthritis is often treated by a team of healthcare professionals, including rheumatologists, physical and occupational therapists, rehabilitation specialists, and orthopaedic surgeons.

Nonsurgical Treatment

  • The treatment plan for managing your symptoms will depend upon your inflammatory disease. Most people find that some combination of treatment methods works best.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) may relieve pain and help reduce inflammation.
  • Corticosteroids. Medications like prednisone are potent anti-inflammatories, usually used in acute flare with severe pain.
  • Disease-modifying antirheumatic drugs (DMARDs). These drugs act on the immune system to help slow the progression of disease. Methotrexate and sulfasalazine are commonly prescribed DMARDs.
  • Physical therapy. Specific exercises may help increase the range of motion in your hip and strengthen the muscles that support the joint.
  • In addition, regular, moderate exercise may decrease stiffness and improve endurance. Swimming is a preferred exercise for people with ankylosing spondylitis because spinal motion may be limited.
  • Assistive devices. Using a cane, walker, long-handled shoehorn, or reacher may make it easier for you to perform the tasks of daily living.

Surgical Treatment

If nonsurgical treatments do not sufficiently relieve your pain, your doctor may recommend surgery. The type of surgery performed depends on several factors, including:
  • Your age
  • Condition of the hip joint
  • Which disease is causing your inflammatory arthritis
  • Progression of the disease

The most common surgical procedures performed for inflammatory arthritis of the hip include total hip replacement.

Total Hip Replacement.

The damaged cartilage and bone is removed, and then new metal or plastic joint surface is used to restore the function of hip. Total hip replacement is often recommended for patients with rheumatoid arthritis or ankylosing spondylitis to relieve pain and improve range of motion.
In total hip replacement, both the head of the femur and the socket are replaced with an artificial device.

The most common complications of surgery include:

  • Infection
  • Excessive bleeding
  • Blood clots
  • Damage to blood vessels or arteries
  • Dislocation (in total hip replacement)
  • Limb length inequality (in total hip replacement)

Recovery

How long it takes to recover and resume your daily activities will depend on several factors, including your general health and the type of surgical procedure you have. Initially, you may need a cane, walker, or crutches to walk.