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Whether you have just begun exploring treatment options or have already decided to undergo hip replacement surgery, this information will help you understand the benefits and limitations of total hip replacement. This article describes how a normal hip works, the causes of hip pain, what to expect from hip replacement surgery, and what exercises and activities will help restore your mobility and strength, and enable you to return to everyday activities.
If your hip has been damaged by arthritis, a fracture, or other conditions, common activities such as walking or getting in and out of a chair may be painful and difficult. Your hip may be stiff, and it may be hard to put on your shoes and socks. You may even feel uncomfortable while resting.
If medications, changes in your everyday activities, and the use of walking supports do not adequately help your symptoms, you may consider hip replacement surgery. Hip replacement surgery is a safe and effective procedure that can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities.
First performed in 1960, hip replacement surgery is one of the most successful operations in all of medicine. Since 1960, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of total hip replacement. According to the Agency for Healthcare Research and Quality, more than 300,000 total hip replacements are performed each year in the United States.
The hip is one of the body’s largest joints. It 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 bone surfaces of the ball and socket are covered with articular cartilage, a smooth tissue that cushions the ends of the bones and enables them to move easily.
A thin tissue called synovial membrane surrounds the hip joint. In a healthy hip, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all friction during hip movement.
Bands of tissue called ligaments (the hip capsule) connect the ball to the socket and provide stability to the joint.
The most common cause of chronic hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease.
In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components.
Femoroacetabular impingement (FAI) is a condition in which extra bone grows along one or both of the bones that form the hip joint — giving the bones an irregular shape. Because they do not fit together perfectly, the bones rub against each other during movement. Over time this friction can damage the joint, causing pain and limiting activity.
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).
A slippery tissue called articular cartilage covers the surface of the ball and the socket. It creates a smooth, low friction surface that helps the bones glide easily across each other during movement.
The acetabulum is ringed by strong fibrocartilage called the labrum. The labrum forms a gasket around the socket, creating a tight seal and helping to provide stability to the joint.
In FAI, bone overgrowth — called bone spurs — develop around the femoral head and/or along the acetabulum. This extra bone causes abnormal contact between the hip bones, and prevents them from moving smoothly during activity. Over time, this can result in tears of the labrum and breakdown of articular cartilage (osteoarthritis).
Types of FAI
There are three types of FAI: pincer, cam, and combined impingement.
FAI occurs because the hip bones do not form normally during the childhood growing years. It is the deformity of a cam bone spur, pincer bone spur, or both, that leads to joint damage and pain. When the hip bones are shaped abnormally, there is little that can be done to prevent FAI.
It is not known how many people have FAI. Some people may live long, active lives with FAI and never have problems. When symptoms develop, however, it usually indicates that there is damage to the cartilage or labrum and the disease is likely to progress.
Because athletic people may work the hip joint more vigorously, they may begin to experience pain earlier than those who are less active. However, exercise does not cause FAI.
The most common symptoms of FAI include:
Pain often occurs in the groin area, although it may occur toward the outside of the hip. Turning, twisting, and squatting may cause a sharp, stabbing pain. Sometimes, the pain is just a dull ache.
If tests show joint damage caused by FAI and your pain is not relieved by nonsurgical treatment, your doctor may recommend surgery.
Many FAI problems can be treated with arthroscopic surgery. Arthroscopic procedures are done with small incisions and thin instruments. The surgeon uses a small camera, called an arthroscope, to view inside the hip.
During arthroscopy, your doctor can repair or clean out any damage to the labrum and articular cartilage. He or she can correct the FAI by trimming the bony rim of the acetabulum and also shaving down the bump on the femoral head.
Activity changes. Your doctor may first recommend simply changing your daily routine and avoiding activities that cause symptoms.
Non-steroidal anti-inflammatory medications. Drugs like ibuprofen can be provided in a prescription-strength form to help reduce pain and inflammation.
Physical therapy. Specific exercises can improve the range of motion in your hip and strengthen the muscles that support the joint. This can relieve some stress on the injured labrum or cartilage.
Bursae are small, jelly like sacs are located throughout the body – especially in joints where a lot of movement occurs, like the hip. Their purpose is to reduce friction and act as cushions during joint movement. Bursitis is inflammation of the bursa.
Bursitis related to the hip may be experienced in two places. The first is on the outside of the hip joint, affecting the greater trochanter of the femur (just next to the femoral head), which is called trochanteric bursitis. The second is called hip bursitis, or more specifically, iliopsoas bursitis, and is felt in the groin area.
Inflammation of a bursa is caused by repetitive-use injuries, prolonged pressure, lumbar spine diseases, rheumatoid arthritis, or sometimes infection. It can affect anyone at any age, but is most common in women and the middle-aged. The main symptom is aching pain in the outer hip. The pain worsens with movement or pressure and may travel down the outside of the thigh toward the knee. Pain caused by pressure at night can make sleeping very difficult.
The labrum is a ring of cartilage that follows the outside rim of the hip joint, and helps to cushion the joint. It also acts like a rubber seal helping to hold the back part of the femur into the hip socket. A hip labral tear involves damage to this cartilage.
While many labral hip tears do not produce symptoms, patients may experience the following:
The hamstring muscles run down the back of the thigh and are heavily involved in day to day activities such as running, jumping, standing, and general posture. The hamstrings are made up of three main muscles: the semitendinosus, the semimembranosus, and the biceps femoris. A pulled hamstring or strain is an injury to one of these muscles. These injuries are very common, and occur most frequently in athletes who perform sprinting, such as track, soccer, and basketball. Most hamstring injuries respond well to simple, nonsurgical treatments.
Surgery is usually performed when there has been a full avulsion, which is when the tendon pulls away from the bone. Surgery may also be needed to repair a complete tear of the muscle tissue itself.
To prevent any further tears or avulsions, be sure to follow your doctor’s advice.
Dear Dr. Sima,
I am writing to express my appreciation to you for providing the surgical skills needed for my recent hip replacement surgery. I am grateful for the commitment you’ve made to continually learn and use innovative techniques which benefit your patient’s successful surgery and recovery.