Hip Osteoarthritis and Total Hip Replacement Surgery
Hip osteoarthritis, also known as hip OA, is an age-related degenerative change of the hip joint. Osteoarthritis can occur in any joint but major weight bearing joints such as the hip and knee are more susceptible to “wear and tear” associated with activities of daily living. It is important to remember that these changes occur in all of us as we age, but may not lead to pain or disability; however, if it does, there are a number of treatment options to consider to decrease pain and improve overall quality of life.
The hip joint is one of the largest in the body and is considered a “ball-and-socket” joint. The socket is formed by the acetabulum, which is a part of the pelvic bone. The head of the femur attaches into the socket to form the ball portion of this joint. Covering the surface of both the acetabulum is articular cartilage which is a smooth, slippery substance which services to protect and cushion the underlying bone. In addition, the hip joint contains a thin synovial lining which helps to lubricate the joint and enable the two bones to move easily on one another.
In patients with hip osteoarthritis, the cartilage lines either side of the joint and gradually wears away over time. No longer smooth, this protective lining becomes rough and frayed leading to decreased space between the two joint surfaces. Eventually, this can lead to bone rubbing on bone. Because of the increased forces played directly onto them, the bones will react and form bony overgrowths also known as osteophytes.
Hip osteoarthritis has no single specific cause. Usually it is a combination of risk factors such as:
- Increasing age
- Positive family history of osteoarthritis
- Previous injury or trauma to the hip joint
- Developmental dysplasia of the hip, which is an improper formation of the hip joint at birth
This list is not exhaustive and sometimes hip osteoarthritis develops in patients without any of the risk factors listed above.
The most common symptom of hip osteoarthritis is pain in or around the hip joint. This pain usually develops slowly and increases over time and is described as a deep ache within the joint. Often pain and stiffness is more pronounced first thing in the morning or after sitting for an extended period of time. Additional symptoms also include:
- Pain in the groin or thigh which may radiate into the buttock or knee
- Increased pain with vigorous physical activity
- A grinding noise coming from within the hip that is associated with movement
- “Locking,” “crunching,” or “sticking” of the hip joint
- Decreased range of motion and strength of the hip
- Increased pain with rainy or cold weather
Diagnosis of hip osteoarthritis usually comes from a combination of both subjective and objective information. In addition to many of the subjective symptoms described above, a qualified health care provider may also use radiographic imaging (x-rays) to determine if a patient has hip osteoarthritis. A positive x-ray will show features such as narrowing of the joint space as well as spurring or bony overgrowth of the femoral head and/or acetabulum due to the excess stress placed on them as a result of lost articular cartilage.
It is important to remember that despite positive x-ray findings, it does not mean you are doomed to a life full of hip pain. There are millions of people living in America with abnormal imaging but yet display no outward signs of pain or disability. However, if hip pain is present along with the diagnosis of hip osteoarthritis, there are several treatment options which may help relieve pain and improve mobility.
- Lifestyle modifications such as decreasing high impact activities that place excessive forces through the hip joint. One such example may be switching from running to cycling or swimming. Losing weight may also help to decrease the stress on the hip joint.
- Physical therapy may help to address the impaired strength and range of motion associated with hip osteoarthritis through a personalized home exercise program. Additionally, manual therapy interventions can help to improve mobility of the hip and surrounding joints as well as provide a pain gating effect. As movement and exercise specialists, physical therapist can also provide education about hip osteoarthritis so patients can better understand their pain and help alleviate fear surrounding this degenerative condition.
- Assistive devices such as a cane, crutch, or walker can help offload the hip joint, thus decreasing pain and improve overall mobility. Long-handled reachers can also help to pick up objects off the floor which may otherwise be painful.
- Certain medications have found to be helpful in managing the pain associated with hip osteoarthritis. Over-the -ounter options include Acetaminophen (Tylenol) as well as nonsteroidal Anti-Inflamatory drugs (NSAIDs) such as Naproxen (Aleve) or Ibuprofen (Advil). Cortisone is a powerful anti-inflammatory corticosteroid which is prescribed by a doctor to be taken orally or injected directly into the hip joint.
Often nonsurgical interventions are attempted to alleviate pain associated with hip osteoarthritis however if these efforts fail, your doctor may talk to you about surgical options. Additionally, surgery may be warrant if hip pain is significantly limiting everyday activities, pain is continuous and not impacted by pain medication or if stiffness limits the ability to move the leg.
There are several surgical options which may be considered however the most commonly performed surgery is a total hip replacement. With a total hip replacement, the orthopedic surgeon will remove the damaged acetabulum and femoral head and replace it with new metal, plastic, or ceramic components in order to restore proper function of the hip joint.
Recovery following a total hip replacement usually starts 24-48 hours after surgery with a physical therapist taking a patient through various range of motion, muscle activation, and gait retraining exercises. This care will continue in the outpatient physical therapy setting where patients will be progressed to more functional strengthening exercises and slowly weaned off of assistive devices. Most patients should be able to resume light activities of daily living within 3 to 6 weeks after surgery however some discomfort and weakness is expected to linger several weeks after surgery. Following a successful total hip replacement, a patient should experience a dramatic reduction in hip pain as well as significant improvements in overall function. Most patients should expect to return to leisurely activities such as walking, swimming, golfing, hiking, or biking.
The best way to prevent a total hip replacement is through the nonsurgical options mentioned earlier such as activity modifications, physical therapy, use of assistive device, and pain medications. All surgeries come with inherent risk and these nonsurgical interventions may help to alleviate a person’s pain without the risk of invasive surgery.