Hip Review Clinic
Hip Revision Surgery
Osteoarthritis is the term used for worn out joints and the hip is a common site for symptoms. This is a weight bearing joint and therefore once the joint starts to fail, it will progressively deteriorate.
Why do hip joints wear out?In any mechanical joint the longevity relates to three key features: -
In most cases there is no easily identifiable cause of osteoarthritis of the hip. We know that there is a genetic component; joint replacement tends to run in families.
There are many factors that can contribute to early failure of the hip joint, most do not show any symptoms until the fourth or fifth decade (explaining the failure of natural selection to rid us of hip arthritis!). Abnormally shaped hips are prone to wear early in life and then develop osteoarthritis. Many conditions from childhood can lead to abnormal shaped hips in adults. For a very few patients interventions in adolescence may be appropriate to make the hip more normal and delay the onset of osteoarthritis. Most people are unaware of small abnormalities of their hips until osteoarthritis develops.
There is controversy surrounding the influence of treatment for labral tears and femoroacetabular impingement on the future development of osteoarthritis.
How do we confirm a diagnosis of osteoarthritis?People usually notice a gradual onset of pain in the groin. You may note stiffness, difficulty get down to the toenails or with socks/stockings. Loss of rotational movement is the main sign on examination. This is tested with the leg straight "rolling the leg on the couch" and in flexion "twisting the hip using the lower leg as a lever".
In the early stages the movement may be present, but limited by "end of range pain". As the condition progresses the stiffness or pain may induce a limp. Night pain becomes more prominent and sleeping is disturbed. In advanced cases the leg may become fixed in one position - producing apparent leg lengthening. A small number of people will develop a secondary avascular necrosis (AVN) with rapidly increasing pain.
A simple x-ray should show changes of osteoarthritis. The x-ray findings include as joint space narrowing, subarticular sclerosis, osteophytes and degenerative cyst formation. People presenting at a young age are often told they have a groin strain and x-rays are not undertaken - delaying the diagnosis. If x-rays are normal an alternative diagnosis should be sort.
What are the treatments for osteoarthritis of the hip?There are no proven interventions to halt the progression of osteoarthritis once established. Symptoms can be minimised by weight-loss and physiotherapy mobilizations. Quality of life can be improved by the regular pain killing medications and the use of a walking stick or pole.
The mainstay of treatment for advanced hip arthritis is total hip replacement, this description covers all operations where two artificial surfaces articulate to recreate pain free hip movement. There are many types of total hip replacement and a large industry of suppliers trying to promote their latest (and most expensive) products.
In the long term the results of total hip replacement are bested assessed by the number of implants surviving more than 10 years. Therefore it takes considerable time to fully evaluate any new design - newer is not always better!
In the Teaching Zone here is a section on total hip replacement which covers the indications, technologies (including resurfacing and ceramic joints) and surgical techniques.