Osteoarthritis (OA) of the hip, one of the most common forms of osteoarthritis, results from wear and tear of cartilage within the joint. Pain and stiffness present challenges to simple routines, from putting on shoes to getting out of a car, and may limit more active pursuits.
Treatments can keep pain in check, lessen the impact on daily life, and help a person stay active. If you and your physician determine that a total hip replacement is your best option, you are in good company. More than 277,000 people in the US underwent the procedure in the United States from 2012 to 2016, according to the American Joint Replacement Registry. And success is high: Most people who have total joint replacement of the hip experience satisfactory relief. More than 90 percent will not require further treatment in the subsequent 10 years.
“Hip replacement is one of the real triumphs of recent medical history because patients generally do so well,” said Jeffrey K. Lange, MD, an orthopaedic surgeon at Brigham and Women’s Hospital. The basic principles of hip replacement surgery have remained relatively unchanged, though with some modifications, in recent years. But each year of experience has shown how to improve results, including faster recovery.
“In our latest iteration, it’s not the technology or the technique that’s so different,” said Dr. Lange. “It’s our ability to get people moving afterward.”
Although symptoms tend to worsen with time, you needn’t rush in to surgery. “I tell patients to really maximize their non-operative therapies first,” Dr. Lange said. “Understand your options and try to treat your condition and control your symptoms without an operation.”
OA can appear in any joint, though most often in those that bear weight. This includes the hip, a “ball-and-socket” joint: The upper part of the thigh bone (called the femoral head) is the ball and a portion of the large pelvic bone forms the socket. Smooth, slippery cartilage cushions the bones, enabling their smooth movement. A healthy hip produces fluid that further lubricates the cartilage and aids motion.
What Causes OA of the Hip?
OA occurs when cartilage in the hip joint wears away, leaving less protection for the bones, which may become damaged. Bone-on-bone rubbing can result in pain around the hip joint. Why comparable activities lead to cartilage degeneration in one person and not another is still not fully understood. But many paths can lead to the same result:
- Traumatic injury. Cartilage and other hip joint structures that are damaged (by an accident or sports injury) may lead to additional degeneration.
- Genetics. OA seems to run in families.
- Extra weight. The stress of carrying extra weight on joints exacerbates wear and tear.
It is possible to preserve hip health, even once degeneration begins:
- Switch from high impact sports (running or tennis) to ones that put less stress on hips (cycling or swimming).
- Lose extra weight to reduce pressure on joints.
- Fully address any injuries when they occur.
First Steps in Treatment
Anyone experiencing hip or groin pain, or joint stiffness, is often examined first by a primary care or other physician. Other conditions might be considered, such as rheumatoid arthritis (RA), a different type of arthritis with roots in the immune system that affects the whole body. RA usually is treated with medication.
If OA is determined to be the cause of symptoms, the next visit may be with an orthopaedic surgeon to understand more about your individual condition and decide on next steps. The rate of OA degeneration also varies from one person to the next. Early treatment may help keep you active and comfortable including:
- Exercises prescribed by a physician or sessions with a physical therapist to strengthen hip and leg muscles and improve flexibility and range of motion.
- Pain-relieving over-the-counter NSAIDS (nonsteroidal anti-inflammatory drugs, such as naproxen and ibuprofen) and others by prescription.
- Injections of corticosteroids and other therapeutics.
For some people, total hip replacement surgery can be delayed by procedures that preserve the hip joint. This is usually considered when non-OA conditions of the hip are present, sometimes together with OA.
- Arthroscopy involves a smaller incision and uses tiny cameras and small instruments to repair abnormalities in the hip that are contributing to wear and tear.
- Surgery around the hip (osteotomy) adjusts anatomical irregularities that may contribute to wear and tear, while preserving the hip’s general structure.
Getting the Best Results from a “Tried and True” Surgery
Patients who ultimately need total hip replacement benefit from years of experience and success in hip replacement, also called hip arthroplasty. The procedure removes damaged bone from the hip socket and the femoral head and replaces it with new joint surfaces (made of metal, plastic, or ceramic). A range of options relate to the location and size of the incision and other aspects of the surgery. An advantage of a robust orthopaedic surgery department such as at the Brigham, Dr. Lange said, is that among its many surgeons, at least one is very experienced in the variation that is best for you. “Within our group, we can tailor the treatment to the patient,” he said.
In recent years, further improvements have come from optimizing each patient’s health and readiness before surgery and controlling pain immediately afterward. Both approaches help patients get on their feet and out of the hospital faster, and bring them one step closer to resuming activities that had been limited by OA.
Optimizing health before surgery: At the Brigham Department of Orthopaedic Surgery preparing patients beforehand addresses overall health. This includes control of diabetes and blood pressure, good nutrition, and possible use of Vitamin D supplements (all with a physician’s guidance), plus whatever muscle conditioning is possible.
“The common thought is that if someone is better-conditioned both medically and physically, they will have a better outcome, and clinical studies are demonstrating this again and again,” said Dr. Lange.
Lange and colleagues also advise patients to get all the right support in place before surgery. This might include arranging adequate assistance at home for after surgery, choosing a physical therapist if needed, and making needed changes to the home (such as having proper handrails on stairs and in bathrooms).
With all these elements in place, recovery and rehabilitation can move along smoothly.
Better pain control: Advances in controlling pain after surgery enable physical therapy to begin just a few hours later. If someone can stand and walk, they can be discharged from the hospital sooner. Beyond the physical benefit is the emotional boost of feeling less like a patient and more like a person who is on the way to resuming activity.
This is a significant change from a decade ago, when hip replacement patients entered the hospital on a Monday and often stayed multiple days. “Now many people can go home the day after surgery,” said Dr. Lange. “We regularly start physical therapy in the hospital the same day as the surgery. You might be walking a mile in a few weeks.”
Once you and your doctor agree that total hip replacement surgery is your best option, it is reassuring to know that you have leeway in deciding when to have the operation. And you have time to make sure you are in good condition for surgery.
“This is not an emergency. Osteoarthritis of the hip is limiting potentially, but it is not a dangerous condition. For as long as you are comfortable, it’s a win for you not to have surgery,” Dr. Lange said. “But if you need surgery, the hip replacement is a tried and true surgery. It can really help you improve pain, function and quality of life.”