Arthritis and Hip Replacement

Who does this affect? This condition occurs when there is degeneration in the hip causing damage to the joint surface (figure 1). There are numerous different causes but the most common is osteoarthritis and this is most often seen in the older patient (figure 2). However, it can occur earlier due to abnormalities within the hip. This may be due to a previous injury, childhood hip disease, femero-acetabular impingement or problems with the blood supply to the hip.

Symptoms Commonly, this causes groin pain often going down the thigh to the knee. The hip is stiff, and the patient walks with a limp. As the arthritis becomes more widespread and severe, the pain becomes more constant, it may occur at night and be associated with increasing stiffness, decreased mobility and activity.

Investigations X-rays of the hip. Scans such as CT or Magnetic Resonance are used in more complex cases to aid surgical planning.

Non-surgical Treatment To begin with, simple measures are tried such as painkillers, weight loss and activity modification. Oral supplements such as glucosamine and chondroitin may benefit some patients, especially with early arthritis. Occasionally, steroid injections may be used to either confirm the source of the pain (e.g. if the patient also has back pain) or in those patients who are not fit for a joint replacement.

Surgical Treatment When a patient has severe arthritis and painkillers no longer effectively control the symptoms, hip joint replacement is advised. This has the benefit of relieving the pain and allowing the patient to return to a near normal level of activity.

In simple terms, the ball of the hip is removed and the thigh bone is prepared before the metal stem is inserted. The pelvic cup is then prepared and the artificial cup is inserted and held using either bone cement or an artificial coating that bonds directly to the surrounding bone surface (figures 3 and 4).

There are different forms of hip replacement and each one has a role to play depending on the patients' age and activity level. The risks and benefits of each type are best discussed with your surgeon.

In general, a hip replacement is a safe and reliable operation. The vast majority of patients are either pain free following the surgery or have a significant improvement in their symptoms, returning to a level of activity that has not been possible for some time.

Approximately, 5% of patients will develop a post-operative complication. The most important of these are deep infection, hip dislocation, leg lengthening, nerve injury and blood clots. Great care is taken by the surgeon to minimize these risks including the use of antibiotics and blood thinning drugs around the time of the operation.

Patients tend to remain in hospital for between 3 and 5 days. During this time they undergo intensive physiotherapy, which continues after their discharge home. Patients are reviewed in out-patients six later and at this point, they can fully return to their normal activities.

Figure 2: Marked hip arthritis showing complete loss of joint space

Figure 4:Post-operative hip replacement