WHAT IT HIP ARTHRITIS
AND WHY DOES IT HAPPEN?
What is hip osteoarthritis?
The hip joint consists of a ball (femoral head) and a socket (acetabulum), and both the ball and the socket have a coating of slippery, hard, articular cartilage. The cartilage enables the joint surfaces to easily glide over each other, but when the cartilage becomes damaged or worn, the frictional forces go up within the joint, and eventually bone starts to rub on bone. This is osteoarthritis and it can lead to a variety of symptoms.
Pain in the groin is the one of the commonest symptoms, and many people are surprised to learn that the hip joint is seated in the groin area, not on the outside of hip (which is a bony contour called the greater trochanter). Sometimes the pain will spread around the side of the hip to the buttock (in a ‘c’ shape), and stiffness and loss of range of movement may ensue. Many patients describe pain when getting up after a long period of sitting or have difficulty putting on shoes or socks. Initially some people find that gentle exercise (getting moving’) helps with their pain and stiffness, but eventually walking and even sleeping may become painful.
Why does hip osteoarthritis happen?
Osteoarthritis isn’t necessarily about getting older, and whilst hip osteoarthritis (OA) occurs more frequently as we age, probably only one in four people will develop symptoms of hip osteoarthritis in their lifetime.
Hip arthritis can also occur to much younger people, so why is this?
We know that certain factors, such as being overweight, can increase the risk of hip OA, as can trauma to the hip. But for many people, the root cause lies in an imperfectly shaped hip (e.g. an inherited predisposition or a joint that was imperfectly formed at birth), which led to early wear and tear.
Advanced hip osteoarthritis
Teaching the next generation of surgeons
When is the right time to consider hip replacement surgery?
Sometimes the pain of hip arthritis becomes intolerable, despite physiotherapy, painkillers, and injection treatments. If a person has considerable pain at rest, at night, or is walking with painful limp, it may be time to consider hip replacement surgery (also known as total hip arthroplasty).
Many myths still surround hip replacement surgery. In the past patients were told that they were ‘too young’ to have a hip replacement, or that hip replacements ‘only last 10 years’. In fact, neither of these are true. 90% of hip replacements are still functioning really well at 25 years, and over a half of all hip replacements last 25 years or more! Your suitability for hip replacement isn’t determined by your age; it’s determined by your clinical need. In our highly active population, hip replacement is becoming much more common in younger age groups.
If you’re suffering with the pain of hip arthritis, hip replacement may be an excellent option for you.
What’s important in ensuring a good outcome from hip replacement surgery?
A successful hip replacement starts with excellent planning; after all, we’re all individuals, and no two hips are identical. In the past, choosing the right size of the implant for the hip replacement relied on using measurements taken from traditional X-rays.
X-rays are two dimensional images, and so to get a much more accurately tailored fit, I prefer to use 3D CT images in the planning process. Three-dimensional pre-operative planning enables me to choose the optimal component size, position and orientation for each individual, which is vitally important in ensuring a great outcome.
Meticulous planning means we can really limit problems such as leg length asymmetry, poor femoral offset (a measurement from the centre of rotation of the femoral head, to the long axis of the femur), and poor positioning of the centre of rotation of the replacement. A wonderfully tailored hip not only functions beautifully, but it also ensures that it endures the test of time.
Advanced recovery techniques mean we can get patients up and walking very swiftly after surgery and avoid complications of a prolonged time in bed.
Physiotherapy after surgery is very important to restore strength and normal movement patterns, but it’s also a good idea to see a physio before surgery, so that you can optimise your body for the journey ahead.
Anterior or posterior hip replacement. Which is better?
There are different ‘approaches’ that a surgeon can use when replacing a hip, which influences where the incision is placed for the surgery. The incision can be placed anteriorly (at the front of the hip), posteriorly (behind the hip) or laterally (over the side of the hip).
There are pros and cons for all the incision sites, and all hip replacement surgeries carried out in the UK are recorded by the National Joint Registry (NJR). Data from the NJR shows that the most common approach used by surgeons is the posterior approach.
The lateral approach has been shown to be associated with an increased risk for early revision surgery and an increased risk of mortality when compared with the other approaches.
The anterior approach has been shown to have a higher rate of surgical complications within the first year when compared to the posterior approach. I use the posterior approach, which is backed by the data as being the safest approach for hip replacement.
How should you choose your hip surgeon?
When it comes to choosing your surgeon, take your time, and take advice and recommendations from people you know and trust. Make sure your surgeon has significant experience and a proven track record with hip replacement surgery – the NJR (National Joint Registry) will enable you to learn more about your surgeon. It’s also very important that you feel taken care of by your surgeon! Everyone is an individual, and a good surgeon will put you at ease, listen carefully, and give you plenty of time for questions.
Women make up just 7.4% of the Consultant Orthopaedic Surgeons in the UK, and yet there is compelling evidence for choosing a female orthopaedic surgeon if you are female:
A recent study of the outcomes of 21 different types of surgery carried out on over 1.3 million patients showed that women are 15% more liable to suffer a bad outcome and 32% more likely to die when a man carries out the surgery, compared to when a woman carries out the surgery. Men on the other hand, have the same outcomes from surgery, regardless of whether a man or a woman carried out the surgery.
Many female patients choose to come to see me because of my many years of experience working in the world of hip surgery, but also, they feel at ease consulting with a female clinician.
If you’re struggling with the pain of hip arthritis or would like to discuss whether hip replacement is right for you, please get in touch.