Minimally Invasive Total Hip Replacement
Total hip replacement is a common orthopedic procedure. As the population ages, it is expected to become even more common. Hip replacement surgery involves removing the head of the thighbone (femur) and replacing the ball-and-socket mechanism of the hip with artificial implants. This relieves pain and improves mobility.
Minimally invasive hip replacement allows the surgeon to perform the hip replacement through one or two small incisions. Patients usually have less pain compared with traditional hip replacement surgery, and rehabilitation is faster.
Osteoarthritis and Hip Replacement
Osteoarthritis of the hip is the most common reason for a hip replacement. Osteoarthritis is caused by the wear and tear of aging. It causes the cartilage covering the joint surfaces to wear out, resulting in pain and stiffness.
Other conditions that can cause destruction of the hip joint include loss of the blood supply to the head of the thighbone (osteonecrosis), rheumatoid arthritis, injury, infection, and developmental abnormalities of the hip. Patients with arthritis may also have brittle bones (osteoporosis), but there is no direct relationship between bone density and the development of arthritis of the hip.
Hip arthritis typically causes pain that is dull and aching. The pain may be constant or it may come and go. Pain may be felt in the groin, thigh, and buttock, or there may be referred pain to the knee. Walking, especially for longer distances, may cause a limp.
Some patients may need a cane, crutch, or walker to help them get around. Pain usually starts slowly and worsens with time and higher activity levels.
Patients with hip arthritis may have difficulty climbing stairs. Dressing, tying shoes, and clipping toenails can be difficult or impossible. Pain may also interfere with sleep.
See your doctor to diagnose hip arthritis. The doctor will inquire about your symptoms and perform a physical examination. X-rays may show loss of the cartilage space in the hip socket and a “bone-on-bone” appearance. Bone spurs and bone cysts are common.
Sometimes, the doctor may recommend additional tests to confirm the diagnosis, including magnetic resonance imaging (MRI) or computed tomography (CT) scans.
Treatment for Osteoarthritis
For hip arthritis, the first treatment a doctor may recommend is over-the-counter, anti-inflammatory medications, such as ibuprofen. Some nutritional supplements, including glucosamine, may also provide some relief. Short-term physical therapy may help improve strength and reduce stiffness.
For patients with more advanced arthritis, use of a cane opposite the affected hip can help transfer weight away from the painful hip and improve walking ability. A walker can also be used. Arthritis, however, is progressive. Even with treatment, it will worsen over time. Weight loss can help decrease stresses on all of the joints.
Pain and mobility may worsen with hip osteoarthritis, even when all of the recommended nonsurgical treatments have been tried. If this happens, the doctor may recommend surgery. Surgical options include:
•Arthroscopy. Arthroscopy of the hip is a minimally invasive, outpatient procedure that is relatively uncommon. The doctor may recommend it if the hip joint shows evidence of torn cartilage or loose fragments of bone or cartilage.
•Osteotomy. Candidates for osteotomy include younger patients with early arthritis, particularly those with an abnormally shallow hip socket (dysplasia). The procedure involves cutting and realigning the bones of the hip socket and/or thighbone to decrease pressure within the joint. In some people, this may delay the need for replacement surgery for 10 to 20 years.