Mr Freedman - Orthopaedic Surgeon
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Hip Arthritis occurs when there is degeneration of the cartilage at the joint surface. Initially the cartilage damage may be in small confined area of the hip but with time a greater area of the hip joint may become involved.
Commonly, hip arthritis causes groin pain and loss of range of movement. Depending on the area of the joint affected there may also be pain at the side or back of the hip. As the cartilage damage becomes more widespread and severe, the pain becomes more constant, it may occur at night and be associated with increasing stiffness, decreased mobility and pain with activity.
Causes of Arthritis:
There are numerous different causes of hip arthritis. Osteoarthritis is the most common and is typically seen in older patient but joint degeneration also occurs in younger patients from abnormalities within the shape of of the hip, previous injury, childhood hip disease, or problems with the blood supply to the hip. Other patients may get arthritis as a result of inflammatory disorders such as rheumatoid arthritis.
There is increasing evidence that structural abnormalities within the hip may lead to impingement between the femur and the socket of the hip, which may cause cartilage damage and lead to premature arthrits.
Plain x-rays of the hip are usually used as the first imaging investigation. Plain-xrays only show the bones of the hip and do not directly show cartilage but loss of joint space due to degeneration of the cartilage layer can be appreciated. In moderate to severe arthritis a plain x-ray is usually all that is required. This can be combined with computer operative planning software to plan hip replacement surgery.
In early arthritis or in cases of complex deformity or revision surgery more complex scans such as CT or Magnetic Resonance may be needed to aid surgical planning.
Simple non-surgical measures for managing hip arthritis are usually tried first and include weight loss and activity modification will usually improve symptoms and can be combined with simple painkillers. 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.
When conservative measures for hip arthritis are insufficient, hip replacement surgery may be appropriate. There are range of different surgical approaches that can be used and a wide choice of prosthetic materials are now available. Mr Freedman is experienced with the traditional posterior approach as well as with the new direct anterior approach. There are advantages and potential disadvantages with each technique which Mr Freedman will discuss with you. In terms of bearing surfaces, Mr Freedman will generally recommend a ceramic total hip replacement for younger patients and in older patients a polyethylene socket may be more appropriate. Mr Freedman does not use metal-on-metal bearings.