Degenerative
Hip Disease Information
Hip arthritis is a
degenerative condition that affects the hip joint and often leads
to a significant impairment in the quality of life. Approximately 43 million
Americans suffer from arthritis and many have significant hip involvement.
It can adversely affect one’s ability to walk, work, and live pain-free.
The treatment of hip arthritis generally involves
activity modification, various exercises, and treatment with anti-inflammatory
medications. The use of assist devices such as a cane can also be helpful.
However, when pain and disability become severe, surgical reconstruction
of the hip joint with total hip replacement becomes necessary.
Anatomy
The hip is a ball and socket joint. The acetabulum,
or socket, is formed by three areas of the pelvic structure: the ilium,
the ischium, and the pubis.
The femoral head is the "ball", which is located on the upper
end of the femur. There is a high degree of fit and stability within this
ball and socket joint. It is stabilized by strong ligaments encapsulating
the joint, which prevent dislocation.
Both the femoral head and the acetabulum are covered with a layer of cartilage,
which allows the hip joint to move smoothly and provides shock absorption
and load distribution within the hip. This cartilage is also a source
of nutrition for the joint. Numerous muscles play an important role in
the stability of the hip, one of which is the gluteus
medius. This is a deep muscle within the buttock, and its proper
function is important in normal walking.
Function
Due to the muscle pull and joint forces that occur, approximately 3 times
the body weight distributes through the hip with routine activities. The
stability of the hip joint is maintained by the precise fit of the femoral
head within the acetabulum. The hip allows rotation in many planes. These
include: flexion/extension (used
most commonly in sitting), internal and
external rotation (used with twisting activities), and abduction
and adduction (inward and outward motion of the hip used to spread
the legs apart). Any degenerative condition within the hip alters biomechanical
relationships and can cause limping, leg length inequality, and disability.
What is hip arthritis?
Hip arthritis is any condition that leads to degeneration of the hip joint
and its cartilage surfaces. Some of these conditions are osteoarthritis,
rheumatoid arthritis, avascular
necrosis and congenital (or developmental)
dysplasia (dislocation) of the hip. Fractures and other injuries
to the hip joint can also lead to hip degeneration.
Osteoarthritis
is a degenerative condition that may affect many joints throughout the
body. Caused by “wear and tear” on the joint, it is, by far,
the most common type of arthritis, and is commonly called “degenerative
arthritis.” Osteoarthritis causes changes in the mechanical structure
of the cartilage, which lead to its breakdown. Over time complete loss
of the articular cartilage can occur resulting in rough, bony surfaces
in contact within the hip joint. This results in radiographic joint space
narrowing, peripheral osteophytes (bone
spurs), stiffness of the hip joint, pain, and disability.
Rheumatoid arthritis
is an inflammatory condition that affects the lining of all joints in
the body. It causes an inflammatory response in the joint lining which
destroys the articular cartilage and surrounding tissues. Rheumatoid arthritis
generally results in rapid destruction of many joints of the body and
may affect other organ systems in addition to the joints.
Osteonecrosis or avascular necrosis
is a condition in which the bone within the femoral head loses its blood
supply and dies. This eventually may lead to the collapse of large segments
of the bone supporting the cartilage of the hip joint, resulting in destruction
of the hip. The main causes of osteonecrosis include:
- injury such as fracture or dislocation
of the hip.
- steroid use for the treatment of such ailments
as lupus, asthma, and kidney transplantation.
- alcohol abuse.
The final common pathway of hip arthritis is loss of the cartilage cushion
between the femoral head and the acetabulum. This results in limitation
of joint motion, shortening of the leg, and continual pain and disability.
Disclaimer:The
information provided here is intended to educate the reader about certain
medical conditions and certain possible treatment. It is not a substitute
for examination, diagnosis, and medical care provided by a licensed
and qualified health professional. If you believe you, your child,
or someone you know, suffer from the conditions described herein, please
see your health care provider immediately. Do not attempt to treat
yourself, your child or anyone else without proper medical supervision.
©2006 Todd Swanson, M.D.
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The minimally invasive total
hip replacement was developed by Dr. Swanson after being introduced
to the concept in early
1997. Dr. Swanson began using the technique in May of 1997 and has continued
to make improvements that now allow reliable surgery and reproducibly
good results in most patients. Standardization of the technique has allowed
teaching to other surgeons. Numerous physicians and orthopedic companies
have shown interest in promoting “minimally invasive surgery” for
total hip replacements.
The minimally invasive technique utilizes a 3-4
inch incision, much smaller than the 8-10 inch approach historically
used for hip replacement. Patients require less anesthesia and pain medication,
and mobilize more quickly. This results in both quicker recovery for
the patient and a lower incidence of complications.
Patients typically recover from minimally
invasive surgery in about half the time it takes to recover from standard
incision surgery (6 weeks vs. 12 weeks).
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