What are the alternatives to total hip replacement?

Various non-surgical methods of treatment for hip arthritis should be utilized before resorting to surgery. These include the use of nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and the use of a cane. Newer NSAIDs, called Cox-2 inhibitors, tend to have fewer side effects than the older NSAIDs, although some have been taken off the market due to cardiovascular side effects (e.g. Vioxx). There has been no real evidence that these newer, more expensive Cox-2 inhibitors are any more effective in alleviating arthritis pain than the less expensive “non-selective” NSAIDs such as Motrin (ibuprofen) or Naprosyn (naproxen). Both Motrin and Naprosyn are available over the counter in the forms of Advil and Aleve, respectively.

Occasionally, steroid (cortisone) injections may give temporary relief of arthritis pain. The hip joint is less often injected than the knee joint due to more difficulty and discomfort injecting the hip joint. Steroid injections reduce the inflammation that accompanies arthritis, thereby giving temporary partial relief of arthritis pain. When these methods no longer provide adequate pain relief, surgery is usually recommended.

Younger patients with hip arthritis caused by congenital or developmental problems (such as congenital/developmental dysplasia of the hip) may be candidates for a procedure known as an “osteotomy.” An osteotomy procedure essentially cuts and re-orients either the ball or socket of the hip joint to provide a better surface to bear the body’s weight than the original joint surface. Osteotomies usually take longer to recover from than total hip replacement, but have the advantage of retaining one’s own natural hip joint for a while, often 5-10 years or longer; then conversion to a total hip may be necessary. These procedures are most commonly used in younger patients where it is desired to “buy some time” before total hip replacement.

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