Arthritis hip

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

The hip joint consists of the articulation of the head of the femur with the "cup" of the acetabulum of the pelvis.

Both the head of the femur as well as the socket of the acetabulum are lined with hyaline cartilage. The joint is surrounded by a capsule which has a thin lining of synovium which produces a thin layer of lubricating fluid. This synovial fluid acts in concert with the articular cartilage as a shock absorbing and gliding surface.

If the cartilage is damaged or if the joint surfaces are not congruent, then the cartilage will wear out much more quickly than normal. This begins the process of osteoarthritis.

Osteoarthritis is therefore the result of mechanical wear and tear on a joint. The primary feature is a loss of cartilage with exposure of underlying bone. There is bony sclerosis, cyst formation and the development of bony spurs, called osteophytes.

The major symptom of arthritis is joint pain. Inflammatory forms of arthritis, like osteoarthritis, may affect the hip and cause pain. The pain is characterized by a dull ache in the groin, outer thigh, or buttocks. Pain is usually worse in the morning and lessens with activity; the pain may limit movement or make walking difficult.

In summary, in an arthritic hip

•The cartilage lining is thin. The degree of cartilage damage and inflammation varies with the type and stage of arthritis.
•The capsule of the hip is swollen and inflamed
•The joint space is narrowed and irregular; this is evident on X-ray.
•Bone spurs also build are seen involving either the acetabular margins, the femoral head, or both. This can produce a syndrome known as femoral acetabular impingement (FAI). If the acetabulum is the primary culprit, then the impingement is called a "pincer" type. If the femoral head is primarily involved, then the deformity is termed a "CAM" impingement type.

The diagnosis of arthritis is made on history, physical examination and x-rays.

Treatment of hip arthritis involves many different modalities including anti-inflammatory medicines, physical therapy, steroid injection, lubricant injection, and surgery.

Early diagnosis and aggressive medical therapy can forestall the need for hip replacement. Lifestyle changes including weight reduction, regular non-impact aerobic exercise, and specific stretching and strengthening exercises are helpful.

Anti-inflammatory medications often can be used with success. Depending on the type of arthritis, disease-modifying anti-rheumatic drugs or biologic therapies may need to be instituted. Consultation with a competent rheumatologist is imperative.

With hip replacement, the femoral head is removed. This allows visualisation of the acetabulum (socket). The socket is then cleared of debris and a reaming tool is used to fashion the socket for placement of the artificial acetabular component.

After reaming is complete, the artificial socket is inserted. There are two types of sockets, (a) a cemented socket or (b) an uncemented socket. A cemented socket is cemented into the bone and an uncemented socket allows bone to grow into it.

Ceramic and metal articulating joint surfaces have lower wear rates than plastic sockets and therefore tend to be used in younger patients. The newer plastics last longer and are appropriately used in older patients.

There have been significant problems noted with metal on metal replacements and they are no longer viewed as being an acceptable alternative.

Traditional hip replacement surgery typically involves a 12-18 inch incision and a hospital stay of up to 3-5 days. However, a patient may be a candidate for minimally invasive hip replacement surgery. This technique uses similar implants to traditional surgery, but avoids danaging as much soft tissue such as muscle and tendon. This technique may also provide other benefits to patients such as:

• Smaller incisions.
• Smaller, less noticeable scars.
• Shortened hospital stay after surgery.
• Reduced recovery time.
• Reduced post-operative pain.

More recently, there has been interest in the use of autologous stem cells to repair and restore cartilage in osteoarthritis of the hip. The key is to get to the hip early. If there is too much damage, a stem cell procedure may not work.

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