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Description of Hip Replacement

Time, injury to the joint, coupled with arthritis, may lead to degeneration of the hip joint, causing pain, deformity, and restricted movement. Hip replacement surgery, also called total hip arthroplasty (THA), hip resurfacing, or total hip resurfacing may be an option if your daily activities are limited by uncontrollable pain and your x-rays show an end-stage arthritis not amenable to other treatments.

The goals of hip replacement surgery are pain relief, return to function, and routine activities of daily living. For more than 30 years, hip replacement surgery has provided an improvement in quality of life and led to a dramatic change in patients’ lifestyles that suffered from arthritic conditions of the hip joint. In the U.S., more than 200,000 hips are replaced each year. The operation is by far the most successful surgery for treating advanced arthritis of the hip, and it may be one of the most successful surgeries ever developed in terms of dramatic change in patient function.

If you have hip pain, some common causes include:

  • Arthritis : Arthritis is among the most frequent causes of hip pain, and there are many treatments available. If conservative treatments fail, hip replacement surgery is an option.
  • Trochanteric Bursitis : Trochanteric bursitis is an extremely common problem that causes inflammation of the bursa over the outside of the hip joint.
  • Tendonitis : Tendonitis can occur in any of the tendons that surround the hip joint. The most frequently encountered tendonitis around the hip is iliotibial band (IT band) tendonitis.
  • Osteonecrosis : Osteonecrosis is a condition that occurs when blood flow to an area of bone is restricted. If an inadequate amount of blood flow reaches the bone, the cells will die and the bone may collapse. One of the most common places for osteonecrosis to occur is in the hip joint.
  • Lumbar Pain - Referred Symptoms : Many back and spine problems can cause symptoms around the buttocks and hip. The most common problems that refer pain to the hip region are herniated discs and sciatica.
  • Snapping Hip Syndrome : Snapping hip syndrome is a word used to describe three distinct hip problems. The first is when the IT band snaps over the outside of the thigh. The second occurs when the deep hip flexor snaps over the front of the hip joint. Finally, tears of the cartilage, or labrum, around the hip socket can cause a snapping sensation.
  • Muscle Strains : Strains of the muscles around the hip and pelvis can cause pain and spasm. The most common strains are groin pulls and hamstring strains.
  • Hip Fracture : Hip fractures are most common in elderly patients with osteoporosis. Treatment of broken hips requires surgery to either replace the broken portion or repair it with a metal plate and screws.
  • Stress Fracture : Stress fractures of the hip are most common in athletes who participate in high-impact sports, such as long distance runners. Treatment usually is successful by avoiding the impact activities.

Childhood Hip Problems:

Developmental Dysplasia

When the hips are dislocated or out of position in infancy, the joint may not develop properly. While this is not usually painful as a child, it will lead to early arthritis and problems with walking.

Legg-Calve-Perthes Disease

Also called Perthes disease, this is a problem similar to osteonecrosis (see above) but in childhood. If severe, it can lead to permanent damage to this hip joint and early arthritis.

When do you need to call your doctor about your hip pain?

If you are unsure of the cause of your symptoms, or if you do not know the specific treatment recommendations for your condition, you should seek medical attention. Treatment of hip pain must be directed at the specific cause of your problem.

Some signs that you should be seen by a doctor include:

o Inability to walk comfortably on the affected side o Injury that causes deformity around the joint o Hip pain that occurs at night or while resting o Hip pain that persists beyond a few days o Inability to bend the hip o Swelling of the hip or the thigh area o Signs of an infection, including fever, redness, warmth o Any other unusual symptoms

The most common reasons for hip replacement surgery are : -

Osteoarthritis : - Generally attributed to wear and tear with age, osteoarthritis is a gradual deterioration of the cartilage that cushions bones within a joint. As cartilage wears away, surrounding joint structures grow irregularly and can become inflamed and painful. Eventually bone can begin to rub against bone. Most forms of osteoarthritis are likely due to a structural or anatomical minor abnormality of the joint that produces abnormal mechanics of the joint over the years, leading to wear.

Rheumatoid arthritis : - Inflammation of the tissues surrounding joints leads to worn and swollen joints. This disease may eventually lead to deterioration of cartilage and destruction of joints. Typically, multiple joints are involved, including the neck (cervical spine) which may be life-threatening if left untreated.

Osteonecrosis : - (also known as Avascular necrosis (or AVN)): A loss of blood supply to the ball of the hip joint occurs. There may be an association with blood clotting factors or proteins and cholesterol metabolism.The result is pain, eventual collapse of the surface of the ball (femoral head), and in the end-stages, severe arthritis may develop, The most common causes that lead to a loss of this blood supply are: heavy alcohol intake on a regular basis, chronic use of oral steroids, such as Prednisone, prior trauma or surgery to the hip (hip dislocation or fracture), blood disorders that may block the blood supply (sickle cell disease), HIV disease (likely causes osteonecrosis in relation to the medications prescribed for HIV), and idiopathic (no known reason established). Less common disorders include metabolic diseases and chronic exposure to high underwater atmospheric pressure (Caisson’s disease).

Hip disorders or fractures : - Hip replacement surgery is also used to repair disorders and fractures of the hip, although less commonly. Occasionally, a partial hip replacement (hemiarthroplasty) may be performed in the treatment of a hip fracture.

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