Hip Hip Hurray

Dr. M. Pradeep Reddy Hip Joint

HIP JOINT PAIN – TOTAL HIP REPLACEMENT

INTRODUCTION:  The hip joint is made up of ball-and-socket. The ball-like head of the thigh one (femur) fits into the cup-like socket formed by the acetabulum, a part of the pelvic bone. A smooth and friction-free material called cartilage lines our joints, providing effortless movement. Any cartilaginous abnormality produces pain with movement radiating down from the buttocks resulting in arthritis.

Sir John Charnley performed the first total hip replacement in UK about 50 years ago. Since then, there have been many modifications of this procedure. Cemented and Cementless are the two main types in total hip replacement procedure.

In the early years of introduction of this technique, metal ball and plastic cup were utilized, which do not last long. But with the development of latest technology, introduction of new designs, biomechanics and latest articulating prosthesis like ceramics have been developed that resemble the natural femoral ball and socket. This advancement has completely changed the scenario, whereas in the previous years, patients feared to sit down due to the fear of dislocating.  Now patients can near a normal life.

Degeneration of joints begin as the person gets old. When compared to the population of Western Countries, majority of the Asian population suffers from knee joint pain to a greater extent than hip joint pain. The effects of this condition are universally similar. This is known as “Primary Osteoarthritis”.

However, most of the hip arthritis are due to the reasons explained below. This is known as “Secondary Osteoarthritis of the Hip”.

  1. DEVELOPMENTAL DYSPLASIA OF THE HIP:

    Few children have abnormality in the development and growth of the hip joint – ball and socket that results in arthritis and unstable hip.

  2. AVASCULAR NECROSIS OF FEMORAL HEAD (AVN):

    This is a pathologic process that results from interruption of blood supply, thereby resulting in necrosis of the femur ball in the hip joint leading to arthritis. Below are some of the causes of AVN:

1) Alcohol.

2) Steroids.

3) Femoral neck fracture.

4) Idiopathic (unknown) reasons.

  1. HIP TUBERCULOSIS:

    Infestation of tuberculosis at the hip joints causes rapid development of irregularities at the joint margins resulting in arthritis.

  2. POST-TRAUMATIC ARTHRITIS:

    This is a common form of arthritis that is caused by a previous injury or severe trauma that impacts the structure of hip joint.

  3. RHEUMATOID ARTHRITIS:

    This is a type of inflammatory arthritis where the cartilage degenerates due to inflammation.

  4. ANKYLOSING SPONDYLITIS:

    Early symptoms of this type of arthritis are pain and hip joint stiffness.

Treatment includes minor daycare modalities like drug therapy, physiotherapy, cord decompression, stem cell therapy, and bone grafting surgery.

In severe stages, there is pain radiating from the groin down to the legs, limping, shortening of limbs due to excessive wear off.  In such cases Total hip replacement (THR) surgery is the solution.

INVESTIGATIONAL PROCEDURES: X-ray and MRI scan are performed to diagnose the severity. X-rays remain an important tool however MRI scan is performed for in-depth and early detection of any problem.

TREATMENT: Surgical techniques, implant options, physiotherapy aid in rapid recovery within a month. The replaced joint through total hip replacement endures for 30 years, and the person can perform all the activities of daily living.

COMPLICATIONS: Though rare to name few :

INFECTION RISK: Though there is major risk of diabetic and rheumatoid infections, these can be controlled with pre-operative precautions and care. Operations performed under sterile, controlled environment, and hi-tech operation theaters have less than 1% risk of infection.

DISLOCATION RISK: In the past, the small prosthetic head measured only 22 mm causing frequent dislocations, but now the ball size is optimized to reducing the possibility of dislocation risk.

WEAR AND TEAR OF JOINTS: Wear and tear occurs rather soon due to the use of prosthesis made of plastic and metal and its quality. Now, the risk is greatly reduced by the usage of prosthesis made of ceramic and cross linked polyethylene, which are durable for about 20-30 years or above.