Hip Joint Pathology

The hip is one of the body’s largest weight-bearing joints. It consists of two main parts: a ball (femoral head) that fits into a rounded socket (acetabulum) in your pelvis. Bands of tissue called ligaments (hip capsule) connect the ball to the socket and provide stability to the joint.

The most common cause of hip pain and disability is arthritis.

Osteoarthritis

Rheumatoid arthritis

Traumatic arthritis

Avascular Necrosis(AVN) of Hip induced arthritis

Symptoms of OA Hip

  • Pain in hip and groin area on walking and after prolonged period of rest.
  • Difficulty in standing from sitting.
  • Difficulty in turning side
  • Clicking or grinding sensation in hip
On examination
  • Tenderness in the hip area,
  • Loss of movement as compared to other side
  • Shortening of the limb

Treatment

Investigation:

  1. X-rays shows typical loss of joint space and osteophytes (new bone formation)
  2. MRI is required to diagnose the disease in early stages.

Treatment:

The treatment for an arthritic hip initially conservative RICE (Rest,Ice,Compression,Elevation)

if no relief surgical intervention (THR Required)

Indication

  • Hip pain limits your everyday activities such as walking or bending.
  • Hip pain continues while resting, either day or night.
  • Stiffness in a hip limits your ability to move or lift your leg.
  • You have little pain relief from anti-inflammatory drugs or glucosamine sulfate
  • Other treatments such as physical therapy or the use of a gait aid such as a cane do not relieve hip pain.

The orthopaedic surgeon will remove the damaged cartilage and bone and then position new metal, plastic, or ceramic joint surfaces to restore the alignment and function of your hip.

Depending the age of Patient the choice of prosthesis is made

Types and precautions

  • Cemented THR – used in elderly patient to promote early ambulation. Here a cement is used to hold the implant in the bone and gives immediate mobility
  • Uncemented THR – is used in a younger population because of its durability. Here an un-cemented implant with Hydroxy or Porous coated implant is press fitted to the bones.

Special Precautions:

  • Do not cross your legs.
  • Do not bend your hips more than a right angle (90°).
  • Do not turn your feet excessively inward or outward.
  • Use a pillow between your legs at night when sleeping until you are advised by your orthopaedic surgeon that you can remove it.

changes at home

The following is a list of home modifications that will make your return home easier during your recovery:

  • Securely fastened safety bars or handrails in your shower or bath
  • Secure handrails along all stairways
  • A stable chair for your early recovery with a firm seat cushion (that allows your knees to remain lower than your hips), a firm back, and two arms
  • A raised toilet seat
  • A stable shower bench or chair for bathing
  • A long-handled sponge and shower hose
  • A dressing stick, a sock aid, and a long-handled shoe horn for putting on and taking off shoes and socks without excessively bending your new hip
  • A reacher that will allow you to grab objects without excessive bending of your hips
  • Firm pillows for your chairs, sofas, and car that enable you to sit with your knees lower than your hips

Expectation from THR

  • An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and cannot do.
  • Most people who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living. However, hip replacement surgery will not enable you to do more than you could before your hip problem developed.
  • Following surgery, you will be advised to avoid certain activities, including jogging and high-impact sports, for the rest of your life. You may be asked to avoid specific positions of the joint that could lead to dislocation.
  • Even with normal use and activities, an artificial joint (prosthesis) develops some wear over time. If you participate in high-impact activities or are overweight, this wear may accelerate and cause the prosthesis to loosen and become painful.
  • If looked after properly and all the instructions of your surgeon and therapist are followed your new hip is likely to bring a very good relief to your symptoms and is likely to last you for life time.
  • Very reliable and predictable surgery for osteoarthritis of Hip.