The treatment of hip arthritis depends entirely upon severity of the patient's
Non-Operative Treatment of Hip Arthritis
Early conditions are usually treated with:
the use of walking aids.
over the counter supplements for
the building blocks of the articular cartilage.
People who have failed to improve with
these non-operative measures may be candidates for surgical reconstruction.
Most often, this is total hip replacement surgery. Patients who have
severe pain with activities, pain at night, loss of the ability to
work and perform routine activities, are those who may benefit from
Treatment of Hip Arthritis
Total hip replacement surgery is very successful and has excellent
short and long term outcomes. The surgeon removes the arthritis from
the hip and inserts a metal
and plastic prosthesis into the hip. This provides for hip function,
limb length equality and restoration of motion. The procedure can
be done with cement, which is a grout type of substance. It penetrates
into the bone in both the acetabulum and the femur, providing fixation
of the prosthesis to the bone. An alternative method uses uncemented
components with roughened surfaces to which the bone adheres. (The
bone grows into the rough titanium surface of the prosthesis). Both
of these techniques have proven effective in long-term follow-up.
The hospital stay lasts from 3-7 days following hip replacement surgery.
The pain relief from removal of the hip arthritis is usually notable
within the first week or two. After 3-6 months, most patients have
recovered and returned to their normal lifestyles. Recovery includes
physical therapy to regain strength and function, and often the use
of a walker, crutches, or a cane for 4-8 weeks.
The complications from total hip replacement are infrequent but may
be severe. These include (in the short term):
infection at the rate of approximately
dislocation: the femoral
head prosthesis becomes dislodged from the socket. This often
requires a procedure known as a closed reduction.
In this operation the prosthesis is replaced in the socket
bleeding, requiring a blood transfusion.
In some cases, the limb lengths cannot
be made totally equal, and these patients may require a shoe-lift.
This is most commonly seen in revision cases in which
an existing hip prosthesis is removed and a second or third prosthesis
is inserted over time.
Long term Complications
The most common reason for loosening
of the components (they become dislodged from the bone) is long-term
wear of the polyethylene liner, which leads to resorption(disappearance) of the bone layer next to the components. This
occurs in both cemented and uncemented protheses. If the components
become loose and the patient has symptoms, revisionsurgery
may be an option. This involves removal of the existing prosthesis,
followed by the insertion of new components and subsequent rehabilitation.
The recovery from revision surgery is longer and more extensive
than primary hip replacement surgery.
Overall, the complication rate from first hip replacement surgery
is less than 5%. The long-term outcome of most conventional hip
designs is roughly 80-85% survival at 15 years. Increased activity,
improper lifting and improper precaution with the hip replacement
may lead to early loosening and the need for revision. Fractures
around the prosthesis both in the pelvis and in the femur may occasionally
occur and may require surgical fixation.