CNY Orthopedic Sports Medicine, PC: InjuryDetail: Total Hip Arthroplasty
 
Injuries and Conditions: Hip: Total Hip Arthroplasty: Medical Details
 
Overview
As the bones of the hip come in contact with each other, an insulating layer of cartilage helps distribute weight and reduce friction across the joint. Osteoarthritis, or other degenerative conditions that affect this cartilage erodes the smooth surface of the joint and begins to interfere with the efficient functioning of the hip. For older patients that have exhausted other treatment options and continue to experience pain, a hip replacement may be recommended to alleviate many of the problems caused by a degenerating joint.

The hip is the largest joint that utilizes a ball and socket construction. As with the shoulder, the ball and socket arrangement allows a large range of motion. The shape and position of the hip provide excellent stability, acting as a junction between the upper and lower body. Degeneration of the cartilage in the hip can be especially debilitating because of the critical role the joint plays during most day-to-day activities. Almost any routine activity of daily living, places tremendous stress across the hip joint.

Cartilage is found throughout the body, and depending upon its location, varies in its composition and structural qualities. In the ear or nose, cartilage provides a flexible construction that can easily bend without harm. In the hip, however, cartilage provides support and protection, while at the same time significantly improving the function of the entire joint. The softer and nearly frictionless cartilage allows the bones to mesh together and move with ease. Degeneration of the cartilage results in bones grating and rubbing against each other, a usually very painful condition.

Cartilage will begin to wear in older individuals and cannot be replaced or repaired by the body. The severity and rate of degeneration varies from person to person. The process of cartilage degeneration occurs in all individuals to the point that approximately 60% of all sixty year-olds will have some cartilage fraying or tearing.

Causes of Injury
  • Many conditions may result in degeneration of the hip joint; the most common is osteoarthritis.
  • Some individuals are more prone to develop osteoarthritis than others. Causes for the condition are not yet known, although it is likely a process similar to other degenerative conditions which result from a combination of factors including: heredity, type and intensity of athletic activity, and the extent of previous injury.
  • Repetitive pounding or impact producing actions to the hip can cause damage to the cartilage over time.
  • Cartilage can also be damaged from a traumatic event, such as a sudden twist or blow to the hip.
  • A traumatic injury to the cartilage can accelerate the rate of the ongoing degenerative condition.
  • Inflammatory arthritis (such as rheumatoid arthritis) destroys the cartilage of the hip.

  • Diagnosis
    Both the patient's previous treatment history and their ability to tolerate the pain associated with a degenerative hip are important factors when considering a hip replacement. A painful hip can greatly reduce the patient's ability to lead an active life. After non-surgical therapies to treat the hip are no longer providing effective pain relief, a hip replacement may be considered.

    The orthopaedic surgeon will review previous treatments. Initial treatment plans may have included steroid injections, anti-inflammatories, activity modification, correction of any bio-mechanical or gait abnormalities, and weight loss. A physical examination and x-rays will be used to determine the extent of the degeneration and if a replacement hip will be used in treating the condition.

    Symptoms

  • Severe osteoarthritis, degenerative joint disease or continual and progressive discomfort and pain throughout the hip.
  • Hip pain that can no longer be managed through other treatments; pain while using the leg in normal activities or particularly intense pain while climbing or descending stairs or during movements that put more pressure on the hip.
  • Discomfort or pain after sitting or keeping the leg and hip motionless for an extended period of time.
  • Stiffness, which increases after the hip has remained motionless.

  • Anatomy
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     Product Considerations
    Reachers
    Reachers were designed to help persons who have suffered an injury, undergone surgery or have a disability which results in difficulty bending over, stooping, or "reaching" common household items. This inability to perform activities of daily living may be temporary and a Reacher can help until you regain the ability to care for yourself without assistance. Reachers are available with many different features. A few are listed below and each person should determine his or her particular needs before choosing a Reacher.

  • Sideways opening jaws work well when picking up boxes from shelves or items with an open top, and allows the user to see the object while grasping it without twisting the wrist.
  • A palm-activated full hand trigger allows the full strength of the user's entire hand to close the jaw, unlike a conventional trigger that uses only a couple of fingers.
  • A comfortable pistol grip and rubber suction cups that can pick up anything from a coin to a 5 pound brick.
  • A design which features a magnet on the front tip for picking up small metal objects.
  • A patented SAF-T-LOK can maintain a secure grasp onto items with out constant tension on the trigger, or even holding the pistol grip.


  • NSAIDs
    NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
  • Pain resulting from inflammation or swelling.
  • Pain after injury.
  • Joint pain and arthritis.


  • Abduction Pillow
    An abduction pillow is used to separate or hold a patient's leg apart at the thighs after total hip replacement or revision surgery. The pillow helps position the legs correctly to properly position the hip prosthesis in the hip joint; used after surgery, this device helps to reduce the likelihood of a dislocation after a hip replacement or revision procedure.

    The pillow is used immediately post-operatively, and is particularly important for maintaining an anatomically correct position while the patient rests and sleeps. As the muscles, tendons and ligaments gradually heal, the pillow will be used less frequently, until it is eventually discontinued.


    About the Clinical Review Team

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