Arthritis literally means “inflammation of the joint” and it can be found in any part of the body, from the shoulder all the way down to the smallest joint of the toe. The ball and socket joint of the hip is comprised of intricate systems of cartilage, bone, muscle and connective tissue, all of which can gradually weaken over time or be damaged by acute injury. While there are more than one hundred known types of arthritis, the three most common forms are osteoarthritis, which is by far the most prevalent; rheumatoid arthritis, which is caused by chronic inflammatory responses in the joints precipitated by the body’s own immune system; and post-traumatic arthritis, which is caused by the lingering damage of devastating, acute injuries.
Arthritis describes any disease process that ultimately leads to cartilage loss. The articular cartilage serves a vital role in the hip, as it “cushions” the joint space and prevents bone-on-bone contact. Through the process of arthritis, cartilage weakens and disappears, ultimately leading to bone-on-bone contact, which is incredibly painful. There are a variety of factors that can contribute to you developing arthritis, but the most common causes are from structural problems of hip such as femoroacetabular impingement (FAI) or hip dysplasia; traumatic injury; and abnormal immune inflammatory responses. Some common risk factors that can increase one’s risk of developing the condition are a genetic predisposition, obesity, previous injury to a joint, and weak or underdeveloped muscles supporting a joint.
The primary symptom of hip arthritis is pain, which can be sharp and radiating or dull and constant. The pain will generally develop slowly and worsen over time, but sudden and severe onset is also possible. As the condition progresses and the pain worsens, it is possible for the hip joint to stiffen and even “lock” or “stick” through the range of motion. As symptoms worsen, patients can ultimately have difficulty walking, bending, and performing the required activities of daily living. Most patients begin to lose motion of the hip causing them to compensate with the other hip and the lower back. Coexistent muscular low back pain is very common in patients with hip pain and often improves with correction of the hip.
Diagnosis and Treatment
Hip arthritis is diagnosed through the combination of a comprehensive physical examination, a detailed personal and family medical history, and diagnostic imaging like x-ray or MRI. Your physician will be looking for telltale signs of the condition, including pain and tenderness in the hip, limited active and passive range of motion, grinding sensation with movement, narrowing of the joint space, degenerative changes in the bones of the hip, and osteophytes (bone spurs).
While there are a number of treatments available to treat hip arthritis, there is no known cure for the condition. All of the treatments we have are aimed at either managing symptoms or replacing the joint entirely. Conservative treatment for hip arthritis includes lifestyle and activity modification, physical therapy, bracing, hyaluronic acid (HA) injections, and non-steroidal anti-inflammatory medications (NSAIDs).
If conservative treatment fails, there are several surgical approaches that can be taken. In the early stages of arthritis, arthroscopic surgery can relieve pain and may delay the need for a total hip replacement. However, in advanced cases of osteoarthritis, total hip replacement is the required treatment.
Direct Anterior Approach Total Hip Arthroplasty
Total hip arthroplasty can be accomplished with a posterior, lateral, or anterior approach, meaning your surgeon can replace the hip either from the back, side, or front of the hip. The traditional approach is posterior, but recent advances in surgical science have allowed surgeons to create novel techniques, including the direct anterior total approach. There are many advantages to an anterior total hip, including less muscle trauma, less pain, quicker recovery, lower likelihood of gait abnormalities, and significantly reduced rates of hip dislocation. Schedule an appointment with Dr. Mai today to see if you may be a candidate for this procedure!