Hip arthritis results from wear and erosion of the cartilage covering the surfaces of both the ball and socket. Cartilage normally has a smooth and slippery consistency much like an ice cube. It allows the joint surfaces to move in a frictionless manner and it helps to distribute loads such as those that occur with weight bearing, sports and other activities of daily living and leisure time activities. Cartilage wear can occur from age related degeneration and family history as well as from injury and overuse. Sometimes the causes of wear are unknown.
When the cartilage wears away, exposed bone beneath the cartilage rubs against opposing bone causing pain and inflammation. This results in joint stiffness thereby limiting mobility and function. As the wear increases, hip pain worsens and people’s quality of life begins to decline. Everyday activities can become painful to the point that people begin to avoid activities to limit pain in the joint.
Management of hip arthritis is multifactorial. Symptom treatment includes anti-inflammatory medications, weight loss, activity modification, modalities like ice and heat and unloading maneuvers like a cane, crutches or a walker. Physical therapy to improve mobility, strengthen the core and gluteal muscles can sometimes help alleviate pain. Pool therapy which allows exercise in an unloaded environment can be helpful. When pain gets severe, cortisone injections into the hip joint can effectively provide pain relief. When routine treatments like over the counter medications are no longer successful and pain is severe and functionally limiting, total hip replacement becomes a reasonable option to restore comfort and function.
Total hip replacement is a well-established operation with a highly successful track record that dates back almost 60 years. Through sequential improvements in prosthesis design, materials and surgical techniques, this operation can restore function to near normal levels for upwards of 20 years. In the majority of cases, patients are able to begin weight bearing on the new joint the day of surgery and return to leisure time and work-related activities within 4-8 weeks. The direct anterior approach to total hip replacement is a more recent adaptation of an older technique that reduces tissue trauma and spares muscles detachment during the procedure. Dr. Mullen has done hip replacements through anterior, lateral, and posterior approaches. Early reports touted the anterior approach as better. However, more recent outcome studies have shown that the different techniques provide a similar timetable for return to function and equal reduction in pain.