HIP SURGERY
Common Hip Problems
Osteoarthritis
Osteoarthritis occurs when the cartilage which cushions the bones in a joint becomes weak and thin. The underlying bone responds by growing abnormally, making the surface rough. Sometimes, tiny fragments of bone or cartilage can break off into the joint. In addition, the synovial membrane which surrounds the joint can become inflamed and produce too much liquid. The ligaments which surround the joint may also become weaker. All these factors cause considerable pain, stiffness and decreasing mobility.
Sporting Injury
Modern active lifestyles and sport have lead to patients seeking attention for hip problems from health care professionals at a much earlier stage than in the past. The hip joint itself is more often the source of the problem than is widely appreciated rather than the surrounding muscles and tendons that are usually blamed. Patients describe an activity related groin ache with a sharp catching in the front of the hip, particularly with the hip fully flexed. The pain may have started acutely following a pivoting injury or build up more gradually. Inconsistent hip function decreases exercise tolerance and disrupts training. A common sporting injury is a tear of the acetabular labrum. This is a skirt of fibrous material attached to the margins of the hip socket, which acts as a seal. Other sporting hip injuries include a torn ligament within the hip joint, loose bodies and damage to the lining of the hip joint itself. All these injuries are usually completely invisible on xrays and may even be missed with MRI scanning. When these injuries are suspected, a hip arthroscopy may be necessary. This keyhole technique allows a clear view of the inside of the hip joint and treatment of any problem found.
Torn Labrum
The labrum is a ring of touch fibrous tissue which surrounds the hip socket (acedebulum). The labrum can tear if exposed to repeated flexing and pivoting motion and a torn labrum can be a consequence of sports such as ice hockey, soccer, tennis and karate. The pain caused by this condition is usually felt at the front of the hip or in the groin and is often described as a sharp, painful locking or clicking sensation.
Avascular necrosis
This is a condition resulting from the temporary or permanent loss of the blood supply to the main weight bearing part of the bone making up the ball of the hip joint. The bone dies making the bone so weak it is unable to support the loads being transmitted through it leading to collapse, a process that may take months or years. The ball can therefore become flattened and abnormally shaped leading to wear of the overlying cartilage and secondary arthritis. Risk factors are steroid treatment, fractures around the hip, sickle cell disease, and alcohol excess, although it can also occur without any obvious cause. In its early stages AVN causes pain, particularly at night and can easily be diagnosed on MRI scan. Treatment involves drilling the dead bone to stimulate healing and relieve pressure; if performed early enough this procedure has a success rate of 80-90%. Once the bone has collapsed, the most reliable treatment is total hip replacement.
Adult Hip Dysplasia
Hip dysplasia describes the condition when the hip socket does not develop properly and is more shallow and upward sloping than normal. The severe forms are detected at birth or infancy (congenital dislocation of the hip) but milder forms may not become apparent until adolescence or early adult life. The condition is much more common in females and causes sharp groin pain, catching, instability and early fatigue in the hip. Without treatment, arthritis develops because the increased stresses on the lining cartilage of the hip cause it to wear out quickly. Early diagnosis is therefore important to improve the mechanics of the hip and relieve symptoms.
The most appropriate treatment is an operation to rotate the hip socket round so it becomes more horizontal (peri-acetabular osteotomy) although surgery may also be necessary on the femur (femoral osteotomy). Whilst these are big operations requiring 2 to 3 months on crutches, they can restore these young people's function without resort to implants and postpone the development of arthritis by decades.
Dysplasia preop and postop jpeg images attached with title: 25 year old female with right hip dysplasia treated successfully with peri-acetabular osteotomy (PAO).