Hip

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Arthritis of the hip joint is a prevalent condition, particularly affecting middle-aged and older individuals, leading to over 40,000 hip replacements annually to alleviate pain. This condition arises when the cartilage covering the femur (leg bone) or lining the acetabulum (pelvic bone) wears down, exposing the bones to direct contact, causing pain, stiffness, and reduced mobility.

Various forms of arthritis exist, with osteoarthritis being the most common. It is characterised by the gradual deterioration of the joint's cartilage. While the exact cause of osteoarthritis remains unknown, it can be influenced by genetic factors, previous injuries, or joint infections.

Rheumatoid arthritis is another prevalent form, marked by chronic joint inflammation and tissue damage, often leading to sudden onset pain, swelling, and stiffness. This autoimmune condition, more common in women, occurs when the body's immune system mistakenly attacks the joints, typically affecting small joints like those in the hands and fingers before progressing to larger lower limb joints.

Less common forms of arthritis fall under the category of "inflammatory arthritis," encompassing conditions such as ankylosing spondylitis, systemic lupus erythematosus (SLE), gout, and juvenile arthritis. Each presents its own unique challenges and symptoms, contributing to the overall burden of arthritis on individuals' quality of life.

Arthritis of the hip joint typically manifests with a gradual onset, often presenting as pain in the groin, lateral thigh, or occasionally in the buttocks. This discomfort may extend down the leg, sometimes reaching the knee and beyond. Pain worsens with physical activity, leading to limitations in walking distance and disruptions in sleep patterns. Morning stiffness is a common symptom, becoming more pronounced as the condition progresses and potentially hindering tasks like bending down to put on socks and shoes.

Diagnosing arthritis usually relies on recognising the symptom pattern, assessing joint stiffness, and noting any signs of inflammation, alongside changes visible on X-ray images.

Initially, managing arthritis typically involves non-surgical approaches. This includes adjusting activities to avoid exacerbating factors, such as discontinuing high-impact exercises like running or jumping, and instead opting for more joint-friendly activities like walking, cycling, or swimming. Optimising weight and quitting smoking can also help prolong the life of remaining cartilage, along with dietary supplements like glucosamine and fish oils.

For pain control, simple analgesics like paracetamol combined with anti-inflammatory medication are often recommended as the first line of defence. Additionally, physiotherapy and hydrotherapy aim to strengthen the muscles around the joint, while walking aids such as sticks or frames can assist in safer, less painful ambulation. When these initial strategies fail to sufficiently alleviate hip pain caused by arthritis, it may be time to consider hip replacement surgery.

Indications

Pain in the hip and groin area can stem from various conditions, both internal and external to the hip joint. Among the internal issues are cartilage tears, the presence of loose bodies, bony growths leading to impingement (known as cam or pincer), inflammation of the joint lining, and ligament tears that affect joint stability.

Surgery

In the operating theatre, X-ray imaging is utilised to confirm the location of your condition and ensure accurate positioning of the arthroscope and surgical instruments. Typically, only two small incisions are necessary on the outer side of the hip for instrument placement, although occasionally a third incision may be needed to complete the procedure.

For common issues like impingement (either cam or pincer), the treatment involves shaving off the bony protrusion and repairing any torn cartilage (labrum).

The procedure usually lasts about an hour, after which the joint is numbed with a local anaesthetic before you leave the operating room. Following an overnight hospital stay, you'll be discharged home with full weight-bearing allowed on the affected hip, using crutches for support.

Post Surgery

Patients can anticipate post-operative physiotherapy follow-up, typically beginning within 4-7 days. It's advisable to refrain from driving during this time frame. Initially, physiotherapy focuses on retraining and strengthening the smaller muscles around the hip to enhance stability, followed by the larger muscle groups such as hamstrings, gluteals, and quadriceps.

Return to work timing depends on the nature of the occupation, typically around 1 week for sedentary jobs and 3 weeks for labor-intensive work. Running and jumping activities should be avoided for 10-12 weeks, after which most patients can gradually resume sporting activities.

Total hip replacement surgery is a thoroughly established and enduring procedure designed to alleviate the pain associated with hip arthritis. With a track record of over 40 years of effective use, it continues to be the preferred treatment option for enhancing the quality of life of individuals grappling with hip arthritis.

Procedure

Anaesthesia

The choice of anaesthesia for the procedure is tailored to each patient's medical condition and preferences. Our team of anaesthesiologists is proficient in both general and regional (spinal) anaesthesia. Prior to the procedure, they will discuss with you the benefits and risks of each technique.

Surgery

Using an incision approximately 12-15cm long, centered over the side of the hip and gently curving towards the buttock, the hip joint can be accessed with minimal trauma to the surrounding muscles. The hip is dislocated, and the femur bone is cut through its neck to expose both sides of the joint. Depending on bone quality and patient age, a cemented or cementless component is affixed to the pelvis and femur. The ball and socket mechanism of the joint are reconstructed using either metal on plastic (polyethylene) or ceramic on ceramic articulation. Computer navigation may ensure correct leg length and optimal component orientation for maximum range of motion.

After surgery, you'll be able to fully mobilise with weight bearing on the hip the day after the procedure. Physiotherapists and nursing staff will assist you, teaching safe use of a frame initially, then graduating to crutches.

Hospital stay typically lasts 5-7 days, depending on home support and progress. Most patients can discard their crutches within 4-6 weeks post-surgery. During this period, sleeping flat on your back, avoiding leg crossing, and using a seat raise for the toilet are advised. These precautions will be reinforced by the physiotherapist during your hospital stay. All patients are prescribed home-based physiotherapy post-discharge.

Post Discharge

Driving is prohibited for 6 weeks after surgery, and car travel as a passenger should be limited during this time to reduce the risk of hip dislocation while the muscles and soft tissues around the hip heal.

Around the 6-week mark after the procedure, you'll have a follow-up appointment with your surgeon. At this point, most patients receive clearance to resume recreational activities such as walking, swimming, cycling, golf, tennis, bowls, gym workouts, and other leisure pursuits as desired. However, running or jumping activities are not recommended following a hip replacement.