The Hip joint is a ball and socket joint. The femoral head (ball) fits into the acetabulum (socket). Around the edge of the socket, a soft cartilaginous ring called the labrum provides additional stability. The joint is also lined by a capsule and synovium, which provides lubrication. The ball and socket are both covered with a layer of smooth cartilage that acts as a cushion.
Osteoarthritis (OA) is a degenerative disease that causes progressive loss or breakdown of the cartilage in the joints. Hip, Knee and the hands are the most commonly affected joints. Over time, and particularly with age or injury, the joint cartilage breaks down due to normal wear and tear. The bones remain unaffected in the early stages, but as the cartilage thins out and loses its protective cushion over the years, the bones start rubbing against each other, causing the classical pain of bone-on-bone osteoarthritis. Recent studies have shown that may patients with OA have inflammatory cells in their joints, especially if they have had any injury in the past.
There are certain risk factors that can increase the chances of developing OA. The modifiable risk factors include obesity, previous injury, high impact sporting activities and muscle weakness. The non modifiable factors are gender (females affected more than males), increased age and family history. Certain conditions during childhood such as hip dysplasia, Perthes disease and slipped capital femoral epiphysis also predispose patients to developing OA.
Pain on movement of the hip is the most common symptom in patients with OA. The hip hurts especially during weight-bearing activities, and reduces at rest. The pain is located in the groin, inner thigh, radiating down to the knee and the buttock. Some people also hear a grating or crunching sound on movement of the joint. Over time, the hip loses its range of motion and becomes stiff. Activities like getting in and out of the car or chair become painful and the walking distance is gradually reduced. People might struggle to put their shoes and socks on and to get in a comfortable position in bed whilst sleeping despite taking regular pain killers.
This is made on the basis of physical examination and X-rays of the hip. In the early stages one can see some narrowing of the joint space as the cartilage deteriorates. Bony spurs (osteophytes) and cysts are also noted in moderately degenerate hip joints. In advanced arthritis where is no cartilage left, the ball and socket might be grinding on each other and the femoral head might even show some signs of deformation. Magnetic resonance imaging (MRI) is helpful in assessing the status of the soft tissues around the hip joint and in ruling out other causes of hip pain if the diagnosis is not clear.
Pain management with appropriate pain killers and anti-inflammatory medications, weight loss, activity modification and physiotherapy is the first line of treatment for all patients with symptomatic arthritis. Steroid injections into the joint are considered to provide some temporary symptomatic relief. These injections can also be used for diagnostic purpose if the diagnosis is not certain.
The role of hip arthroscopy (keyhole surgery) is controversial in the patients with established arthritis. It is contraindicated if the joint has moderately advanced degenerative changes. Reorienting the acetabulum (socket) called periacetabular osteotomy and/or femur (upper end of thigh bone) called femoral osteotomy is considered in adolescent or young adults with hip dysplasia and secondary mild to moderate OA. Some surgeons would offer hip resurfacing to young male runners.
A total hip replacement is an effective treatment option for patients with severe bone on bone osteoarthritis and provides excellent long term outcomes.
Mr Jalgaonkar also performs total hip replacement through a minimally invasive approach (MIS) as this potentially decreases the surgical trauma, post-operative pain, reduces blood loss and results in shorter hospital stay and faster return to daily activities.