Hip Pain

The Symptoms
The symptoms of osteo-arthritis (OA) in the hip usually manifests itself with pain in the groin, sometimes even radiating to the knee which is referred pain. Many patients think that they have osteo-arthritis of the knee but in fact it is OA of the hip with referred pain in the knee. Osteo-arthritis of any joint is a condition that is sometimes called ‘wear and tear’.

When the pain is only mild and intermittent I would suggest a change in lifestyle. Losing weight, gentle physical activity (cycling, swimming, etc.) would be helpful. If your pain is not relieved by lifestyle change you may have to take medication. Anti inflammatory medication is usually prescribed. If the pain is not relieved by medication and change in lifestyle then I would discuss a total hip replacement with you.

Treatment: Total Hip replacement
After discussion and examination we can agree a date for your operation. You will come in a few weeks before your operation for pre-operative checks and to discuss the anaesthetic. You can discuss the options with the anaesthetist of either having a general anaesthetic together with a local anaesthetic block (femoral and lateral cutaneous nerve of thigh) or a spinal anaesthetic. In both cases you will be comfortable during and after the operation. I use what is called the ‘lateral approach’ to the hip. The wound is kept as small as possible and when the hip is implanted well early recovery can be faster.

Choice of implant:

Cemented total hip replacement

The cup and the shaft of a
‘cemented total hip’ prosthesis are fixed to the skeleton with a self curing polymer compound called bone cement. The bone cement fills completely the space between the skeleton and the surface of the prosthesis.

Uncemented total hip replacement
For most of my patients I choose an
‘uncemented hip replacement’. A combination of the bearing surfaces are usually metal on metal, Ceramic on Ceramic and/or Metal on high density polyethylene (HDPE).

The wear in a hip replacement is related to a number of factors. The young, active patient tends to wear out a standard hip replacement in 10 to 15 years. That is why we are constantly looking to develop better implants, better bearing surfaces and better ways of fixing implants. There are several different ways to reduce the wear and increase the implant life.

After the hip replacement you will wake up in recovery where you will be closely monitored until you are safe to return to the ward. Six hours after the operation you will be given an injection to reduce the risk of developing DVT (blood clot). The next day you may be sitting in a chair and able to walk under careful supervision of physiotherapists. Most of my patients return home between 4 – 6 days.

A follow up appointment will be made for you to see me again in 6 weeks back at the hospital.

Hip resurfacing option
Resurfacing hip arthroplasty is an alternative to total hip replacement to conserve as much bone as possible to help future revision of the hip replacement if necessary.

In the younger patient, a total hip replacement may not be the best solution for their hip pain because it can mean a revision in later life. Hip resurfacing, however, leaves more of the bone in place, giving these patients more time before a total hip replacement becomes necessary.

In hip resurfacing, the hip joint is relined rather than replaced. The head and neck of the femur are preserved. The worn surfaces of the head and socket are carefully reemed away with precision instruments. The joint is then lined with a metal covering for the head and socket. In a resurfaced hip the femoral head is similar in size to the natural hip. In conventional total hip replacement the average head size is smaller than the natural hip. The advantage of a larger head size is a greater range of movement of the hip and increased stability, in other words less chance of it coming out of joint (dislocating).

Just like a standard total hip replacement, in most cases post-surgery you will be able to negotiate stairs within 2 – 3 days, go home within 4 – 5 days and resume a large number of your daily activities as you recover. Generally speaking, you should be relatively independent after about 6 weeks when you will be permitted to drive. About 3 months after surgery most patients return to every day activities including returning to work.

Am I suitable for a resurfacing procedure?
As there is a lot of conflicting advice in the press and from manufacturers I would be very willing to discuss with you what type of operation, resurfacing, cemented or uncemented total hip replacement, what bearing surfaces would be suitable for you so that you are fully informed before surgery.

Hip revision surgery also known as ‘revision hip arthroplasty’:
The most common reason for a hip replacement to become painful is usually because the implants have worn out and become loose from the bone. In most cases, increasing pain, greater difficulty in placing weight on the hip, and loss of mobility in the hip joint are early indications that revision surgery is necessary. When implants are loose, they have to be removed and replaced with new, well fixed implants. It is therefore best to address the loose implants at the earliest opportunity so that corrective surgery will be less complex.

Hip prostheses that contain parts made of polyethylene typically become loose because wear and tear on the prosthesis gradually produces tiny particles from the plastic that irritate the soft tissue around the prosthesis. The inflamed tissue begins to dissolve the underlying bone in a process known as ‘osteolysis’. Eventually, the soft tissue expands around the prosthesis to the point at which the prosthesis loses contact with the bone.

Once the implants have been removed, the degree of damage to the surrounding bone can be determined. If there is minimal damage to the surrounding bone, excellent results can be obtained by re-cementing new implants. Sometimes, when there is extensive damage to the bone, bone grafts will be necessary. The bone graft is usually obtained from the bone bank from the ball of the hip joint donated by patients previously undergoing a hip replacement. The big advantage of using bone graft is that the bone stock is eventually restored and as a result, if any future operations are required, they will be very much easier to do.

Hip revision surgery is more complex surgery than a primary hip replacement and usually takes three to four hours. A cut is made along the hip and thigh usually over your previous scars. The original artificial hip joint is removed and replaced with new implants. You will be in hospital for about 5 – 6 days.

There are certain movements that you should not do in the first eight weeks. For example, you should not cross your legs or twist your hip inwards and outwards. You will be able to move around your home and manage stairs. You will find some routine daily activities, such as shopping and driving difficult for a few weeks and you will need to ask for help. You will need to use crutches for about six weeks. I usually advise return to work after 6 – 8 weeks. But if your work involves a lot of standing or lifting, you may need to stay off longer.