Are you experiencing severe pain in your hip that is affecting your ability to complete normal tasks? Perhaps you have arthritis or you’ve suffered an injury that has fractured or broken your hip. There are thousands who suffer from hip pain that wonder what options can remedy the problem and help them regain their quality of life. If you suffer from severe hip pain, you may have heard of hip replacement surgery or hip resurfacing surgery. These are just two of the many orthopedic surgeries we offer here at Olsen Orthopedic in Oklahoma City, OK.
Hip Pain: A Large Problem
The hip is one of the largest joints in the body and plays a major role in mobility. This joint works as locomotion as the thigh moves forward and backward. It also rotates when you sit and when you change direction while walking. Understandably, having pain or a break in this joint has a large impact on your quality of life.
The Anatomy of the Hip
In the hip joint, the ball of the thigh bone, called the femur, is joined with the pelvis at a socked called the acetabulum. Cartilage covers both the acetabulum of the pelvis and the bone of the femur in the hip joint. This hip joint is surrounded by a lining tissue called synovium that provides nutrients to the joint’s cartilage and lubricates the joint.
There are ligaments around the hip joint that attach the femur bone to the bony pelvis. There are also many tendons and muscles that glide around the hip joint using tiny fluid-filled sacs called bursae. Major veins and arteries pass the front of the hip joint while the body’s largest nerve, the sciatic nerve, passes behind it.
Causes of Hip Pain
As you can see, there are many components to the hip joint that work together. You may experience hip pain if there is a problem with any of these components. There are various factors that can cause pain in the hip joint. These factors can be chronic or acute and can be caused by external or internal influences, including:
- Inflammatory/noninflammatory arthritis
- Septic/Infectious arthritis
- Gaucher’s disease
- Avascular necrosis
- Muscle strain
- Aseptic necrosis (lack of adequate blood flow to the hip)
- Iliotibial band syndrome (IT band syndrome)
- Bursitis (inflammation of the bursae)
Because there are so many possible causes of hip pain, it’s important that you consult with an orthopedic specialist to determine the cause of your symptoms.
How Hip Pain Is Diagnosed
Health care professionals will diagnose hip pain by gathering your medical history, conducting a physical examination, and completing imaging studies.
Your health care professional will gather your medical history and medications to see if there is a link between them and your hip pain. There are certain medical conditions they will look for, such as cancer, rheumatoid arthritis, osteoarthritis, and sickle cell anemia. They will also discuss your family history for a history of osteoarthritis.
You will be asked about any past physical injuries, particularly in the hip or lower back. They will also inquire about your intake of certain substances, like steroids or alcohol. It is important to be completely honest during this consult because it will help to determine the cause of your symptoms.
During the physical examination, the health care professional will perform maneuvers like internally and externally rotating the hip. They may also raise the leg straight to detect any signs of sciatica. These movements can be used to detect positions that aggravate pain. They may also palpate over any inflamed areas to elicit responses of tenderness.
The health care professional may also use imaging studies to aid in the diagnosis of your hip problem. These include CT scans, X-rays, and MRI scans. If your bone is fractured or inflamed, they may also use nuclear medicine bone scans to image the bone.
Two Options for Severe Hip Pain
If the condition of your hip is severe and your symptoms are detrimental to your quality of life and movement, the orthopedist may recommend that you undergo hip surgery. There are two major options that are considered for advanced arthritis of the hip or hip fractures: hip replacement and hip resurfacing.
Hip Replacement Surgery
Hip replacement surgery involves complete removal and replacement of the hip joint with a prosthesis made of metal and plastic components. This surgery, called arthroplasty, involves the removal of the entire hip joint as well as the neck of the femur and the insertion of a stem deep inside the bone. This stem will connect with the pelvic socket and joint liner.
Hip resurfacing involves trimming the femoral head and then capping it with a hollow, smooth metal covering that is cemented to the bone. The damaged bone within the hip bone socket is also removed and replaced with a matching metal cup that is held in place by friction between the bone and the metal.
What Is the Difference Between a Hip Replacement and Hip Resurfacing?
Each type of surgery offers its own advantages and disadvantages, but resurfacing has been shown to have greater benefits than traditional hip replacement surgery, especially when contrasting differences in bone removal, postoperative results, quality of life, naturalness, and longevity.
Resurfacing removes a lot less bone than a hip replacement. This is because the entire hip joint, as well as the neck of the femur, is removed in replacement surgery. However, only the top of the femoral head and the damaged bone within the hip socket is removed in resurfacing. This allows you to keep more of your natural bone in your hip joint and strengthen it.
Because of the nature of hip replacement surgery, which involves cutting off the top of the femur and replacing it with a stem, there are greater possibilities for the patient to have inaccurate leg length. Because the prosthetic hip joint is a total replacement, there is also a higher chance for dislocation due to loosening.
Only a few millimeters of the femoral head is removed during resurfacing, with no femoral bone being removed and replaced. Metal is also cemented on top of natural bone and creates friction, so there is less chance for the outcomes that can be associated with a total hip replacement.
Quality of Life
Whether you choose to resurfacing or a complete hip replacement, both options will give you a better quality of life and mobility than living with hip pain. However, a prosthesis cannot fully mimic the function of the natural joint, cartilage, and bone. So it will be difficult to return to your former activities.
Because resurfacing only removes a small amount of bone and a metal cap is cemented to it, the natural bone is actually strengthened. This can allow you to return to your previous activities, like climbing, running, and even competitive sports eventually. This is nearly impossible to achieve with a hip replacement.
Resurfacing will feel more normal because it is more natural. The bone will still bear weight as it always has because only a minimal amount has been replaced. This will actually strengthen the remaining upper bone as time passes. It will also allow for a more natural walking pattern.
In contrast, hip replacements will send weight-bearing loads down the metal stem to the inside of the femur and completely bypass the remaining upper bone. This will cause the upper bone to weaken over time. There is also more likely to be a noticeable stiffness or limping walking pattern with a total hip replacement.
The longevity of resurfacing is probably the biggest advantage it offers. Resurfacing is a permanent procedure that has been proven to last just as long, and even longer than traditional hip replacements in high-demand, young patients. The probability of failure is very low for this procedure compared to total hip replacement. This is because there is still much natural bone preserved.
If the resurfacing procedure does fail, then correction may only involve a simple replacement surgery or completing the lower half of a total hip replacement. In contrast, hip replacement failure results in a complex revision surgery that involves removing and replacing the entire prosthesis. This is often less successful than the first replacement due to bone loss.
Who Qualifies for Hip Resurfacing?
Resurfacing truly does offer many advantages over traditional hip replacements. However, unlike hip replacement surgery, it is not suitable for all patients. The most ideal candidates for resurfacing will be less than 60 years old with strong, healthy bone and an active lifestyle. This type of surgery is also usually more successful in male patients.
Patients who are smaller-framed, older, female, or have damaged or weaker bone may not be an ideal candidate for the long-term success of the procedure. Thus, it is important to get a comprehensive evaluation by the orthopedist to determine your candidacy.
Hip Resurfacing: What to Expect
It is important to know what to expect before, during, and after the surgery to ensure maximum comfort and success of the procedure.
Before the Procedure
Before surgery, your orthopedic surgeon will conduct the initial exam to determine the cause of your hip pain and your eligibility for surgery. If you are chosen as a candidate, you will discuss your options for anesthesia and pre-operative instructions and have any questions answered. The day you are admitted into the hospital, the surgeon will sign your hip to verify the surgical site.
During the Procedure
The surgery generally takes anywhere from 1.5-3 hours to complete. You will first be put under the anesthesia of your choice. The surgeon will then make an incision in the thigh to reach the hip joint and dislocate the femoral head out of the socket. The surgeon will then trim the head with specially designed power instruments and cement a metal cap over it.
The surgeon will remove the cartilage lining the socket with a reamer, then push a metal cup into the socket. This cup is held in place by friction between the metal and the bone. Once this cup is in its correct place, the femoral head will be relocated back into the socket and the incision will be closed.
After the Procedure
You will be taken to the recovery room after surgery and monitored closely by nurses as you recover from anesthesia. You will then be taken to your hospital room. You can go home 1-4 days after surgery and may need a cane, walker, or crutches the first few days or weeks until you can walk without assistance.
The doctor may prescribe pain medication if needed for comfort, and he or she may also recommend physical therapy to maintain your range of motion and restore your leg strength. You will continue to have follow-up visits with the surgeon at regular intervals and can resume regular activities of daily living around six weeks after surgery.
A Solution to Your Hip Pain
We know how badly arthritis and fractures in the hip can affect your ability to move and your quality of life. Contact us here at Olsen Orthopedic in Oklahoma City, OK to help you gain your life back and relieve the symptoms of hip pain. We look forward to helping you with your orthopedic needs.