The hip joint is a ‘ball and socket’ joint. The ‘ball’ component is formed by the upper end or head of the femur, also known as the thigh bone. The ‘socket’ component is formed by the acetabulum within the pelvis bone. The surfaces of the joint are covered by a smooth elastic tissue called cartilage. The cartilage allows the joint surfaces to glide smoothly and painlessly against each other. Damage to the cartilage and bone within the hip joint is called osteoarthritis. This can result from degeneration (wear and tear), trauma, avascular necrosis (depletion of the blood supply to the head of the femur), inflammatory disorders (such as rheumatoid arthritis) or childhood disorders (such as dysplasia, where the acetabular socket has an abnormal shallow shape).
Patients who develop osteoarthritis of the hip joint can present with pain, stiffness and limping. This can sometimes be severe enough to affect daily mobility and one’s quality of life. The diagnosis of hip osteoarthritis is made after a thorough clinical assessment of the hip joint. X-rays and MRI scans are done to confirm the diagnosis. Occasionally additional blood tests may be done to find out the underlying cause of the osteoarthritis.
Patients with early osteoarthritis and mild symptoms may be treated non-surgically with a course of rehabilitation. However, patients with severe symptoms and advanced osteoarthritis are candidates for surgical treatment.
Surgical treatment involves hip replacement surgery. The surgery involves replacing the worn out ball and socket components of the hip joint with prosthetic devices which are usually made of cobalt-chromium, titanium and polyethylene (medical grade plastic). Sometimes ceramic components may be used, particularly in younger patients. Such surgery is usually performed under general anaesthesia and may take about 2-3 hours to perform. A 3-4 stay in hospital is usually required after the surgery and 2-6 weeks of walking aid-assisted ambulation may be advised.
The rehabilitation process after the surgery is generally supervised by a physiotherapist, and consists of progressive range of motion exercises, muscle strengthening exercises, and functional therapy. The whole rehabilitation process may last to 3-6 months following the procedure. The success rate of hip replacement surgery has been reported to be 90%. The complications of this procedure include deep vein thrombosis, infection, limb length discrepancy and prosthetic wear.
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