Osteoarthritis or degenerative joint disease of the hip is a loss of cartilage of the hip joint. This condition may be due to normal wear and tear over the course of many decades. However, there are many other reasons that can cause arthritis of the hip, such as:
- Avascular necrosis (AVN) or osteonecrosis (ON) of the femoral head (the ball of the hip)
- Developmental dysplasia
- Genetic conditions such as epiphyseal dysplasias
- Hip impingement
- Labral tears
- Perthes disease
- Prior trauma
- Slipped capital femoral epiphysis
If you have - or think you have - arthritis of the hip, we at the University of Michigan Department of Orthopaedic Surgery have the experience and expertise to improve the quality of your life. As one of the oldest and most well-regarded orthopaedic surgery units in the United States, we have diagnosed and treated hundreds of patients with arthritis of the hip, and have brought them relief and a new lease on life with a variety of non-surgical and surgical options just for them.
Symptoms of Arthritis of the Hip
Typical symptoms can include:
- Pain, most commonly in the groin or front pocket. May also have pain in the thigh that radiates to the knee or less commonly pain on the outer portion of the hip.
- Limited range of motion/stiffness of the hip, such as:
- Difficulty putting on shoes/socks or trimming toenails
- Difficulty getting in/out of low cars
- Difficulty getting off a low seat
- Limp where it is more comfortable to lean over the painful hip while walking or while using a cane in the opposite hand
- Pain in bed without a pillow at the knee
- Pain with certain sexual positions
- Pain that is limited to the outside of the hip and is worse when laying on that side in bed is often trochanteric bursitis or tendonitis which may respond to therapy and will not need surgery
Diagnosis of Arthritis of the Hip
Your University of Michigan surgeon will:
- Take a thorough medical history and talk with you about your pattern of symptoms.
- Conduct a physical exam that may include an assessment of your range of motion, gait, neurovascular status, and reproduction of the pain in the front pocket distribution with seated range of motion of the hip joint.
- Possibly give you a diagnostic hip injection. Injections don't usually provide long-term relief for hip pain. However, your surgeon may order an injection to help make the diagnosis, particularly if there are also symptoms that could be related to low back issues. These injections will be performed by a trained individual using an ultrasound machine or fluoroscopic X-ray machine to assure that the injection is in the hip.
Treatment of Arthritis of the Hip
Non-surgical Interventions for Arthritis of the Hip
Your surgeon may decide that a non-surgical approach is best for you. Among our options are:
- Activity modification
- Using an assistive device such as a cane, walker, crutches or trekking poles
- Weight loss, if you're over your ideal body weight
- Motrin, naprosyn or other NSAIDS (non-steroidal anti-inflammatory drugs)
- Physical therapy - It's rarely beneficial for hip arthritis itself, but physical therapy may help with gait and bursitis symptoms.
Hip Replacement Surgery
At the University of Michigan, total hip replacement - also known as total hip arthroplasty - is a highly successful and durable surgical procedure. It replaces the femoral head (ball), neck and damaged cartilage in the acetabulum (pelvis).
Three different types of bearing surfaces are available for total hip replacements or arthroplasties:
- Metal on highly cross-linked polyethylene (metal ball on plastic liner): This is our current recommendation for most patients. It's highly successful and durable and has the best track record: 98% of metal ball on plastic liner hip replacements last about 20 years in young, active patients.
- Ceramic on ceramic: This is more common in Europe and has the potential for improved wear. There are increased risks associated with this procedure, including a 4% chance of squeeking and need for revision if there is bad positioning (malposition).
- Metal on metal: This was originally popular in the 1970s with a number of patients doing well long term, but many patients had complications that were thought to be related to the manufacturing of the implants. With improved manufacturing techniques, metal on metal hip replacements regained popularity between 2001 and 2008. Metal on metal is the only articulating bearing surface available in resurfacing or “capping” types of hip replacement. But we are currently not recommending or performing this procedure due to a portion of these patients having problems associated with the metal debris generated. We recommend metal ion testing in patients who already have this type of hip replacement.
Risks of Surgery
The risks of surgery are very rare but can include: Infection, bleeding, damage to nerves or blood vessels, soft tissue trauma, bruising, continued pain, stiffness, fracture, dislocation, limb length discrepancy, numbness or tingling, loosening or wear of prosthesis and need for further surgery. Risks of anesthesia can include: heart attack, blood clot, stroke, pulmonary embolism or death.
When it comes to hip replacement surgery, education is important. Before surgery, we will encourage you to attend a two-hour class (informational session) which explains what to expect before surgery, during your hospitalization and throughout your post-operative recovery. This will give you an opportunity to meet members of your health care team, ask any questions and hear answers to questions that other patients will ask, which is always helpful. We've found that our patients and their families find these sessions very rewarding and informative.
Even if you're only considering surgery at this point, please attend these worthwhile sessions.
Post-op Care Following Total Hip Replacement
- Pain relief can be immediate (especially the pain in the groin that occurs even with gentle motion).
- Typically, weight bearing and walking (ambulation) will probably be started immediately.
- You could be discharged to your home as soon as the day of surgery or the day after. Discharge to an extended care facility for patients with limited help at home can occur after 3 days in the hospital.
- To prevent blood clots that can occur in 5% of patients, we encourage early activity and blood thinning medication for 1 month.
- Initially, a walker or crutches is used. This can be quickly advanced to a cane for a couple of weeks as needed.
- Total hip precautions (avoiding deep hip flexion and extreme twisting) for 6 to 12 weeks after surgery to prevent dislocations.
- We schedule approximately 2-3 follow-up appointments within the first 3 months after surgery, and then 1 year after surgery, and then every 5 years thereafter for routine X-rays to evaluate for signs of wear.
Contact Us/Make an Appointment
- Orthopaedics, 734-936-5780
- Physical Medicine and Rehabilitation, 734-936-7175
- Rheumatology, 888-229-3065
You're about to make an important decision, and we want to help you make a good one. Let our years of experience diagnosing and treating hip conditions help you. Visit our Contact Us page to see a list of Musculoskeletal Call Centers. Our staff will be glad to talk with you about your options and how we can help.