Hip arthritis affects 3–6% of the Caucasian population and can be due to multiple causes. Understanding when and how hip arthritis requires surgery — and what can be done before it reaches that point — is critical for optimal management.
What is Hip Arthritis?
Hip arthritis is a common condition, affecting between 3–6% of the Caucasian population, with a lower prevalence in Asian, Black, and East Indian populations. It can be due to multiple causes, including osteonecrosis (death of the femoral head), trauma (fractures), sepsis (infections), or rheumatoid arthritis. Newer evidence has also implicated femoroacetabular impingement in its cause — occurring when there is a mismatch between the ball and socket of the hip joint.
Hip pain often affects the groin, but can radiate to the buttocks, lateral thigh, and knee. It is important to ensure there is no other cause of hip pain prior to any surgery, as back, knee, and even intra-abdominal problems can mimic hip arthritis.
Non-Operative Management
Not all hip arthritis requires surgery. Where it is not significantly impacting daily living, it can and should be treated with medication, walking aids, and activity modification. Once hip arthritis is advanced enough, a total hip replacement is warranted.
Evidence has shown considerable benefit with some non-operative measures including a walking stick (held on the opposite side to the arthritic joint), glucosamine, fish oil, and anti-inflammatory medications.
Hip Arthritis in Younger Patients
Young hip arthritis is a major issue, as hip replacements do not last forever. They wear like any other bearing surface, and the particles generated from wear cause damage to surrounding bone due to the body's inflammatory response. This makes subsequent hip replacements more difficult. There is a reluctance to perform hip replacements in patients under 60 for this reason.
In many young patients, hip pain is not due to arthritis but rather femoroacetabular impingement — a diagnosis that needs treatment, often surgically, as it is known to lead to osteoarthritis.
Hip Arthritis in Patients in Their 20s
In very young patients, hip arthritis is usually due to trauma in childhood, congenital deformity, infection damaging the joint, or femoroacetabular impingement. This can lead to rapid advanced arthritis.
An arthrodesis (hip fusion) is a procedure where the hip joint is stiffened so it no longer moves, relieving pain without hip replacement. This can be a very successful operation in the young. Depending on the method of arthrodesis, the hip joint can potentially be reconstructed with a total hip replacement in the future if required.
When Surgery is Required
Dr Chien-Wen Liew assesses patients for hip arthritis by performing a thorough history, physical examination, and plain X-rays. Imaging may include X-rays, ultrasounds, CT scans, or MRI scans depending on what the surgeon determines is most appropriate.
Once hip arthritis is advanced enough and significantly impacting quality of life, a total hip replacement is the recommended treatment. Dr Liew exclusively performs hip replacements via the direct anterior approach.
Patient Information Summary
Download a PDF summary of this article to read later or share with family.