Introduction
Anatomy
Cause
Symptoms
Diagnosis
Non-surgical treatment
Surgical treatment
Rehabilitation
Prevention
Pain and stiffness of the hip are most commonly found among the elderly population, especially those between 60 and 80 years old. It is important to find out what the causes are and to manage accordingly.
The hip is one of the body’s largest weight-bearing joints. It consists of two main parts: a ball (femoral head) at the top of the hip bone (femur) that fits into a round socket (acetabulum) in your pelvis. Bands of soft tissue called ligaments and the joint capsule) connect the ball to the socket and provide stability to the joint.
The surfaces of the ball and its articulating socket have a smooth durable cover of articular cartilage that cushions both sides of the joint and enables the femur to move on the pelvis.
A thin, smooth tissue called synovial membrane covers all surfaces of the hip joint. In a healthy hip, this membrane secretes a small amount of fluid that lubricates and decreases friction in the hip joint.
The most common cause of chronic hip pain and disability is arthritis. Primary osteoarthritis or secondary osteoarthritis resulting from rheumatoid arthritis, developmental incongruity, necrosis of hip bone and trauma are the most common pathologies responsible for hip pain.
Primary osteoarthritis usually occurs to people over the age of 50. They may have a family history of arthritis. This may be associated with subtle developmental incongruity of the hip. The articular cartilage in the joint is worn out, leaving raw bones rubbing against each other, causing pain and stiffness.
Rheumatoid arthritis is an auto-immune inflammatory disease in which the synovial membrane becomes hypertrophic and inflamed. The hypertrophic synovium erodes the neighboring joint capsule and cartilage, produces excessive synovial fluid and blowing up the joint capsule.
Post-traumatic arthritis can follow a serious hip injury, fracture or dislocation. A hip fracture or dislocation can lead to a condition known as osteo-necrosis of the hip. The femoral head crumbles, losing its congruity with its articulating socket. The resulting articular cartilage damage causes hip pain and stiffness.
Everyday activities, such as walking, bending, or getting in and out of a chair may be painful and difficult.
The hip is stiff and it may be hard to put on shoes and socks.
In advance disease, hip pain continues even at rest, throughout the day and night.
Stiffness in the hip may significantly affect lower limb functions.
An evaluation of your hip will typically include:
a medical history, in which your orthopaedic surgeon gathers information about your general health and asks questions about the extent of your hip pain and how it affects your ability to perform everyday activities;
a physical examination to assess hip mobility, strength and alignment;
X-rays to determine the extent of damage or deformity in your hip; and
Blood tests or other tests such as MRI or bone scanning may be needed to determine the condition of the bone and soft tissues of your hip.
Treatment options such as medications and physical therapy may be considered prior to considering surgery. Weight reduction or holding a cane is often helpful in avoiding excessive stress across the hip joint and thus can alleviate symptoms.
A total hip replacement surgery may be recommended if medications, changes in your everyday activities and the use of walking aids such as a cane are not helpful in alleviating your hip pain and immobility.
Recommendations for surgery are based on the extent of your pain, disability and general health status. Your orthopaedic surgeon will explain the potential risks and complications of hip replacement surgery, including those related to the surgery itself and those that can occur over time after your surgery.
The surgical procedure takes a few hours. The orthopaedic surgeon will remove the damaged cartilage and bone and then position a prosthesis, metal, plastic or ceramic joint surfaces to restore the articulating surfaces, alignment and function of your hip.
After the surgery, you will usually stay in the hospital for a few days. The success of your surgery will depend very much on how well you follow your orthopaedic surgeon's instructions regarding ambulation and care at home in the first few weeks after surgery.
Following surgery, you are advised to avoid certain activities, including jogging and high-impact sports, for the rest of your life. You will be asked to avoid adopting some specific positions of the joint that can lead to dislocation of the prosthesis.
Early lower limb movement and walking are important to your recovery and will begin on the day of or the day after your surgery. The physical therapist will teach you specific exercises to strengthen your hip and restore movement for walking and other normal daily activities.
Take special precautions to avoid falls and injuries. If a fracture ever occurs near a hip replacement, fixation might require more and complicated surgery.
To assure proper recovery and to prevent dislocation of the prosthesis, you must take special precautions, such as:
Do not cross your legs.
Do not bend your hips more than a right angle (90 degrees).
Do not turn your feet excessively inward or outward.
Use a pillow between your legs at night when sleeping until you are advised by your orthopaedic surgeon that you can remove it.