ARTHRITIS OF THE HIP
Roy I Davidovitch, MD
Assistant Professor of Orthopaedic Surgery
NYU School of Medicine
NYU Hospital for Joint Diseases
Director, The New York Hip Center
Agenda
1. How your hip works &
why it hurts
2. Is hip arthritis preventable?
3. What are the options for the
arthritic hip?
4. Your questions
How your hip works
Anatomy of the hip
• Ball-and-socket joint
• Ball (femoral head)
at the end of the
leg bone (femur)
• Hip socket
(or acetabulum)
holds the ball
What Is Arthritis?
Healthy hip
The end of each bone in the joint
is covered with cartilage, acting as
a cushion so the joint functions
without pain
Diseased hip (osteoarthritis)
Wear and tear deteriorates natural
cushion, leading to bone-on-bone
contact, soreness and swelling
NORMAL HIP
ARTHRITIC HIP
QuickTime™ and a
decompressor
are needed to see this picture.
Arthritis—Background
• Arthritis is the second most common chronic
condition in the US (sinusitis is first)
– Most common among elderly
• 20-30% of people over age 70 suffer from osteoarthritis
(OA) of the hip
• Arthritis affects over 32 million people in the US
• Total costs associated with arthritis are over $82B/year,
including hospital and drug costs, nursing home costs, and
lost productivity and work
Types of Arthritis
•
•
•
•
•
Osteoarthritis (MOST COMMON)
Post-Traumatic
Inflammatory (rheumatoid arthritis)
Secondary to childhood hip disease
Many more…..
Is Arthritis of the Hip
Preventable?
• 5 years ago the answer was NO!
• Today, the answer is… SOMETIMES!
Femoral Acetabular
Impingement
(FAI)
• Mismatch between the roundness of the
head (ball) and the roundness of the
acetabulum (socket)
• Associated with congenital abnormality,
childhood hip injury.
QuickTi me™ and a
T IFF (Uncompressed) decompressor
are needed to see thi s pi cture.
Q uickT ime™ and a
TI F F (Uncompressed) decompressor
are needed to see t his pict ure.
QuickT ime™ and a
T IFF (Uncompressed) decompressor
are needed to see thi s pi cture.
Hip Labrum Tear is Caused
by FAI
• Labrum: outer
thickening of the
cartilage of the socket
that cushions the soft
cartilage of the surface
of the socket.
Labrum Tears May Progress to
Arthritis of the Hip at an Early Age
How do I know if I have FAI?
• Groin pain with sitting or
deep flexion of the hip
(squatting)
• Clicking/popping at hip
(with golf swing)
• Pain is progressive
• Pain is not constant
Treatment
• Hip Arthroscopy
• Mini-open
decompression
• Hip Surgical Dislocation
• Hip socket reorientation
• Physical therapy usually
not helpful
These treatments are
effective at relieving pain.
May slow down or prevent the
progression of cartilage damage and
development of arthritis
Symptoms of Arthritis
• Do you sometimes limp?
• Does your hip feel stiff?
• Are you losing motion in the hip?
• Is it difficult to perform daily tasks—
like walking, housework or tying shoes?
• Does pain limit your activities & lifestyle?
• Does one leg feel “shorter”?
• Do you experience pain in the groin or front of thigh?
Treatment Options: Non-operative
•
•
•
•
Activity Modification
Weight Loss
Cane/walker
Physical Therapy
• Medications:
– NSAIDs (aleve, motrin, advil)
– COX-2 Inhibitors (celebrex)
– Nutritional supplements
• Injections:
– Corticosteroid
– Viscosupplementation
There is only one “CURE” for
arthritis.
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decompressor
are needed to see this picture.
Total Hip Replacement (THR)
• Implants replace
damaged surfaces
• Helps relieve pain and
restore mobility
• 260,000 each year in the
U.S.
Goals of Joint Replacement Surgery
• Relieve pain!!!
• Restore function,
mobility to the
prearthritis levels
What is Hip Replacement
Technique: Total Hip Replacement
Technique: Total Hip Replacement
Technique: Total Hip Replacement
Technique: Total Hip Replacement
Background
• Total joint replacement is one
of the most commonly
performed and successful
operations in orthopaedics as
defined by clinical outcomes
and implant survivorship*
Implant Considerations
• Current technology has improved the bearing
surfaces
• Makes total hip replacement a viable option in
young patients.
• Components are more durable.
Bearing surfaces are the contact
points of ball and socket
When should you have a hip
replacement?
• Arthritis has caused an unacceptable level of
pain and decreased ability to participate in
activities that the PATIENT considers essential.
• Age is less of an issue with current technology
Risks of Hip Replacement
•
•
•
•
•
•
•
Dislocation
Leg length discrepancy
Infection (surgical treatment)
Blood clots (DVT)
Fracture
Loosening of components
Future surgery to revise components
Dislocation Precautions
Dislocation precautions, leg length
discrepancies and recovery can be
dependent on the surgical
approach used to enter the hip
Surgical Approach
• Posterior (the back of the hip)
– Highest dislocation rate
– Easiest for surgeon
• Lateral (the side of the hip)
– Lower Dislocation rate
– Most damage to the muscle
• Anterior (the front of the hip)
– Lowest dislocation rate
– Hardest for the surgeon
Minimally Invasive Surgery
(MIS)
• “traditional” incision
was 12”
• MIS incisions are 4”
• Supposed to have lower
dislocation rate and
decreased pain
MIS???
• Currently no proven
benefit to smaller
incision other than
cosmetic appearance
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MIS= Minimal Incision Surgery
• The goal of MIS should be minimal disturbance
of natural and healthy structures during
replacement of the damaged structures
• This should allow an anatomic reconstruction of
the joint and thereby maintain the stability of
the hip
Anterior Total Hip Replacement
What is it?
• Incision is made on the front (anterior) of the leg rather
than the side (lateral) or back (posterior)
• A natural interval BETWEEN muscles exists in the front of
the hip
• Surgery is performed through this natural interval
• Muscles and tendons are not cut during the procedure.
Traditional MIS Surgery
• Patients typically lie on side or
front
• Incision on side or back of leg
• Surgeon detaches muscles,
disrupts tissue
• Surgeon relies on post-operative
X-ray to check component
placement & leg length
Anterior Approach
• Patients lie on back
• Incision on front of leg
• No detachment of muscles,
minimal disruption of tissue
• Surgeon can check component
placement & leg length during
procedure
Benefits of the Anterior Approach
•
•
•
•
Dislocation rate <1%
NO HIP PRECAUTIONS
Leg length more reliably assessed
Recovery time significantly accelerated (no
cane within 2-3 weeks)
• Less pain
Who is NOT a candidate for
Anterior Approach Total Hip
Replacement?
• Severe deformity of the femur (diagnosed
with an xray)
• Morbid obesity (BMI> 40)
• History of previous hip replacement surgery
on the same side
95% of patient ARE candidates
for an anterior approach. This
can be determined rapidly by an
experienced surgeon examining
the patient and the xrays.
Thank You!
NYHipCenter@NYUMC.org