Hip

The hip joints are ball and socket joints, like the shoulders, and enable us to move in various directions: flexion and extension, abduction and adduction, internal and external rotation. Ligaments and muscles help to hold the balls of the joints in the sockets.

The pelvis is composed of the sacrum and the two hip bones. It is connected to the spine and enables humans to have a stable, upright posture. The female pelvis is very different from the male equivalent: women’s pelvises are wider (particularly the pelvic outlet) for giving birth. 

Here are some of the common problems and diseases that can affect the hips and pelvis.

It is not a comprehensive list.

• Hip osteoarthritis
• Hip displasia
• Femoral offset

Hip osteoarthritis

Hip osteoarthritis causes the surfaces of the joint to become uneven, so that they gradually wear down. As a result, the hip joints develop signs of wear and tear and can no longer move freely. This can lead to the following problems and diseases:

• Worn out cartilage
• Abnormal bony growths on the joint surfaces (osteophytes)
• Build up of fluid or swelling
• Shortened and thickened tendons

Hip displasia

A hip displasia is a congenital deformation of the hip joint. The ball of the joint does not sit securely within the hip socket, because the acetabular roof has not formed properly and does not provide the necessary support. Up to four percent of all babies suffer from hip displasia. It can be identified during the routine examination shortly after the birth and sometimes treated conservatively (for example with loose swaddling).

If the deformation causes excessive strain or incorrect pressure on the cartilage, it can lead to osteoarthritis. A special surgical procedure can be used to move the hip socket into the correct position over the ball of the joint. However, if a person is already suffering from advanced osteoarthritis, often the only treatment that can help is a total hip replacement.

Femoral offset

A femoral offset is a geometric problem with the hip. Instead of being nice and round, the ball of the femur has a lump on it, which bumps against the hip cavity again and again when the hip is moving. The hip cavity is covered by the labrum, a kind of ‘reinforcement ring’ made of fibrocartilage. It is full of sensitive nerve fibres and emits painful sensations in the groin area if a lump regularly bumps against the hip cavity. This can even damage the labrum and the cartilage near the hip cavity, which can lead to early osteoarthritis. Surgery is reasonably effective for treating offset disorders. The lump on the hip joint is milled down using keyhole surgery. If the labrum has been damaged by the offset, it may be partially or wholly removed, repaired or made smooth again.

1)- Hip replacement:

Hip replacement surgery, also known as hip arthroplasty, is a surgery where the damaged hip joint is removed and replaced with an artificial joint of a prosthesis either made from metal, plastic or ceramic.  This procedure is considered when all other treatment options proves to be ineffective in relieving the pain. This surgery is recommended after hip fracture or for chronic pain relief caused by arthritis.

a) Total hip replacement:

Total hip replacement surgery involves removing the damaged hip socket and the ball or the thigh bone (femur) and replacing it with the prosthesis to improve range and mobility and reduce pain. The artificial joint is either fixed to the bone with the special cement or has a surface that new bone will grow into.

To learn about the preparation for hip surgery, risks, precautions and post-surgery care, please click here

b) Hip revision surgery:

With time artificial hip joints may go through wear and tear. Hip revision surgery is performed to correct the problem so that the hip can continue to function properly.

On average, the life of an artificial hip joint is between 10-15 years, depending on the daily activity of an individual.  Because of the wear and tear of the hip joint, after sometime, the prosthesis may not fit properly and is not effective. In such cases, the surgeon may recommend revision surgery.

Revision surgery is also recommended in case of infection developing around the joint and its surrounding tissues, which can further damage the hip joint and may risk damaging the hip bone too.

2) Hip arthroscopy surgery (including labral repair and acetabulo femoral impingement surgery)

Hip arthroscopy is a minimally invasive procedure in which a device called an arthoscope (a small video camera) is used to examine and treat the inside of the hip joint through a small incision (cut). The camera on the arthroscope helps the surgeon to look in the joint and treat damage at the same time, using two to five incisions.

Some of the common conditions and injuries that are treated with arthroscopic hip surgery are: 

• Hip impingement / femoroacetabular impingement, which is a disorder in which the bone starts growing abnormally either around hip socket or femoral head, causing constant pain and limiting the range of movement. It is also one of the major causes of osteoarthritis. Arthoscopic surgery is performed typically to trim the abnormal bone growth.
• Labral tears, where the labrum, a specialised ring of cartilage which holds the ball of the hip in the hip socket, gets torn or damaged.
• Loose fragments of cartilage and bone inside the joint, usually caused by an injury, can also be managed arthroscopically by removing or tightening these loose bodies.

It is imperative that the surgeon is experienced in arthroscopic surgery as it is not a very common procedure and the success of this type of surgery depends on the surgeon’s skill. 

3) Sports-related musculo tendinous injuries:
 

Muscle injury is a strain to the muscle or tendon (tissue that connects muscle to a bone) which can range from simple stretch or tear of muscle tendons. The strain occurs mostly at the musculotendinous junction due to acute injury or from overuse injuries. A patient with this injury often complains about a feel of “popping” or a “tearing” sensation. Common symptoms include pain, bruising, swelling, reduced motion, weakness and difficulty walking.