Hip Surgery & Disorders Overview
The hip is a ball-and-socket joint, where the head of the femur articulates with the cuplike acetabulum of the pelvic bone. The acetabulum fits tightly around the ball, however the ball is usually held in the socket by very powerful ligaments that create a complete ‘blanket’ around the joint (joint capsule). This arrangement allows a large amount of motion required for daily activities such as, walking, squatting and stair-climbing. The capsule has a delicate lining (the synovium). The head of the femur and the hip socket is covered with a layer of smooth cartilage (articular cartilage), which is a soft, white substance.
This cartilage cushions the joint and allows the bones to move on each other with minimum friction.
Dr Pavitar Sunner uses the Anterior Hip Replacement approach. The Anterior approach involves making an incision in front of the hip and accessing the hip joint by going between the muscle tissues, rather than cutting directly through the muscle. The prosthesis is the same regardless of the approach.
The potential benefits of Anterior Hip Replacement include:
- Shorter incisions.
- Less soft tissue trauma.
- Less post-operative pain.
- Quicker recovery and earlier discharge from the hospital.
- Reduced risk of dislocation and therefore fewer restrictions are required.
- Quicker return to work.
The direct anterior approach is not suitable for all patients. Revision
or dificult primary hip replacement is better carried out through
traditional approaches, such as the posterior approach.
Childhood Hip Disorders
Developmental dysplasia (dislocation) of the hip (DDH) is an abnormal formation of the hip, in which the femur is not held firmly in the socket. In some cases, the ligaments of the hip joint may be loose and stretched. The degree of looseness or instability varies in DDH and it can be detected in an x-ray. DDH is much easier to cure if it is realised at an earlier stage, otherwise the treatment becomes more complicated and uncertain.
Perthes’ Disease occurs in the femoral head – this is the rounded top of the femur. Something happens to the small blood vessels, which supply blood to the femoral head. Thus, parts of the femoral head lose their blood supply. This consequents in the softening of the particular affected areas of the femur. The bone can fracture, break up and become distorted due to the fragility of the bone, however the severity of the condition can vary.
Slipped Upper Femoral Epiphyses (SUFE)
In childhood, there are growth plates – epiphyses at the junction between the head and neck of the femur and also at the lower end of the bone. In later childhood, for some unknown reason, the head of the femur may slip up and down.
Trauma – Fractures & Fracture Dislocations
This can be the result of high energy injuries, such as motor vehicle accidents, sports related injuries in the young and simple falls in the elderly with osteoporotic bones.
Inflammatory arthritis is arthritis that causes significant inflammation of the joints. Rheumatoid arthritis is the most common type of inflammatory arthritis. Other types of inflammatory arthritis are psoriatric arthritis, ankylosing spondylitis and Reiter’s syndrome (reactive arthritis).
Avascular Necrosis of the Femoral Head (AVN)
Avascular necrosis of the femoral head is an increasingly common cause of musculoskeletal disability as well as a major diagnostic and therapeutic challenge. Although, initially patients experience no symptoms, AVN usually progresses to joint destruction, requiring total hip replacement.
AVN is characterized by areas of dead trabecular bone and marrow extending to involve the subchondral plate. The anterolateral aspect of the femoral head, the principal weightbearing region, is typically is involved, but no region of the femoral head is necessarily spared. In adults, the involved segment usually never fully revascularises and, once detected radiographically, a collapse of the femoral head will usually follow.
Bursae (singular: bursa) are fluid-filled sacs that cushion areas of friction between tendon and bone or skin. Generally people have 160 bursae in their bodies, however the number varies. Bursae are lined with synovial cells, which release a fluid rich in collagen and proteins. This fluid serves as a lubricant when parts of the body move. When this fluid becomes affected by bacteria or irritated due to too much movement, a painful condition called bursitis is developed.
Referred Pain From the Back
Referred pain is commonly found in the lower back, which radiates to the buttocks, groin and thighs. The type of pain and severity differs from person to person.
Arthritis of the Hip
Arthritis is loss of articular cartilage. Hence, there is no cushioning effect on the bones and the underlying bone bears greater stress as a result. It loses its elasticity and becomes more stiff. Any of the above mentioned conditions may result in arthritis of the hip. All conditions affecting the hip joint can present as premature arthritis. Some symptoms may include a bit of discomfort and stiffness in your groin, buttock, or thigh when you wake up. The pain intensifies when you are active and settles when you rest.
Femoro Acetabular Impingement FAI
Femoroacetabular Impingement FAI is a condition resulting from abnormal pressure and friction between the ball and socket of the hip joint resulting in pain and progressive hip dysfunction. When left untreated this leads to the development of secondary osteoarthritis of the hip.
Hip Labral Tear
Labrum is a ring of strong fibrocartilaginous tissue lining around the socket of the hip joint. Labrum serves many functions where it acts as shock absorber, lubricates the joint, and distributes the pressure equally. It holds the head of the femur in place and prevents the lateral and vertical movement of the femur head within the joint. It also deepens the acetabular cavity and offers stability against femoral head translation.
Labral tear may be caused by trauma, femoroacetabular impingement (FAI), hip hypermobility, dysplasia, and degeneration. It is one of the rare conditions and is common in athletes playing sports such as ice hockey, soccer, golf and ballet. Structural abnormalities may also cause a hip labral tear. Patients may experience hip pain, clicking and locking of the joint along with a restricted range of motion. Patients may also experience dull pain upon movement of the hip joint that may not subside on rest. A hip labral tear is often diagnosed by assessing a patients symptoms, history, physical examination and radiological techniques. Magnetic resonance arthroscopy may be more appropriate for diagnosing a hip labral tear. Your doctor may start with conservative treatment, prescribing non-steroidal anti-inflammatory drugs and advising you to rest. These methods may offer symptomatic relief while surgery is required to repair the torn labrum. Your doctor may perform arthroscopic surgery using a fibre-optic camera and surgical instruments through smaller incisions. Depending on the severity of the tear, the damaged or torn labrum may be removed or may be sutured.
Total Hip Replacement (THR)
A Total Hip Replacement (THR) procedure replaces the total hip joint or part of the hip joint with an artificial device (prosthesis) to alleviate pain and restore joint movement.
Anterior Hip Replacement
Anterior Hip Replacement is a minimally invasive hip surgery to replace the hip joint without cutting through any muscles. The surgical procedure involves a small incision in front of the hip anterior, as opposed to an incision on the side or back of the hip. It is referred to as a muscle sparing surgery because no muscles are cut to access the hip joint enabling a quicker return to normal activity.
Hip Resurfacing or a bone conserving procedure replaces the acetabulum (hip socket) and resurfaces the femoral head. This means the femoral head has some or very little bone removed and replaced with the metal component. This spares the femoral canal.
Minimally Invasive Hip Surgery
The hip joint is one of the body’s largest weight-bearing joints and is the point where the thigh bone (femur) and the pelvis (acetabulum) join. It is a ball and socket joint in which the head of the femur is the ball and the pelvic acetabulum forms the socket. The joint surface is covered by a smooth articular cartilage that cushions and enables smooth movements of the joint.