x
Dartmouth-Hitchcock logo
Summer Flowers In This Section

Hip

Non-surgical treatments

Medications:
over-the-counter non-steroidal anti-inflammatory medicines or more potent prescribed medicationsHip graphic

Corticosteroid injections:
direct anti-inflammatory effects when injected into a degenerative joint

Viscosupplementation:
injection of synthetic forms of synovial fluid (a lubricant for the joint) into the hip joint to treat the symptoms of arthritis

Physical therapy:
you can see a physical therapist in your local community or one of our specialists in the Rehabilitation Medicine Department

Walking aids:
use of a cane or walker to improve your gait and functional mobility

Weight management:
diet and exercise regimens for healthy living can also help to treat your hip and knee pain; we offer dietitian services to assist you

Exercise program:
directed exercises can improve your stamina and reduce the symptoms of arthritis; your physical therapist can help design a customized program for you

Surgical options 

Hip arthroscopy:
After making small cuts, using a pencil-sized instrument called an arthroscope, the surgeon can see an image of your hip that is transmitted through a small camera, via optic fibers, to a television monitor. The TV image allows the surgeon to examine the interior of your hip and determine the source of your problem. During the procedure, the surgeon can also insert surgical instruments through other small incisions in your hip to remove or repair damaged tissues. This is an outpatient procedure, meaning you can go home the same day after your surgery. This type of procedure is often recommended if you have loose particles or torn or loose portions of the hip cartilage or labrum that need to be removed. Recovery time is typically about three weeks.

Hip osteotomy:
During the surgery, the bones of the hip joint are cut, reoriented, and fixed in a new position. Healthy cartilage is placed in the weight-bearing area of the joint, followed by reconstruction of the joint in a more normal position. The osteotomy can be done on the thigh bone (femur), the pelvis, or both. Osteotomies are usually performed on patients with an underlying problem, most often hip dysplasia, that has led to early arthritis of the hip joint (primarily in patients in their 20s, 30s, or 40s). This procedure usually requires a short hospital stay as well as a program of physical therapy in order to improve joint function. Your weightbearing may be limited for a period of time until the bone heals.

Hip resurfacing:
Resurfacing is an alternative option to standard joint replacement. The implant involved with this surgery is smaller and less bone is taken out during the process, making this a popular option for younger patients (healthy adults in their 40s, 50s, or 60s). During the hip resurfacing procedure, only a small amount of bone is removed from the ball-and-socket hip joint, and a metal cap is placed on top of the ball. A metal socket is placed in the pelvis, similar to the hip replacement procedure. Hip resurfacing preserves much more normal bone than a standard hip replacement. In the event you need a total hip replacement down the line if your pain returns, there should be enough bone left to complete that surgery successfully. If you have this surgery, it will require a stay at the hospital – most often two to three days. You will be allowed to bear full weight on the joint right away and may be able to perform athletic activities afterwards.

Partial hip replacement:
If only one part of the joint is damaged or diseased, a partial hip replacement may be recommended. In most cases, the pelvic socket is left intact and the head of the femur is replaced, using a component similar to those used for a total hip replacement. Another option uses a device resembling a half circle which fits over the head of the femur so that it need not be replaced. This is fixed to the femur with cement around the femoral head and has a short stem that passes into the femoral neck. This type of treatment is frequently used in patients with hip fractures and femoral head damage.

Hip resurfacing components

Hip Resurfacing Components

Total hip replacement components

Total Hip Replacement Components

Total hip replacement: The hip is a ball-and-socket joint. The round head of the thighbone (femur) moves inside the hollow socket (acetabulum) of the pelvis. This is what allows your leg to swing easily from your hip. To duplicate this action, a total hip replacement implant has three parts: the stem, which fits into the femur and provides stability; the ball, which replaces the spherical head of the femur; and the cup, which replaces the worn-out hip socket. Each part comes in various sizes in order to accommodate various body sizes and types. This surgery is performed for people with serious osteoarthritis and sometimes for hip fractures or osteonecrosis (a condition in which the bone of the hip ball dies). Most patients are in the hospital for two to three days after surgery and then either go home or to a skilled nursing facility. Physical therapy is critical to the success of your new joint and speed of healing after surgery. Prosthetic hip joints typically last 20 years or more before revision surgery may be needed due to loosening or failure of the components.

In general, if you experience the following, this surgery may be for you:

  • The pain is severe enough to restrict not only work and recreation, but also the ordinary activities of daily living
  • The pain is not relieved by arthritis (anti-inflammatory) medicine, the use of a cane, and restricting activities
  • There is significant stiffness of the hip
  • X-rays show advanced arthritis, or other problems

Additionally, there are a variety of approaches for this type of surgery:

Posterior: This is the most commonly used approach. The incision is made from the back of the hip. Small, non-critical tendons are detached to get to the hip joint and then are later re-attached during the operation. Patients who have this approach are usually walking without the aid of a walker, crutches, or cane within six weeks after surgery.

Lateral: For this approach, the incision is made midway between the front and side of the hip to reach the joint. This is the second most commonly used technique. Some surgeons prefer this technique because there tends to be less chance of a hip dislocation. Part of the hip muscle is detached from the bone and re-attached later in the process. For some patients, this can mean a longer recovery process but the results within a few months after surgery are similar to patients who have other approaches.

Anterior: This is one of the newer approaches for hip replacement surgery in the U.S., though this approach has been used by a small group of surgeons in France for over 50 years. Surgeons who use this approach make a small incision on the front part of the leg near the hip without detaching the muscle or tendons from the bone.

Hana Table
hana table, Courtesy of Mizuh OSI

A special table, called the hana® table, is used to position the patient's leg during the surgery so the surgeon can accurately reach the hip joint and implant the replacement pieces. Our surgeons who offer this procedure have gone through extensive training to learn the technique and proper positioning of the patient's leg. Currently, there is no scientific study data that gives reliable results for the benefits of this approach to surgery. Anecdotally, we have seen that patients who have the anterior approach for joint replacement may have a shorter length of stay in the hospital, and a shorter recovery. As with any surgery though, individual recovery time is different from one person to another.

Revision surgery: Please note that if you are having difficulty with a previous total hip replacement, our team has years of experience in doing revision hip replacement surgery – it is our specialty. Our surgeons work together as a team in surgical planning and operative care for complex cases involving failed or infected total joint replacements.

Contact Us

0