The Hip

Your hips are joints - basically a ball-and-socket connection between the thighbone and the pelvic bone. We may take our hips for granted, until we injure them. While a normal hip is fairly strong, years of wear-and-tear can take a toll. Hips can also be affected by a number of diseases and conditions, including:

• different types of arthritis (Read about "Arthritis & Rheumatic Diseases")
• osteoporosis (Read about "Osteoporosis")
• bursitis (Read about "Tendinitis & Bursitis")
• fractures (Read about "Bone Fractures")

Other conditions that can lead to pain in the hip area include sciatica and ruptured disc. (Read about "The Spine") In addition, accidents can lead to hip dislocation.

Hip Problems

Each year thousands of Americans have such serious hip problems, that they turn to hip replacement surgery. (Read about "Joint Replacement") It can be a very beneficial procedure, but the best way to maximize those benefits is through proper rehabilitation. (Read about "Rehabilitation")

There are several different problems that may lead to hip replacement surgery. The most common, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), is the wearing down of the hip joint that results from osteoarthritis. (Read about "Osteoarthritis")

Other conditions that could lead to the need for such surgery are:

• rheumatoid arthritis, which is a chronic inflammatory disease that causes joint pain (Read about "Rheumatoid Arthritis")
• avascular necrosis, which is the loss of bone caused by insufficient blood supply (Read about "Osteonecrosis")
• injury and bone tumors (Read about "Bone Tumors - Benign")

Hip replacement surgery is becoming more common. The American Academy of Physical Medicine & Rehabilitation (AAPMR) says as Baby Boomers age, the number of hip replacements is expected to increase by more than 60 percent in the next 30 years. And while the surgery used to be an option primarily for people 60 and older, in recent years, doctors have found it successful in younger people as well.

Not everyone is a candidate for hip replacement. For some the surgery could be problematic. For example, NIAMS says people who suffer from severe muscle weakness or Parkinson's disease (Read about "Parkinson's Disease") are more likely to damage or dislocate an artificial hip. Doctors also may not recommend the surgery for people who are in poor health or who are at high risk for infection. Before deciding on replacement surgery, your doctor might suggest arthroscopy. Arthroscopy is a procedure used to diagnose and treat problems inside a joint. A small incision allows a lighted tube and a camera lens to be inserted into the joint, where the doctor can see exactly what the problems are. (Read about "Arthroscopy")

Alternative treatment

There are alternatives to hip replacement surgery. Before considering a hip replacement, doctors might try different things like walking aids, such as a cane. Different regimens of exercise and physical therapy may be used as well. An exercise program can also help to strengthen muscles in the hip joint and relieve pain.

Hip resurfacing may be an option. With hip joint resurfacing, the surface of the top part of the femur (that's your thigh bone) is replaced and the surface of the acetabulum (the socket of the hip) is also replaced. The amount of the head of the femur that is affected is dependant on the amount of damage to the head of femur. If only the head of the femur is covered, the procedure is deemed a partial hip resurfacing. The American Academy of Orthopaedic Surgeons (AAOS) says that hip resurfacing requires a larger incision than a total hip replacement. (Read about "Joint Resurfacing")

Doctors may also recommend medication. Medications are used to treat inflammation in the hip joint to help relieve pain. The most common are non-steroidal anti-inflammatory drugs, or NSAIDs. Some common NSAIDs are aspirin and ibuprofen, which are available over-the-counter, but doctors can also prescribe NSAIDs in stronger doses. (Read about "Medication and Digestion") In a few cases, if NSAIDs do not relieve the pain, doctors may prescribe corticosteroids, such as prednisone or cortisone. But because these medications can cause further damage to the bones in the joint, they are not always a treatment option. This type of treatment must be closely monitored. (Read about "Taking Medicine" "Drug Interaction Precautions")

Surgery

If persistent pain and disability interfere with daily activities, surgery is an option. There are different types of surgery, including:

• Osteotomy is surgical repositioning of the joint. The surgeon cuts away damaged bone and tissue and repositions the joint. The goal of this surgery is to restore the joint to its correct position, which can relieve pain.
• Hip replacement surgery or arthroplasty, involves taking out the diseased parts of the hip joint and replacing them with new artificial parts called a prosthesis. The goal of such surgery is to improve mobility and function of the hip joint and relieve pain. (Read about "Joint Replacement") Hip replacement can also be performed with the help of a robotic arm system (Read about "Robotic Surgery"), to place the implants in the desired location. Depending on the extent of the damage in the hip joint, and the cause of the damage, your physician may recommend a partial hip replacement rather than a total replacement.
• Hip resurfacing may be another option, especially for younger people. In hip resurfacing, the damaged surfaces of the femoral head and the hip socket are reshaped. A cap is placed over the resurfaced femoral head, and a thin cup is inserted into the hip socket. The joint is then put back together.

Rehabilitation

It can take weeks and even months for patients to recover from hip surgery. Older or less mobile people may want to transfer from the hospital to a rehabilitation unit where they can stay until they are able to care for themselves. Rehabilitation can be especially difficult during the first few weeks, as it requires many changes in the way you carry out your daily activities including bathing, dressing and cooking. Most patients will need help from a physical or occupational therapist. The therapist will give you help in your daily activities, as well as teach you exercises to strengthen your new joint and regain mobility. (Read about "Rehabilitation")

There are some things you can do around your home to make recovery easier. The American Academy of Orthopaedic Surgeons (AAOS) recommends you:

• store items you use every day at a level you can easily get to, so you won't have to bend or stretch to reach them
• rearrange furniture to make it easier to get around with a walker or crutches
• install safety equipment in your bathroom, such as a gripping bar, shower seat, and raised toilet
• avoid using the stairs or crossing your legs until your doctor says it's OK
• you may need a new chair, one you don't sink into and that is a little higher and easier to get out of
• take up throw or area rugs that could cause you to slip
• securely fasten or remove electrical cords to reduce the chance of tripping over them
• use things like long-handled shoehorns, a long-handled sponge or a grabbing tool so that you don't have to bend over too far
• find yourself an apron or shirt with big pockets or a bag with soft straps to help you carry things while you're on crutches or using a walker

It will also be important to exercise. Talk to your doctor or therapist about what types of exercise and how soon you can do them. AAOS says ankle pumps and rotations, along with bed-supported knee bends are good for circulation shortly after surgery. Once you start to get mobile, exercises can include:

• knee raises
• hip abductions
• hip extensions

Again, talk to your doctor before beginning any exercise program. Some other possible activities include swimming, walking, dancing, light golfing and bicycling on level surfaces. Avoid activities that put stress on the joint such as tennis, basketball, contact sports and jogging. You should also avoid weight lifting or lifting anything over 40 pounds.

Related Information:

    Accidental Falls

    Hip Fractures

    Age and Bone Loss

    Skeletal System

    Chronic Pain