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What is Osteoarthritis of the Hip?
Osteoarthritis, also called degenerative joint disease, is the most common form of arthritis. It occurs most often in the elderly. This disease affects the tissue covering the ends of bones in a joint called cartilage. In osteoarthritis, the cartilage becomes damaged and worn out, causing pain, swelling, stiffness and restricted movement in the affected joint. Although osteoarthritis may affect various joints including the hips, knees, hands, and spine, the hip joint is most commonly affected. Rarely, the disease may affect the shoulders, wrists, and feet.
What are the Causes of Osteoarthritis of the Hip?
Advanced age is one of the most common reasons for osteoarthritis of the hip. You may also develop osteoarthritis in the following cases:
- Previous hip injury or fracture
- Family history of osteoarthritis
- Suffer from hip diseases such as avascular necrosis and other congenital or developmental hip diseases
What are the Symptoms of Osteoarthritis of the Hip?
You will experience severe pain that is confined to the hip and thighs, morning stiffness and limited range of motion.
How is Osteoarthritis of the Hip Diagnosed?
Based on your symptoms, your doctor will perform a physical examination, X-rays and other scans, and some blood tests to rule out the other conditions that may cause similar symptoms.
How is Osteoarthritis of the Hip Treated?
There are several treatments and lifestyle modifications that can help you ease your pain and symptoms.
- Medications: Pain-relieving medications such as NSAIDs and opioids may be prescribed. Topical medications such as ointments can be applied over the skin to relieve pain. If the pain is very severe, corticosteroid injection can be administered directly into the affected joint to ease the pain.
- Other treatments: Your physiotherapist will teach you exercises to keep your joints flexible and improve muscle strength. Heat/cold therapy that involves applying heat or cold packs to the joints provides temporary pain relief. Lifestyle modifications are encouraged to control your weight and avoid extra stress on the weight-bearing joints.
- Surgery: Hip joint replacement surgery is considered as an option when the pain is so severe that it affects your ability to carry out normal activities.
What is Direct Anterior Approach Hip Replacement Surgery?
Direct anterior hip replacement is a minimally invasive hip surgery to replace the hip joint without cutting through any muscles or tendons as against traditional hip replacement that involves cutting major muscles to access the hip joint.
What is the Procedure for Anterior Hip Replacement?
Anterior hip replacement surgery is performed under general anesthesia or regional anesthesia. You will lie down on your back, on a special operating table that enables your surgeon to perform the surgery from the front of the hip. Your surgeon may use fluoroscopic imaging during the surgery to ensure the accuracy of component positioning and to minimize leg length inequality.
Your surgeon will make an incision, about 3-4 inches long on the front of the hip. The muscles are pushed aside to gain access to the joint and perform the replacement. Next, the femur is separated from the acetabular socket. The acetabular surface is prepared using a special instrument called a reamer. The acetabular component is cemented or fixed with screws into the socket. Then a liner made up of plastic, metal, or ceramic is placed inside the acetabular component.
The femoral head that is worn out is cut off and the femur is prepared using special instruments so that the new metal component fits the bone properly. Then, the new femoral component is inserted into the femur either by a press fit or by using special bone cement. The femoral head component made of ceramic or metal is then placed on the femoral stem.
Once the artificial components are fixed in place, the instruments are withdrawn and incisions are closed with sutures and covered with a sterile dressing.
What are the Risks and Complications of Anterior Hip Replacement?
All surgeries carry an element of risk, whether it is related to the anesthesia or the procedure itself. Risks and complications with anterior hip replacement are rare, but can occur and may include:
- Infection at the incision site or joint space
- Fracture
- Nerve damage
- Hemarthrosis - excess bleeding into the joint after the surgery
- Deep vein thrombosis (blood clot)
- Leg length inequality
What Does Postoperative Care for Anterior Hip Replacement Involve?
Post surgery, your doctor will give you specific instructions to be followed at home for a faster recovery. These include:
- Take medications as prescribed to relieve pain and prevent infection.
- Participate in physical therapy to restore hip function and strength.
- Eat a healthy diet and do not smoke to facilitate healing and promote a faster recovery.
- Contact your doctor if you observe increasing swelling or redness in the operated area.
As anterior hip replacement uses a muscle-sparing technique there is increased joint stability after surgery and in most cases, no need for the standard hip precautions recommended after traditional hip replacement. However, you are advised to avoid extremes of motion.
What are the Advantages of Anterior Hip Replacement?
The advantages of anterior hip replacement include:
- Smaller incisions
- Shorter operative time
- Minimal blood loss
- Short hospital stay
- Less postoperative pain
- Minimal soft-tissue trauma
- Less scarring
- Quicker recovery
- Early mobilization
- Less postoperative restrictions
- Quicker return to normal activities
- Lower risk of dislocation
What is Robotic Total Hip Replacement?
Robotic total hip replacement is a minimally invasive procedure where your surgeon is assisted by a robotic system to perform a total hip replacement surgery such as anterior hip replacement.
What Happens During Robotic Total Hip Replacement?
The robotic system consists of a surgeon's console, robotic arms, a high-performance vision system, and special surgical instruments. A computed tomography (CT) scan is taken before the surgery to create a 3D model of the affected hip joint. During surgery, the information provided by the CT scan is interpreted by the robotic system and guides your surgeon with the procedure. The 3D camera provides your surgeon with a magnified view of the operating area. Your surgeon sits at a console and controls the movement of the robotic arms holding the special surgical instruments. The movements of your surgeon’s hands are translated by the robotic system into precise movements of the miniaturized instruments that are held by the robotic arms. The enhanced vision and superior control of the micro-instruments improve the precision of the surgery. This accuracy helps repair the damaged joint and optimally position the prosthetic implant while ensuring minimal injury to neighboring tissues.
What are the Advantages of Robotic Total Hip Replacement?
Robotic total hip replacement surgery offers the following benefits:
- Smaller incisions leading to reduced scarring
- Minimal blood loss
- Less postoperative pain
- Shorter hospital stay and recovery period
- Quicker return to daily normal activities
- Precise placement of the hip implant with a reduced risk of hip dislocation
- Improved safety and reduced risk of injury to adjacent tissues
- Increased longevity of the implant
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