Effects of Arthritis
Arthritis is the condition which results from gradual deterioration and loss of the joint surface articular cartilage. This deterioration of cartilage may occur due to the effects of previous injury or from progressive wear and tear which occurs with aging. In addition, inflammatory conditions such as rheumatoid arthritis, may destroy joint surface cartilage. Mild arthritis causes joint stiffness and some discomfort. As the cartilage deterioration progresses, nearly constant pain and permanent stiffness occur. At this point, normal activities of daily living become difficult to carry out. Patients with advanced arthritis are only able to walk short distances before needing to rest, have difficulty going up and downstairs, and need assistance getting out of a chair or car.
Your orthopedic evaluation assesses the severity of your arthritis. This evaluation leads to a treatment recommendation.
The evaluation begins with questions concerning the severity of your hip pain. We attempt to discover how your hip pain and stiffness limits your usual daily activities such as walking, stair climbing and driving and riding in a car. We also ask about previous treatments such as medications, cortisone shots and the use of a cane.
Examination of the hip includes assessment of the range of motion and the presence of any fixed contractures (stiffness). In addition, ability to walk and the presence of a limp are noted.
X-rays are very useful in determining the severity of arthritis. As arthritis and cartilage deterioration progresses, the “cartilage space” between the bones decreases in size and may disappear altogether (“bone rubbing on bone”). When this occurs pain usually becomes significant. Abnormal calcifications or spurs also develop as arthritis progresses.
After completion of the orthopedic examination (symptoms, exam, x-rays) the various treatment options and specific recommendations can be discussed.
With mild arthritis, some moderation of activities and arthritis medications may be adequate. Occasional use of a cane may be helpful and exercise and weight loss are often recommended. Physical therapy or a Cortisone injection into the affected joint may occasionally be of benefit.
As arthritis progresses, the hip pain and loss of function usually becomes more resistant to conservative or nonoperative treatment.
The question as to when to proceed with hip replacement surgery is a highly individual matter. This depends on the patient’s pain threshold, their activity level, their social situation, and the help that they may have available at home.
Most patients choose to proceed with hip replacement when their pain becomes generally disabling. This usually occurs when pain is present everyday and often with every step and interferes with realistic activities for the patient’s age. Night pain that interferes with sleep is a significant disability and usually prompts people to seek operative intervention. Most patients who come to hip replacement surgery have difficulty tying their shoes, going up and down stairs and getting in and out of a car. They are frequently dissatisfied with their general quality of life. One final factor that frequently is considered in joint replacement surgery is if the hip arthritis is aggravating arthritis elsewhere in the body, such as the knee or the spine to a significant degree.
As the pain becomes more severe or constant, and the inability to carry out daily activities increases, surgery with hip replacement may be the recommended treatment.
The standard hip replacement consists of two basic components. The acetabular or socket component is a high density polyethylene plastic which has an indentation for the metal ball of the femoral component. The socket component often includes a thin metal shell around the surface of the plastic where it meets the bone to help provide more stability. The femoral component is a long peg that extends down into the shaft of the femur or thigh bone. The top of the stem is made up of a round highly polished ball that articulates with the plastic socket. The ball is held into the socket by the muscles of the hip and gradually a new capsule around the ball is formed after surgery as the healing process occurs.
Total hip replacement surgery requires replacement of the damaged joint surfaces with metal and plastic components (prosthesis). Metal on plastic artificial joints have proven to be self-lubricating and show minimal wear despite years of use.
The artificial hip components are held to the bone with a plastic cement. In younger patients, components which allow “bone ingrowth” will be placed without cement. A more recent trend in hip replacement involves implanting a noncemented “bone ingrowth” acetabular (socket) component and cemented femoral component —- a “hybrid” total hip. Recommendations regarding the use of cement versus bony ingrowth fixation will be made on an individual basis preoperative based on your age, weight, activity level and bone density.