How is hip arthritis treated?

The treatment of hip arthritis depends entirely upon severity of the patient's symptoms.

Non-Operative Treatment of Hip Arthritis
Early conditions are usually treated with:

People who have failed to improve with these non-operative measures may be candidates for surgical reconstruction. Most often, this is total hip replacement surgery. Patients who have severe pain with activities, pain at night, loss of the ability to work and perform routine activities, are those who may benefit from surgical treatment.

Surgical Treatment of Hip Arthritis
Total hip replacement surgery is very successful and has excellent short and long term outcomes. The surgeon removes the arthritis from the hip and inserts a metal and plastic prosthesis into the hip. This provides for hip function, limb length equality and restoration of motion. The procedure can be done with cement, which is a grout type of substance. It penetrates into the bone in both the acetabulum and the femur, providing fixation of the prosthesis to the bone. An alternative method uses uncemented components with roughened surfaces to which the bone adheres. (The bone grows into the rough titanium surface of the prosthesis). Both of these techniques have proven effective in long-term follow-up. The hospital stay lasts from 3-7 days following hip replacement surgery. The pain relief from removal of the hip arthritis is usually notable within the first week or two. After 3-6 months, most patients have recovered and returned to their normal lifestyles. Recovery includes physical therapy to regain strength and function, and often the use of a walker, crutches, or a cane for 4-8 weeks.

Complications
The complications from total hip replacement are infrequent but may be severe. These include (in the short term):

• infection at the rate of approximately 1%.
  
• dislocation: the femoral head prosthesis becomes dislodged from the socket. This often requires a procedure known as a closed reduction.  In this operation the prosthesis is replaced in the socket under anesthesia.
  
• bleeding, requiring a blood transfusion.
  
• nerve injury.
  
• In some cases, the limb lengths cannot be made totally equal, and these patients may require a shoe-lift. This is most commonly seen in revision cases in which an existing hip prosthesis is removed and a second or third prosthesis is inserted over time.

The most common reason for loosening of the components (they become dislodged from the bone) is long-term wear of the polyethylene liner, which leads to resorption (disappearance) of the bone layer next to the components. This occurs in both cemented and uncemented protheses. If the components become loose and the patient has symptoms, revision surgery may be an option. This involves removal of the existing prosthesis, followed by the insertion of new components and subsequent rehabilitation. The recovery from revision surgery is longer and more extensive than primary hip replacement surgery.

Overall, the complication rate from first hip replacement surgery is less than 5%. The long-term outcome of most conventional hip designs is roughly 80-85% survival at 15 years. Increased activity, improper lifting and improper precaution with the hip replacement may lead to early loosening and the need for revision. Fractures around the prosthesis both in the pelvis and in the femur may occasionally occur and may require surgical fixation.