Is hip pain keeping you from enjoying life and staying active? Are you looking for relief from arthritis that’s affecting your hip?
If so, it’s important to see a specialist who can provide a diagnosis and treatment plan — and soon, according to Dr. Donald Hohman, a fellowship-trained orthopedic surgeon on the medical staff at Texas Health Center for Diagnostics and Surgery.
“Hip pain can be very debilitating,” he added. “And it can progress to the point where people start to lose motion at the hip.”
The most common cause of most hip pain, especially among adults 50 and up, is arthritis.
“And the most common reason for someone to have an arthritic condition is just run-of-the-mill wear and tear osteoarthritis,” Dr. Hohman said. As people get older, arthritis is very common; a healthy and active lifestyle can’t always prevent it.
Most everyday movement involves the hip. When arthritis is present in the hip, that can trigger pain while getting in and out of a car, using the bathroom, or standing up from a chair. The pain may be reduced or relieved by sitting down — but that can lead to a sedentary lifestyle that may only exacerbate the problem.
Patients with arthritis in the hip may experience stiffness, or pain so severe enough it wakes them up at night. Some patients experience groin pain. Others describe a searing, burning pain in the hip joint when walking.
If a new patient comes to his office wearing slip-on shoes, Dr. Hohman added, he immediately suspects arthritis in the hip.
“These patients don't wear shoes that require lacing or tying because it hurts to lift their leg to try to tie their shoes,” he said.
Left untreated, arthritis of the hip tends to get worse.
“There’s this chain reaction of problems that can result from having an arthritic hip,” Dr. Hohman said. “We even see people where the hip will become so bad it'll start to make their back hurt.”
Before considering surgery, most physicians recommend less invasive treatments: over-the-counter pain medications, such as Tylenol; modified activities; and physical therapy to address weaknesses and take some stress off the joints. Although injections are not a cure, they do provide lasting relief for some patients.
Posterior versus Anterior Hip Replacement
If non-surgical options have been tried and failed to provide relief, Dr. Hohman helps patients consider surgical options, including hip replacement.
Hip replacement, also called hip arthroplasty, involves removing the damaged sections of the hip joint and replacing them with an artificial joint (prosthesis), usually constructed of metal, ceramic and very hard plastic. This artificial joint helps improve function and reduce pain.
There’s more than one approach to hip replacement, each with its own pluses and minuses. When considering hip replacement surgery, patients should talk with their surgeon to weigh the advantages and disadvantages of posterior versus anterior hip replacement. Research suggests that the posterior approach may involve a shorter operative time, but the anterior approach has the potential to decrease the length of the hospital stay and provide greater short-term functional restoration.1
With the posterior approach, the surgeon accesses the hip joint through the back (posterior) of the hip. The downside is that the hip is more prone to instability after surgery. Patients must take precautions to avoid certain positions.
Dr. Hohman prefers the anterior hip replacement option for those patients who are good candidates. Anterior hip replacement is minimally invasive and muscle-sparing.
The benefit of anterior hip replacement is that there are no position restrictions after surgery; the procedure creates a more stable hip joint.
“It's actually easier to take care of patients after anterior hip replacement,” said Dr. Hohman. “In fact, they do so well, so quickly, that often we have to slow them down, so they don’t overdo it. Sometimes we even wonder if anterior hip replacement works a little too well! Because many patients feel so well that they’re tempted to do too much too soon.”
The key disadvantage: with the anterior approach, the surgeon moves the femoral nerve out of the way to reach the hip. One of the branches of the femoral nerve controls sensations on the front and the side of the leg.
“Nerves don't like it when you push them around, so there is an incidence of a funny sensation on the side of the leg after the operation,” Dr. Hohman. “Thankfully, almost everybody who has this issue gets better.”
Not all patients are candidates for both approaches. For example, certain deformities might preclude the option of anterior hip replacement. Each patient’s needs are a bit different.
“That’s why a conversation with your surgeon is essential, to help you feel confident you’ve made the right choice,” said Dr. Hohman.
Life after Hip Replacement
Those who do proceed with hip replacement surgery are often pleasantly surprised by how quickly they recover.
“It's not uncommon for people to go home the same day after a hip replacement,” Dr. Hohman said. “Many have a very minimal amount of pain and require only Tylenol for pain control. We’re getting away from narcotics and other medicines that can really slow people down after surgery.”
Even better, he adds, “A lot of times people actually feel better right after surgery, because their arthritic pain that led to surgery improves immediately.”
What to expect after hip replacement? Expect recovery to take some time, but possibly not as much time as you might assume. Most patients return to work within four to six weeks, if not sooner, after surgery, and may continue to show improvements even for a year to year and a half after the operation.
In short, hip replacement surgery is a great option for many patients who want to reduce their pain, restore joint function, and improve their overall well-being.
“For patients with end-stage arthritis of the hip, a hip replacement can be a very reliable, very predictable, very successful operation,” Dr. Hohman said.
[1] Fagotti L, Falotico GG, Maranho DA, Ayeni OR, Ejnisman B, Cohen M, Astur DC. POSTERIOR VERSUS ANTERIOR APPROACH TO TOTAL HIP ARTHROPLASTY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. Acta Ortop Bras. 2021 Nov-Dec;29(6):297-303. doi: 10.1590/1413-785220212906244610. PMID: 34849093; PMCID: PMC8601379. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8601379/