ARTHRITIS OF THE HIP

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ARTHRITIS OF THE HIP

• Roy I Davidovitch, MD
• Assistant Professor of Orthopaedic Surgery
• NYU School of Medicine
• NYU Hospital for Joint Diseases
• Director, The New York Hip Center

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Agenda

• How your hip works why it hurts
• Is hip arthritis preventable?
• What are the options for the arthritic hip?
• Your questions

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How your hip works

• Anatomy of the hip
• Ball-and-socket joint
• Ball (femoral head) at the end of the leg bone
  (femur)
• Hip socket (or acetabulum) holds the ball

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What Is Arthritis?
Healthy hip The end of each bone in the joint
is covered with cartilage, acting as a cushion
so the joint functions without pain Diseased
hip (osteoarthritis) Wear and tear deteriorates
natural cushion, leading to bone-on-bone
contact, soreness and swelling
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NORMAL HIP
ARTHRITIC HIP
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ArthritisBackground

• Arthritis is the second most common chronic
  condition in the US (sinusitis is first)
• Most common among elderly
• 20-30 of people over age 70 suffer from
  osteoarthritis (OA) of the hip
• Arthritis affects over 32 million people in the
  US
• Total costs associated with arthritis are over
  82B/year, including hospital and drug costs,
  nursing home costs, and lost productivity and work

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Types of Arthritis

• Osteoarthritis (MOST COMMON)
• Post-Traumatic
• Inflammatory (rheumatoid arthritis)
• Secondary to childhood hip disease
• Many more..

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Is Arthritis of the Hip Preventable?

• 5 years ago the answer was NO!
• Today, the answer is SOMETIMES!

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Femoral Acetabular Impingement(FAI)

• Mismatch between the roundness of the head (ball)
  and the roundness of the acetabulum (socket)
• Associated with congenital abnormality, childhood
  hip injury.

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Hip Labrum Tear is Caused by FAI

• Labrum outer thickening of the cartilage of the
  socket that cushions the soft cartilage of the
  surface of the socket.

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Labrum Tears May Progress to Arthritis of the Hip
at an Early Age
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How do I know if I have FAI?

• Groin pain with sitting or deep flexion of the
  hip (squatting)
• Clicking/popping at hip (with golf swing)
• Pain is progressive
• Pain is not constant

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Treatment

• Hip Arthroscopy
• Mini-open decompression
• Hip Surgical Dislocation
• Hip socket reorientation
• Physical therapy usually not helpful

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These treatments are effective at relieving pain.

• May slow down or prevent the progression of
  cartilage damage and development of arthritis

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Symptoms of Arthritis

• Do you sometimes limp?
• Does your hip feel stiff?
• Are you losing motion in the hip?
• Is it difficult to perform daily tasks like
  walking, housework or tying shoes?
• Does pain limit your activities lifestyle?
• Does one leg feel shorter?
• Do you experience pain in the groin or front of
  thigh?

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Treatment Options Non-operative

• Activity Modification
• Weight Loss
• Cane/walker
• Physical Therapy
• Medications
• NSAIDs (aleve, motrin, advil)
• COX-2 Inhibitors (celebrex)
• Nutritional supplements
• Injections
• Corticosteroid
• Viscosupplementation

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There is only one CURE for arthritis.
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Total Hip Replacement (THR)

• Implants replace damaged surfaces
• Helps relieve pain and restore mobility
• 260,000 each year in the U.S.

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Goals of Joint Replacement Surgery

• Relieve pain!!!
• Restore function, mobility to the prearthritis
  levels

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What is Hip Replacement
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Technique Total Hip Replacement
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Technique Total Hip Replacement
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Technique Total Hip Replacement
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Technique Total Hip Replacement
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Background

• Total joint replacement is one of the most
  commonly performed and successful operations in
  orthopaedics as defined by clinical outcomes and
  implant survivorship

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Implant Considerations

• Current technology has improved the bearing
  surfaces
• Makes total hip replacement a viable option in
  young patients.
• Components are more durable.

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Bearing surfaces are the contact points of ball
and socket
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When should you have a hip replacement?

• Arthritis has caused an unacceptable level of
  pain and decreased ability to participate in
  activities that the PATIENT considers essential.
• Age is less of an issue with current technology

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Risks of Hip Replacement

• Dislocation
• Leg length discrepancy
• Infection (surgical treatment)
• Blood clots (DVT)
• Fracture
• Loosening of components
• Future surgery to revise components

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Dislocation Precautions
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Dislocation precautions, leg length discrepancies
and recovery can be dependent on the surgical
approach used to enter the hip
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Surgical Approach

• Posterior (the back of the hip)
• Highest dislocation rate
• Easiest for surgeon
• Lateral (the side of the hip)
• Lower Dislocation rate
• Most damage to the muscle
• Anterior (the front of the hip)
• Lowest dislocation rate
• Hardest for the surgeon

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Minimally Invasive Surgery(MIS)

• traditional incision was 12
• MIS incisions are 4
• Supposed to have lower dislocation rate and
  decreased pain

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MIS???

• Currently no proven benefit to smaller incision
  other than cosmetic appearance

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MIS Minimal Incision Surgery

• The goal of MIS should be minimal disturbance of
  natural and healthy structures during replacement
  of the damaged structures
• This should allow an anatomic reconstruction of
  the joint and thereby maintain the stability of
  the hip

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Anterior Total Hip Replacement

• What is it?
• Incision is made on the front (anterior) of the
  leg rather than the side (lateral) or back
  (posterior)
• A natural interval BETWEEN muscles exists in the
  front of the hip
• Surgery is performed through this natural
  interval
• Muscles and tendons are not cut during the
  procedure.

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Traditional MIS Surgery

• Patients typically lie on side or front
• Incision on side or back of leg
• Surgeon detaches muscles, disrupts tissue
• Surgeon relies on post-operative X-ray to check
  component placement leg length

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Anterior Approach

• Patients lie on back
• Incision on front of leg
• No detachment of muscles, minimal disruption of
  tissue
• Surgeon can check component placement leg
  length during procedure

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Benefits of the Anterior Approach

• Dislocation rate lt1
• NO HIP PRECAUTIONS
• Leg length more reliably assessed
• Recovery time significantly accelerated (no cane
  within 2-3 weeks)
• Less pain

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Who is NOT a candidate for Anterior Approach
Total Hip Replacement?

• Severe deformity of the femur (diagnosed with an
  xray)
• Morbid obesity (BMIgt 40)
• History of previous hip replacement surgery on
  the same side

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95 of patient ARE candidates for an anterior
approach. This can be determined rapidly by an
experienced surgeon examining the patient and the
xrays.
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Thank You!
NYHipCenter_at_NYUMC.org