Hip arthritis: when is surgery required?

Hip arthritis occurs when the cartilage in the hip joint is damaged and worn away. It is a progressive disorder, meaning it worsens overtime. Leading Birmingham-based consultant orthopaedic surgeon, Mr Ravi Karthikeyan looks explains how hip arthritis occurs, what the main symptoms are and when surgery is required.  

How common is hip arthritis?

Hip arthritis is common and particularly prevalent as primary arthritis, in people who are in their 60s and 70s.  However, younger people can also experience secondary arthritis due to a specific trigger that exacerbates cartilage breakdown. This may be a result of trauma, such as an injury sustained to the hip socket, femoral neck or femoral head which disrupts the blood supply to this region, hip dysplasia or infection.

What are the main symptoms of hip arthritis?

The main problems caused as a result of hip arthritis are pain, stiffness and limited movement.

What happens if you leave hip arthritis untreated? 

If left untreated, the aforementioned symptoms would persist. Pain may be present at rest, as well as when moving like walking long distances, climbing stairs and fulfilling daily activities. Day-to-day life can be greatly disturbed as a result of pain and stiffness.

When is hip surgery required?

In the early stages, hip arthritis can normally be treated non-operatively. Although, if the pain becomes a persistent problem to the point that the patient is constantly on pain killers, or if they experience pain at rest or have to reduce daily activity as a result, surgery is recommended. Patients may also have a deformity, like a flexion deformity, meaning they are unable to straighten their hip well when they are lying down or when they are walking. This can lead to an alteration in the gate, called an antalgic gait or a painful hip gate. These are potential reasons why a hip replacement might be needed.

How often do periprosthetic fractures occur and where are they typically seen?

Periprosthetic fractures occur more often in people who have had revision surgery in the hips, when they have had a second or a third replacement. It is also more likely to happen in certain types of hip replacements, especially uncemented hip replacements, but the instances are less than 10% in most hip replacements. They usually occur a few years after a hip replacement has been done and when a patient sustains an injury as a result of a fall, or even novel activity. Periprosthetic fractures can be treated by fixing these fractures as they break, or even providing a revision hip replacement.