Hip Choices
In choosing what do do about a hip problem it may be helpful to know what sort of options are available.
Joint Replacement Options
Joint replacement should be looked on as the last resort. The ball and socket joint is replaced with an artificial one - a prosthesis or implant. If the whole joint is replaced this is known as a total hip replacement or total hip arthroplasty. If only the ball is replaced, this is a hemiarthroplasty, but this is generally only done in the emergency situation of a hip fracture, where a patient might be frail or unwell and there is a need to keep the anaethetic to a minimum and the operating time as short as possible.
Hip resurfacing and the Birmingham Mid Head Resection are types of total hip replacement but there are differences in the way the femoral side (ball) are secured.
Osteotomy
In some patients where there is a major mal-alignment or developmental problem with the hip, the architecture can be improved by re-aligning the bone rather than replacing it. This involves carrying out a controlled fracture and re-securing the bone in the preferred position. It does of course rely on the bone healing properly and is sometimes a means of buying time before further measures are necessary. For this reason they are usually preferred in very young patients.
Hip Arthroscopy
This area of hip surgery is new and exciting. Looking around the knee with a small telescope (arthroscope: "arthro" meaning "joint") has been done for many years and is now a mature part of the surgical armory. The hip is deeper, less accessible and surrounded by very powerful protective girdle muscles. Technically, therefore this procedure is much more challenging, but in the right hands, sometimes in combination with a small open incision operation guided by the scope, joint preserving surgery and surgery on the tissues around the hip is now possible.
Hip Injection
Not to be underestimated and injection into the hip using local anaesthetic and often steroid can provide good pain relief. The procedure is done as a day case and Xray guidance is necessary. Some people have concerns about the steroid component - very little is absorbed into the body and within the hip is is intended to have an anti-inflammatory effect. There is no agreed upper limit on the number of injections you can have or evidence that multiple injections cause harm. I our experience there tends to be a diminishing return on the response to repeated injections in terms of their benefit and many patients start looking at other options after the first 1 or 2 injections. Nevertheless, hip injection has a valuable role to play particulary in the following situations:
1) Where there is a question over exactly where the pain is coming from or how much pain is coming from the hip itself and how much from perhaps the back or knee
2) In young patients where every attempt is being made to defer major surgery if possible or if the pain requires action but the stage of damage on medical imaging looks early
3) In the elderly or infirm who may be wishing to avoid larger procedures if at all possible