The hip joint is one of the most important joints in the human body. It allows us to sit, stand, walk, and run - to move our bodies in general. It allows for a large range of motion, which unfortunately, can also lead to many injuries.

Discover all you can about the hip joint, including its makeup, common hip pains, conditions and injuries, and surgeries that can restore function if you’re dealing with issues.

Anatomy of the Hip

The hip joint is a complex ball-and-socket joint where the thigh bone meets the pelvis. As one of the body’s largest weight-bearing joints, the hip is also responsible for the movement of the upper leg.

In order to identify what hip pain can mean and to better understand its conditions and injuries, it’s helpful to learn the anatomy of the hip:

The femoral head, on the upper part of the thigh bone, is the ball of the hip joint and fits into the acetabulum.
The acetabulum is a circular socket at the top of the pelvis.
Articular cartilage covers the weight-bearing bones, allowing for smooth movement of the hip.

Large muscles support the joint and allow it to move properly, including:

The gluteals are the muscles of the buttocks that are located on the back of the hip.
The adductor muscles are the muscles of the inner thigh that pull the leg inward toward the opposite leg.
The iliopsoas muscle begins in the lower back and connects to the upper femur.
There are four quadriceps on the front of the thigh that run from the hip to the knee.
Hamstrings run down the back of the thigh and go from the hip to just below the knee.

There are also major nerves and blood vessels running through the hip, including the sciatic nerve at the back of the hip and the femoral nerve at the front of the hip, and the femoral artery, which begins in the pelvis and passes by the front of the hip and down the thigh.

Common Causes of Hip Pain

Arthritis is the most common cause of chronic hip pain and instability. The three most common types of arthritis that affect the hip include osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis. Other forms can still occur.

Osteoarthritis

This form of arthritis refers to the breakdown of hip cartilage, synovium, and eventually, the hip bones. People 50 years and older are more prone to this wear-and-tear condition in which the joint is gradually eroded. In the most advanced stage of osteoarthritis, the bones rub against each other, leading to hip pain and stiffness. Total hip replacement is an option for people with advanced osteoarthritis.

Rheumatoid Arthritis

This autoimmune disease affects the synovial membrane, causing it to become thickened and inflamed. Chronic inflammation damages the cartilage, causing pain and stiffness. Unlike osteoarthritis, however, rheumatoid arthritis originates from an immune system disorder. Thus, the disease is best managed with methods that target the underlying processes of the immune system, such as biologic drugs.

Post-Traumatic Arthritis

A serious hip injury or fracture can damage the cartilage permanently, which may cause the development of post-traumatic arthritis.

Avascular Necrosis

Similar to post-traumatic arthritis, avascular necrosis is caused by an injury to the hip. A dislocation or fracture may limit blood supply to the femoral head, which eventually leads to a collapse in the surface of the bone.

Childhood Hip Disease

Sometimes infants are born with congenital hip abnormalities that result in arthritis later in life. One example is hip dysplasia, a condition in which the hip socket does not fully cover the ball of the thigh bone. Adults with hip dysplasia are at a greater risk for hip injuries, such as dislocation, and may experience chronic pain related to the condition.

Treatment Options for Hip Conditions

The treatment method chosen for a hip condition depends on the characteristics of the patient’s diagnosis. The following examples are common treatments used for certain hip problems:

Core Decompression

Core decompression involves surgical drilling into dead bone near the joint affected by avascular necrosis.The surgeon must drill into the femoral neck to stimulate blood flow, reduce pressure, and slow the deterioration of the hip joint. The procedure is most appropriate for stage 1 and early stage 2 hips.

Hip Arthroscopy

This minimally invasive procedure may be recommended if you have certain painful conditions that do not respond to conservative treatments, such as rest, physical therapy, and injections. Arthroscopy involves the insertion of a small camera into the hip joint, which projects images onto a video monitor. Because the arthroscope (camera) and instruments are so thin, the surgeon can perform tiny incisions during the procedure. Arthroscopy can alleviate the painful symptoms of problems affecting the labrum, articular cartilage, and soft tissues of the hip.

Hip Resurfacing

Hip resurfacing and hip replacement are commonly used for patients with advanced arthritis or another condition that has caused severe damage to the joint. Hip resurfacing is less invasive than hip replacement, requiring a trimming of the femoral head (rather than a complete prosthesis replacement). The femoral head is capped with a smooth metal covering and the damaged bone and cartilage are also removed and replaced with a metal shell.

Many patients choose hip resurfacing because less bone is removed and the remaining bone will stay strong and healthy for longer than a hip replacement. There is also a lower risk of dislocation, and the surgery is easier to revise, should the need arise in the future.

Total Hip Replacement

Over the last two decades, the number of total hip replacements being performed each year has steadily increased in the United States, according to the American Association of Hip and Knee Surgeons. When the hip has worn down significantly due to arthritis, a prosthetic hip can take its place. This surgery, also called hip arthroplasty, involves removing the damaged bone and cartilage.

The damaged femoral head must be removed and replaced with a metal stem, which is positioned in the hollow of the femur.
A metal or ceramic ball is placed on the top of the stem, replacing the damaged femoral head.
The cartilage surface of the socket must be extracted and replaced with a metal socket with screws holding the socket in place.
A spacer is inserted between the new ball and socket to ensure a smooth surface.

Total hip replacement surgery requires extensive rehabilitation following the procedure to restore movement and strength. Most patients can perform physical therapy exercises without assistance, but the speed of your recovery will depend largely on the consistency of your exercise regimen.

There are no absolute weight or age limits for a hip replacement, and each patient is evaluated for this surgery on an individual basis. The procedure has been performed successfully on people of all ages, from young teenagers to elderly patients.

Total Hip Replacement Surgery: Before, During, and After

When your hip joints become damaged due to arthritis or another chronic condition, everyday activities like walking become more painful. If conservative treatments such as rest and physical therapy do not alleviate your pain, your doctor may suggest hip replacement surgery.

The degree of pain and disability you have are certainly factors. While the majority of patients who receive hip surgery are between the ages of 50 and 80, younger patients may also need this procedure to restore mobility. Prior to determining if surgery is the best course of action, your doctor will take notes about your medical history and evaluate your current hip condition. Imaging tests may be ordered to confirm the extent of damage in the joints.

Before Hip Replacement

Before surgery, your hip specialist will make sure you understand all that hip surgery entails and what you can expect from the results. If you were highly active and engaged in high-intensity sports, you may not be able to return to these activities. Low-impact exercises, such as swimming and biking, are more suitable post-surgery.

If a patient is overweight, a hip doctor may ask that they lose weight before surgery, which will take some pressure off the hip joints. Your physician’s recommendations will vary depending on your lifestyle and other factors. You’ll also receive specific instructions on how to prepare for the day of the surgery and what to bring to the hospital.

Below are a few ways to prepare for hip replacement surgery to make recovery as easy as possible:

Physical Exam

Your health care provider will take a detailed account of your medical history and some may want to perform a physical exam as well. It’s crucial that you’re in good health when going in for your hip replacement to ensure your body can handle the procedure and that you’ll be able to recover properly. Explain all of the medications you’re currently taking to your doctor and let them know of any illnesses or pains you’re experiencing beforehand.

Quit Smoking

Tobacco and nicotine use are known to impair the body’s ability to heal and recover following surgery. Quitting smoking before a knee or hip replacement may lower the risk of complications during the surgery.

Conditioning Exercises

Your doctor will sometimes instruct you to perform conditioning exercises in order to strengthen the muscles surrounding your hip. This may help your recovery go more smoothly as you will have strong muscles to take the work off of the hip joint as it heals from surgery.

Prep Your Home

You’ll be immobile for the first week or so following the surgery, so it’s important to prep your home beforehand so you have everything you need readily available. Arrange for a friend or family member to stay with you immediately after your return home to help you. Stock meals, beverages, and entertainment to keep you occupied while you heal.

During Total Hip Replacement Surgery

After anesthesia is administered, the doctor will begin the procedure. The total joint replacement surgeon will choose which type of prosthesis best meets your joint needs. With complete hip replacement surgery, there are typically two major components: the femoral head or “ball,” made of either strong metal or ceramic material, and the acetabulum or “socket,” made of either plastic, ceramic, or metal. The prosthetic components are either fit into the bone or cemented into place, depending on the strength of the patient’s bones.

The procedure usually takes a few hours.

Hip Replacement Recovery

After the anesthesia wears off and you wake up, your surgeon will clearly explain what you need to do at home to fully recover. This will include keeping the incision areas dry until they have fully sealed. Your doctor will also recommend that you consume a balanced diet with an iron supplement and drink plenty of fluids. Within three to six weeks following surgery, patients should participate in light to normal activities in order to regain their regular range of motion and to strengthen their new joints.

Given your recovery goes well, this procedure will help you move around better without hip pain. If you have any questions about home care, talk to your surgeon.

About Rothman Orthopaedics

The orthopaedic experts in our Joint Replacement Program perform more than 12,000 surgeries each year. Although joint replacement is a major procedure, we walk patients through every step of the process to make them more comfortable.

What else makes our hip surgeons exceptionally qualified? Here are our top traits:

Fellowship-trained. Each doctor has undergone advanced subspecialty training within a fellowship program, in addition to their residency training.
Innovative. We research orthopaedic diseases, develop new treatments, and set surgical standards. Our dedication to innovation is how we are able to give patients the best care possible.
Patient-centered. When patients trust us with their health, they are in good hands. Our physicians and surgeons are determined to provide education, support, and top-quality care each and every day.

For more information, visit us here or contact us at 1-800-321-9999.

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