The hip is primarily responsible for holding up the weight of your body while allowing you to walk, run, sit, and perform many activities of daily living with ease. If your hip is injured, whether from injury or aging, it can severely limit your quality of life. Whether you are an athlete, grandmother, or just want to maintain flexibility and a pain-free life taking care of your hip is of utmost importance.
Surgery might be necessary if you have fractured your hip, suffer from arthritis, or have torn a ligament. Most people might assume that a hip reconstruction is the same as a total hip replacement. However, they are not, so let’s discover the differences between a total hip replacement and a hip reconstruction and how we, at AICA Orthopedics, can help you!
Anatomy of the Hip
The term ‘hip’ is the colloquial term that encompasses the hip joint, part of the pelvis, top of the femur, and all surrounding muscles, tendons, and ligaments. When discussing hip replacement or resurfacing, the focus is on the hip joint and associated ligaments. The hip is responsible for the following movements due to its ball and socket construction.
- Hip flexion and extension – moving the leg back and forth
- Hip abduction and adduction – moving the leg out to the side (abduction) and inward toward the other leg (adduction)
- Rotation – pointing toes inward (internal rotation) or outward (external rotation) and then moving the straightened leg toward the toes.
Bones
The hip joint is a ball and socket joint that attaches the leg to the pelvis, and it is the point of articulation of the leg. The two bones that make up the joint are the femoral head, or the “ball,” and the part of the pelvis known as the acetabulum, or “socket.”
The femur is a long bone and the strongest bone in the body. It is a weight-bearing bone and joins with the pelvis to make up the hip joint.
The pelvis is an irregular bone consisting of several different parts. The flared sides of the pelvis are bony, and the acetabulum joins with the femur to complete the hip joint.
Labrum
Similar to the shoulder, the labrum is a fibrocartilagenous extension of the acetabulum. It deepens the hip socket but is flexible, which assists in the flexibility of the hip joint. The labrum lines the acetabulum, promoting smooth movement, and forms a ring around the edges surrounding the femoral head, creating a seal.
The labrum has several functions that make it an important part of the hip joint.
- Joint stability – by extending the surface area of the acetabulum, the increased contact with the femoral head causes increased joint stability.
- Shock absorber
- Joint lubricator – seals in synovial fluid
- Pressure distributor – using the same seal function to keep synovial fluid in the labrum keeps other fluid out, helping to maintain even pressure on the joint.
Due to its importance to the functionality of the hip joint, damage to the labrum can result in pain, instability, and risk of further injury.
Hip Reconstruction
A hip reconstruction is an umbrella term for different procedures with the same outcome of a stronger, healed hip joint while preserving more of your natural bone and tissues. Reconstruction results include less pain, faster recovery, slower joint degeneration, and better mobility. A good way to look at reconstruction is by fixing the individual parts to strengthen a joint instead of replacing the entire joint.
- Labrum repair – The labrum is a key part of the hip joint. It is the ring of fibrocartilaginous connective tissue that surrounds the femoral head and supports the hip joint. Reconstruction repairs the labrum to its correct function, including suturing tears, transplanting the tissue, or debriding any damaged areas.
- Periacetabular osteotomy (PAO) – the hip bone is reshaped to remove damaged bone and cartilage, including smoothing the ball and socket movement and redistributing uneven pressure on the joint.
- Resurfacing – Hip resurfacing preserved the head of the femur (the ‘ball’) instead of removing it entirely. The femoral head is resurfaced and capped with a contoured piece of metal. The acetabulum, or socket, is fit with a metal cup. Resurfacing is a more complicated surgery but can often have better mobility results than a standard replacement. The prostheses involved in a resurfacing procedure are only made out of metal. Somespeculate this could cause future issues as the metal-on-metal friction produces debris in the body.
- Arthroscopy – An arthroscopy is a minimally invasive procedure to help improve your hip function. An incision is made, and tools are inserted into the joint. A second incision is made, and a microscopic camera is also inserted to give surgeons visualization. During the arthroscopy, your surgeon will repair damaged bone or cartilage to relieve friction and pain in the joint.
- Bone reduction – this is done when the hip is fractured. The bones are realigned and held in place with plates or screws.
- Capsular Reconstruction – Occasionally, procedures done on the hip joint can result in delayed healing of the capsular tissues of the hip, resulting in pain and discomfort that needs to be addressed. If necessary, your doctor will proceed with a capsular reconstruction; the capsular tissues are repaired or reconstructed to restore hip stability.
- Bone Grafting – If a fracture is severe enough, your surgeon might need to remove a significant amount of bone. In that case, they can harvest bone tissue from another part of the body and graft it to the appropriate areas of the joint.
Hip Replacement
A conventional hip replacement is also called hip arthroplasty, and it is a standard procedure chosen over a reconstruction or repair if the joint is too damaged. The procedure involves removing deteriorated tissue, cartilage, and bone and replacing the hip joint with a prosthesis. A partial hip replacement involves removing the femoral head and placing a metal or ceramic femoral head secured with screws. In a total hip replacement, the acetabulum is also smoothed and fitted with another prosthesis. These fit together and move as the natural hip joint would have.
There are three standard approaches to a total hip replacement.
- Posterior Approach – This is the most common technique used by surgeons. You will be lying on your side while the incision is made on the outside of your hip towards the buttock. This approach does require cutting some muscles to access the joint.
- Lateral Approach – Similar to the posterior approach, you will be on your side, and some muscles will be cut, but the incision will be closer to the abdomen.
- Direct Anterior Approach – This approach is becoming the preferred option when possible. The incision made by the surgeon is on the thigh instead of the hip. With this approach, you will be on your back, and the surgeon will be able to work aroundthe muscles instead of cutting. This helps speed up recovery time and lessen post-operative pain.
A hip replacement has a high degree of success and often lasts upwards of 15 years after placement. When held against a reconstruction, it has been seen to be a better choice in older patients. A hip replacement is strong, but you do lose a certain amount of flexibility and movement. In addition, while 15 years seems like a long time, if you need a replacement due to trauma or injury when you are younger, you will need revision surgery to replace the prosthesis. This is a more complicated surgery due to natural bone erosion leaving less surface area to attach a new prosthesis.
Surgery Outcome and Recovery
The main difference between a hip replacement and hip reconstruction is the activity levels and abilities after surgery. With reconstructive surgery, the surgeon is not removing the femoral head from the femur, and this allows the joint to maintain its security in the acetabulum. Because of this, reconstruction is sometimes offered to younger, more active patients over more senior patients. As the repair lasts longer and if a hip replacement is needed later in life, the preservation of bone will make that revision more successful. The improved mobility with reconstruction will allow more active individuals to continue to play sports, ski, hike, and remain in active professions.
On average, 90% of hip surgery patients receive significant relief from pain and discomfort after surgery. However, every surgery comes with risks, and standard risks associated with any surgery include blood clots, nerve damage, infection, and delayed healing.
Hip replacement and reconstruction come with a few more specific risks. The following are known risks of hip replacement and reconstruction:
- Fracture – usually of the femoral neck (in reconstruction) or the middle of the femur (Typically, along where the hardware shaft is inserted during a replacement.)
- Dislocation – higher with replacement versus reconstruction
- Limb shortening
- Instability
After surgery, it is common to need assistance at home to safely ambulate while using temporary assistive devices. You will also begin post-physical therapy. AICA recovery program will be designed and monitored by our expert physical therapists and care team at AICA Orthopedics. You will focus on mobility, range of motion, and strengthening the new or repaired joint. We are striving for long-term recovery after surgery so you can live an active and pain-free life.
Signs You May Need Hip Surgery
Several things can contribute to the need for hip replacement or hip reconstruction. Certain risk factors, congenital conditions, external causes, and lifestyles all contribute to the decision to have surgery.
- Arthritis– including osteoarthritis and rheumatoid arthritis
- Age – as you age, your bones can be weaker and more prone to injury.
- Fracture – this can be from trauma (car accident, fall, etc.) or from something like osteoporosis (a reduced bone mass that causes weakening and propensity for fractures and is primarily seen in older women)
- Labral tear
- Hip dysplasia – is a congenital condition in which the acetabulum is too shallow for the femoral head to sit in securely.
Regardless of what path brought you to the point of needing surgery, AICA Orthopedics is here to help you through the entire process. Symptoms that may indicate you should be evaluated for the health of your hip joint.
- Discomfort or pain with basic tasks like walking or climbing stairs
- Pain that does not improve with medication
- Immobility or stiffness (especially if it persists)
- Swelling or bruising
- Pain continues to increase despite standard treatment
Diagnosis
If you are experiencing hip pain, instability, or have recently suffered a fall or car accident, it is important to have your hip evaluated. Our expert orthopedic specialists will complete a full history and physical examination to help diagnose the root of your pain. Part of the physical exam may contain tests to ascertain your flexibility and range of motion.
Imaging is frequently needed to assist in finding the source of your pain or instability.
- X-ray – used to see skeletal aspects of your body, an x-ray will show if there are any fractures in your pelvis or femur (the primary bones of the hip). An x-ray can also show if a hip has been dislocated or subluxated.
- CT or MRI – used to visualize the soft tissues in the body such as ligaments, tendons, and muscles. These tests can show tears in the labrum, locate swelling, or even fluid collection.
Get Relief from Your Hip Pain Today
If you have severe pain, instability, or minor tear of a ligament, we will usually attempt more conservative approaches first. This can include medical pain management, physical therapy, or even an evaluation by one of AICA Orthopedic’s chiropractors. However, if these avenues fail or stop treating pain effectively, it might be time to consider surgery.
AICA Orthopedics staff are standing by 24/7. Whether you’ve been in a car or sports accident or your hip pain is a result of aging or overuse, we are here to help. Our expert orthopedic specialists are ready to evaluate and treat your hip condition to get you mobile and back to your daily activities.
