Hip Surgery

Hip pain and functional problems, can be caused by multiple conditions. A thorough history, examination and investigations are used, to outline the issue and implement appropriate management. When surgery is required, Dr Gomes uses evidence based techniques, with consistent patient outcomes.

Anatomy


 

The bones that make up the hip are the:

• Pelvic bones
o Make up the joint socket or acetabulum 
o Include the ilium, pubis and ischium 
• Femur (thigh bone)
o There are several parts, including the:
- Femoral head
- Femoral neck 
- Greater trochanter
- Lesser trochanter
- Diaphysis 

 

The femoral head and acetabulum are lined by articular cartilage, which is the smooth bearing surface. Lubrication is provided by the synovial fluid, which is secreted by the joint lining (synovium).

The hip is stabilised by the:

• Shape of the femoral head (ball) and acetabulum (socket)
• Joint capsule & ligaments
• Acetabular labrum, which is a fibrocartilage ring around the acetabulum, that deepens the hip socket

The conditions that affect the structural components of the hip, lead to symptoms, which often require treatment.

Conditions Treated

Arthritis

•  Damage to the articular cartilage (bearing surface), which lines the joint surfaces
•  Severe osteoarthritis may require hip replacement surgery

Femoroacetabular Impingement (FAI)

•  Abnormal shape of the acetabulum and/or femur
•  This leads to impingement of the bones, against each other, in the functional range of movement
•  Impingement can lead to structural damage in the joint & accelerated hip osteoarthritis

Greater trochanteric pain syndrome

•  Is characterised by pain and tenderness on the side of the hip
•  It is associated with muscle weakness and dysfunction, which exacerbates the problem
•  The structural changes can include:
- Trochanteric bursitis
- Hip abductor (gluteus medius and minimus) degeneration and tears
•  Treatment focuses on controlling pain, improving function and dealing with the structural changes

Hamstring tendon tears

•  Occur with a traumatic event
•  Lead to severe pain and usually significant bruising, in the back of the thigh
•  Complete tears of the attachment to the pelvis, often require surgical re-attachment
•  Surgical treatment is helped by early identification of the injury

Labral Tears

•  Can occur with a traumatic injury or be part of the degenerative process within the hip
•  Loss of the labrum, predisposes to damage of the articular cartilage (hip osteoarthritis)
•  Labral tears may require hip arthroscopy, to:
- Remove debris within the hip
- Repair the labrum

Meralgia Paraesthetica

•  Compression of the lateral femoral cutaneous nerve of the thigh
•  Causes numbness over the front and outside of the thigh

Osteonecrosis

•  Loss of blood supply to some of the bone around the joint
•  This can lead to bone collapse and articular cartilage damage
•  Severe disease may require hip replacement surgery  

Common Hip Surgeries

The types of hip surgery performed include:

•  Total hip replacement
•  Revision total hip replacement
•  Fracture treatment
•  Hip conserving surgery
•  Osteotomies
•  Tendon repairs
- Hamstring tendon avulsion
- Hip abductor (gluteus medius and minimus)

Non-operative Treatment

Many hip problems are treated without the need for surgery. Some of the treatments used are:

Medications
•  Simple pain relievers, such as paracetamol
•  Anti-inflammatory medications

Injections
•  Corticosteroid
•  Platelet rich plasma (PRP)
- Can be particularly useful for conditions that involve tendon degeneration

Activity modification

Walking aids, such as crutches, walking sticks or frames

Physiotherapy

Low impact exercise

Weight loss