Hip Arthritis

What is hip arthritis?

Osteoarthritis is the most common form of arthritis affecting the body and occurs when the loss of cartilage leads to “bone on bone” pain and disability. Other forms of arthritis include inflammatory arthritis (including rheumatoid arthritis and psoriatic arthritis) and septic arthritis. Nearly 31 million Americans suffer from the osteoarthritis, which causes debilitating pain and loss of joint function. By 2040, that number will balloon to 78 million people. Also called “wear and tear” arthritis, osteoarthritis is most common in weight-bearing joints like the hip and knee. Some 300,000 total hip replacement procedures are performed on arthritis patients every year.

As our knowledge and technology has advanced, so has the way we prevent, manage, and surgically treat hip arthritis. Hip arthritis can be addressed either non-surgically or surgically.  Only you can decide when your pain and daily disability is severe enough to warrant an elective hip procedure, whether it be a hip resurfacing or a total hip replacement. Until then, Dr. Prem Ramkumar can guide you through the process and provide non-surgical and hip preservation solutions to try to keep you pain-free.

Dr. Prem Ramkumar, hip arthritis specialist, is located in Long Beach and serves patients in Los Angeles, Orange County, and surrounding Southern California areas.

What are the early stages of hip arthritis?

Arthritis of the hip is most often gradual, taking place over time, and can be part of the natural aging process. Early-onset hip arthritis can affect younger people with structural differences (femoroacetabular impingement and dysplasia), inflammatory arthritis, or those with family histories of arthritis. Sometimes, the pain can be severe, while other times, the disease goes into remission, and symptoms disappear, only to return. Although arthritis often develops over years, a fall or a recent overexertion may trigger pain that persists. Thus, arthritis does not always mean chronic and persistent pain over years. Dr. Ramkumar matches your history, exam, and imaging to help you understand your diagnosis and treatment options. For example, many patients may have x-rays that suggest arthritis, but no symptoms.

The most common form of hip arthritis is osteoarthritis, which causes the breakdown of joint cartilage, leading to pain and inflammation. Osteoarthritis occurs for many reasons, including a previous injury or the shape of the joint. Two conditions that tend to accelerate the progression of hip arthritis are:

• Hip dysplasia – This is a congenital malformation of the hip socket (acetabulum) resulting in a shallow articulation that cannot fully contain the femoral head, resulting in abnormally increased forces across the joint. This accelerates joint degeneration, causing hip arthritis.
• Femoroacetabular impingement (FAI) – This is a growth plate disturbance that typically occurs during adolescence on both sides of the hip, the femur (ball) and the acetabulum (socket). When the hip is loaded with heavy or repetitive activity and exercise while the growth plate along the femoral neck is open, abnormal bone grows. Similarly, where the quadriceps muscle attaches just above the acetabulum can create bone with repetitive trauma. With this abnormal bone between the femoral neck and acetabular rim, there is pain, restricted motion, and injury between the aberrant bone and the articular cartilage.

What are the symptoms of hip arthritis?

If you notice groin or anterior hip pain, you may have the early stages of osteoarthritis.  Symptoms tend to come and go and worsen as the condition progresses. Symptoms can include but are not limited to:

• Pain in the thigh, knee or groin
• Hip joint stiffness
• Limited range of motion
• Crunching or popping sound
• Feeling as if the hip will give way

How is hip arthritis diagnosed?

Dr. Ramkumar will conduct a thorough physical examination of the hip joint to find areas of tenderness or pain. He’ll also take a complete medical history and discuss any previous injuries. X-rays and/or an MRI scan may help to confirm the diagnosis. 

How is hip arthritis treated?

A conservative, non-surgical approach is typically the first line of treatment for early-stage osteoarthritis. Often times people live with symptoms for years before seeking treatment or receiving an arthritis diagnosis.

Non-surgical treatments include:

• Activity Modification
• Rest and Ice
• Physical Therapy
• NSAIDs – Non-steroidal anti-inflammatory drugs
• Hip Injections – corticosteroids and hyaluronic acid gel

Surgical treatments include:

• Hip Arthroscopy – A minimally invasive procedure used to remove impingement as a source of pain and cartilage deterioration, repair labral injury, and never meant to be performed in the setting of moderate to severe arthritis. In the setting of early or very mild, focal arthritis and advanced age, Dr. Ramkumar may aspirate and injected bone marrow aspirate concentrate to help preserve the hip joint.
• Hip Resurfacing – An open procedure that removes only the diseased portions of the femoral head to accept a metal cap and replaced the socket of the hip with a metal shell. Dr. Ramkumar only performs this procedure on younger, more active male patients.
• Total Hip Arthroplasty (Replacement) – A surgical procedure where the femoral neck and acetabular socket are removed and replaced with a four-part metal and plastic implant system that eliminate pain and restore function. Dr. Ramkumar performs this using the direct anterior approach and always uses the MAKO robotic arm.

What is the recovery like after hip surgery for arthritis?

Recovery times vary from person to person and depend on the procedure. All patients are expected to be standing the same day and wean off assist devices between two to four weeks. Return to work can be expected at this time as well, although more time is generally better to focus on your health and recovery! Following all of Dr. Ramkumar’s post-surgical guidelines will optimize your chances of achieving the best outcome. Rehabilitation and physical therapy after surgery are as important as the surgical repair.