Hip, hip, hooray!!!
More people under 60 are having hip replacement surgery. Is this the best management of hip arthritis in this younger group of patients?
Total hip replacement
The hip joint is a ball and socket joint. A hip replacement is where the hip joint is replaced by a prosthetic implant. It is used to relieve the pain of arthritis and in some hip fractures. A total hip replacement consists of replacing both the acetabulum (the socket) and the femoral head (the ball).
Hip replacements are currently one of the most common orthopaedic operations, though patient satisfaction both short and long term can vary widely.
More and more younger people are having hip replacements. This is partly due to improvements is diagnostic tests which can pick up cartilage tears and arthritis early. In fact the keep Britain working document cites this as an economic success story. It shows that 60% of working age people who had a hip replacement in 2016 returned to work.
The other side of this success story is there is a higher risk of revision surgery for these younger patients. For women under 55 the 13 year revision rate is 13.5%, for men it is 10%. So patients need to weigh up the benefits and cost of having an early joint replacement and consider the non-surgical options.
What is the cause of osteoarthritis in the hip?
Osteoarthritis is the most common reason for hip replacements, however this is not just an unavoidable result of getting older, it is a complex condition with many causes.
- General causes: age, gender(women 50%more likely to have a THR) and genetics.
- Intrinsic causes: incongruency of the joint, joint laxity.
- Extrinsic causes: weight, heavy joint loading (manual labour and excessive weight bearing exercise).
Alternatives to surgery
Patients need to understand their condition and find strategies to manage it.
NICE recommend education, exercise and weight loss as a gold standard combination of treatments for hip osteoarthritis. The evidence is there to support this conservative management including strengthening and aerobic exercise eg. Cycling, walking, Pilates and yoga. Click on the link to view some great exercises to help http://altrinchamphysio.co.uk//glutes-activation-program . These will help to improve pain and mobility. Have a look at the NICE website for more hints and tips regarding Physical Activity. http://nice.org.uk
Sometimes hip surgery will be the answer however, but the conservative strategies of weight loss and exercise may delay the hip replacement surgery long enough to prevent revision hip surgery in the future.
If you would like some information regarding Pilates Classes please click on the link. http://www.altrinchamphysio.co.uk