The hip joint is a true ball-and-socket joint. This arrangement gives the hip a large amount of motion needed for daily activities like walking, squatting, and stair-climbing.
Understanding how the different layers of the hip joint are built and connected can help you understand how the hip joint works, how it can be injured, and how challenging recovery can be when the hip joint is injured. The deepest layer of the hip includes the bones and the joints. The next layer is made up of the ligaments of the joint capsule. The tendons and the muscles come next.
The important structures of the hip joint can be divided into several categories. These include
bones and joints
ligaments and tendons
Avascular necrosis of the hip occurs when the blood supply to the hip joint is damaged. Bones are living tissue, and like all living tissue they rely on blood vessels to bring blood to keep them alive. Most living tissues have blood vessels that come from many directions into the tissue. But some joints of the body have only a few blood vessels bringing blood into the joint. The hip joint is one of those.
Avascular necrosis of the hip is also referred to as osteonecrosis, which means “bone death.” In living bone, the bone cells are constantly repairing the wear and tear that affects bone tissue. If the repair process stops, the bone begins to weaken, just like rust affects the metal structure of a
Having different leg lengths is not a cause for alarm, in fact it is a fairly common occurrence. Researchers estimate that 40 to 70 percent of the population has one slightly shorter leg.
Although having different leg lengths is normal, it can be a problem for certain groups of people. For example, in athletes, a small difference in leg length can make a big difference in their performance.
Depending on how great the difference is, and what physical condition they are in, elderly people may have a problem with different leg lengths. Researchers attempted to determine how much discrepancy could become a problem using a set of 44 healthy participants age 55 to 86. Small shoe lifts of varying heights were
Anterior approach hip replacement provides four distinct benefits to the hip replacement patient.
The anterior approach is one in which the orthopedic surgeon approaches the hip joint from the front of the hip, as opposed to the side (lateral) or back (posterior). The incision is a small one, just 3” – 4,” making anterior approach hip replacement a minimally invasive procedure. The muscles are not cut, they are merely pushed aside to give the surgeon access to the hip joint. This results in less pain for the patient.
As you would expect, a smaller incision and less trauma to the muscles involved means a faster recovery for the patient undergoing anterior approach hip replacement. They are up
A stress fracture of the hip is a hairline crack in bone which can grow larger, if left unattended. When they occur in the hip, it is usually the result of fatigue - a break in normal bone that has been put under extreme pressure. A fatigue fracture can be caused by any strenuous, repetitive activity. For example, by the daily marching and running required of military personnel, especially when carrying loaded rucksacks weighing 60 pounds or more. Distance runners are highly susceptible to fatigue fractures too.
Most stress fractures of the hip usually involve the femoral neck, the short, thinner section of bone that connects the head of the femur to the main shaft of the bone. The femoral neck is under
What to do about hip pain? When arthritis of the hip becomes so painful and limiting that their lives become unlivable, many people choose hip replacement as a way to relieve their hip pain. With hundreds of thousands of hip replacements done last year in the U.S for incapacitating hip pain ---and half of those being done in patients under the age of 65--- this has quickly become an acceptable and predictable procedure to relieve pain and return patients back to their active lives.
Over the last 30 years there have been great advancements as orthopedic surgeons have learned which materials and designs will give the longest lasting replacement joints. Currently most hip replacements are made of titanium to
Minimally invasive hip replacement surgery has been popularized over the past decade when patient demand for less pain and faster recovery put pressure on both surgeons and implant manufacturers to develop better techniques. What have evolved are better implants and instruments, which match better-trained and understanding surgeons.
Historically, the vast majority of hip surgeons use a posterior (from the back) lateral approach to enter the hip joint during a replacement operation. Over the recent years some of the surgeons have been able to reduce the surgical incision (typically 8-10” in length) and the detachment of surrounding musculature when performing a hip replacement surgery. The technique
Hip pain in the middle-aged patient may or may not lead to hip replacement surgery. Surgical treatment for hip pain in the middle-aged patient depends on the type of underlying pathology and condition of the joint. The amount of degeneration, bony deformities present, and the ability to repair the labrum and cartilage damage are factors to be considered in the decision.
The hip joint is surrounded by ligaments, which hold the bones together, and muscles on top of the ligaments, which are responsible for moving the bones. All of these tissues work in conjunction to allow you to move your leg in a controlled manner. If any of these tissues are disrupted, the direction of forces change across the joint and
The last two questions we'll address in this series about total hip replacement relate to regaining motion and to residual hip pain.
Will I notice anything different about my hip?
Hopefully, the thing that you notice first is the lack of pain in the joint. Of the things that may be unexpected, the one that is more often noted is a feeling of numbness down the lateral (outside) aspect of the thigh beyond the incision. This area is given feeling from a skin nerve that is variably distributed in the area of the hip surgery and may be injured in the anterior approach. Although the function of the muscles is usually not involved, the numb feeling may be permanent.
Most patients regain the motion they
Getting “back to normal” will depend greatly on your pre-operative physical condition and what you consider to be normal activity. Consult with your surgeon or therapist for their advice on your activity. Here are the answers to a few of the most frequently asked "When can I..." questions.
When will I be able to get back to work?
We recommend that most people take at least one month off from work, unless their jobs are quite sedentary or require little thought or analysis, in which case they can usually return to work with a cane somewhat sooner. Both pain medications and the effect of surgery on the body’s physiology can keep you from making clear decisions and functioning at peak levels. A
Everyone looks forward to going home from the hospital! With the direct anterior approach to total hip replacement performed by Dr. Robert Zehr, you can expect to be home in just 2-3 days. Here are a few things you can do to make your homecoming easier on yourself.
Will I need help at home?
Maybe. Most patients that have done their pre-op physical therapy are able to function well at home without great assistance. Importantly, our program is designed for patients to have a family member (“Caddy”), who has been with them from the beginning, help them at home. For the first several days or weeks, depending on your progress, you will benefit from someone to assist you with meal preparation,
With your preparations for total hip replacement surgery completed, you probably have some questions about what to expect. Here are the most frequently asked questions about what will happen after your hip replacement surgery.
How long will I be incapacitated right after surgery?
We expect you will get out of bed and walk the day of surgery. This is extremely important to get your muscles moving to help prevent blood clots from forming in your legs. In addition, the next morning you will get up and will be walking with a walker to participate in physical therapy. You will be allowed to shower the day after surgery.
Most patients are able to walk ¼ mile around a track set up in the hospital prior
Properly preparing for total hip replacement surgery includes doing some paperwork, considering some important medical issues and getting your home ready for your return after hip surgery. Here’s what you need to know to complete step two.
Pre-register with the hospital
In most hospitals you will need to pre-register in the admitting department of the hospital prior to your surgery day. An appointment will be made for you. Plan about one hour for this visit. The admitting department is found in the front lobby of the hospital. Usually there are hospital volunteers at the information desk to assist you in finding this area.
At this visit you will be providing personal information to the hospital
We recently discussed some basic questions to ask before getting a total hip replacement. Educating yourself is an all-important step when considering hip replacement surgery.
Are you ready to go ahead with your minimally invasive hip replacement surgery? Then let’s go to step two - preparing for surgery.
Get in shape before the surgery
Your surgeon knows that physically fit patients recover much faster and return to activity sooner than patients who are sedentary. If you want your recovery to be shorter in time and have less pain then you need to get yourself in shape. It is, in fact, your responsibility to make yourself as strong as you can.
We will direct you to a physical therapist for
If it seems that you are hearing about increasing numbers of younger people having hip replacement surgery, you are hearing correctly. Each year, over 400,000 people in the U.S. undergo total hip replacement surgery and of that group, half are under the age of 65 years old. Both movie stars and your “average Joe” are afflicted with the process we know as osteoarthritis. Typically, these younger patients are unwilling to accept the chronic pain and limitations of a deteriorating hip joint that severely diminishes their ability, to not only play sports but also even to perform normal daily activities. This often leads to a loss of independence and self-esteem not to mention, family bliss.
Recovering from hip surgery, patients have many questions. One of the first questions that a hip replacement patient asks is “When can I….?” You can fill in the blank with any activity but they all entail bending your hip joint.
If you have had a total hip replacement using the posterior approach, you need to avoid bending your hip more than 90 degrees. This severely limits your activities, such as gardening. For instance, you can kneel down, but should avoid kneeling directly on the side you were operated on. Try to keep your weight evenly placed. While kneeling in your garden, you need to avoid bending too forward at the hip.
You cannot get onto your hands and knees because this position puts
Treating trochanteric bursitis focuses on reducing the inflammation and pain. Trochanteric bursitis is an inflammation of the bursa at the point where a large tendon stretches across the bony bump on your hip known as the greater trochanter. It is the result of a buildup of friction, which can be caused by a repetitive use injury, an acute injury, a systemic condition like arthritis or an infection.
Your orthopedic surgeon can usually diagnose the condition by reviewing your medical history and conducting a physical examination. If an injection of a local anesthetic into the bursa relieves the hip pain immediately, the diagnosis is usually trochanteric bursitis. Occasionally, your doctor may order X-rays
Trochanteric bursitis is an inflammation of the bursa on the side of the hip. Your body contains hundreds of thin, slippery sacs called bursa. These sacs contain a small amount of fluid. They are located where there is movement of a joint causing two tissues to rub against each other. Their purpose is to reduce friction in these areas to allow the joint to move freely.
Causes of trochanteric bursitis
Bursa can become inflamed, usually because of repetitive overuse injury or excessive pressure. An acute injury such as a bruise, systemic conditions such as arthritis, and infection of the bursa can cause them to become inflamed. When the normally slippery bursa becomes thickened and swollen, bursitis is the
Repair or replace a fractured hip? Left to itself, a fractured hip, like most broken bones, will mend itself. The healing process, however, requires immobilizing the joint through complete bed rest, which often takes three to four months. There is potential for other medical problems to develop, especially in the elderly. The complications of prolonged bed rest can include blood clots, bedsores, malnutrition, and pneumonia. Surgery to resolve the problem is therefore recommended.
A hip fracture can impair the flow of blood to the structures in your hip joint. If an adequate blood supply is not restored quickly, bone and tissue can die. This complication of hip fractures is called avascular necrosis
Hip dislocation following hip surgery is rare, with fewer than 200,000 cases reported per year. New surgical methods, advanced technology, and improvements to hip implants have combined to reduce the number of hip dislocations following hip replacement surgery. However, the risk of hip dislocation following surgery has not been entirely eliminated, therefore it is wise to take some precautions during your recovery from hip surgery. These precautions focus on keeping your hip in a safe position while the soft tissues of the hip joint heal. You will want to avoid bending the hip back, turning your hip and leg out or spreading your leg outward.
Avoid hip dislocation with these tips
Walk with short steps to
When to get a hip replacement? That question is always in the back of the mind of patients suffering from hip pain.
Approximately 1 in 4 people develop osteoarthritis of the hip over the course of their lifetime. We sometimes refer to osteoarthritis (OA) as degenerative, or wear-and-tear, arthritis. It affects the articular cartilage in your hip. Articular cartilage is the smooth lining that covers the surfaces of the ball-and-socket joint of the hip. When the articular cartilage degenerates, or wears away, the layer of bone just beneath it, called the subchondral bone, is exposed. This creates a “bone on bone” condition in the hip. Hip alignment problems, hip injuries, medical conditions affecting the
Rehabilitation after hip fracture surgery is designed to help you begin moving as quickly as possible. Movement is critical so you can avoid dangerous complications. Pneumonia, blood clots, joint stiffness, and pain can arise from being immobilized in bed.
Your physical therapist will work with you in the hospital to begin rehabilitation after hip fracture surgery. You'll begin walking with a walker or crutches. Then you will start doing exercises to tone the muscles around the hip and thigh and to prevent the formation of blood clots.
How much weight you can place on the operated leg depends on the severity of your fracture. It also depends on the type of surgery you have. Most patients are able to
There are risks associated with surgery of any kind, and surgery for a hip fracture is no different. Regardless of whether you have had a simple pinning procedure or a total hip replacement, you and your surgeon need to watch for complications from hip fracture surgery. The more common complications actually result from being immobilized after surgery, not the surgery itself, so the sooner you are up and walking around, the better.
Complications from anesthesia
Problems with anesthesia can be reactions to the drugs used, problems related to other medical complications, and problems due to the anesthesia. Some patients simply do not tolerate the process of anesthesia well. If you have concerns about the
Osteoarthritis is the most common of the more than 100 different rheumatic diseases and conditions known as arthritis. Osteoarthritis affects more than 75% of people over the age of 55. "Osteoarthritis is a huge public health problem that's going to grow considerably in the next 20 years," predicts rheumatologist Patience White, a spokesperson for the Arthritis Foundation. Almost 54 million Americans say they have been diagnosed with arthritis. By 2030, the number is expected to grow to 67 million. Obesity, lack of physical activity, injuries, and the aging population are all factors contributing to this unprecedented growth.
Osteoarthritis is a chronic condition characterized by a breakdown of articular
As people live longer and more people receive joint replacements at younger ages, it is expected that an increasing number of those implants will wear out and / or fail for some reason. In these cases a second operation will be necessary to replace or revise the failed first replacement and this procedure is referred to as revision joint replacement. The increasing demands placed on these implants by patients in terms of longevity and durability; and expectations of patients to maintain their active lifestyles even with a joint replacement has presented a considerable reconstructive challenge to the surgeon, most of whom will not even attempt these complex revision surgeries.
Fortunately, despite the
As soon as your doctor determines that your overall medical condition is stable; he will begin treatment for your hip fracture. The most common treatment for a hip fracture is surgery. If possible, the surgery is performed within 24 hours of your admission to the hospital.
The goal of any surgical procedure to treat a fractured hip is to hold the broken bones securely in position, in order for them to heal properly. The type of surgery you have generally depends on the location of the fracture in the bone, the severity of the fracture and your age. Most hip fractures are treated in one of three ways: by repairing it with hardware, replacing part of the femur or replacing the entire hip joint.
You surgeon may
It may be difficult to diagnose a hip fracture. The hip is comprised of a large structure of bone that forms a ball-and-socket joint. The buttock and thigh muscles, along with some cartilage, support the hip.
After a hip injury, your doctor has to determine whether or not your hip has actually been fractured. This diagnosis may not be as simple as it sounds. A hip fracture is typically determined with x-rays. Occasionally, x-rays do not show the fracture and an MRI is necessary to make small fractures visible so your doctor can properly diagnose a hip fracture. In an MRI, magnetic waves are used to take a series of pictures of the hip.
It is very important to determine if the pain in your hip after an
What causes a hip fracture? In order to explain what causes a hip fracture, it is necessary to have some understanding of the anatomy of the hip. The hip is a large structure of bone that forms a ball-and-socket joint. The buttock and thigh muscles as well as cartilage support the hip. One key element of the hip that is important to understand is how blood is supplied to it. Blood flows through the neck of the femur (thighbone). If for any reason, blood flow to the hip is stopped as a result of damage; there is no alternative blood supply to that area. If a hip should fracture and cause the blood to stop flowing to the hip, the bone will die. This is one of the complications of a hip fracture.