Hip Osteoarthritis and the Direct Anterior Approach

Posted on

May 11, 2020

Share This
Osteoarthritis (OA) means arthritis of the bone and is a disease that affects the entire joint involving the cartilage, joint lining, ligaments, and underlying bone. It is the most common form of arthritis. The deterioration, or wear of these tissues, eventually leads to pain and joint stiffness. One of the joints most commonly affected is the hip. When the cartilage begins to degenerate in the hip joint due to arthritis, the surface becomes rough leading to exposed bone which contains nerve endings. With movement, the roughened surfaces rub and cause pain.
HipArthritis Symptoms
Hip arthritis can present with very minor symptoms and can progress to debilitating symptoms. Symptoms include pain in the groin with activity. The pain is usually worse in the morning and the hip feels stiff. With early OA the stiffness normally subsides as the day progresses, but may recur at the end of the day. With advancing arthritis the hip loses motion and this stiffness does not improve throughout the day. Patients may have difficulty walking, have a limp and may require use of an assistive device such as a walker.
If a patient suspects they may have arthritis, or if they are having any of the above symptoms, they should seek consultation with an orthopedic surgeon. At OSS Health, we have orthopaedic surgeons who are fellowship trained in treating hip and knee OA. A diagnostic evaluation will include obtaining a medical history, physical examination and x-rays.
Non-surgical Treatment Options
Treatment almost always begins with non-surgical options. Typically an anti-inflammatory medication may be prescribed. If oral medications fail, we typically offer injections of corticosteroids into the joint. For the hip joint these are typically performed as an outpatient procedure in our pain department. The injection blocks inflammation and helps reduce symptoms. Injections can my repeated every 3-4 months, so long as they continue to provide relief of symptoms.
Physical therapy or exercise programs will also be prescribed to improve flexibility, build strength, and maintain muscle tone. Swimming, in particular, is an excellent exercise for people with arthritis. When the arthritis becomes severe causing loss of motion and balance at the hip, devices such as canes or walkers are prescribed to make it easier and safer to walk. Lastly, but most importantly, lifestyle modifications can also help to reduce the symptoms of arthritis of the hip and help prolong the time until hip replacement is necessary. These include:

maintaining a healthy weight (and losing weight, if necessary)
changing activities to minimize stress on the hip
exercising to build up strength and flexibility

Surgical Options
If the non-surgical treatment options fail, surgery will help to reduce pain, enhance quality of life, and improve the ability to perform everyday activities with few or no restrictions. To treat end stage arthritis of the hip, total hip replacement has been utilized providing excellent long term outcomes. Today, there are many surgical approaches being utilized by orthopedic surgeons to perform a total hip replacement. An increased interest has developed in the Anterior Approach. This is a minimally invasive approach and is considered tissue sparing.
The Anterior Approach
The Anterior Approach for total hip replacement provides the potential for less pain, faster recovery and improved mobility because the muscle tissues are spared during the surgical procedure. With this surgical approach the surgical plane is between muscles allowing access to the hip without detaching them. Keeping the muscles intact may also help decrease incidence of dislocations.
With the Anterior Approach, one small incision is done on the front (anterior) of the hip. Since the incision is in front, the patient avoids the pain of sitting or lying on the incision site. There are fewer restrictions after surgery and during recovery as compared to the traditional approaches. There is reduced scarring as only a small incision is utilized on the front of the hip. This surgical procedure is often times performed utilizing a high-tech operating table that facilitates exposure and allows for real time x-ray evaluation of the hip for the most optimized positioning of implants and evaluation of leg length.
If you are suffering with hip pain and are looking for treatment options, you can schedule an appointment via the website (www.osshealth.com) or by calling 717-848-4800.

Editors Note: This article was contributed by Dr. George Margetas, an orthopaedic surgeon with OSS Health.

Other Articles You May Like

My Spouse Has Been Diagnosed with Dementia. Are We Going To Lose Everything?

Has your spouse been diagnosed with dementia? You may wonder if you're at risk of losing everything, but the short answer is no. However, it's crucial to take the time to gather resources and learn about the diagnosis. Seek advice from healthcare professionals, organizations like the Alzheimer's Association, and other experts who can provide guidance. Once you feel comfortable with this information, it's wise to consult an elder law attorney to understand asset protection and the differences between care in assisted living facilities and long-term care facilities, as this can significantly impact how you'll pay for care. Planning for dementia can be challenging due to the variable progression of the disease. Some individuals may experience a slow decline while others deteriorate rapidly, and in certain cases, the journey could span 15 to 20 years or even longer. It's essential to seek advice early and regularly, allowing you to create a comprehensive plan and maintain a sense of control over the situation. In our office, our elder care coordinator, Meg Motter, assists families in developing a life care plan. This plan provides detailed instructions from start to finish and is continually adjusted as needed. It serves as a lifeline, empowering our clients' families to feel in control of the situation rather than being controlled by it.Considering the high costs of care, it's essential not to leave things to chance. Take action now and consult an estate planning and elder law attorney if you find yourself in this situation.To further support and equip you with valuable information, we invite you to register for our free educational workshop. Join us and gain valuable insights into dealing with dementia and securing your family's future. Don't miss out on this opportunity secure your spot today!

Understanding and Managing Osteoporosis

Bone Health - Understanding and Managing Osteoporosis An estimated 54 million Americans are affected by osteoporosis, a condition that weakens bones, making them more prone to fractures from minor incidents. An estimated 50% of women and 20% of men will break a bone from osteoporosis. The trained specialists at The Orthopaedic Group, P.C., emphasize the importance of bone health, especially among seniors, to manage and prevent this condition. Identifying Risks and Signs Osteoporosis often goes unnoticed until a fracture occurs. Risk factors include a history of falls, being over 65 (men) or 50 (women), a family history of the condition, and lifestyle habits like smoking or alcohol use. Certain medical conditions and treatments also increase susceptibility. Diagnosis and Screening Healthcare providers use DEXA Scan (dual-energy X-ray absorptiometry) to diagnose osteoporosis and assess fracture risk. This scan is recommended for adults over 65 and those with risk factors. It's a quick, painless procedure using minimal x-rays. Prevention and Treatment Diet plays a key role, with a focus on high-calcium foods (preferably Calcium Citrate) and Vitamin D supplementation for absorption. Exercise, including weight-bearing and balance activities, is vital for enhancing bone density and preventing deterioration. Medication and Personal Care For those at high risk, medications may be prescribed to mitigate bone loss or increase bone mass. Oral health care is critical due to the potential risk of osteonecrosis of the jaw from osteoporosis medications. The Orthopaedic Group offers a comprehensive orthopedic bone health care and education program through its Fracture Liaison Service (FLS), which provides tailored treatment plans to reduce fracture risk and improve quality of life. The Orthopaedic Group, P.C., advocates for proactive screening, preventive nutrition and exercise, and informed treatment decisions to address osteoporosis. Our specialists focus on maintaining independence and well-being so you can live the life you love! Learn more about our fellowship-trained doctors and advanced practice providers at www.TheOrthoGroup.com.

Moving Out of State?

Are you planning to move out of state? Bellomo & Associates, an estate planning and elder law firm based in York and Lancaster, Pennsylvania, is here to assist you. Our services cover everything from basic estate planning documents to asset protection and more. One common question we often receive is about the validity of documents when moving to a new state. Generally, if your documents were valid in the state where they were created, they should also hold validity in your new state. However, its crucial to remember that a confused mind may lead to complications. In many cases, it makes sense to consider redoing your documents according to your new states rules and regulations. Each state has its own specific requirements for documents like Powers of Attorney. If your new state has stricter or different requirements, you may encounter difficulties in having institutions accept your documents. While you may eventually prevail, it could be a hassle and time-consuming process. Let me share an example we experienced in the Commonwealth of Pennsylvania. A client moved from Arizona with documents deemed valid in Arizona at the time of creation. Despite having an affidavit from an Arizona attorney, we faced considerable difficulties in Lancaster County when attempting to accept the Will for probate. To avoid potential confusion and refusals to accept your documents, we strongly recommend updating your documents if you have the capacity to do so after moving. Although this might not be the technical rule, its a safer option for you and your family. Take the necessary steps to ensure your documents comply with your new states regulations. To learn more about estate planning and how to protect your assets, we invite you to join our free educational workshop. Register now and secure your spot!