Hip Osteoarthritis and the Direct Anterior Approach

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May 11, 2020

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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.
Diagnosis
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.

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