1. ARTHRITIS OF THE HIP Roy I Davidovitch, MD
Assistant Professor of Orthopaedic Surgery
NYU School of Medicine
NYU Hospital for Joint Diseases
Director, The New York Hip Center

2. Agenda How your hip works & why it hurts Is hip arthritis preventable?
What are the options for the arthritic hip?
Your questions

3. How your hip works Anatomy of the hip Ball-and-socket joint
Ball (femoral head) at the end of the leg bone (femur)
Hip socket (or acetabulum) holds the ball

4. What Is Arthritis? Healthy hip Diseased hip (osteoarthritis)
The end of each bone in the joint is covered with cartilage, acting as a cushion so the joint functions without pain
Diseased hip (osteoarthritis)
Wear and tear deteriorates natural cushion, leading to bone-on-bone contact, soreness and swelling

5. NORMAL HIP
ARTHRITIC HIP

6. Arthritis—Background
Arthritis is the second most common chronic condition in the US (sinusitis is first)
Most common among elderly
20-30% of people over age 70 suffer from osteoarthritis (OA) of the hip
Arthritis affects over 32 million people in the US
Total costs associated with arthritis are over $82B/year, including hospital and drug costs, nursing home costs, and lost productivity and work

7. Types of Arthritis Osteoarthritis (MOST COMMON) Post-Traumatic
Inflammatory (rheumatoid arthritis)
Secondary to childhood hip disease
Many more…..

8. Is Arthritis of the Hip Preventable?
5 years ago the answer was NO!
Today, the answer is… SOMETIMES!

9. Femoral Acetabular Impingement (FAI)
Mismatch between the roundness of the head (ball) and the roundness of the acetabulum (socket)
Associated with congenital abnormality, childhood hip injury.

11. Hip Labrum Tear is Caused by FAI
Labrum: outer thickening of the cartilage of the socket that cushions the soft cartilage of the surface of the socket.

12. Labrum Tears May Progress to Arthritis of the Hip at an Early Age

13. How do I know if I have FAI?
Groin pain with sitting or deep flexion of the hip (squatting)
Clicking/popping at hip (with golf swing)
Pain is progressive
Pain is not constant

14. Treatment Hip Arthroscopy Mini-open decompression
Hip Surgical Dislocation
Hip socket reorientation
Physical therapy usually not helpful

15. These treatments are effective at relieving pain.
May slow down or prevent the progression of cartilage damage and development of arthritis

16. Symptoms of Arthritis Do you sometimes limp? Does your hip feel stiff?
Are you losing motion in the hip?
Is it difficult to perform daily tasks— like walking, housework or tying shoes?
Does pain limit your activities & lifestyle?
Does one leg feel “shorter”?
Do you experience pain in the groin or front of thigh?

17. Treatment Options: Non-operative
Activity Modification
Weight Loss
Cane/walker
Physical Therapy
Medications:
NSAIDs (aleve, motrin, advil)
COX-2 Inhibitors (celebrex)
Nutritional supplements
Injections:
Corticosteroid
Viscosupplementation

18. There is only one “CURE” for arthritis.

19. Total Hip Replacement (THR)
Implants replace damaged surfaces
Helps relieve pain and restore mobility
260,000 each year in the U.S.

20. Goals of Joint Replacement Surgery
Relieve pain!!!
Restore function, mobility to the prearthritis levels

21. What is Hip Replacement

22. Technique: Total Hip Replacement

23. Technique: Total Hip Replacement

24. Technique: Total Hip Replacement

25. Technique: Total Hip Replacement

26. Background
Total joint replacement is one of the most commonly performed and successful operations in orthopaedics as defined by clinical outcomes and implant survivorship*

27. Implant Considerations
Current technology has improved the bearing surfaces
Makes total hip replacement a viable option in young patients.
Components are more durable.

28. Bearing surfaces are the contact points of ball and socket

29. When should you have a hip replacement?
Arthritis has caused an unacceptable level of pain and decreased ability to participate in activities that the PATIENT considers essential.
Age is less of an issue with current technology

30. Risks of Hip Replacement
Dislocation
Leg length discrepancy
Infection (surgical treatment)
Blood clots (DVT)
Fracture
Loosening of components
Future surgery to revise components

31. Dislocation Precautions

32. Dislocation precautions, leg length discrepancies and recovery can be dependent on the surgical approach used to enter the hip

33. Surgical Approach Posterior (the back of the hip)
Highest dislocation rate
Easiest for surgeon
Lateral (the side of the hip)
Lower Dislocation rate
Most damage to the muscle
Anterior (the front of the hip)
Lowest dislocation rate
Hardest for the surgeon

34. Minimally Invasive Surgery (MIS)
“traditional” incision was 12”
MIS incisions are 4”
Supposed to have lower dislocation rate and decreased pain

35. MIS???
Currently no proven benefit to smaller incision other than cosmetic appearance

36. MIS= Minimal Incision Surgery
The goal of MIS should be minimal disturbance of natural and healthy structures during replacement of the damaged structures
This should allow an anatomic reconstruction of the joint and thereby maintain the stability of the hip

37. Anterior Total Hip Replacement
What is it?
Incision is made on the front (anterior) of the leg rather than the side (lateral) or back (posterior)
A natural interval BETWEEN muscles exists in the front of the hip
Surgery is performed through this natural interval
Muscles and tendons are not cut during the procedure.

38. Traditional MIS Surgery
Patients typically lie on side or front
Incision on side or back of leg
Surgeon detaches muscles, disrupts tissue
Surgeon relies on post-operative X-ray to check component placement & leg length

39. Anterior Approach Patients lie on back Incision on front of leg
No detachment of muscles, minimal disruption of tissue
Surgeon can check component placement & leg length during procedure

40. Benefits of the Anterior Approach
Dislocation rate <1%
NO HIP PRECAUTIONS
Leg length more reliably assessed
Recovery time significantly accelerated (no cane within 2-3 weeks)
Less pain

41. Who is NOT a candidate for Anterior Approach Total Hip Replacement?
Severe deformity of the femur (diagnosed with an xray)
Morbid obesity (BMI> 40)
History of previous hip replacement surgery on the same side

42. 95% of patient ARE candidates for an anterior approach
95% of patient ARE candidates for an anterior approach. This can be determined rapidly by an experienced surgeon examining the patient and the xrays.

43. Thank You!