Presentation on theme: "ARTHRITIS OF THE HIP Roy I Davidovitch, MD"— Presentation transcript:
1ARTHRITIS OF THE HIP Roy I Davidovitch, MD Assistant Professor of Orthopaedic SurgeryNYU School of MedicineNYU Hospital for Joint DiseasesDirector, The New York Hip Center
2Agenda How your hip works & why it hurts Is hip arthritis preventable? What are the options for the arthritic hip?Your questions
3How 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
4What 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 painDiseased hip (osteoarthritis)Wear and tear deteriorates natural cushion, leading to bone-on-bone contact, soreness and swelling
6Arthritis—Background Arthritis is the second most common chronic condition in the US (sinusitis is first)Most common among elderly20-30% of people over age 70 suffer from osteoarthritis (OA) of the hipArthritis affects over 32 million people in the USTotal costs associated with arthritis are over $82B/year, including hospital and drug costs, nursing home costs, and lost productivity and work
7Types of Arthritis Osteoarthritis (MOST COMMON) Post-Traumatic Inflammatory (rheumatoid arthritis)Secondary to childhood hip diseaseMany more…..
8Is Arthritis of the Hip Preventable? 5 years ago the answer was NO!Today, the answer is… SOMETIMES!
9Femoral 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.
11Hip 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.
12Labrum Tears May Progress to Arthritis of the Hip at an Early Age
13How 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 progressivePain is not constant
14Treatment Hip Arthroscopy Mini-open decompression Hip Surgical DislocationHip socket reorientationPhysical therapy usually not helpful
15These treatments are effective at relieving pain. May slow down or prevent the progression of cartilage damage and development of arthritis
16Symptoms 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?
26BackgroundTotal joint replacement is one of the most commonly performed and successful operations in orthopaedics as defined by clinical outcomes and implant survivorship*
27Implant Considerations Current technology has improved the bearing surfacesMakes total hip replacement a viable option in young patients.Components are more durable.
28Bearing surfaces are the contact points of ball and socket
29When 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
30Risks of Hip Replacement DislocationLeg length discrepancyInfection (surgical treatment)Blood clots (DVT)FractureLoosening of componentsFuture surgery to revise components
32Dislocation precautions, leg length discrepancies and recovery can be dependent on the surgical approach used to enter the hip
33Surgical Approach Posterior (the back of the hip) Highest dislocation rateEasiest for surgeonLateral (the side of the hip)Lower Dislocation rateMost damage to the muscleAnterior (the front of the hip)Lowest dislocation rateHardest for the surgeon
34Minimally Invasive Surgery (MIS) “traditional” incision was 12”MIS incisions are 4”Supposed to have lower dislocation rate and decreased pain
35MIS???Currently no proven benefit to smaller incision other than cosmetic appearance
36MIS= Minimal Incision Surgery The goal of MIS should be minimal disturbance of natural and healthy structures during replacement of the damaged structuresThis should allow an anatomic reconstruction of the joint and thereby maintain the stability of the hip
37Anterior 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 hipSurgery is performed through this natural intervalMuscles and tendons are not cut during the procedure.
38Traditional MIS Surgery Patients typically lie on side or frontIncision on side or back of legSurgeon detaches muscles, disrupts tissueSurgeon relies on post-operative X-ray to check component placement & leg length
39Anterior Approach Patients lie on back Incision on front of leg No detachment of muscles, minimal disruption of tissueSurgeon can check component placement & leg length during procedure
40Benefits of the Anterior Approach Dislocation rate <1%NO HIP PRECAUTIONSLeg length more reliably assessedRecovery time significantly accelerated (no cane within 2-3 weeks)Less pain
41Who 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
4295% 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.