ARTHRITIS OF THE HIP JOINT

There are other operations that can be useful in treating hip disease:

1. Hip fusion (arthrodesis) was frequently performed before the era of hip replacement. The hip ball is fused to the pelvis. This is a single-operation, permanent-cure for the painful hip. Lost hip motion is made up by extra movement of the knees and spine. You must have a normal spine, normal knees, and a normal opposite hip for arthrodesis to be even considered. Few people today will accept the inconvenience of a stiff hip joint. It is usually only offered to very young people whose work involves heavy manual labor.

2. An osteotomy of the thigh bone may be an alternative for very young patients. The femur is cut and re-aligned to change the direction of forces across the arthritic hip. It takes three months for the cut bone to heal and the results are unpredictable and almost never permanent. The procedure is much more popular in Europe than in America.

3. Femoral Hemiarthroplasty (“half a hip replacement”) is sometimes offered to younger patients, when the hip ball is damaged, but the socket cartilage is normal, such as in patients who have osteonecrosis (see Introduction to Hip Disease). The socket is not replaced. The femur component is similar to that of a total hip replacement, but it has a large ball, sized to fill the socket. The metal ball moves directly against the socket cartilage, which can wear out and become painful, requiring a second operation to install an artificial socket. In general, Dr. Huddleston does not recommend hemi-arthroplasty for hip disorders, other than for hip fractures in the elderly. These are usually displaced fractures of the neck of the femur (see figure below). The implant is almost always cemented for hip fractures, except in patients under 65 or so, depending again on bone quality.

   Everything in this booklet concerning total hip replacement (complications, postoperative course, short and long-term care, etc.) applies equally to femoral hemi-arthroplasty.
   

4. Surface Replacement of the Hip had a vogue in the early 80’s. An improved version is now making a come-back of sorts. Instead of removing the femoral head, it is shaved (like peeling an apple) and a metal cap is cemented onto it. In some versions the socket is left untouched as in the hemi-arthoplasty (above). In others, the socket is lined with a metal shell (metal-on –metal).
   

5. Pseudoarthrosis (Girdlestone) involves removing the femoral head and leaving the hip without any replacement. The procedure is sometimes used as a last resort treatment for persistently infected hip replacements, or when the bone is totally inadequate for further reconstruction after multiple failed hip replacements. It leaves the patient with a short leg and an unstable hip and the need to use two
   crutches permanently.
   

6. Core Biopsy involves removing a core of bone about one quarter-inch in diameter from the femoral head using a coring device. It is used in the earliest stages of osteonecrosis (see Introduction to Hip Disease) in the hope that it will allow the blood supply to return to the femoral head. Some doctors report 85% success rate with this procedure, but generally the results are much less optimistic. Because there is a danger of fracturing the weakened bone, patients have to be on crutches for six weeks. If the procedure is unsuccessful, you will almost certainly need a hip replacement.

7. Hip arthroscopy has a very limited role in the management of hip arthritis. It is occasionally used to help diagnose perplexing hip symptoms. It has no role for removing bone spurs or smoothing over the arthritic bone, as some surgeons claim.
   

8. Other “possibilities” which patients frequently ask about include:
   1. Is it possible to restore the cartilage to the joint? It is now possible to implant new cartilage cells in a young knee with minimal, localized damage. It is not applicable to the hip.

   2. Does “robot surgery” improve the outcome? Recently the media has focused on attempts at “robot” surgery: little more than a milling machine, used to do a small part (about 10%) of the operation. It prolongs the procedure and has not been shown to be superior to conventional surgery. “Navigation”, i.e. computer guided surgery, somewhat akin to GPS missile guidance, may revolutionize hip replacement in the future.

   3. Are custom implants better than standard implants? Custom implants are extremely expensive because each is manufactured specifically for one patient.They rarely needed, and add very little to the ultimate success of the operation.