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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. Agenda. How your hip works & why it hurts Is hip arthritis preventable?

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arthritis of the hip

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

agenda
Agenda
  • How your hip works & why it hurts
  • Is hip arthritis preventable?
  • What are the options for the arthritic hip?
  • Your questions
how your hip works
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
what is arthritis
What Is Arthritis?

Healthy hip

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

slide5
NORMAL HIP

ARTHRITIC HIP

arthritis background
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
types of arthritis
Types of Arthritis
  • Osteoarthritis (MOST COMMON)
  • Post-Traumatic
  • Inflammatory (rheumatoid arthritis)
  • Secondary to childhood hip disease
  • Many more…..
is arthritis of the hip preventable
Is Arthritis of the Hip Preventable?
  • 5 years ago the answer was NO!
  • Today, the answer is… SOMETIMES!
femoral acetabular impingement fai
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.
hip labrum tear is caused by fai
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.
how do i know if i have fai
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
treatment
Treatment
  • Hip Arthroscopy
  • Mini-open decompression
  • Hip Surgical Dislocation
  • Hip socket reorientation
  • Physical therapy usually not helpful
these treatments are effective at relieving pain

These treatments are effective at relieving pain.

May slow down or prevent the progression of cartilage damage and development of arthritis

symptoms of arthritis
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?
treatment options non operative
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
total hip replacement thr
Total Hip Replacement (THR)
  • Implants replace damaged surfaces
  • Helps relieve pain and restore mobility
  • 260,000 each year in the U.S.
goals of joint replacement surgery
Goals of Joint Replacement Surgery
  • Relieve pain!!!
  • Restore function, mobility to the prearthritis levels
background
Background
  • Total joint replacement is one of the most commonly performed and successful operations in orthopaedics as defined by clinical outcomes and implant survivorship*
implant considerations
Implant Considerations
  • Current technology has improved the bearing surfaces
  • Makes total hip replacement a viable option in young patients.
  • Components are more durable.
when should you have a hip replacement
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
risks of hip replacement
Risks of Hip Replacement
  • Dislocation
  • Leg length discrepancy
  • Infection (surgical treatment)
  • Blood clots (DVT)
  • Fracture
  • Loosening of components
  • Future surgery to revise components
slide32
Dislocation precautions, leg length discrepancies and recovery can be dependent on the surgical approach used to enter the hip
surgical approach
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
minimally invasive surgery mis
Minimally Invasive Surgery(MIS)
  • “traditional” incision was 12”
  • MIS incisions are 4”
  • Supposed to have lower dislocation rate and decreased pain
slide35
MIS???
  • Currently no proven benefit to smaller incision other than cosmetic appearance
mis minimal incision surgery
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
anterior total hip replacement
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.
traditional mis surgery
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
anterior approach
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
benefits of the anterior approach
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
who is not a candidate for anterior approach total hip replacement
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
slide42
95% of patient ARE candidates for an anterior approach. This can be determined rapidly by an experienced surgeon examining the patient and the xrays.
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