A joint is formed by the ends of 2 or more bones that are connected by thick bands of tissue called ligaments. The hip -- which, like the knee joint, must bear the full force of your weight -- consists of two main parts:

• • A ball (femoral head) at the top of your thigh bone (femur).
• • A rounded socket (acetabulum) in your pelvis.

Normal hip joint, showing healthy articular cartilage.

The ball (femoral head) on the thigh bone fits into the rounded socket (acetabulum) in the pelvis. Ligaments -- bands of tissue -- connect the ball to the socket and help keep the ball and socket steady. The surfaces of the ball and socket are covered by a smooth, tough material called articular cartilage, which cushions the bones and lets them move easily.

All the rest of the surfaces of the hip joint are covered by a thin, smooth tissue liner called synovial membrane, which makes a small amount of fluid that acts as a lubricant so that the bones in the hip joint will not rub against each other.

 

What Causes Hip Joint Pain?

One of the most common causes of joint pain is arthritis. The most common types of arthritis are:

Osteoarthritis (OA) -- sometimes called degenerative arthritis because it is a "wearing out" condition involving the breakdown of cartilage in the joints. When cartilage wears away, the bones rub against each other, causing pain and stiffness. OA usually occurs in people aged 50 years and older, and frequently in individuals with a family history of osteoarthritis.

Rheumatoid Arthritis (RA) -- produces chemical changes in the joint space that cause it to become thickened and inflamed. In turn, the synovial fluid destroys cartilage. The end result is cartilage loss, pain, and stiffness. RA affects women about 3 times more often than men, and may affect other organs of the body.

Post-traumatic Arthritis -- may develop after an injury to the joint in which the bone and cartilage do not heal properly. The joint is no longer smooth, and these irregularities lead to more wear on the joint surfaces.

Other causes of joint pain include avascular necrosis, which can result when bone is deprived of its normal blood supply (for example, after organ transplantation or long-term cortisone treatment), and deformity or direct injury to the joint. In some cases, joint pain is made worse by the fact that a person will avoid using a painful joint, weakening the muscles and making the joint even more difficult to move.

What's causing your hip pain? Is getting relief through total hip replacement an option for you? These are just some of the answers that an orthopaedic specialist can provide. But first, it's a good idea to be sure you have information about joint replacement that will help you understand what the specialist tells you.

 

Diseased hip joint, showing worn cartilage.

 

Ready to Consider Total Hip Replacement? You're Not Alone

If arthritis (or injury) has damaged your hip, and different treatments for your pain haven't helped you get through your everyday activities comfortably, you may be ready to consider hip replacement surgery. You'll be in good company: Today, more than 300,000 Americans a year have total hip replacement surgery. First performed in 1960, this procedure is considered one of the most important surgical advances of the past 100 years. It has amply fulfilled its promise of restoring many people to the lives they knew before their hip pain worsened.

 

Having an Orthopaedic Evaluation

If you're ready to consider having total hip replacement, the next important step is to talk with an orthopaedic specialist. The medical management of arthritis and joint degeneration may be handled by a family doctor, an internist, or a rheumatologist. However, when medical management is not effective, an orthopaedic specialist should be consulted to determine if surgery is an option. In some cases, the orthopaedic specialist may be the first physician to see a patient and make the diagnosis of arthritis.

Note: Many factors will go into making your joint pain diagnosis. Be sure to print out the results of your Assessment and the Preparing for Your Specialist Appointment page, and show them to your orthopaedic specialist during your visit.

While every orthopaedic evaluation is different, there are many commonly used tests that an orthopaedic specialist may consider in evaluating a patient's condition. In general, the orthopaedic evaluation usually consists of:

• • A thorough review of your medical history
• • A physical examination
• • X-rays
• • Additional tests as needed

The information that the orthopaedic specialist gathers during the medical history usually suggests the possibility of several different diagnoses (causes). After the medical history is taken, the orthopaedic specialist conducts a physical examination. (If you are experiencing pain in your hip joint, your back may be examined, because hip pain may actually be the result of problems in the lower spine.)

After the physical examination, X-ray evaluation is usually the next step in making the diagnosis. The X-rays help show how much joint damage or deformity exists. An abnormal X-ray may reveal:

• • Narrowing of the joint space
• • Cysts in the bone
• • Spurs on the edge of the bone
• • Areas of bony thickening called sclerosis
• • Deformity or incorrect alignment
• • Other abnormalities

Additional tests may include laboratory testing of blood, urine, or joint fluid and/or magnetic resonance imaging (MRI) or a bone scan of the joint and surrounding soft tissue.

 

Treatment Options

Following the orthopaedic evaluation, the orthopaedic specialist will review and discuss the results with you. Based on his or her diagnosis, your treatment options may include:

• • Medication
• • Physical therapy
• • Hip joint fluid supplements (injections that provide temporary pain relief)
• • Total hip joint replacement

If you and your orthopaedic specialist decide that total hip replacement surgery is an option to relieve your pain, the orthopaedic specialist will provide the specific-to-you details of which type of artificial hip he or she will use, what you need to know to prepare for the surgery, how the surgery will be performed, and what results you can expect once you're up and moving again