How A Hip Works

By understanding how a normal, healthy hip works, it will be easier for you to understand the way an artificial hip joint works.

The ball (femoral head) on the thigh bone fits into the rounded socket (acetabulum) in the pelvis. Ligaments, which are 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.

Causes Of Hip Pain

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


Normal hip joint, showing healthy articular cartilage


Diseased hip joint, showing worn cartilage


Post-operative hip joint with prosthesis in place

Osteoarthritis (OA) - sometimes called degenerative arthritis because it is a "wearing out" involving the breakdown of cartilage in the joints. When cartilage wears away, the bones rub against each other, causing pain and stiffness. This 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 synovium that cause it to become thickened and inflamed. In turn, the synovial fluid destroys cartilage. The end result is cartilage loss, pain, and stiffness. This 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.


Treating Hip Pain

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

What You Should Know About Hip Joint Replacement

"Joint replacement" is usually reserved for patients who have severe arthritic conditions. Most patients who have artificial hip joints are over 55 years of age, but the operation is being performed in greater numbers on younger patients thanks to new advances in artificial joint technology.

Circumstances vary, but generally patients are considered for total joint replacement if:

  • Functional limitations restrict work, recreation and the ordinary activities of daily living.
  • Pain is not relieved by medications or physical therapy or by the use of a cane, and/or by restricting activities.
  • Stiffness in the joint is significant.
  • X-rays show advanced arthritis or other problems.

What Is Total Joint Replacement?<

Total joint replacement is a surgical procedure in which certain parts of an arthritic or damaged joint are removed and replaced with a plastic or metal device or an artificial joint. The artificial joint is designed to move just like a healthy joint. Hip replacement involves replacing the femur (head of the thigh bone) and the acetabulum (hip socket). Typically, the artificial ball is made of a strong metal or ceramic, and the artificial socket is made of polyethylene (a durable, wear-resistant plastic) backed with a metal shell. The artificial joint may be cemented in position or held securely in the bone without cement.

Are You Ready to Consider Hip Joint Replacement?

If different treatments haven't helped you get through your everyday activities comfortably, you may be ready to consider hip replacement surgery. 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.

Possible Complications of Surgery

Serious complications may occur with any surgical procedure. These include but are not limited to: problems with anesthesia, cardiovascular problems including heart attack, vascular problems including thrombus, bronchopulmonary problems including emboli, genitourinary problems, and gastrointestinal problems. Certain additional complications related to joint replacement surgery in particular may include but are not limited to: bleeding problems, blood clots in the legs and/or lungs, wound healing problems, damage to nerves and blood vessels, limb length discrepancy, bone erosion or abnormal bone formation, dislocation, infection, pain, bone fracture or non-union, component wear or fracture, component loosening. Complications may require medical intervention including additional surgery and, in rare instances, may lead to death.

Will an Artificial Hip Joint Last Forever?

As successful as most of these procedures are, over the years, an artificial joint can become loose and unstable or wear out, requiring a revision (repeat) surgery. These issues — together with the fact that increasing numbers of younger and more active patients are receiving total joint replacement and patients are living longer — have challenged the orthopaedic industry to try to extend the life cycle of total joint replacements.

Recent improvements in surgical techniques and instrumentation will help to further the success of your treatment. The availability of advanced materials, such as titanium and ceramic and new plastic joint liners provides us with options that may help you to increase the longevity of the artificial joint.

Orthopaedic Evaluation

If you're ready to consider having hip joint replacement, the next important step is set up an appointment with us. 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 surgeon should be consulted to determine if surgery is an option. In some cases, we are the first to see a patient and make the diagnosis of arthritis.

While every orthopaedic evaluation is different, there are many commonly used tests that we perform when 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

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

Treatment Options

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

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