Orthopedics & Spine

Causes of hip joint pain that may require hip replacement


November 10, 2020

Plus, what makes someone a good candidate for hip replacement surgery?

Chronic hip pain can prevent you from doing the activities you love and even cause discomfort when you’re trying to relax or sleep. Depending on the cause of your hip joint pain, the treatments you’ve tried, and your overall health, a hip replacement may be an option.

“When we see someone who has substantial hip discomfort and associated joint damage, and nonsurgical things have stopped providing them relief from their symptoms,” said Gregory Polkowski, MD, an adult reconstructive surgeon with Vanderbilt Orthopaedics, “that’s when we think hip replacement is indicated.”

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Vanderbilt Orthopaedics can assess whether hip replacement is right for you.

Causes of hip joint pain and deterioration

The most common condition that causes hip joint pain and damage is chronic degenerative osteoarthritis, Polkowski said. The arthritic process can result in cartilage destruction. The second most common cause is avascular necrosis, also called osteonecrosis. An interruption or reduction in the blood supply to the hip bone causes the tissue to deteriorate or die, Polkowski explained.

Additionally, rheumatoid arthritis, which is an autoimmune disease, and post traumatic arthritis, a condition that can develop after a fracture, can both cause damage that may eventually necessitate a hip replacement. Structural hip problems like hip dysplasia, where the hip socket is too shallow to accommodate the femoral head, or ball, can also create the need for surgery.

What makes someone a good candidate for surgery?

Nonsurgical interventions can offer potential pain relief, Polkowski said. But they can’t fix the underlying arthritis or reverse joint damage. So if nonsurgical treatments have stopped working for someone, that’s when surgery becomes a consideration.

Patients are good candidates for joint replacement when their pain affects their quality of life. “We don’t make the judgment purely on how the joint looks on X-ray,” Polkowski explained. “It has to be a combination of joint damage and chronic pain that really limits them from doing the things that they need to be doing.” Those limits could include anything from putting on socks or getting out of the car to walking or hiking. “All of those things you take for granted when the joints are working,” Polkowski said.

“We don’t make the judgment purely on how the joint looks on X-ray. It has to be a combination of joint damage and chronic pain that really limits the patient from doing the things that they need to be doing.”

However, certain underlying medical conditions can impact whether surgery is the right path for a patient. “If someone has too many risk factors that would increase the risk of having a bad outcome,” Polkowski said, “in those cases, we don’t necessarily recommend a surgical intervention.” Smoking, morbid obesity and poor nutritional status are some examples that can impact healing or increase the risk of infection.

But in many cases, a patient can work with the health care provider to reach optimal health and become a candidate for surgery, Polkowski explained. For example, if someone has diabetes that is poorly controlled, surgery can be delayed until better control is achieved. Or someone who smokes can undergo a cessation program first. “We really try to emphasize for people to improve their medical status going into a surgery like a hip replacement,” Polkowski said.

Not every risk factor can be eliminated, but having a pre-existing condition, like chronic lung disease or congestive heart failure, doesn’t eliminate surgery as an option for a patient. Vanderbilt’s pre-operative anesthesia team helps to optimize health before major surgery in high-risk patients, Polkowski said. “There are some things that we can’t fix before surgery,” he explained. “But we don’t want to deny the opportunity for those patients to experience the benefits from a hip replacement if at all possible.”

If you are dealing with an injury, facing surgery or coping with chronic pain, Vanderbilt Orthopaedics offers a full spectrum of care. Our specialists work with you from evaluation and “prehab” through physical therapy and, if needed, surgery. We’ll help you get back to doing the things you love, pain-free. To make an appointment, call 615-936-7846.

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Gregory Polkowski, M.D., is associate professor of Orthopaedic Surgery at Vanderbilt University Medical Center. In addition to co-chairing development of the AAOS CPG for osteoarthritis of the hip, he is co-chairing guidelines on the diagnosis and prevention of periprosthetic joint infections around hip and knee replacement surgery. Polkowski is a member of the board of directors of the American Association of Hip and Knee Surgeons (AAHKS).