The hip joint unites the head of the femur to the acetabulum of the coxal bone. Intra-articular surfaces are covered by cartilage and the acetabular labrum attaches to the bony acetabular rim within the joint.

Hip injuries

An injury to the hip joint can cause a labral tear. It may cause pain in the groin a young person born with abnormal bone shapes causing an impingement (femoroacetabular impingement). A torn labrum can be repaired and the abnormal bone shape corrected by surgery.

Be careful! Patients with groin pain without an injury are seldom improved by hip arthroscopy even if imaging techniques demonstrate a degenerated or torn labrum.

Hip bursitis (trochanteric bursitis) causes pain of the outer hip and thigh. In young people it can be associated with a “snapping”. In the older population, a degenerative tear of the gluteus tendons is sometimes associated. Surgery may be required to treat this problem.

Hip osteoarthritis

Osteoarthritis is the destruction of cartilage surfaces, often related to the aging process. Pain is mostly felt in the groin and sometimes in the buttock and the knee.

It is not possible to regenerate cartilage. When hip pain get worse and surgery is the only option left, a total hip replacement (THR) is performed with implants made of metal, plastic or ceramic.

Frequently asked questions

Approximately 50% of patients rate their hip as normal following surgery. Another 45% report improvement following THR but feel their hip is not back to normal.

The most common complaints of those rating the result of their surgery as good are scar tissue discomfort and discomfort caused by some movements.

Most total hip replacements are performed on patients 65 year-old or older with severe osteoarthritis because implant survival is approximately 20 years. Hopefully, this will prevent eventually a new surgery to change the prosthesis.

More and more patients benefit from surgery before the age of 65 year-old.
Improvement of materials used to produce prosthesis allows most of these patients to lead a normal life. However, these patients accept the risk of a new surgery one day to change the prosthesis. The younger the patient at surgery, the higher the risk of revision surgery. That's why some orthopedic surgeons refuse to perform surgery on young patients.

Yes, but globally the complication rate is higher. Some more specific risks are malposition of implants because the joint access is more difficult, and sciatic nerve injury by a greater force needed to dislocate the joint or greater pressure applied by the soft tissue retractors during the surgery.

That's why it is better to loose weight before surgery and some surgeons refuse to perform surgery on obese patients.

There's no age limit for total hip replacement. To qualify for surgery, general health must be good enough to expect an eventful surgery, and the post-operative goal must be a realistic significant improvement in the quality of life.

This is still a matter of debate between orthopedic surgeons.

When surgery if performed from the front of the hip (anterior approach), no tendons are cut. Gait is often steady right away making early rehabilitation easier. Surgical technique is more demanding especially in some obese patients, with short stature or important deformation of the hip joint.

When surgery is performed from the back of the hip (posterior approach), Gluteus Maximus muscular fibers are spreaded and some small external rotator tendons are cut and repaired at the end of surgery. Gait is often less steady making the first few days of rehabilitation less predictable. Surgical technique is easier. Dislocation rate is higher unless a “large” femoral head is used to reduce the risk to the same as the anterior approach.

Whatever approach is used, implants need to be in good position to provide a good result.

This is a subject of controversy among orthopedic surgeons.

For many surgeons, mechanical properties of irradiated plastic (also called cross-link polyethylene) used to produce acetabular liners justify its use on all patients. These liners may be used with femoral head made of metal to create a metal-on-polyethylene (MoP) bearing or made of ceramic to create a ceramic-on-polyethylene (CoP) bearing.

For the others, mechanical properties of ceramic used to produce acetabular liners and femoral heads (always used as a ceramic-on-ceramic - CoC - bearing) justify its use in young active patients. MoP and CoP bearings are used only on older less active patients.

Yes. Motion of the hip is mandatory for good lubrication of the hip joint by the synovial fluid produced by the membrane (synovium) inside the joint. However, impacts and torsions can damage the prosthesis and reduce its life expectancy.

That's why cycling, swimming and walking are recommended while running and jumping are not. Skiing, skating and playing tennis may be possible sometimes.