Following previous hip surgery, some patients can develop weakness or failure of the muscles/tendons at the side of the hip. This can cause instability of the hip or a waddling walk and eventually pain at the side of the hip.
SUFE or Slipped Upper Femoral Epiphysis is a childhood condition where there is a fracture through the growth plate of the femoral head. This occurs in early adolescence and usually presents with pain in the groin and occasionally on the front of the knee.
This is a condition where there is erosion of the inner wall of the socket (acetabulum) and the femoral head migrates into the pelvis. It is more common in females and can be associated with inflammatory arthritis such as rheumatoid arthritis. They are often very symptomatic and can require high levels of pain killers.
There are a number of childhood conditions such as Perthes disease, Hip Dysplasia and Slipped Upper Femoral Epiphysis (SUFE) which can cause significant abnormalities in the immature hip. There are a variety of ways of treating these conditions but traditionally, they would have been treated with surgery to change the shape of the femur. The picture below shows an x-ray of the right hip in a 40 year old male who had undergone a previous valgus osteotomy. While it gave him relief for some years, he then began to get increasing pain in his hip. X-rays showed that arthritis had set in due to his abnormal anatomy.
Perthes disease is a condition that affects children (often boys) between 4 and 10 years of age. There is disruption to the blood supply of the femoral head, which causes softening of the cartilage and eventually a change in the shape of the femoral head. Once the collapse occurs, the bone then heals and remains abnormally shaped. Because this can occurs at such a young age, the socket can remodel to try to match the head. While this can give the patient a functional hip for some years, once they reach their 20's or 30's, degenerative changes can set in and the hip becomes painful.
Since the 1990's there has been a significant increase in the number of hip resurfacings being carried out in the UK. This type of implant was developed in Birmingham and still remains the market leader. It was developed on the basis that it was an optimal implant to use in younger patients, as it conserved bone on the femoral side and the large head gave greater stability. However, as more and more implants have been implanted and other companies have developed their own versions, which had different geometries, problems have emerged. It has become clear that a minority of patients will develop soft-tissue reactions due to the production of metal debris. It seems to be more common in those with smaller femoral head sizes. It is currently only recommended in males under the age of 55 and is not carried out by Professor Fehily due to these problems. Following multiple reports of problems with these implants, the numbers being implanted in the UK have dropped significantly.
This is a procedure carried out in patients who are not suitable for hip arthroscopy. If a patient has had childhood hip disease such as Perthes, Slipped Upper Femoral Epiphysis or Avascular necrosis, their hip can often be left deformed and this can lead to the femoral head "impinging" against the rim of the acetabular socket. If the deformity is severe, then it is difficult to ensure that a full correction/reshaping has been carried out arthroscopically. In this cases an open procedure is advised.
The rate of deep infection in total hip replacements is about 1-2% and can vary from surgeon to surgeon and hospital to hospital. The most common organisms are not MRSA but bacteria that are normally present on the skin and only cause a problem when in the wrong place. Infection will either occur early, often due to contamination at the time of surgery or later due to spread via the blood stream (haematogenous spread). Patients will usually complain of a deep seated pain. There may have been a history of wound infection at the time of surgery. Often, the patient will say that the joint "never felt right". Clinically there may be little to find but x-rays may show evidence of loosening and blood tests will be abnormal. The patient will have an abnormal bone scan due to the increased blood supply around the hip and a positive white cell scan indicating the bodys' attempt to eradicate the infection.
Revision hip surgery is carried out for a variety of reasons. These can include the original hip wearing out, the presence of deep infection, recurrent dislocations and fracture around the hip replacement. Because of the variety of indications, both the investigations and the surgery must be tailored to each patient.
Implant loosening is the most common cause/indication for revision hip surgery. Hip replacements have been carried out in the UK regularly since the 1960's and this, in combination with the increasing lifespan of the average person, means that there is an increasing need for revisions. Patients often present with dull pain in either their groin or thigh, depending on which part of the components are loose.
When a patient has severe arthritis and painkillers no longer effectively control the symptoms, hip joint replacement is advised. This has the benefit of relieving the pain and allowing the patient to return to a near normal level of activity.
This is an innovative procedure that allows access to the hip joint using minimally invasive surgical techniques. It has been carried out episodically for some years, but in its current form has only been practiced over the last 5 to 10 years. It was pioneered by surgeons in the UK, Australia and the US and since then the indications have rapidly expanded. Initially it was used to remove loose bodies, take tissue samples and to investigate joint pain. However, since the concept of impingement has become clearer, it has been used to reshape both the pelvic cup (acetabular) rim and the femoral head/neck.
As hip replacements age, the components will wear and the hip will lose its' initial soft-tissue tension. This combined with a general increase in tissue laxity can lead to episodes of dislocation. The risks of dislocation are greatest during the early post-operative period when the tissues are still healing and later at 5-7 years. Treatment of early dislocation is usually conservative, so long as the components are correctly positioned. However, patients who dislocate after many years tend to continue to do so and often require revision..