Normal anatomy of the Hip joint
The hip joint is a ball in socket joint composed of the acetabulum (socket) and the femoral head (ball). The joint is lubricated with synovial fluid, and has a shock absorber on both the acetabulum and the femoral head called joint or articular cartilage. The acetabular labrum is a suction cup attached to the rim of the socket, and this helps to hold the joint in place, and spread the lubrication around the joint.
Sometimes the labrum can be torn and cause pain, as it has a very dense innervation with pain nerve fibres. There are various ligaments which combine to form the capsule of the hip joint which holds in the joint fluid. When the articular cartilage wears out, this is called osteoarthritis, or arthritis for short. Generally the treatment for arthritis in the hip is some type of hip replacement surgery.
Our hip & pelvis procedures:
Hip arthroscopy is a relatively new surgical technique that can be effectively employed to treat a variety of hip conditions. Arthroscopy of the hip joint is generally done through two keyholes and allows access to repair the acetabular labrum, and to reshape or recontour abnormal bone shape of the acetabulum or femoral neck called hip dysplasia. This technique has generally replaced open surgery of the hip for labral tears or certain types of hip dysplasia.
Femoro Acetabular Impingement FAI
Femoro Acetabular Impingement FAI is a condition resulting from abnormal pressure and friction between the ball and socket of the hip joint resulting in pain and progressive hip dysfunction. When left untreated, leads to the development of secondary osteoarthritis of the hip. If conservative treatment such as physiotherapy and medication does not improve symptoms and function, hip arthroscopy can be used to manage this problem.
A cam lesion is a lump of bone on the femur which can either be a result of hereditary disease, slipped capital femoral growth plate or hip dysplasia.
A pincer lesion is where the socket is too tight and does not allow adequate movement of the femur, and this can be associated with tearing of the acetabulum labrum.
A Total Hip Replacement (THR) procedure replaces all or part of the hip joint with an artificial device (prosthesis) to eliminate pain and restore joint movement. This operation is one of the most successful surgical interventions ever performed, and the results in the National Joint Replacement Registry of Australia demonstrate around 95% of hip replacements still functioning well 15 years after they have been put in. Most patients rate their hip replacement somewhere between 90% and 100% as good as a normal hip, with most activities allowed after total hip replacement surgery.
Total Hip Replacement (THR)
Hip Resurfacing or bone conserving procedure replaces the acetabulum (hip socket) and resurfaces the femoral head. This means the femoral head has some or very little bone removed and is replaced with a metal component. This spares the femoral canal. A hip resurfacing is a metal on metal device, and as such requires more regular follow-up to ensure that levels of chromium and cobalt remain at a normal level. Hip resurfacings require metal ions to be regularly checked, and are still an option for appropriate patients, as long as certain guidelines are followed
A Revision Hip Replacement may be recommended when a previous hip replacement needs to be revised. This operation varies from a very minor adjustment to a massive operation replacing significant amounts of bone. This type of hip surgery is more complicated than primary total hip replacement and requires knowledge of different approaches, techniques, prosthetic devices and bone grafting skills, and is indicated when one or both of the components of a hip replacement become loose, worn, or painful.
Revision Hip Replacement
Hip bursitis refers to pain associated with the lubricating sack over the outside of the hip bone, called the greater trochanter. Bursitis may be incredibly painful, and for some as debilitating as end stage arthritis. It tends to affect ladies in their 50's and 60's, and men in their 70's and 80's. The treatment for hip bursitis includes anti-inflammatory tablets, physiotherapy and ultrasound, dry needling, and surgery which can be arthroscopic (keyhole) or open in more severe cases.
Dislocation is a complication associated with a total hip replacement. Essentially the ball pops out of the socket. This can be very painful and can affect the confidence of the person with the hip replacement. It is more common in people who have scoliosis or severe back stiffness, and people who have weak hip abductor muscles, or neuromuscular disorders. After a hip replacement some surgeons request patients to have a period of restrictions with limited angulation the hip. Some hip replacements have larger heads to reduce the dislocation risk.
There are various muscle problems in the hip which can range from tear of the rectus femoris muscle, or the attachment of the hamstrings. Many of these issues can be managed via the use of analgesia, physiotherapy and other strengthening activities, but occasionally require reattachment surgery. The treatment pathway depends on the severity and the age and activity of the person with the injury.
Muscle Strains in the Thigh
Snapping hip may be caused by snapping of the sewers tendon over the front of the femoral head (coxa saltans interna) or of the iliotibial band (ITB) over the outside of the femur (coxa saltans externa). Snapping hip is initially managed conservatively with physiotherapy, stretching exercises, and injections of cortisone. Surgery is recommended when the pain of snapping becomes severe and limiting. This is generally done arthroscopically via a keyhole approach.
For information about non-surgical treatment options click here
Our specialist hip & pelvis surgeons are:
Dr Al Burns graduated in medicine from the University of Sydney in 1995, and completed his advanced orthopaedic training in Sydney.
A graduate of the University of Sydney Dr Nicholas Tsai did his internship and residency in Westmead Hospital.
Professor Paul Smith graduated in medicine from The Flinders University of South Australia 1986, and completed orthopaedic surgical training in 1995.
Dr Kulisiewicz graduated from the University of Sydney in 1998, then went on to work at The Canberra and Calvary Hospitals as an intern...