Young woman with lower back pain

Why Would You Need A Hip Replacement Surgery?

Total hip replacement surgery is a major operation, though it can be a very good operation if performed appropriately. What causes you to have enough pain in your hip that you would undergo this invasive, inpatient surgery, and are there any other options?

People enjoy running, walking, and participating in daily activities. At some point, your hip – which is a ball and socket joint with a hard, Teflon-like cartilage coating – wears down over time. If you experience injuries, like a fall or an accident or a sports injury, you can wear down that hard cartilage that’s protecting the ball and socket. This can lead to the formation of little potholes (divots or worn spots in the cartilage).

Why is that important? Because this hyaline cartilage is like Teflon, protecting the bone underneath. Bones are alive; they have nerve endings and blood vessels. When you don’t have protection over those nerve endings, and you put pressure on them, it hurts.

So when your orthopedic doctor views your X-rays and tells you that you have narrowing on one side of your hip joint, and that you are “bone on bone” or “almost bone on bone”, what they are really implying is that you’ve worn out some of that hard, Teflon-like cartilage. You have an area of thinning on that X-ray that’s suggestive of exposed nerve endings.

The only surgical solution to this problem known as chondromalaica is to cut out the joint and remove the nerve endings. That’s what hip replacement surgery accomplishes. It removes your entire natural joint and replaces it with a mechanical implant. It sounds like a big surgery for a very simple problem because it is! Surgery at any hospital has intrinsic risks associated with it. Note that a hip replacement doesn’t last forever. It’s not a bionic hip; you’re not going to be running at 50 miles per hour. It lasts about 10 – 15 years, per the package inserts from the people that make these implants. Are there any alternatives?

The answer is that it depends on what your hip joint looks like.

The hyaline cartilage, the Teflon coating, is the same material you see on the end of a chicken bone. When you eat chicken, that hard, white, rubbery cartilage that’s on the tip of a chicken bone? That’s hyaline cartilage. If you’re experiencing “bone on bone” hip pain, what you’ve done, over time, is worn out low areas or little potholes in your chicken bone cartilage. And then the nerve endings underneath don’t have protection, so when you put pressure on the joint through movement, it hurts. The medical term for this condition is chondromalacia. If it’s painful or bothersome to walk, you may change how you walk by limping, shifting a little to the left, etc. You may have a hard time getting out of the car. Your activity depends on the torquing and the pressure put on that low area.

Steroids and anti-inflammatory medicines are ways of reducing the swelling and inflammation inside of the joint. What most patients don’t realize is that the pain they’re feeling in their hip is a symptom of chondromalacia, yes, but it is more than a symptom.The pain is actually perpetuating the inflammation by releasing inflammatory proteins inside of the joint. The nerve endings are stimulating more inflammation because your body is trying to create a fluid cushion, so you don’t keep hitting that pothole.

Your hip is an encapsulated joint (a capsule surrounds it; it is an enclosed space). So as that fluid becomes more and more full, the space becomes tighter, the pressure becomes greater, and the pressure will press on the nerve endings, which stimulates more inflammation. It is a feedback loop that goes on for years. You’ll end up with chronic arthritic pain, stiffness, and change in your mobility, all because your muscles are adapting and shifting to try to protect you from hitting that pothole.

Think of it like you think of major hurricanes. The worse the conditions in the Gulf of Mexico – the warmer the air and the water are – the larger and more violent the storm typically is. There are no hurricanes in January, because the air and water are cold. The conditions aren’t right. When you remove the heat, the storm dissipates. Arthritic inflammation is like that. Nerve pain is like the “heat” and makes the inflammation worse, which in turn destroys more cartilage. The more pain, the worse the conditions for this perfect storm. When you ease the pain, you ease the inflammation, which decreases the visible swelling and associated stiffness.

When you undergo hip replacement surgery, you’re essentially removing the whole joint and replacing it with an implant. And voila! The nerve endings are gone. The pain is gone, and so is the inflammation…and so is the entire joint! That’s how joint replacement treats hip pain for chondromalacia.

But if the ball joint is still mostly intact and has a round shape – if it’s still functioning with just a bit of narrowing – that’s a really big surgery just for joint pain. Ironically, hip replacement surgery is positioned as a very simple solution to your problem. Remember, it is a big surgery that is hospital-based, takes a few hours, and requires six to twelve weeks of rehab afterwards. Obviously, though, there are risks of infection or other complications because of anesthesia.

If your joint is normal in appearance, though, you need to call us. AROmotion performs other, minimally invasive procedures that can help solve chondromalacia nerve pain and inflammation in your joint. Our alternatives to hip replacement allow you to keep your natural joint rather than having it cut out and replaced.

Interested? Call us for a free MRI review or visit aromotion.com to learn more.

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