The hip is a ball and socket joint composed of the upper end of the femur (the thighbone), and the acetabulum, the cup shaped socket in the pelvis. Both the ball and socket are lined with articular cartilage to reduce friction allowing the bones to easily glide over each other. The synovium, a specialized cell layer surrounding the joint surface, provides synovial fluid to lubricate the joint. Tendons and ligaments support the joint and facilitate movement. It is very stable joint and, when working well, provides great mobility without pain.
The hip is the largest weight-bearing joint in the body. The primary function of the hips is to carry your body weight while standing, walking, running and the ability to perform the routine activities of daily life.
There are several types of arthritis that affect the hip, which can significantly impact quality of life. The most common type is Osteoarthritis, a progressive, degenerative condition which leads to loss of joint space and pain with range of motion or weight bearing. Other less common types of hip arthritis include Rheumatoid arthritis, Psoriatic arthritis and infectious arthritis.
OA is degenerative arthritis often called “wear and tear” that can develop as we age or following injury to cartilage within a joint. It typically affects weight bearing joints like the hip and knee in people over the age of 50. Hip OA is common, affecting 15-18% of the U.S. population. It is the leading cause of disability among an aging or injured population causing functional impairment.
With age or injury, the articular cartilage at the ends of bones deteriorates narrowing the joint space. Simply put, the loss of cartilage leads to a “bone on bone” articulation of the joint. This is akin to having a flat tire where the wheel’s rim directly contacts the road leading to seizing and further structural damage. Within the body, this “flat tire” changes hip biomechanics allowing the bones to rub together causing further joint damage, instability and pain. In response, large, numerous bone spurs can develop in an attempt to auto-protect and redistribute weight in the joint, further reducing range of motion and exacerbating discomfort.
There are many factors that increase you risk of developing hip OA including:
- Sex – some studies report that women are more at risk than men
- Weight, increased BMI increases the risk
- Genetics – studies report that genetic factors contribute about 60% of the risk of hip OA
- Occupation – long term high-impact physical activity from sports or heavy labor
- Abnormal hip joint development called hip dysplasia
- Femoroacetabular impingement (FAI) and labral tears – A tear of the labrum is a contributing factor to development of OA.
- Injury (post-traumatic OA)
- Pain, swelling and stiffness with prolonged sitting (car ride, chair)
- Gait abnormalities (trouble with prolonged standing or walking)
- Pain in the groin, thigh, buttocks, upper knee
- Reduced range of motion (difficulty donning socks, tying shoes, exiting vehicle)
- A grinding sensation when the hip is moved called crepitus
- Painful intercourse
- Aching night pain (trouble sleeping)
The experts at LALL Orthopedics + will conduct a complete orthopedic evaluation which includes a review of your medical and family history, ask about the presence and frequency of your symptoms, and perform a thorough physical exam of the hip, low back, knee, ankle and foot. X-rays will be ordered and reviewed in-person to view the bones in the joint. The team may also order advanced imaging such as a CT scan or MRI to further evaluate the bones and soft tissues surrounding the joint such as articular cartilage and the labrum.
Many people find relief from improved self-care and focused symptom management.
- Regenerative Medicine (Platelet-Rich Plasma, Stem-Cell)
- With advances made in use of natural biologic medicine, LALL Orthopedics + employs the most cutting-edge regenerative medicine techniques available worldwide. These techniques utilize “Cell Therapy” to decrease joint inflammation and potentially improve cartilage regrowth via Ultrasound-Guided targeted treatments of Platelet-Rich Plasma (PRP) and Stem-Cell harvest.
- Physical Therapy / Lifestyle Modification
- Physical therapy can improve strength and range of motion of the muscles surrounding an injured hip joint, which can improve joint biomechanics and decrease fatigue. Our team highly recommends manual therapy treatments such as cupping, acupuncture, and tissue massage. Lifestyle modifications such as swimming and yoga instead of high-impact activities and weight management can also improve symptoms of OA.
- Over The Counter Medications
- This involves the use of anti-inflammatory and other pain-relieving modalities to help with hip pain symptoms.
There are several highly specialized surgical options, many of which have been developed by the expert team at LALL Orthopedics +, that exist to definitively cure hip OA. Options include:
Robotic Total Hip Replacement (Mako Total Hip)
Robotic (Mako) total hip replacement involves the removal and replacement of both the damaged socket and the head of the thighbone with the use of live tracking intraoperative robotic guidance systems. Newly placed surfaces along the joint allow for a smooth contact thereby improving joint range of motion, power generation, endurance, and overall function. The expert team at LALL Orthopedics + are trained to perform the most technologically advanced, minimally-invasive, direct-anterior, robotic hip replacement procedures. Patient are allowed to return to full activities without limitations.
Hip resurfacing is a novel bone conserving procedure performed by only a few surgeons worldwide, including the team at LALL Orthopedics +. In fact, our team recently published the technique for a minimally invasive direct-anterior approach hip resurfacing, which is considered by many to be a novel breakthrough in the field of joint reconstruction.
This surgery involves replacing damaged bone in the socket with a new surface, like total hip replacement. However, in contrast to total hip replacement, treatment of the head of thigh bone involves a removal of damaged cartilage followed by “resurfacing” with a covered cap. Since nearly all the thigh bone remains, the patient’s hip has potential to feel more natural allowing patients to return to full-contact sports and activities once again.
No matter the treatment option, LALL Orthopedics + is committed to helping get you back in the game doing what you love.
Dr. Ajay C. Lall is a former dual sport NCAA collegiate athlete (football and track & field), American board certified, triple fellowship-trained expert orthopedic surgeon who specializes in hip arthroscopy, robotic hip replacement and cutting-edge regenerative medicine such as platelet-rich plasma (PRP) and Stem-Cell therapy. He treats non-athletes and athletes at all levels of play from collegiate to professional to the Olympic level. Dr. Lall is a world-renowned orthopedic surgeon who cares for all patients like family.
At a Glance
Ajay C. Lall, MD, MS, FAAOS
- Board Certified – Orthopedic Surgery
- Triple Fellowship Trained
- Performs over 750 Surgeries Per Year
- Learn more