Hip surgery

Hip diseases

The hip joint is a deep articulation which is not very accessible to palpation; it is commonly located laterally, it actually radiates pain, essentially forward, i.e. at groin level.

Pains caused by certain spine diseases and those radiating from the hip can often be mistaken because they feel very similar. In the same way, hip pains often descend towards the knee.

Sometimes prior to childbirth, there is a bad leg position of the foetus in the mother’s womb which may lead to hip malformation called dysplasia. As people grow older, it may contribute to hip arthritis, known as osteoarthritis (osteoarthritis is caused by the painful wear and tear of the concerned joint cartilage).

Hip joint Hip Labrum

There are three types of hip disorders :

The first type most often affects younger patients : such as tears in the hip meniscus called labrum, but it can also be a conflict between the neck of the femoral head and the pelvis bone better known as femoroacetabular impingement.
The second type includes hip osteoarthritis called coxarthrosis, most commonly occurring in patients over 50 years of age and which may have different sources: trauma from accidents and injuries that have damaged the joint; dysplastic origin when a birth malformation led to repeated dysfunction of the joint, microtraumatic origin when sporting activities or repeated carrying of heavy loads has made the joint wear out over time.
For this type, only rest, medication and corticoid injections (cortisone or gel = hyaluronic acid) may help to relieve pain in order to delay the inescapable deadline of the replacement of the joint by a hip implant.
The third common condition is hip osteonecrosis or osteonecrosis of the femoral head. It involves patients of all ages (especially between 30 and 50), but the intensity of the pain associated with the progressive death of bone tissue inevitably leads to total hip replacement despite the patient’s age which can usually restrain the replacement of the joint (because an implant is mostly a part made of metal and ceramic, therefore with limited lifetime, although advances have made it possible to extend this duration to over 15 to 20 years on an average).
And yet, after all this time, not only does the prosthesis wear but also the bone around it and the replacement can possibly be done only if the bone is not too damaged.

To cope with these three types of hip conditions, there are many possible treatments: the most frequent is medication and especially anti-inflammatory medication, adapted rehabilitation therapy sessions, intra-articular injections of medications and eventually, when all else has failed to relieve pain: surgery.

Hip surgery and operations

Arthroscopic hip surgery has developed lately; this technique requires appropriate equipment and can only be performed by a few centres in France such as the Saint-Privat clinic: it consists in repairing the hip without opening the joint by making two incisions in the skin to allow passage of the instruments and especially a micro-camera into the centre of the joint. It thus allows to treat a torn hip meniscus called « labrum », in the same way as meniscus tears are treated in a knee injury. It is also possible to treat the femoroacetabular impingement, whether produced by cam or pincer effect (see chapter on femoroacetabular impingement).

Prosthetic surgery is performed without a camera; it increasingly makes use of minimally invasive techniques; the most developed minimally hip surgery technique in recent years is the minimally-invasive anterior approach; it allows to perform a total hip replacement procedure without any muscular lesion, with a 6 to 7 cm skin incision; this makes it possible, among other benefits, to reduce the hospitalization length to a few days or even to consider an outpatient hip replacement, which was unthinkable only a few years ago.

The minimally invasive anterior hip replacement procedure has been commonly performed in our clinic for 10 years, which makes the centre a forerunner in this field. It thus allows to treat all the types of hip arthritis and necrosis mentioned above.