How to Manage Hip Arthritis

By Simon Greenbaum, MD

Did you know that arthritis is the number one cause of disability in the U.S., impacting over 50 million Americans? Over half of this population is unable to participate in daily activities due to pain, according to the CDC.

What exactly is arthritis? Arthritis is the mechanical wear and tear of the cartilage that lines joints. There are many forms of arthritis including autoimmune conditions such as ankylosing spondylitis, rheumatoid arthritis, psoriatic arthritis, but the most common type is osteoarthritis.

Osteoarthritis is a degenerative joint disease that typically affects hips, knees and fingers. While some people may experience mild osteoarthritis, others endure significant pain restricting their everyday life. Osteoarthritis is caused by normal wear and tear that occurs as a person ages. Sometimes, prior injuries can exacerbate osteoarthritis, making it accelerate faster. There is also a genetic component – your risk may be higher if your parents suffered from severe early-onset arthritis.

If you are experiencing arthritic joint pain, the best thing to do is keep moving. Arthritis sets you up for stiffness so treatments like physical therapy, anti-inflammatory medications and various injections are good non-surgical management tools to manage the pain.

Maintaining a healthy weight is also important to alleviate joint pain.

If the pain is too severe, your physician may recommend a joint replacement. Hip and knee replacements are the best surgical ways to treat stiffness that stems from arthritis.

The good news is hip replacements, in particular, are very successful procedures with high patient satisfaction. Patients report pain relief and restored mobility post-surgery.

The two most common surgical approaches for a hip replacement are anterior and posterior. In the anterior approach, the surgeon makes an incision in the front of the leg, while the posterior approach requires an incision on the back of the hip. From there, the procedure is technically the same.

Personally, I prefer an anterior approach because it’s muscle-sparing. By definition, if you go in posteriorly, you will have to cut through some muscle that will then need to be repaired. If you go in from the front, you have the ability to move the muscles aside temporarily while you complete the replacement.

Thus, patients who undergo a hip replacement via the anterior approach will likely have a faster recovery in the early stages. This makes it very conducive for an outpatient environment where patients will be discharged the same day to recover at home.

I feel this is a great option for someone of a healthy weight who wants to return to an active lifestyle sooner also well as those who opt for an outpatient procedure. There are fewer restrictions in the first 6 weeks after surgery compared to the posterior approach.

That being said, the posterior approach is considered the “classic” approach that has been used for decades while the anterior approach has gained traction during the past 15 years.

I perform hip replacements both anteriorly and posteriorly, and discuss with my patients which approach is best for them. The bottom line is that hip replacement surgery is very successful. While the benefits of different surgical approaches may seem small, they do exist so it’s worth having a conversation with your surgeon about what’s best for you.