15 Aug Hip pain and hip replacement surgery

Hip pain and hip replacement discussed by local specialists Damian Clark (knee surgeon, NBT), Richard Baker (hip surgeon, NBT) and Lucy Prewett (GP, Bristol).

How useful do hip surgeons find the Oxford Hip Score in determining whether the patient needs a hip replacement?

A certain score on the Oxford Hip Score is not used clinically to decide if a patient should have a hip replacement. The most important factor when deciding on hip replacement surgery is to evaluate the patient’s symptoms. Do these symptoms affect their quality of life? The Oxford Hip Score is, however, very useful in measuring the postoperative improvement and allowing audit and research of the surgical outcome.

What red flags or sinister symptoms do you want to see? Conversely, is there anything you don’t want to see?

If a patient is suddenly incapacitated following a significant increase in symptoms and/or they have noticed the shortening of the leg. This could represent a collapse of the femoral head and can be very painful. Furthermore, the collapse of the head can cause significant damage to the acetabulum. This makes hip replacement more difficult and costly.

A red flag would also be bone pain that is not relieved by rest. This could be a malignant lesion of bone. Typically a patient can’t get comfortable, will have hip pain at night and made worse by bearing weight. A previous history of carcinoma could indicate bone metastasis.

Where a patient has chronic ulceration of the affected limb it is unlikely that hip replacement surgery would be offered. This is due to an increased risk of post-operative infection. In these cases, patients should be counselled that surgery is an unlikely option.

Are there any new approaches to hip pain, arthritis and hip surgery?

There are few changes in hip pain surgery that have a real advantage over current hip replacements. They are already one of the most successful operations performed. Recently there has been a vogue to perform hip replacements through an anterior approach, especially in mainland Europe and the USA. This hasn’t taken off in the UK due to complications such as fracture and difficulties extending the approach to deal with complications and revisions.

What can patients do to prevent hip pain and arthritis?

Nothing can prevent hip osteoarthritis! Weight loss will decrease the level of symptoms in early disease. Exercise should be encouraged as pain permits. But, there comes a point when the degenerative process is so far advanced weight loss won’t help the symptoms.

After reading this month’s blog I spoke with Gemma Artz from the CCG and she has put me on to Nikki Walsh’s “escape pain pathway.” This is a structured exercise program for reducing arthritis pain. We will look into this in the coming months.

In the next blog, Steve Hepple will answer questions on foot and ankle.