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Arthritis of the Hip - Overview

An Interview with Dr. Paul M. Pellicci

Arthritis of the hip is one of the most commonly treated conditions at the Hospital for Special Surgery (HSS). Arising from a variety of underlying conditions, all hip arthritis shares in common a loss of cartilage of the hip joint that eventually leads to bone rubbing on bone, and destruction of the joint. Unfortunately, once the arthritic process begins, progression is almost always inevitable. However, the degree of pain and disability experienced by people with arthritis varies considerably.

Anteroposterior radiograph of a normal hip joint
Anteroposterior radiograph of a normal hip joint. There is a uniformly lucent joint space (arrow).

Depending upon the extent of the damage and the patient's symptoms and age, hip arthritis may be managed either non-surgically or with surgery. A combination of approaches may also be recommended. The non-surgical approaches that reduce pain and disability include activity modification--giving up those activities that cause pain, anti-inflammatory medication such as ibuprofen and naprosyn, and weight loss. (While some claims have been made for the benefits of so-called nutraceuticals, such as glucosamine and chondroitin supplements, there is no good scientific evidence to support their use. Moreover, because these supplements are not regulated by the FDA, there is no assurance of quality.)

Anteroposterior radiograph of a hip with osteoarthritis
Anteroposterior radiograph of a hip with osteoarthritis. There is asymmetric superolateral joint space narrowing. Sclerosis and subchondral cyst in the adjacent bone are seen (arrow).

Surgical treatment options for arthritis of the hip include osteotomy (in which the bone is cut to realign the joint) and, more frequently, total hip arthroplasty (THA) or replacement of the joint.

The decision to undergo THA is made by the patient in consultation with the physician. For some people, the inability to participate in recreational activities that they enjoy prompts exploration of joint replacement. Pain--especially night pain--is another strong incentive for surgery. Others would rather modify their activities and rely on various methods for pain relief for as long as possible.

The availability of excellent surgical techniques and durable materials to replace the arthritic hip joint has made THA a more attractive option for many patients. These developments and the greater interest in participating in sports and recreational activities throughout one's lifetime have brought down the average age of individuals undergoing hip replacement.

Overall, THA is considered highly safe and effective. The surgery is performed with epidural anesthesia--the same type of anesthesia that many women receive during childbirth--so that they may be awake throughout if they so choose. This form of anesthesia significantly reduces the chance of complications associated with surgery and allows a more rapid recovery. Patients are usually hospitalized for no longer than 5 days and are then free to return home or, if they require additional assistance, to a rehabilitation facility.

Long term results at HSS are excellent with success rates of 85-93% over a 20 year period. While complications can occur, their incidence is low.

Diagnostic imaging examinations provided by HSS Radiologists *Summary Prepared by Nancy Novick


Headshot of Paul M. Pellicci, MD
Paul M. Pellicci, MD
Attending Orthopedic Surgeon, Hospital for Special Surgery
Professor of Clinical Orthopedic Surgery, Weill Cornell Medical College

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