Orthopedics focuses on the musculoskeletal system. Learn about the diagnosis, treatment, and rehabilitation of bone, joint, ligament, and muscle conditions.
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Why does a hip joint fail? For most people, it isn’t a single event but a slow process of degeneration. The smooth cartilage that allows our joints to glide is durable, but it is not invincible. Over decades of use, or due to specific biological triggers, this cartilage can deteriorate. Once it is gone, the body cannot grow it back. The exposed bone ends become rough and pitted, grinding against each other with every step.
Understanding the cause of hip damage is important because it can influence the type of surgery you need and your recovery. While osteoarthritis is the most common culprit, other conditions like rheumatoid arthritis, fractures, and childhood hip diseases also lead to the operating room. This section explores the various reasons hips wear out, looking at the biology of joint destruction and the mechanical failures that make replacement necessary.
Osteoarthritis is the leading reason for hip replacement surgery. It is often referred to as “wear and tear” arthritis because it is strongly associated with aging. However, it is more complex than just high mileage. It involves a breakdown of the cartilage matrix—the proteins and water that make cartilage spongy.
As the cartilage thins, the joint space narrows. The body tries to repair this damage by growing extra bone at the edges of the joint, called bone spurs or osteophytes. These spurs restrict movement and cause stiffness. Eventually, the cartilage wears away completely in spots, leading to bone-on-bone contact. This friction causes inflammation, pain, and the grinding sensation known as crepitus.
Unlike osteoarthritis, which is mechanical, rheumatoid arthritis is an autoimmune disease. In this condition, the body’s immune system mistakenly attacks the synovial membrane—the lining of the joint capsule. This lining becomes inflamed and swollen.
This chronic inflammation produces chemical substances that eat away at the cartilage and bone. Rheumatoid arthritis often affects both hips at the same time. Because the bone itself can be softened by the disease, surgeons may use specific types of implants designed for soft bones to ensure a secure fit.
Bones are living tissue that require a steady supply of blood to survive. Avascular necrosis (AVN) occurs when the blood supply to the femoral head (the ball of the hip) is disrupted. Without blood, the bone cells die.
As the bone dies, it loses its structural integrity. Eventually, the femoral head collapses, flattening like a deflated ball. This collapse destroys the smooth spherical shape needed for the joint to rotate. AVN can be caused by long-term steroid use, excessive alcohol intake, sickle cell disease, or a traumatic dislocation of the hip that tears the blood vessels.
An injury to the hip, even if it occurred years ago, has the potential to trigger arthritis later in life. A severe fracture of the pelvis or acetabulum (socket) can damage the cartilage surface. Even if the bones heal, the cartilage surface may remain uneven.
This unevenness acts like sandpaper inside the joint. Over time, the friction wears down the remaining cartilage much faster than normal. A hip dislocation can also damage the blood supply or the labrum (a rubbery seal around the socket), leading to instability and degeneration years down the road.
Some people are born with hip problems that lead to replacement in adulthood. Developmental dysplasia of the hip (DDH) occurs when the hip socket is too shallow. Because the socket doesn’t fully cover the ball, the weight of the body is concentrated on a small area of cartilage rather than being spread out evenly.
This concentrated pressure wears the cartilage out prematurely. Similarly, conditions like Legg-Calvé-Perthes disease (a childhood form of AVN) or slipped capital femoral epiphysis (where the ball slips off the neck of the bone) can leave the hip joint misshapen. This “square peg in a round hole” mechanic inevitably leads to arthritis, often requiring hip replacement in relatively young patients.
While rare, tumors can grow in or around the hip joint. These can be benign (non-cancerous) or malignant (cancerous). A tumor can eat away at healthy bone structure, making the hip weak and painful.
In these cases, hip replacement is not just about pain relief but about removing the tumor and reconstructing the joint to restore stability. These surgeries are often more complex and may require specialized “tumor prostheses” that replace larger sections of bone.
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Yes. Excess weight puts a significant extra load on the weight-bearing joints, including the hips. This increased mechanical stress accelerates the breakdown of cartilage. Additionally, fat tissue produces inflammatory chemicals that can damage joint tissues.
There is a genetic component. If your parents or siblings had hip osteoarthritis, you are more likely to develop it. Your genes partly determine the shape of your hip joint and the durability of your cartilage.
For most people with healthy joints, recreational running does not cause arthritis. In fact, the cyclical loading can keep cartilage healthy. However, if you have a pre-existing hip problem or poor mechanics, high-impact running can accelerate wear.
Excessive alcohol consumption is a major risk factor for avascular necrosis (AVN). Alcohol can increase the amount of fatty substances in the blood, which can clog the tiny blood vessels supplying the femoral head, leading to bone death.
True hip joint pain is usually felt in the groin or the front of the thigh. Bursitis often causes hip pain, and back pain can cause buttock pain. Groin pain is the classic sign of cartilage loss inside the joint.
Did you know hip bursitis can make simple tasks hard? Hip bursitis is when the bursae, fluid-filled sacs, get inflamed. These sacs cushion joints and
Hip bursitis is a common condition that causes a lot of pain. This depends on how the condition affects a person’s life. To decide if
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