Practice Policy Update regarding COVID-19



This page is devoted to patient education. My goal is to provide simple, clear, and practical information about anterior hip replacement.

The hip joint consists of a ball called the femur head and a socket called the acetabulum. They are held together with ligaments and muscle that push the ball into the socket.

The normal lining between the ball and socket is made of cartilage and is very smooth.

When the lining is damaged and gets rough patients start to feel pain in the joint. Over time this leads to wear of the bone as the lining dissapears. This when the pain can be severe.

Conditions that can damage this smooth hip lining and make it rough include:

Normal Hip Normal Hip X-ray

Hip Arthritis

Hip ArthritisOsteoarthritis is form of arthritis the most common. It is a degenerative disease that occurs mainly in adults over age 50 but can occur at any age, especially if the relationship was (in one way or another) damaged. It usually reaches the main weight-bearing joints of lower limbs (hip and knee), but can also affect the joints of the spine and upper limb. Patients with osteoarthritis (in the case of hip osteoarthritis) often osteophytes around the joint that still limit the range of motion.

Rheumatoid Arthritis

Rheumatoid Arthritis

Rheumatoid arthritis is often found in young subjects, especially in women. The disease usually results in the alteration of many joint surfaces, so that patients complain of similar symptoms in the hands, feet, shoulders, hips and knees. There are also other symptoms such as anemia, weight loss, and recurrent episodic swelling of the affected joint, accompanied by pain, stiffness and instability.

Hip Fractures and Injuries

Broken Hip Socket (Fracture)

Post-traumatic arthritis is caused by a severe trauma that damages the articular surface, possibly with rupture of ligaments, tendons and muscles leading to global instability of the joint.

Avascular Necrosis

Avascular Necrosis

Aseptic necrosis may occur in some cases of hip fracture, even after consolidation. Aseptic necrosis is the death of the femoral head due to an interruption of blood supply. Apart from fractures, loss of blood supply in this part of the hip joint can be caused by a sickle cell anemia or a reaction to medication. Often there is no identifiable cause.

Arthritis After an Infection

Infectious arthritis occurs when a localized infection in another part of the body is carried by the bloodstream and becomes lodged in the hip joint. Bacteria and the body’s response to this invasion can quickly destroy the articular cartilage (in days). Open wounds in the hip joint can also be the cause of infectious arthritis.



Groin pain can appear slowly over time or quickly within a few months. The pain can radiate over the top of the thigh towards the inner part of the knee. Pain can also be located in the buttock.

Stair climbing can become difficult. Stiffness can occur in the morning or when getting up from a seated position. Low back pain is also associated, as patient can have arthritis in both hip and spine.Usually pain improves at night. This is called mechanical pain. This is typical of osteoarthritis.

When the pain is present with the same intensity during effort and at rest, we call this inflammatory pain. It may be associated with diseases such as rheumatoid arthritis.

Physical Exam

  • The patient will often limp because the leg is shorter, weaker, and more painful
  • The groin is tender to pressure
  • Range of motion is limited initially in rotation and eventually in flexion
  • The leg can be shorter when there is loss of cartialge or if the bone starts to erode


Once we have established that the patient has a hip problem we may need to order more tests to evaluate the problem and its cause.

  • Plain x-rays are obtained in the office and usually give us the most useful information
  • CT-scans are sometimes ordered if there has been a prior fracture or if the shape of the bones looks deformed on the x-rays
  • MRI is needed if we are suspecting that the bone has lost its blood supply or if we are suspecting infection or inflammation
  • Nuclear bone scans may be needed if we are suspecting infection
  • Bone density studies are ordered to evaluate hardness of the bone
  • Routine blood tests
  • EKG

    Blood test to evaluate for bone density may be ordered:

  • Calcium level
  • Vitamin D level: Most of our patients have a deficiency in vitamin D. This vitamin is essential for good bone health
  • Parathyroid Hormone level: Important hormone for bone