Medical Q&As

Arthritis in the hip - hip replacement?

My spine is curving and for the last 3 weeks I’ve had dreadful pain in my lower back, hips and shins. My x-rays showed little space for my hips to move in the sockets. I also have chondromalacia of the patella and had my left kneecap removed last year. Am I possibly looking at more surgery, like hip replacements? My physiotherapist won't touch me until I've seen my orthopaedic surgeon, but I'm afraid he won't do much, as he was on holidays when this happened and I went to a chiropractor and he did the x-rays for me. What do you think?

The sign you refer to on your hip x-rays is technically referred to as “loss of joint space” and is a feature of osteoarthritis of the hip. The hip joint is an example of a ball and socket joint where the ball refers to the rounded head of the femur or thighbone and the socket refers to the cup shaped socket in the pelvis into which the head of the femur fits. The opposing surfaces of the ball and socket are covered with a layer of shiny lubricated cartilage that allows one surface to glide over the other. This material is not radio-opaque, which means that it is invisible on the x-ray and in the case of a normal hip x-ray a gap is clearly visible between the surfaces of the ball and socket. In the case of significant osteoarthritis this covering material has been eroded and the gap between the ball and socket disappears. This results in one rough surface of bone grating off the other, which gives rise to the pain and stiffness we associate with arthritis. “Loss of joint space” is a cardinal feature of osteoarthritis of the hip. The possibility certainly exists that you may need a hip replacement and the orthopaedic surgeon is the best person to advise you on this matter. I would attend the specialist and get his opinion on what needs to be done. I would not be deterred from that course of action because you had previously attended a chiropractor. That fact should have no relevance with regard to your future management.