Hips & pelvis

The hip joints are ball and socket joints, like the shoulders, and enable us to move in various directions: flexion and extension, abduction and adduction, internal and external rotation. Ligaments and muscles help to hold the balls of the joints in the sockets.

The pelvis is composed of the sacrum and the two hip bones. It is connected to the spine and enables humans to have a stable, upright posture. The female pelvis is very different from the male equivalent: women’s pelvises are wider (particularly the pelvic outlet) for giving birth. 

Here are some of the common problems and diseases that can affect the hips and pelvis.

It is not a comprehensive list.

• Hip osteoarthritis
• Hip displasia
• Femoral offset

Hip osteoarthritis

Hip osteoarthritis causes the surfaces of the joint to become uneven, so that they gradually wear down. As a result, the hip joints develop signs of wear and tear and can no longer move freely. This can lead to the following problems and diseases:

• Worn out cartilage
• Abnormal bony growths on the joint surfaces (osteophytes)
• Build up of fluid or swelling
• Shortened and thickened tendons

For more information, see the clinical picture of osteoarthritis and rheumatoid arthritis, chronic polyarthritis.

Hip displasia

A hip displasia is a congenital deformation of the hip joint. The ball of the joint does not sit securely within the hip socket, because the acetabular roof has not formed properly and does not provide the necessary support. Up to four percent of all babies suffer from hip displasia. It can be identified during the routine examination shortly after the birth and sometimes treated conservatively (for example with loose swaddling).

If the deformation causes excessive strain or incorrect pressure on the cartilage, it can lead to osteoarthritis. A special surgical procedure can be used to move the hip socket into the correct position over the ball of the joint. However, if a person is already suffering from advanced osteoarthritis, often the only treatment that can help is a total hip replacement.

Femoral offset

A femoral offset is a geometric problem with the hip. Instead of being nice and round, the ball of the femur has a lump on it, which bumps against the hip cavity again and again when the hip is moving. The hip cavity is covered by the labrum, a kind of ‘reinforcement ring’ made of fibrocartilage. It is full of sensitive nerve fibres and emits painful sensations in the groin area if a lump regularly bumps against the hip cavity. This can even damage the labrum and the cartilage near the hip cavity, which can lead to early osteoarthritis. Surgery is reasonably effective for treating offset disorders. The lump on the hip joint is milled down using keyhole surgery. If the labrum has been damaged by the offset, it may be partially or wholly removed, repaired or made smooth again.

Click on the links below for more information.

Our medical specialists regularly answer readers’ questions in newspapers, magazines and online. We have put together a few of these questions and answers for you here. Please note that the Q&A is purely informative. The advice provided is not comprehensive and does not substitute a consultation with a medical professional.

• Total hip replacement surgery or hip resurfacing operation?
• Prosthetic hip in old age
• When should an artificial hip be replaced?

Total hip replacement surgery or hip resurfacing operation?

«Dear medical team, I have suffered from coxarthrosis in my right hip for years. I’m 49 years old and would like to continue playing a lot of sport, so a surgeon explained to me the possibility of having a hip resurfacing operation rather than a conventional total hip replacement. The particular advantages of this method is that the rehabilitation time is shorter and. I have to decide which method I would prefer, which is why I would appreciate your opinion on the matter.»

Regarding your coxarthrosis: it would appear that you are being presented with the choice between resurfacing or a conventional entirely prosthetic hip.

You will of course hear all kinds of different opinions on the topic and receive different recommendations, depending on the experience and preferences of the respective surgeons. Since you are directing your question at me and would therefore like my personal opinion, I will gladly provide you with my subjective view on the matter. I do not perform resurfacing and would not have this procedure done myself. This method is currently in vogue and certainly has a few benefits, however it is technically very complex and there is a considerable lack of long-term studies. Possible complications include the risk that the femoral neck may fracture after the operation. The ‘advantage’ that less tissue needs to be removed is negligible, because the current hip replacement technique also involves minimal tissue removal and means that a second replacement later in life is essentially no longer a problem. In addition, a fully prosthetic hip is a well-known, reliable and sturdy piece of technology that will enable you to fulfil your desire to continue playing sport. If the hip replacement is performed using a minimally invasive method, the hospitalisation period even tends to be shorter than that of a resurfacing operation, and you are likely to be able to start using the joint again sooner. As you can see, from my point of view, there’s no doubt about it: if I were you I would opt for the full hip replacement.
Dr. med. Bernhard Thomann, Hirslanden Klinik Permanence

Prosthetic hip in old age

«My mother is 82 years old and has osteoarthritis and osteoporosis. Otherwise, mentally, she’s very fit. Now the question of a prosthetic hip has come up. Generally speaking, is it possible to have such an operation at her age? And what is the recovery process like? Rehabilitation? She lives on her own, looks after the place herself and would like to be able to continue doing so after the operation.»

Hip replacement operations can also be carried out on elderly people and those suffering from osteoporosis. The operation is usually very rewarding, because it not only reduces or eliminates pain, but may also enable the patient to retain their independence. The healing process is the same regardless of age, as long as the person is not limited by any other ongoing conditions. It is usually a good idea to use a walking stick for about the first four weeks after surgery. Often patients complete a rehabilitation programme or visit to a health resort for two weeks directly after being discharged from the hospital.
Prof. Brigitte Jolles-Haeberli, Centre for Orthopaedic Surgery, Clinique Bois-Cerf

When should an artificial hip be replaced?

«As a patient, how can I work out when it’s time for my hip joint to be replaced again (apart from symptoms like vague pain and slightly impaired mobility)? My joints are now 12 years old and I was born in 1945 (70 years old). What should I pay special attention to, so that the operation is not carried out too early or too late? And what kind of preventative measures are important at my age?»

Artificial hip joints are usually monitored with regular x-ray examinations. Typically, the examinations are performed every two years. The x-ray examinations are generally combined with a clinical check-up, during which the patient is asked about any pain or problems they may be experiencing and the function of the joint can be measured. These days, artificial hip joints normally last for 10 to 20 years – sometimes even 25. After that you can assume the joint will need to be replaced. It is important that the joint is replaced at the best possible time. If the artificial hip is very badly worn out, the replacement operation will also be much more difficult and technically complex. The best time for a replacement operation can usually be determined by examining the x-ray images. The decision is always based on the patient’s individual circumstances.
Dr. med. Walter Seelig, Hirslanden Klinik Birshof, Münchenstein