Question: I am having my left hip replaced, and i have already had my right replaced 2.5 yrs. ago..I was wondering if the way I walk is the source of my hip replacements, as i am pigeon toed. I am 36 years old….
Answer: Thank you for submitting your question regarding hip arthritis. The cause of hip arthritis has been a constant source of research dating back to the 1950s and 1960s. Since that time there have been many studies which have examined the anatomic shape of the hip joint, gender, ethnicity and other factors such as activity or body weight. Unfortunately, there is still no clear answer as to the exact cause of hip arthritis.
Overall, the current thought is that most hip arthritis is secondary to dysplasia. Hip dysplasia is a condition which the hip socket or hip ball is not completely formed correctly. This results in stresses across the hip joint which are not evenly distributed across the ball-and-socket. This then causes early wear of the cartilage, inflammation of the hip joint and formation of loose bodies, all of which lead to arthritis throughout the entire joint. People with severe hip dysplasia may need hip replacements at a very young age. However, studies have shown that people with subtle hip dysplasia did not necessarily have an increased risk of needing hip replacement surgery. This appears to be related more to genetic and/or ethnic factors as Caucasian persons with subtle hip dysplasia seem to have a higher risk of needing hip replacement surgery than do African American or Asian people.
There are also several other causes of severe hip arthritis which may require hip replacement surgery. One of the most common may be osteonecrosis of the hip. This is a condition in which the bone of the hip ball temporarily loses its blood supply and becomes necrotic (dead). Then the process by which this dead bone is replaced by live bone results in a weakened hip ball which then collapses. The ball, which then is no longer round leads to early wear of the hip cartilage. Risk factors for osteonecrosis include the use of corticosteroids which are often use to treat conditions such as asthma, heavy alcohol use, bleeding disorders and Caisson’s disease which is related to scuba divers. Other causes of hip arthritis include rheumatoid arthritis, Paget’s disease or history of severe trauma/dislocation. All of these conditions result in wearing out of the cartilage and severe arthritis.
The fact that you are “pigeon toed “may actually be related to your need for hip replacement surgery at 36 years of age. The actual etiology of being “pigeon toed “or intoeing is sometimes related to excessive forward angulation of the hip joint/femur. We refer to this as anteversion. There have been studies which suggests that excessive anteversion may lead to early degenerative changes of the hip. However, other studies have not confirmed that finding. Without seeing your x-rays, it would be impossible to make a firm conclusion but I would suspect that you may have some subtle underlying dysplasia along with your femoral anteversion which is lead to early wear of your hip socket.
Hip replacement surgery in a young person such as yourself can be challenging. One of the main challenges is that many patients with dysplasia of the hip socket have altered anatomy of the bone which may make it difficult to appropriately place the hip replacement components. If the components are not placed in the proper position, the hip can dislocate and the components may wear out prematurely. In addition, traditional hip replacement surgery done through the posterior approach cuts several muscles and may not result in a functional outcome commensurate with a person in her 30s or 40s. Alternatively, anterior hip replacement surgery is done between muscles and is thought to result in better function and quicker recovery.
At Specialty Orthopedic Surgery we have experts in hip and knee replacement surgery. Our physicians routinely take on extremely difficult cases with successful outcomes. We would be happy to see you for a second opinion regarding hip replacement surgery. In addition, our physicians are also experienced and trained in the anterior hip replacement which may be a good choice for a young person having hip replacement surgery.