Welcome to the South West London Hip Clinic

• The bones that come together to make the joints in our body allowing us to move are covered in an extremely smooth, highly durable layer. This is called articular cartilage, not to be confused with the cartilages of the knee frequently injured by sportsmen. Articular cartilage may wear out as we get older or may be damaged by injury. As this lining of the joint disappears, the underlying bone may become exposed and if this occurs on both sides of a joint then this is osteoarthritis. This is a painful condition as the exposed bone contains nerve endings, not present in articular cartilage, and these send pain signals to the brain. As the condition progresses, so more bone becomes exposed, the joint becomes more painful and stiffness becomes a problem – as the smooth, slippery surface of the joint is lost.

• Left untreated, osteoarthritis of the hip will lead to an extremely painful, stiff hip causing disturbed sleep, limited walking distance, inability to enjoy active pastimes and difficulty with footcare. Osteoarthritis is more common in females than males, and females are often affected by osteoarthritis in more than 1 joint, especially the big toe, thumb, neck and knee as well as the hip.
   

• This is not well understood, with most cases still being labelled as ‘idiopathic’ which basically means no known cause. There is undoubtedly a genetic element as osteoarthritis does seem to run in families, but this is very complex and multi-factorial. Plain and simple ‘wear and tear’ is often assumed to be to blame. “I’ve played years of football Doc” is regularly given as an explanation by patients for their hip arthritis. This is not totally accurate, however, as articular cartilage is easily able to stand the test of 70-80 years of abuse in many people.
  There are, however, many instances where the cause of hip osteoarthritis is easily identified. Following an injury to the hip the articular cartilage may be directly damaged leading to early loss. Alternatively the bones of the hip may be damaged such that they lose their original/congruent shape. This leads to high areas of stress concentration in parts of the hip and eventually to damage and loss of the joint lining. People may be born with joints that are not symmetrical/congruent or they may develop such problems during growth. This can have the same effect as trauma/injury with abnormally high forces developing in certain areas of the hip leading to damage and loss of the joint lining.

• Infection in the hip can have devastating consequences for the lining of the joint. Bacteria can produce enzymes which digest articular cartilage leading to rapid joint destruction. Infection in the hip joint is an emergency requiring prompt surgical intervention and antibiotic therapy. Even with appropriate treatment, osteoarthritis may rapidly follow a period of joint infection.

• Rheumatoid arthritis is an inflammatory condition whereby, due to abnormal immune system processes, the lining of the joints is destroyed. Other conditions such as psoriasis and ankylosing spondylitis may result in the same final result of joint damage. The early mainstream therapy of these conditions is medical with drugs aimed at stopping/slowing down the destructive process. However, if this is unsuccessful then bone-on-bone arthritis will be the end result, commonly requiring joint replacement surgery.

What is the bearing surface?

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