Hip Problems? Ask the Kayal Orthopaedic Center Expert!

Hip Problems? Ask the Kayal Orthopaedic Center Expert!

As an experienced NJ orthopedic surgeon, I am thrilled to have the opportunity to eliminate pain and suffering—while restoring patients to a life of activity and health. If you’re experiencing regular hip pain, clicking or reduced range of motion, you don’t have to live in misery. Our team of premier surgeons can help. Below, you’ll find answers to the common questions my patients have about hip problems. Don’t see the answer to your hip question below? Call our office at 201-447-3880 to learn more!


Hip arthroscopy is a relatively new technology, and Dr. Pope and I are two of only a few surgeons in the NY-Metropolitan area to regularly perform this cutting-edge surgery. During the orthopedic procedure, small instruments are placed through puncture sites around the hip joint to address pathology in the hip joint, itself. Such conditions include, but are not limited to: loose bodies, osteoarthritis of the hip, labral tears of the hip and a condition called femoroacetabular impingement (FAI). Hip arthroscopy is typically performed as an outpatient surgery, and is used to treat hip joint pain, loss of motion, snapping, clicking and mechanical complaints of catching, buckling or giving way. Many times, a hip MRI arthrogram is performed prior to the procedure to better assess your hip joint pathology. The procedure often leads to significant and rapid improvement of your hip joint symptoms. Total hip replacement is a common orthopedic procedure. As the population ages, it is expected to become even more common. Hip replacement surgery involves removing the head of the thighbone (femur) and replacing the ball-and-socket mechanism of the hip with artificial implants. This relieves pain and improves mobility.

Minimally invasive hip replacement allows our surgeons to perform the hip replacement through one or two small incisions. Patients usually have less pain compared with traditional hip replacement surgery, and rehabilitation is faster.

2. WHAT IS THE MOST COMMON REASON FOR A HIP REPLACEMENT? Osteoarthritis, caused by the wear and tear of aging, is the most common reason for hip replacement. Osteoarthritis causes the cartilage covering the joint surfaces to wear out, resulting in pain and stiffness. Other conditions that cause destruction of the hip joint include:

  1. Loss of the blood supply to the head of the thighbone (osteonecrosis)
  2. Rheumatoid arthritis
  3. Injury & infection
  4. Developmental abnormalities of the hip.
  5. Patients with arthritis may also have brittle bones (osteoporosis), but there is no direct relationship between bone density and the development of arthritis of the hip.

3. HOW DO I KNOW IF I HAVE ARTHRITIS IN MY HIP? WHAT ARE THE SYMPTOMS? Hip arthritis typically causes pain that is dull and aching. The pain may be constant, or it may come and go. Pain may be felt in the groin, thigh, and buttock, or there may be referred pain to the knee. Walking, especially for longer distances, may cause a limp. Some patients may need a cane, crutch, or walker to help them get around. Pain usually starts slowly and worsens with time and higher activity levels. Patients with hip arthritis may also have difficulty climbing stairs. Dressing, tying shoes, and clipping toenails can be difficult or impossible, and pain commonly interferes with sleep.See a qualified orthopedic physician to diagnose hip arthritis. First, we’ll inquire about your symptoms and perform a physical examination. X-rays may show loss of the cartilage space in the hip socket and a “bone-on-bone” appearance. Bone spurs and bone cysts are also common. We may recommend additional tests to confirm the diagnosis, including magnetic resonance imaging (MRI) or computed tomography (CT) scans.


Nonsurgical Treatment

For hip arthritis, the first recommended treatment is usually over-the-counter, anti-inflammatory medications, such as ibuprofen. Some nutritional supplements, including glucosamine, may also provide some relief. Short-term physical therapy may help improve strength and reduce stiffness.For patients with more advanced arthritis, use of a cane opposite the affected hip can transfer weight away from the painful hip and improve walking ability. A walker can also be used. Arthritis, however, is progressive. Even with treatment, it will worsen over time. Weight loss can help decrease joint stress.

Surgical Treatment

Pain and mobility may worsen with hip osteoarthritis, even when all of the recommended nonsurgical treatments have been tried. If this happens, our NJ orthopedic team may recommend surgery. Surgical options include:

  1. Arthroscopy: Arthroscopy of the hip is a minimally invasive, outpatient procedure that is relatively uncommon. Your doctor may recommend it if the hip joint shows evidence of torn cartilage or loose fragments of bone or cartilage.
  2. Osteotomy: Candidates for osteotomy include younger patients with early arthritis, particularly those with an abnormally shallow hip socket (dysplasia). The procedure involves cutting and realigning the bones of the hip socket and/or thighbone to decrease pressure within the joint. In some people, this may delay the need for replacement surgery by 10 to 20 years.


Traditional Hip Replacement

Traditional hip replacement surgery involves making a 10- to 12-inch incision on the side of the hip. The muscles are split or detached from the hip, allowing the hip to be dislocated.Once the joint has been opened up and the joint surfaces exposed, your surgeon removes the ball at the top of the thighbone, or femur. The hip socket is prepared by removing any remaining cartilage and some of the surrounding bone. A cup-shaped implant is then pressed into the bone of the hip socket. It may be secured with screws. A smooth plastic bearing surface is then inserted into the implant so the joint can move freely.Next, the femur is prepared. A metal stem is placed into the femur to a depth of about 6 inches. The stem implant is either fixed with bone cement or is implanted without cement. Cementless implants have a rough, porous surface. It allows bone to adhere to the implant to hold it in place. A metallic ball is then placed on the top of the stem. The ball-and-socket joint is essentially “recreated.”

Minimally Invasive Hip Replacement

Minimally invasive hip replacement surgery allows Kayal Orthopaedic Center surgeons to perform your hip replacement through one or two smaller incisions. Candidates for minimal incision procedures are typically thinner, younger, healthier, and more motivated to have a quick recovery, compared with patients who undergo the traditional surgery.Before you decide to have a minimally invasive hip replacement, get a thorough evaluation from myself or Dr. Pope to discuss the risks and benefits. Both traditional and minimally invasive hip replacement procedures are technically demanding, and they require that your surgeon and operating team have considerable experience.

SURGICAL TECHNIQUE: The artificial implants used for the minimally invasive hip replacement procedures are the same as those used for traditional hip replacement. Specially designed instruments are needed to prepare the socket and femur and to place the implants properly.The surgical procedure is similar, but there is less soft-tissue dissection. A single, minimally invasive hip incision may measure only 3 to 6 inches. It depends on the size of the patient and the difficulty of the procedure. The incision is usually placed over the outside of the hip. The muscles and tendons are split or detached, but to a lesser extent than in the traditional hip replacement operation. They are routinely repaired after implants are placed. This encourages healing and helps prevent hip dislocation.Two-incision hip replacement involves making a 2- to 3-inch incision over the groin for placement of the socket. A 1- to 2-inch incision is made over the buttock for placement of the stem. To perform the two-incision procedure, our team may require X-ray guidance. It may also take longer to perform this surgery than it does to perform traditional hip replacement surgery.

BENEFITS (Reported benefits of less invasive hip replacement include):

  1. Reduced pain
  2. More “cosmetic” incisions
  3. Less muscle damage
  4. Faster rehabilitation
  5. Shorter hospital stays

For traditional hip replacement, hospital stays average 4 to 5 days. Many patients need extensive rehabilitation afterward. With less-invasive procedures, the hospital stay may be as short as 1 or 2 days. Some of our patients even return home the day of surgery.While early studies suggest that minimally invasive hip replacement surgery streamlines the recovery process, the risks and long-term benefits of less-invasive techniques have not yet been documented.


Tired of living in pain? Our premier orthopedic surgeons can help! Contact our caring staff to schedule a comprehensive hip assessment with Dr. Pope or myself—and discover how we can eliminate your pain and return you to vitality!