Several other conditions can damage the hip joint and lead to hip replacement. A previous infection in the hip joint may cause long-term changes that lead to arthritis. An infected joint during childhood or a bone infection, osteomyelitis,can injure the growing bony surfaces.
A patient who has had an infection as a child or teenager may develop arthritis when he or she becomes an adult. Infection after previous hip surgery can also cause arthritis. The infection can erode cartilage and destroy the joint.
A low-grade infection can persist for a long period of time, even years, in bone. When an infection develops after surgery, bacteria may remain in bone even though the infection appears to be treated.
If hip replacement is planned on a hip that was once infected, testing should be done to make sure no active infection remains.
Hemophilia is a disease where absence of a clotting factor (mostly factor VIII or XI) causes abnormal bleeding. Patients with hemophilia have bleeding into a joint or hemarthrosis. This causes a process that results in destruction of the joint.
The hip is less affected by hemophilia than the knees or ankles, but disease can still occur. When hip replacement surgery is performed, the missing clotting factor must be replaced before surgery. An appropriate level of clotting factor should be maintained during surgery and in the postoperative period.
Ankylosing spondylitis is a condition that develops in young men between teenage years and age 40 years. It causes fusion of joints, particularly in the pelvis and spine. Joints in the rib cage that allow the chest wall to expand when breathing are also involved. A special blood test, HLA-B27, can help make the diagnosis when it is positive.
A hip joint with ankylosing spondylitis can develop arthritis with symptoms that are similar to osteoarthritis. The hip usually fuses in a bent or flexed position. Gaucher’s disease is a storage disease. Due to a metabolic disorder, abnormal amounts of fatty material are deposited or stored in different organs of the body. These include liver, spleen, brain and bone marrow. The fatty deposits in the bone marrow can cause avascular necrosis of the femoral head and eventually arthritis. Like hemophilia,
Gaucher’s disease is a genetic disorder that can be passed on from one generation to the next. Sickle cell anemia is found predominantly in African Americans or people of African descent. Under certain conditions, the normally round red blood cells take on a crescent or sickle shape and cannot pass through small vessels in the body. Blood supply to tissues is blocked. Patients can experience painful sickle cell crises.
In bone, sickle cell disease causes areas of bone death or infarcts. This leads to avascular necrosis in the femoral head. When hip replacement is performed, measures must be taken to prevent a sickle cell crisis during the procedure.
Paget’s disease is a metabolic disease of bone. Bone is rapidly destroyed and then repaired. It can involve one or several bones at a time. It most often affects the spine, pelvis, and long bones, such as the humerus or femur. The rapid rate of bone metabolism causes deformity and abnormal appearance of the bone. Sometimes stress fractures may develop.
Paget’s disease can cause osteoarthritis of the hip. The abnormal anatomy and bone structure may make hip replacement more difficult.