Normal hip function cannot be restored once end stage arthritis destroys the articular cartilage. Treatment is predominantly for pain relief, which can be produced by various salvage procedures.
Total hip arthroplasty
Most commonly performed with very good results. The native femoral head and the acetabulum are replaced by metallic implants. Not preferred in young people due to concerns of wear and loosening requiring repeated surgeries. Repeated surgery tends to be less successful. It is the best option for bilateral arthritis and less active paients.
The femoral head is fused to the acetabulum. Provides excellent pain relief and is durable. Disadvantages are difficulty with certain activities, and spine and knee arthritis in the long term. Conversion to a total hip is difficult and less successful. Bilateral hip arthritis is a strong contraindication.
Long pins are placed through the skin into the pelvis and the femur, and the hip joint is pulled apart to allow growth of cartilage. Advantages are that it is minimally invasive and it is adjustable without additional surgery. Pins frequently get infected and loosen. Uncommonly used and is not likely to work.
Growth hormone injection
Injection of high doses of growth hormone into the joint was shown to produce cartilage in a few patients. It is not an approved treatment and the dosage is experimental.
Pelvic support osteotomy
The femoral bone is cut and bent out wards to support the pelvis and eliminate limp. A second cut close to the knee allows realignment of the knee. It can allow good painless motion without a huge limp or apparent deformity. Disadvantages are it requires a longer period for lengthening the limb, which is associated with several complications, and creates a major internal deformity of the bone. This deformity makes conversion to a total hip very difficult. Patients seem to be less satisfied with bilateral pelvic support procedures.