Hip

Arthritis or osteoarthritis is a condition where the articular cartilage of a joint is damaged and is progressively lost.

The hip joint is one of the common joints affected by arthritis. Because it is a major weight-bearing joint with an essential role in many activities, it can have a significant impact on your life. Arthritis is a slowly progressive disease that progresses over years to decades. When the cartilage is entirely lost, you may reach the stage of having “bone on bone”.

Many conditions lead to cartilage damage and osteoarthritis. However, most cases are idiopathic, which means that there is no specific cause. There is probably a genetic component to this idiopathic variety, and joints other than the hip are commonly involved (knee and hand). Another cause of hip arthritis, particularly in younger patients, is hip dysplasia. Fractures around the hip joint and femoroacetabular impingement can lead to cartilage damage. There is some evidence that long-term repetitive trauma can also impact on the hip. Diseases that cause inflammation of a joint such as Rheumatoid Arthritis can lead to cartilage damage. Arthritis is more common as we age, but it is not an inevitable consequence of ageing. Finally, there is evidence that obesity may have a primary role in the development of arthritis as well as placing an increased load through the joint.

Symptoms

The predominant symptom of arthritis is pain. The discomfort is usually felt in the groin and may radiate into the thigh. Often the pain from osteoarthritis is intermittent. Factors such as increased activity (e.g. going for a much longer walk than usual) or a minor injury may trigger an acute exacerbation. Typically these flares tend to resolve with time and appropriate nonsurgical treatment. As the arthritis progresses, the pain tends to worsen both in intensity and duration. In the later stages of the disease, the pain can be disabling.

Arthritic pain tends to “mechanical,” i.e. it is worse physical activities such as walking or work. Discomfort also occurs with specific activities such as getting in and out of a car, putting on shoes and socks/stockings and sitting in low chairs. Rest usually helps settle the pain.

Other symptoms of hip arthritis include stiffness typically in the morning and after prolonged sitting. Range of movement is generally lost especially moving the leg and to the side and backwards. As motion is lost, the spine is strained, leading to back pain.

Hip arthritis diagnosis

The diagnosis of hip arthritis can be made based on your age, symptoms and the findings when a doctor examines your hip. X-Rays will confirm the presence of arthritis. These show the characteristic changes of joint space narrowing and the presence of bone spurs (osteophytes).

Treatment

The initial treatment of arthritis is nonsurgical.

Non-surgical treatment

Low impact exercise
It is vital to reduce activity initially until the pain resolves. Physical activity reduction may mean stopping running or other high impact activities. However, in the long term, walking, cycling, swimming and other water-based exercise is appropriate. If you continue to walk, avoid walking on hard surfaces such as concrete and wear walking shoes with good shock-absorbing qualities.

Muscle strengthening
Loss of muscle mass starts in our thirties and worsens as we age. Arthritis will compound the problem. An appropriate exercise program, facilitated by a physiotherapist or an exercise physiologist, will strengthen your leg and improve its function. At a minimum should include the quadriceps, gluteal and “core” muscle groups.

Healthy weight
If you are overweight, losing weight will reduce the load and stress on the hip. Weight loss can have a significant beneficial effect on the arthritis as well as improving your overall health.

Medication
Medications may be required to help with the arthritic pain. Paracetamol is the recommended first-line analgesic. Paracetamol is useful for an acute flare of pain, or more regularly, as the arthritis worsens. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be helpful for short term use. Because of potential side effects, use caution for people with heart, kidney and gastrointestinal conditions. Therefore please discuss with your family doctor before using. COX-2 inhibitors such as Celebrex can be tried and are often better tolerated.

More potent analgesics such as opioid-containing drugs should be used cautiously and only for a short duration. Surprisingly they are often not that helpful for the pain of arthritis.

Injections
Cortisone injections into the hip can be helpful for some people, mainly if there is an inflammatory component to the arthritis. The duration of benefit of a cortisone injection is variable. They also tend to be less effective with repeated injections.

Non-proven cures
There are also many treatments purported to help or “cure” arthritis, but there is little evidence for their use. Glucosamine and chondroitin are two of the building blocks of cartilage. Although widely used, their benefit remains unproven. There is no scientific substantiation for many other heavily advertised supplements. Stem cell therapy is a costly and heavily promoted procedure with little evidence of its clinical benefit.

Surgical treatment

Hip replacement
Hip replacement (or hip arthroplasty) has become the treatment of choice for people with end-stage arthritis. It is a significant procedure that involves removing the worn-out articular cartilage and then resurfacing the hip with metal and plastic components. Most people stay in the hospital for four to five days after the operation.

Rehabilitation to get the hip moving and to build up strength is critical to a good outcome. A rehab program should continue for a minimum of three months for you to obtain maximum benefit from the hip replacement. The vast majority of people get good pain relief and improved function.