Osteoarthiritis of the Hip

Arthritis of the hip is common, affecting approximately 10% of the population. The most common cause is Osteoarthritis, but there are numerous other causes relating to development of your hip as a child or specific injuries.

Osteoarthritis is a disease which affects joints in the body. The surface of the joint is damaged and the surrounding bone grows thicker. ‘Osteo’ means bone and ‘arthritis’ means joint damage and swelling (inflammation). Other words used to describe osteoarthritis are ‘osteoarthrosis’, ‘arthrosis’ and ‘degenerative joint disease’.

When a joint develops osteoarthritis, the cartilage gradually roughens and becomes thin, and the bone underneath thickens. The bone at the edge of the joint grows outwards (this forms osteophytes or bony spurs). The synovium swells slightly and may produce extra fluid, which then makes the joint swell slightly. The capsule and ligaments slowly thicken and contract, as if they were trying to stabilise the joint as it gradually changes shape. Muscles that move the joint may weaken and become thin or wasted.

When we look at osteoarthritic joints under a microscope, we see the joint is trying to repair itself. All the tissues of the joint are more active than normal. For example, new tissue is produced to try to repair the damage, such as the osteophytes. In many cases, especially in small finger joints, the repair is successful. This explains why many people have osteoarthritis but experience few or no problems. However, sometimes the repair cannot compensate for the damage. Osteoarthritis may then seriously affect the joint, making it painful and difficult to move. This occurs particularly in large joints such as the knees and hips.

Osteoarthritis is a slow process that develops over many years. In most cases there are only small changes that affect only part of the joint. Sometimes, though, osteoarthritis can be more severe and extensive.

In severe osteoarthritis, the cartilage can become so thin that it no longer covers the thickened bone ends. The bone ends touch and start to wear away. The loss of cartilage, the wearing of bone, and the bony overgrowth at the edges can change the shape of the joint. This forces the bones out of their normal position and causes deformity.

Other Causes of Hip Pain

1.Developmental abnormalities

DDH – developmental dysplasia of the hip which causes abnormality in development of the cup or acetabulum of the hip joint.

Perthes’ disease – which affects the blood supply of the ball (femoral head) of the hip joint.

SUFE – or slipped upper femoral epiphysis which can cause abnormal movement of the growing part of the ball of the hip joint.

Many of this conditions are picked up in childhood/adolescence and are treated accordingly. Some less obvious cases may not be picked up and therefore can cause secondary osteoarthritis in early adulthood.

2.Trauma

Dislocation of the hip and/or fractures of the hip joint can cause reduction in the blood supply especially to the ball (femoral head) of the hip joint and cause avascular necrosis of the femoral head together with collapse and secondary osteoarthritis.

3.Inflammatory Conditions

Conditions such as rheumatoid arthritis, ulcerative colitis, psoriasis and many others can be associated with an inflammation of the lining (synovium) of the hip joint which can cause secondary arthritis. In these types of patients, at times the X-rays can look relatively normal compared with patients with osteoarthritis.

HIP OSTEOARTHRITIS – Arthritis of the hip


Arthritis of the hip is common, affecting approximately 10% of the population. The most common cause is Osteoarthritis, but there are numerous other causes relating to development of your hip as a child or specific injuries.

Treatment

Hip arthritis is never life threatening, the main aim of treatment is therefore symptomatic for pain and to try to keep mobility and range of movement of the joint.

Treatment follows a progression from simple measures to major surgical intervention.

 

Simple measures

Exercise – Non-impact exercise such as walking, swimming and cycling keeps muscle strength and tone. Hip joint stretches to keep the hip supple are beneficial. A consultation with a physiotherapist for education and a home exercise program can be useful.

Walking stick – Using a walking stick in the opposite hand reduces load in the hip and usually increases your walking distance. A strong stick of correct length with a non slip rubber end is best.

Paracetamol – A simple but safe analgesic when used correctly. Often needs to be used 3 or 4 times a day (1000 mg / 2 tablets on each occasion). This can be safely used by most people at prolonged periods at these doses.

Natural remedies – Often not proven but some people gain relief from various naturopathic potions, magnets, acupuncture and the like. This affect may be placebo but some plant substances have proven anti-inflammatory effects. You should check the use of these with your local Doctor as some may react with other medicines or be dangerous.

Glucosamine and Chondroitin Sulphate – The most common arthritis remedies at the present time. There is some early evidence that over time they may help to maintain articular cartilage and slow progression of Osteoarthritis. Nothing can ‘put cartilage back’ after Osteoarthritis is established. Some people also report a reduction in arthritis symptoms when taking these substances. Their main side effect is diarrhoea. They should not be taken if you are pregnant or allergic to shellfish.

Fish oils – Have been associated with some improvement in cartilage quality and may be beneficial.

Anti-inflammatories (NSAID’s) – Several types of Non steroidal anti-inflammatories are available. They can be very effective in reducing pain and swelling associated with osteoarthritis. All these medications have potential side effects and are not always tolerated. The most common effects are: exacerbating asthma, stomach upset (ulcers etc), increased blood pressure and ankle swelling.

Weight loss – There is no doubt that if you are above ideal weight, weight loss can have a significant impact in reducing pain from osteoarthritis. Weight loss can also reduce the risk of anaesthetic complications and wound healing. Many people after loosing weight no longer need surgery for their Osteoarthritis. You may be given an ideal weight to attain prior to consideration for surgery. Consulting a dietician may be beneficial.

Injections – A hip injection is often used by your specialist to differentiate between back pain and hip joint pain. An injection is given to ‘numb’ the hip and you then keep a record of the pain experienced. Sometimes steroids are used to provide longer relief of pain. The procedure is done under X-ray guidance with a small risk of infection.

 

Surgery

Arthroscopy – Hip arthroscopy is usually reserved for a few relatively rare hip conditions such as loose fragments in the joint or labral tears. It may be used to help the diagnosis.

Hip replacement – This is only considered when non-operative options have been exhausted. It involves replacing the worn out ball and socket joint with an artificial one. It was the most successful operation of the 20th Century with 98 of every 100 people feeling it was worthwhile. It usually provides lasting pain relief and improved walking and function. I use and ‘Exeter’ hip replacement manufactured by Stryker. This is a ‘cemented hip’ and has been available since 1970. It has, I believe the best published results of all hip replacements on the market. About 2% of these hips will fail in the first 10 years, some quite quickly from infection and loosening, the other 98% should last beyond 10 years. Over 90% of Exeter stems from 1970 are working at 30 years.

If your hip replacement fails it can be re-done (revised). This is a bigger operation, but still very successful.

All hip replacements require regular check ups for EVER. Normally at 1 year, 2 years, 5 years and then every 5 years.

Hip resurfacing – This may or may not be the future for hip replacement. I believe it has a place in hip arthritis in young people who get in awkward positions such as kneeling, crawling etc. It remains under close scrutiny.

 

In summary

Keep active, keep supple and keep walking. Take simple pain killers and use a stick. If and when ‘something needs to be done’ we can guide you through the options available.