Hip Arthritis

Sometimes called the ‘wear and tear’ arthritis, Osteoarthritis is the commonest cause of hip arthritis. Occasionally the arthritis is caused by inflammation (Inflammatory arthritis like Rheumatoid arthritis).

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 Osteoarthritis can affect any joint, but most affected are the weight bearing joints like the hip joint.  Since Arthritis gradually worsens over time, early start of treatment can lessen the impact on life. Although there is no cure of Osteoarthritis, there are many options of treatment available that can help manage the symptoms and stay active.

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There are certain factors which predispose to the development of Osteoarthritis:

  • Advancing age
  • Family history of osteoarthritis
  • Previous injury/ fracture to the Hip joint or Pelvis
  • Obesity
  • Defective formation of the hip joint at birth, a condition known as developmental dysplasia of the hip or other childhood hip diseases like Perthe’s disease.
  • Impingement of the hip due to defective hip formation or injuries to the Labrum

The Hip joint is a ‘ball and socket’ type of joint and is one of the largest in the body. The ‘socket’ is the acetabulum, part of the large Pelvis bone and ‘ball’ is the femoral head which is the upper end of the thigh bone. Smooth and slippery cartilage called the articular cartilage covers the bony surfaces of the ball and socket. This protects and cushions the bones, thus enabling them to move easily and freely. The joint is lined by a thin membrane-like lining called the synovium.

The Hip is surrounded by large and powerful muscles. While these muscles provide strength and stability to the joint, they can also mimic pain from the hip joint which lies underneath.

What happens to the Joint in Arthritis?

Osteoarthritis is a wear and tear process that mostly occurs in people at 50 or over but can occur in those under the age as well. In Osteoarthritis, over a period, the cartilage wears away. During this process, the cartilage becomes rough and irregular and space between the head and socket of the joint reduces gradually. Eventually all the cartilage wears away, resulting in bone rubbing against bone. This process most of the times is gradual and pain worsens over time.

Your knee will usually be put in a bent position for the procedure so that all surfaces of the joint are exposed. The surgeon will begin by making an incision of around 10-15cm, allowing the kneecap to be moved aside and the damaged joint surfaces to be cut away. After testing the components for proper function, the parts of the new knee are fitted. The incision is then closed. A Total Knee Replacement usually takes about 1-2 hours depending on the type of procedure.

Symptoms of Arthritis

Gradual onset of pain and stiffness, worsening over time are the most common symptoms. Additional symptoms include:

  • Pain in your groin or thigh that radiates to your buttocks or your knee. The pain often flares up with activity but with time, can be present at rest or disturb your sleep. Pain can increase in cold weather.
  • Stiffness in the hip joint that makes it difficult to walk or bend.
  • "Locking" or "sticking" of the joint, and a grinding noise (crepitus) during movement caused by loose fragments of cartilage and other tissue interfering with the smooth motion of the Hip.
  • Stiffness in the hip that affects the ability to walk and may cause a limp.
What happens when you see a Consultant?

First step in the assessment will be a detailed History of your symptoms. Any background history of injury, previous treatment, and any other health problems that you may have. 

This is followed by a thorough physical examination of the Hip joint and any other joints or areas that may be the cause of your Hip pain.

With a detailed History and Physical Examination, the Specialist will have a good idea about the cause of your symptoms. To confirm the diagnosis, following investigations are considered: 

X-rays: An x-ray of the Hip is a simple test which gives all the necessary information about bones and the extent of arthritis. Often this is the only imaging needed to make a diagnosis. X-rays of an Arthritic Hip show a narrowed joint space, changes in the bone and presence of bony spurs called osteophytes. 

Other imaging: Occasionally a Magnetic Resonance Imaging (MRI) which better defines the soft tissues around the Hip joint, or a Computerised Tomogram (CT) may be needed to plan your treatment.

Blood Tests: Most common type of Arthritis is ‘wear and tear’ type of Arthritis, but occasionally inflammatory arthritis like Rheumatoid Arthritis can affect the hip and some blood tests are useful in the diagnosis.

How is Hip Arthritis treated?

Although there is no cure for Arthritis, there are many treatment options available: 

NON-SURGICAL:  

Early treatment of Hip Arthritis is non-surgical. Your specialist may recommend one or a combination of the following: 

Lifestyle modification: Some changes in lifestyle can help protect the hip and reduce the symptoms. These include reducing activities that aggravate the symptoms like bending or climbing stairs, reduce the stress on the hip by avoiding high-impact activities like jogging and take up low impact activities like swimming or cycling and reducing weight. 

Physiotherapy: Individualised exercise regime organised by your specialist and physiotherapist may help improve the core strength and improve the range of motion.

Assistive devices: Using walking aids like crutches, walking stick or a Zimmer frame can improve mobility and reduce pain by taking the weight off the hip. Other devices like a long-handled reacher can also help.

Medication: Over the counter Painkillers or Nonsteroidal anti-inflammatory drugs (NASID) may help relieve the pain. Sometimes your doctor may prescribe stronger painkillers or NSAIDs to help alleviate the symptoms. It is important to be aware of the side-effects of these tablets.  

Hip Injections: Occasionally Hip injections under x-ray control may be beneficial in alleviating symptoms. These are often used in combination with other non-surgical modalities to improve the core strength and flexibility or to optimise other medical conditions before surgery. 

SURGICAL:

When the non-surgical treatment is unsuccessful in controlling the symptoms, the specialist will recommend surgical treatment. 

Total Hip Replacement: The specialist will remove the worn out parts of your ‘ball and socket’ joint and replace it with new Metal, Ceramic or Plastic joint surfaces.