Osteoarthritis of the Hip
Other popular names
- OA of the Hip
- Osteoarthrosis of the Hip
- Arthrosis of the Hip
Who does it affect?
Generally a condition associated with age, however it could be due to heredity factors, childhood conditions or injury. Often people engaged in active sport may suffer with osteoarthritis as they get older.
10% of the population are affected by osteoarthritis.
Why does it happen?
Like other joints that carry your weight, your hips may be at risk for "wear and tear" arthritis (osteoarthritis), the most common form of the disease. The smooth and glistening covering (articular cartilage) on the ends of your bones that helps your hip joint glide may wear thin.
Osteoarthritis is a disease which affects joints in the body and the hip is one such joint. 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.
Your first sign may be a bit of discomfort and stiffness in your groin, buttock, or thigh when you wake up in the morning. The pain flares when you are active and gets better when you rest. Sleep disturbance and stiffness of the hip is common.
If you do not get treatment for osteoarthritis of the hip, the condition keeps getting worse until resting no longer relieves your pain. The hip joint gets stiff and inflamed. Bone spurs might build up at the edges of the joint.
When the cartilage wears away completely, bones rub directly against each other. This makes it very painful for you to move. You may lose the ability to rotate, flex or extend your hip. If you become less active to avoid the pain the muscles controlling your joint get weak, and you may start to limp.
During a physical examination, your consultant will determine how much the disease has progressed and in doing so you will be required to move and rotate your leg and hip into various positions to check for pain.
An x-ray will be used to determine the extent of the osteoarthritis and also to detect if you have developed bone spurs or other abnormalities.
If you have early stages of osteoarthritis of the hip, known as gonarthrosis, treatment may include:
- 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.
- Exercise – Low 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 (1000mg / 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.
If you have later stages of osteoarthritis, your hip joint hurts when you rest at night, and/or your hip is severely deformed, your doctor may recommend total hip replacement surgery, known as an arthroplasty.
You will get a two-piece ball and socket replacement for your hip joint. This will cure your pain and improve your ability to walk. You may need crutches or a walking frame for a while after surgery.
Rehabilitation is important to restore the flexibility in the hip and work your muscles back into shape.