Do you ever experience difficulty tying your shoes or putting on socks? Do you suffer from pain in your groin or discomfort that shoots down your thigh to your knee? If so, you may have arthritis in your hip. This common disorder can be quite debilitating and most often occurs in the population over the age of 50.
Patients may initially confuse the symptoms of hip arthritis with a knee or back disorder as they may experience pain in the region of the knee. This is due to a phenomenon known as referred pain whereby signals of discomfort are sent from the source region to an area further below. A similar finding occurs in patients with shoulder problems as the pain many times radiates down towards their elbow.
Patients with stiffness and pain in their hip may initially try rest, anti-inflammatories or an over the counter joint nutrient called glucosamine and chondroitin sulfate. However, as the disease progresses, these modalities will typically fail to provide consistent relief. A visit to one’s physician will often yield an x-ray of the hip, which typically shows the classic arthritic signs of bone spurs and joint space narrowing.
At this point a referral is often made to an orthopedic surgeon. Depending on the severity of the disease found on x-ray and the symptoms the patient is experiencing, the orthopedist may initially recommend a course of physical therapy for range of motion and strengthening of the hip region. Weight loss will also take pressure off of the joint and can relieve symptoms. Injections of steroid into the joint under x-ray guidance can also provide temporary relief of pain by decreasing swelling.
If these non-operative measures fail, the physician and patient must decide together if a hip replacement is the correct next step. In patients with severe arthritis of the hip, replacement of both the ball and socket of this joint has been demonstrated to provide excellent pain relief and give a better quality of life. Generally, physicians will counsel their patients to wait until they are in their 50s or 60s to have a hip replacement because the prostheses have been shown to last an average of 20 years. However, these are individualized decisions.
Pain relief is generally fairly rapid after hip replacement and length of stay in the hospital is typically two or three nights. A walker or crutches may be utilized for a few weeks after hip replacement, however, many people transition to a cane by one month after the operation. The procedure is not without risk as infection, blood clot and dislocation are the most common complications. The chances for such events are lessened by many preventative measures that are taken perioperatively. Successful results for pain relief and functional improvement after hip replacement are generally found in greater than 90% of patients undergoing this procedure.
What can be done for the condition?
» Nonsurgical Treatment
OA can't be cured, but therapies are available to ease symptoms and to slow down the degeneration of the joint. Recent information shows that your condition may be maintained and in some cases improved.
Your physician may prescribe medicine to help control your pain. Acetaminophen (Tylenol) is a mild pain reliever with few side effects. Some people may also get relief of pain with anti-inflammatory medication, such as ibuprofen and aspirin. Newer anti-inflammatory medicines called COX-2 inhibitors show promising results and seem not to cause as much stomach upset or other intestinal problems.
Medical studies have shown that glucosamine and chondroitin sulfate can also help people with OA. These supplements seem to have nearly the same benefits as anti-inflammatory medicine with fewer side affects. Many doctors feel the research supports these supplements and are encouraging their patients to use them.
If you aren't able to get your symptoms under control, a cortisone injection may be prescribed. Cortisone is a powerful anti-inflammatory medication, but it has secondary effects that limit its usefulness in the treatment of OA. Multiple injections of cortisone may actually speed up the process of degeneration.
Repeated injections also increase the risk of developing a hip joint infection, called septic arthritis . Any time a joint is entered with a needle, there is the possibility of an infection. Most physicians use cortisone sparingly, and avoid multiple injections unless the joint is already in the end stages of degeneration and the next step is an artificial hip replacement.
Physical therapy plays a critical role in the nonsurgical treatment of hip OA. A primary goal is to help you learn how to control symptoms and maximize the health of your hip. You will learn ways to calm pain and symptoms, which might include the use of rest, heat, or topical rubs. A cane or walker may be needed to ease pressure when walking. Range-of-motion and stretching exercises will be used to improve hip motion. You will be shown strengthening exercises for the hip to steady the joint and protect it from shock and stress. Your therapist can suggest tips for getting your tasks done with less strain on the joint.
In some cases, surgical treatment of OA may be appropriate.
Surgeons can use an arthroscope to check the condition of the articular cartilage in a joint. An arthroscope is a miniature TV camera inserted into the joint though a small incision. While checking the condition of the cartilage, your surgeon may try a few different techniques to give you relief from pain. One method involves cleaning the joint by removing loose fragments of cartilage. Another method involves simply flushing the joint with a saline solution, after which some patients report relief.
This procedure is sometimes helpful for temporary relief of symptoms. Hip arthroscopy is relatively new, and it is unclear at this time which patients will benefit.
When the alignment of the hip joint is altered from disease or trauma, more pressure than normal is placed on the surfaces of the joint. This extra pressure leads to more pain and faster degeneration of the joint surfaces.
In some cases, surgery to realign the angles of the pelvic socket or femur (thighbone) can result in shifting pressure to the other healthier parts of the hip joint. The goal is to spread the forces over a larger surface in the hip joint. This can help ease pain and delay further degeneration.
The procedure to realign the angles in the joint is called osteotomy . In this procedure, the bone of either the pelvic socket or femur is cut, and the angle of the joint is changed. The procedure is not always successful. Generally it will reduce your pain but not eliminate it altogether. The advantage to this approach is that very active people still have their own hip joint, and once the bone heals, there are fewer restrictions in activity levels.
An osteotomy procedure in the best of circumstances is probably only temporary. It is thought that this operation buys some time before a total hip replacement becomes necessary.
» Artificial Hip Replacement
An artificial hip replacement is the ultimate solution for advanced hip OA. Surgeons prefer not to put a new hip joint in patients less than 60 years old. This is because younger patients are generally more active and might put too much stress on the joint, causing it to loosen or even crack. A revision surgery to replace a damaged joint is harder to do, has more possible complications, and is usually less successful than a first-time joint replacement surgery.
What should I expect after treatment?
Nonsurgical rehabilitation of hip OA is used to maximize the health of your hip and to prolong the time before any type of surgery is necessary. If you attend physical therapy as part of nonsurgical rehabilitation, you will probably progress to a home program within two to four weeks.
In cases of advanced OA where surgery is called for, patients may see a physical therapist before surgery to discuss exercises, special precautions to be followed just after surgery, and to practice walking with crutches or a walker.
» After Surgery
Shortly after surgery, your physical therapist will see you in your hospital room. You'll practice getting out of bed and walking using your walker or a pair of crutches. Exercises are used to improve muscle tone and strength in the hip and thigh muscles and to help prevent the formation of blood clots.
During your recovery, you should follow your surgeon's instructions about how much weight you can put down while standing or walking. After you return home from the hospital, your surgeon may have you work with a physical therapist for up to six in-home visits.
These visits are to ensure you are safe in and about the home and getting in and out of a car. Your therapist will make recommendations about your safety, review special hip precautions and make sure you are placing a safe amount of weight on your foot when standing or walking. Home therapy visits end when you are safe to get out of the house.