Arthritis of the Hip

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

Osteoarthritis is often inherited (50%) with involvement of the hips, knees, base of thumbs, and swelling on the fingers (Heberden’s nodes).

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, and stretching the hip joint to keep it supple are good. A consultation with a physiotherapist, for education in a home exercise program is worth considering

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

Paracetamol – A simple but safe analgesic. Often needs to be used 3 or 4 times a day (1000mg/2tablets on each occasion). This can be safely used by most people for 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 - (Osteoeeze, arthroeeze and most joint supplement formulas) are the most common arthritis remedies at the current time. There is some early evidence that over time they may help to maintain articular cartilage and slow progression of OA. Nothing can “put cartilage back” after OA 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 Oil – Has been associated with some improvement in cartilage quality and may be beneficial

Anti-inflammatories (NSAID’s) – Non steroidal anti inflammatories are available only on prescription, there are many different agents, all related. They can be very effective in reducing pain and swelling associated with arthritis. 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. The newest anti-inflammatories (COX-2) such as Vioxx, (withdrawn 2004) Celebrex, and Mobic are under scrutiny for cardiac effects, but are easier on the stomach.

Injections – A hip injection is often used to differentiate between referred back pain and hip joint pain, numbing the hip and asking you to keep a record of the pain. Sometimes steroid is also used to try to provide longer relief. There is a small risk of infection and the procedure is usually performed in X-ray.

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.

Osteotomy – This is a procedure to cut and re-align the bone to change the way your hip carries you when you walk, it is used in rare instances in younger people.

Hip Replacement – This 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 an ‘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 early from infection and loosening, the other 98% should last beyond 10 years. Over 90% of the Exeter stems from 1970 are working at 30 years! Read more at www.exeterhip.co.uk

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. This is to allow early detection of wear and changing of parts.

Hip Resurfacing – This may or may not be the future of hip replacement, it currently, I believe, has a place in hip arthritis in young people who have to get in awkward positions Kneeling, crawling etc. for work or family reasons. It remains under close scrutiny. Read more at www.birminghamhipresurfacing.com

To Summarise:

Keep active, keep supple and keep walking, take simple analgesia (Paracetamol) and use a stick. If and when ‘something needs to be done’, we are here to guide you through this.