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What are the most popular treatment options for hip osteoarthritis?22nd March 2018
Hip osteoarthritis is a condition that results in the degeneration of cartilage in the hip joint area. When cartilage is lost, friction increases and leads to pain and stiffness. The condition is fairly common and affects around 11% or the population over the age of 45. There is a range of treatment options available to sufferers. However, every treatment has its strengths and weaknesses, and these should be considered carefully.
What are the symptoms of hip osteoarthritis?
The first signs of hip osteoarthritis tend to be hip pain, swelling and a reduced range of motion in the hip. The pain and stiffness are often mistaken for a general ache and many sufferers will try to get through the discomfort, believing it will improve. However, as it is a progressive condition, hip osteoarthritis worsens with time and eventually, suffers will need to seek out a medical explanation.
In addition to pain in the hip, pain in the groin, buttock, thigh and back can be a sign of the condition. The pain may radiate up the back and as far down as the knee. An aching feeling early in the morning, after sports or when tired is common. The pain may lessen when the person is resting or taking weight off their hip by lying down. Mechanical issues in the hip’s ball-and-socket cause the decrease in possible range of motion and any changes here should be noticed. The typical range of motion activities affected includes spreading your legs apart, extending your leg behind you or internal rotation motions such as crossing your legs. When the joint becomes irritated, tissue around the area can become inflamed. Swelling can be seen around the hip and this leads to further pain and can weaken the surrounding muscles and cause even more loss of range of motion.
What treatments will my doctor prescribe?
Depending on the severity of your condition, your age, weight and overall fitness, your doctor will decide which treatment is needed and has the best chance of success. While most doctors will err on the side of caution in regard to hip osteoarthritis and will firstly prescribe exercising and stretching, other treatments such as medicines, therapy, and surgery might also be necessary. As hip osteoarthritis is a degenerative disease, many sufferers will be prescribed conservative, non-invasive treatments for many years before surgery becomes necessary or advisable.
Physical therapy and exercise
Physical therapy for hip osteoarthritis is a three-part program, including exercises that are designed to build up supporting muscles and reduce wear and tear on the hip, therapy to improve gait and posture if these are indicated as contributing factors, and manual manipulation. Contrary to popular belief, sufferers of hip osteoarthritis are not encouraged to rest and do nothing. Staying fit and flexible actually becomes even more important. However, some exercises and sports, such as running and golf, exacerbate the condition. Instead, a therapist might prescribe swimming and yoga. In the early stages of hip osteoarthritis, physical therapy and exercise is the best option. Catching the condition early can offset the likelihood of a quick degeneration and help sufferers avoid surgery. However, for sufferers who have lived with the condition for a long time and who feel ready for a more serious intervention, a year of physiotherapy can be frustrating.
Pain and inflammation medications
Medications that may help alleviate the symptoms and degeneration of the hip osteoarthritis condition include over the counter analgesic pain medications and anti-inflammatories, as well as topical analgesic pain medication. These are considered relatively safe, but long-term use has certain negative side effects. Analgesic pain medications such as paracetamol are effective for relieving pain, but do not reduce swelling.
Most people experience very few side effects from paracetamol, but users must be careful. It is surprisingly easy to take too many paracetamol tablets, and overdoses can damage your stomach, liver, and kidneys and can even be fatal. Anti-inflammatory pain medications such as ibuprofen and aspirin reduce pain and also the swelling and inflammation that might cause the pain. However, long term use also comes with its own cautions, as studies have linked this to gastrointestinal bleeding. For this reason, many hip osteoarthritis sufferers prefer to use topical analgesics. These creams, lotions or sprays usually contain active ingredients such as ibuprofen and are applied directly to the skin around the hip area. While ibuprofen needs to reach the brain to be effective at reducing pain, many products specifically created for osteoarthritis also contain counterirritants such as eucalyptus oil. The tingling effect of this stimulates the nerve endings in the area and might also help with blood flow. In combination, this distracts the senses from the hip pain and may make everyday activities easier.
Steroid or hyaluronic acid injections
These two products are used as a treatment for hip osteoarthritis, with the intention of reducing swelling and stiffness and providing lubrication around the joint. Steroid injections are hormonal treatments, which reduce swelling, stiffness, and pain. Hyaluronic acid injections lubricate the hip joint by imitating the thick fluid that usually provides this lubrication. This in turn, reduces friction, improves the range of motion and as a result, reduces pain and swelling. The pros of both of these injections are clear, however, not everyone enjoys these benefits every time. You would need to have these injections every 6 to 12 months, but many people find the results are variable. Furthermore, neither is a cure. Most doctors prescribe these injections so that the sufferer can begin a physical therapy program.
Either alone or in conjunction with their physical therapy program, some sufferers use orthopedic products to help take pressure and weight off the hip. Cushioning shoe inserts are a good product for easing walking discomforts and using a cane can also help take weight off the hip. In more severe case, when there is a greater likelihood of a trip or fall, a walker may be helpful.
If treatments or pain medications and physical therapy fail to bring relief after a year or more, surgery may be necessary. There are three types of surgery commonly used for hip osteoarthritis, and they are Arthroscopy, Osteotomy and Arthroplasty operations.
Arthroscopy is the least invasive of the three and involves the removal of loose pieces of cartilage or bone spurs around the hip joint. These small pieces may be rubbing and causing osteoporosis symptoms, and for many people, their removal brings a lot of improvement.
Osteotomy is a more serious procedure and involves the realignment of the hip socket and ball bones to reduce friction. This is commonly used when structural malformations are the cause of the condition.
In an Arthroplasty procedure, the hip joint is replaced with an artificial one. This is the typical ‘hip replacement surgery’. While it sounds very invasive, it is considered less invasive and has better recovery rates than knee replacement surgery. This makes the surgery still a viable option for older patients. Over 160,000 hip replacement surgeries are performed in the UK every year. While there will be recovery and downtime, overall hip replacement surgery is very safe and patients suffer less than a 1% chance of serious complications.
As with many complaints, the symptoms of hip osteoarthritis that we notice are usually a sign that the condition has already gone too far. We can reduce the likelihood of developing hip osteoarthritis by keeping to a healthy body weight and exercising regularly. Even in the early stages, losing weight and becoming active can help. However, with ever improving medical technologies and practices in the UK, the success rates of hip operations are now very high. This means that a diagnosis of hip osteoarthritis no longer foretells the end to a full and active lifestyle.