Hip Arthritis

Arthritis of the Hip

Arthritis is one of the most common causes of persistent pain of the hip joint. Pain, swelling, and stiffness are the primary symptoms of arthritis. Any joint in the body may be affected by the disease, but it is common in the weight-bearing joints such as the hip.

Causes of Hip Pain and Arthritis

Many causes and forms of arthritis exist; they can be divided into a few categories:

• Osteoarthritis (OA). OA is by far the most common type of hip arthritis.  This is an age-related "wear and tear" type of arthritis. It usually occurs in people 50 years of age and older and often in individuals with a family history of arthritis. The cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness. Osteoarthritis may also be caused or accelerated by subtle irregularities in how the hip developed in childhood.
• Rheumatoid arthritis (RA) / “Inflammatory Arthritis”. RA is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage the cartilage, leading to pain and stiffness. Rheumatoid arthritis is the most common type of a group of disorders termed "inflammatory” or “autoimmune” arthritis.
• Post-traumatic arthritis. This can follow a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.
• Avascular necrosis. An injury to the hip, such as a dislocation or fracture, may limit the blood supply to the femoral head. This is called avascular necrosis (also commonly referred to as "osteonecrosis"). The lack of blood may cause the surface of the bone to collapse, and arthritis will result. Some diseases can also cause avascular necrosis.
• Childhood hip disease. Some infants and children have hip problems. Even though the problems are successfully treated during childhood, they may still cause arthritis later on in life. This happens because the hip may not grow normally, and the joint surfaces are affected. Hip dysplasia, Perthes Disease, and Slipped Capital Femoral Epiphysis are examples of such conditions.

Hip arthritis of the hip causes pain and stiffness.  It can make everyday activities, like bending over to tie a shoe, rising from a chair, or taking a short walk hard to do.  It is a major cause of lost work time and a serious disability for many people.

Because osteoarthritis gradually worsens over time, the sooner you start treatment, the more likely it is that you can lessen its impact on your life. Although there is no cure for arthritis, there are many treatment options available to help manage pain and keep people staying active.

Anatomy

The hip is one of the body's largest joints. It is a "ball-and-socket" joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone).

The bone surfaces of the ball and socket are covered smooth rubber-like layer called articular cartilage that protects and cushions the bones and enables them to move easily, with almost no resistance.  There is also a bumper-like wedged shaped ring of cartilage called the labrum which attaches to the rim of the socket to deepen and stabilize the hip joint.

Bands of tissue called ligaments form the hip capsule, which holds the ball tightly in the socket and provides stability to the joint.

Description

Osteoarthritis is a degenerative type of arthritis that occurs most often in people 50 years of age and older, though it may occur in younger people, too.

With arthritis, over time, and with wear and tear or chronic inflammation the cartilage surface deteriorates and becomes rough.  Bone spurs can form along the edges of the joint. The cartilage can even wear all the way through, such that the under lying bone begins to rub bone on bone, like sand paper on wood.  This is very irritating to the joint and causes inflammation, pain and reduced function.

Cause

Osteoarthritis has no single specific cause, but there are certain factors that may make you more likely to develop the disease, including:

• Increasing age
• Family history of osteoarthritis
• Previous injury to the hip joint
• Obesity
• Improper formation of the hip joint at birth, a condition known as developmental dysplasia of the hip

Even if you do not have any of the risk factors listed above, you can still develop osteoarthritis.

Symptoms

The most common symptom of hip osteoarthritis is pain around the hip joint. Usually, the pain develops slowly and worsens over time, although sudden onset is also possible. Pain and stiffness may be worse in the morning, or after sitting or resting for a while. Over time, painful symptoms may occur more frequently, including during rest or at night. Additional symptoms may include:

• Pain in your groin or thigh that radiates to your buttocks or your thigh and knee
• Pain that flares up with vigorous activity
• 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
• Decreased range of motion in the hip that affects the ability to walk and may cause a limp
• Increased joint pain with rainy weather

When to seek Medical Attention

If you are experiencing these symptoms on a consistent basis, and simple home remedies or over-the counter medications are not providing enough relief, make an appointment.  We can help confirm your diagnosis and discuss a treatment plan to help regain your function and mobility.

Examination

During your appointment, your symptoms and medical history will be reviewed.  A physical examination will be performed, and x-rays will be reviewed.

Physical Examination

During the physical examination, Dr. Latteier will look for:

• Tenderness about the hip
• Range of passive (assisted) and active (self-directed) motion
• Crepitus (a grating sensation inside the joint) with movement
• Pain when pressure is placed on the hip
• Problems with your gait (the way you walk)
• Any signs of injury to the muscles, tendons, and ligaments surrounding the hip

Imaging Tests

X-rays. These imaging tests create detailed pictures of dense structures, like bones. X-rays of an arthritic hip may show a narrowing of the joint space, changes in the bone, and the formation of bone spurs (osteophytes).

(Left) In this x-ray of a normal hip, the space between the ball and socket indicates healthy cartilage. (Right) This x-ray of an arthritic hip shows severe loss of joint space and bone spurs.

Other imaging tests. Occasionally, a magnetic resonance imaging (MRI) scan, a computed tomography (CT) scan, or a bone scan may be needed to better determine the condition of the bone and soft tissues of your hip.

Treatment

Although there is no cure for osteoarthritis, there are a number of treatment options that will help relieve pain and improve mobility.

Nonsurgical Treatment

As with other arthritic conditions, early treatment of osteoarthritis of the hip is nonsurgical.  Some of the non-operative treatment options are outlined below.

Lifestyle modifications. Some changes in your daily life can protect your hip joint and slow the progress of osteoarthritis.

• Minimizing activities that aggravate the condition, such as climbing stairs.
• Switching from high-impact activities (like jogging or tennis) to lower impact activities (like swimming or cycling) will put less stress on your hip.
• Losing weight can reduce stress on the hip joint, resulting in less pain and increased function.

Physical therapy. Specific exercises can help increase range of motion and flexibility, as well as strengthen the muscles in your hip and leg. Your physical therapist can help develop an individualized exercise program that meets your needs and lifestyle.

Assistive devices. Using walking supports like a cane, crutches, or a walker can improve mobility and independence. Using assistive aids like a long-handled grabber to pick up low-lying things will help you avoid movements that may cause pain.

Other remedies. Applying heat or ice, using pain-relieving ointments or creams, may provide some relief from pain.

Medications. If your pain affects your daily routine, or is not relieved by other nonsurgical methods, there are medications that can help relieve some of the symptoms. Several types of drugs are useful in treating arthritis of the hip.

• Acetaminophen (Tylenol) is an over-the-counter pain reliever that can be effective in reducing mild arthritis pain.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) may relieve pain and reduce inflammation. Over-the-counter NSAIDs include naproxen (Aleve) and ibuprofen (Advil / Motrin). Other NSAIDs are available by prescription.
• Glucosamine and chondroitin sulfate, substances found naturally in joint cartilage, can be taken as dietary supplements. Although patient reports indicate that these supplements may relieve pain, there is no evidence to support the use of glucosamine and chondroitin sulfate to decrease or reverse the progression of arthritis

Injections. For more severe symptoms injections into the joint can be effective in reducing pain.

• Corticosteroids (also known as cortisone) are powerful anti-inflammatory agents that can be injected into the joint. These injections provide pain relief and reduce inflammation; however, the effects do not last indefinitely. It is recommended that we limit the number of injections to three or four per year, per joint, due to possible side effects.
• Platelet Rich Plasma (PRP) involves drawing blood, and concentrating the platelets.  Platelets contain growth factors that can speed up healing and reduce inflammation. This can be injected into the hip to help decrease symptoms.

Alternative therapies. Many alternative forms of therapy are unproven, but may be helpful to try, provided you find a qualified practitioner and keep us informed of your decision. Alternative therapies to treat pain include the use of therapies such as acupuncture, and magnetic pulse therapy among others.

Surgical Treatment

Surgery may be recommended if your pain from arthritis causes disability and is not relieved with nonsurgical treatment. As with all surgeries, there are some risks and possible complications with surgery. Possible complications will be discussed with you before your operation.

Arthroscopy. During arthroscopy, a camera and thin instruments are passed through small incisions to diagnose and treat joint problems.  Arthroscopic surgery is not often used to treat arthritis of the hip. In cases where osteoarthritis is accompanied by a degenerative labral cartilage tear, arthroscopic surgery may be recommended to treat the torn labrum.

Total hip replacement.  In a hip replacement the worn ball is removed and a titanium stem is placed in the hollow marrow space of the thigh bone. A new ball is placed on the post on top of the stem.  A titanium socket is placed in the pelvis, and a plastic bearing snaps into the socket so the ball can move smoothly and restore the function of your hip.

Recovery

After any type of surgery for arthritis of the hip, there is a period of recovery. Recovery time and rehabilitation depends on the type of surgery performed usually between 2 to 6 weeks.

Physical therapy is sometimes recommended to help you regain and to restore range of motion. Depending upon your procedure, you may need to use a walker or a cane for a time.

In most cases, surgery relieves pain and makes it possible to perform daily activities more easily.

Source: drlatteier.com