Treatment options for Osteoarthritis of the Hip

What is Arthritis of the Hip? 

Arthritis in general is the inflammation of a joint marked by cartilage loss and structural changes to the joint. Cartilage is the white, smooth covering on the surface of the hip that allows pain free motion. As arthritis sets in, the cartilage begins to wear out and sometimes allows the underlying bone to be exposed. As the disease progresses, the bone itself begins to change.  What this means for patients is pain and limited mobility of the hip. 

Anatomy of the hip: 

The hip is made up of two parts, the head of the femur, and the cup of the pelvis (the acetabulum). The hip is where the leg and the torso come together. Looking at the outside of the body, the hip is located directly below the groin. Structurally, the hip is a ball and socket joint. This design allows for a wide range of motion and a variety of different types of motion.  Healthy hips allow rotation, flexion, extension, and twisting. Both the head of the femur and the acetabulum are covered with a thick layer of cartilage. This covering lets the hip move without friction and, consequently, without pain.   

The ball and socket nature of the hip makes it very stable. The hip is surrounded by the largest muscles in the body, such as the labrum, a ring of extra strong cartilage called the labrum, which acts to give sensation and extra stability to the hip. This combination of stability and muscular support makes the hip one of the toughest joints in the body.  One weakness of the hip is its blood supply. The extensive range of motion the hip allows can make getting blood and nutrients to the cartilage of the hip somewhat tenuous. 

Types of Hip Arthritis: 

• Osteoarthritis (OA):  This is by far the most common type of hip arthritis and is often referred to as “wear-and-tear” arthritis. In osteoarthritis, the hip cartilage just wears out, which is why it is known as a degenerative joint disease. For this reason, osteoarthritis is strongly associated with increasing age. The older the hip is, the more likely it is to have worn out. Certain conditions that cause more wear can lead to a higher likelihood of osteoarthritis as well. One common such condition is cam impingement. This is an anatomic deformity of the hip that make for less smooth motion and leads to more wear. Another condition associated with osteoarthritis is obesity. It makes sense that the more weight the hip is required to carry, the sooner it could wear out.     

• Inflammatory Arthritis (IA):  This is much less common than OA but can lead to wearing out of the hip.  In inflammatory arthritis, the body can attack the cartilage leading to increased friction and pain in the joint. Rheumatoid arthritis, psoriatic arthritis, and lupus arthritis are all types of inflammatory arthritis. People with IA tend to wear their hips out at a younger age than people with OA.   

• Avascular Necrosis (AVN):  This condition is associated with the fragile nature of the blood supply to the hip.  Certain medical conditions, drugs, and some medications can lead to disruption of the blood supply of the femoral head.  The most common causes of AVN are alcohol abuse, prolonged steroid use, certain chemotherapy drugs, and trauma.  Without blood supply, the hip can collapse causing pain and dysfunction.  

Symptoms: 

The most common symptom of all types of hip arthritis is pain. Hip pain is very often located in the groin. Initially, it is associated with activities like walking or running, which could cause hip locking. As hip arthritis progresses, many patients will start to have pain at rest and even at night while sleeping.  Stiffness is also a common symptom of hip arthritis. Many patients complain of difficulty putting on socks and shoes. As the hip arthritis becomes severe, patients often experience shortening of the affected leg which leads to a limp. The combination of these symptoms makes hip arthritis one of the more debilitating arthritic conditions.   

Diagnosis:   

If you are suspicious you have hip arthritis, your orthopedic doctor can help. You can expect your doctor to take a thorough history and listen carefully as you describe the symptoms you are having. They will also do a physical exam and range-of-motion testing, looking for the tell-tell signs of hip arthritis including problems with gait, and tenderness or pain when pressure is placed on the hip. The final step in diagnosing hip arthritis is an x-ray.  As the hip disease progresses there will be signs such as deterioration of cartilage or the growth of bone spurs, on the x-ray that will help make the diagnosis. An MRI may also be taken to look for bone and soft tissue degradation. 

Non-surgical Treatments of Osteoarthritis of the Hip: 

• Supplements and braces: Over-the-counter supplements such as glucosamine and chondroitin, when compared to placebo have not been shown to improve hip pain.  While these medications have not been shown to be harmful, they are generally not considered effective for the treatment of hip arthritis.  Braces are not commonly used to treat hip arthritis pain.    

• Activity: If you are having hip pain with certain, high-intensity activities, the first step to improving that pain is to decrease the activity. In early OA, activity modifications can improve the symptoms and decrease the pain, at least initially.  

• Weight Loss:  Studies of patients with hip pain have consistently shown that the most effective, non-surgical, treatment for hip pain is weight loss.  The more weight your hips carry, the more painful hip arthritis will be.  It is a difficult thing to lose weight in a meaningful way, but it can have a drastic improvement on your hip pain.   

• Physical Therapy: Patients with hip arthritis typically have weakness in the muscles that surround the hip. Strengthening those muscles under the direction of a physical therapist can improve your symptoms and ability to increase your function.   

• Non-Steroidal Anti-Inflammatories (NSAIDS):  Pain in arthritis is mediated by inflammation. Medications such as Ibuprofen and Naprosyn that decrease inflammation can be very effective in treating hip arthritis pain. You should be careful using these medications, however, as they do have side effects, but talking with your doctor can help.   

• Injections:  The hip is located deep within the body. This makes the placement of injection medications in the hip difficult. In addition, injection medications tend not to provide long-term relief from hip arthritis pain. Some medications that are given by injection include corticosteroids, PRP, and stem cells. None of these have been shown to lead to consistent, long-lasting pain relief. For these reasons, hip injections are not commonly used for the treatment of hip arthritis.   

Surgical Treatments of Osteoarthritis of the Hip: 

There is not a complete cure to Osteoarthritis of the hip, but there are certain surgical interventions that can provide short or long-term relief:   

• Hip arthroscopy:  This treatment involves the use of a small scope and shaver to remove damaged cartilage from the hip joint.  It is typically reserved for younger patients with very early signs of arthritis. Studies have shown that it is not a good treatment option for long-term relief of hip pain or treatment of hip arthritis.    

• Hip Replacement: Nearly all advanced hip arthritis is treated with hip replacement. This may sound like bad news, as many patients would like to avoid surgery. But, hip replacement is very effective at eliminating hip pain and allowing patients to return to all activities.  A hip replacement can often mean a new life for patients who have been suffering with hip pain for many months or years. In a hip replacement operation, your surgeon will remove the damaged hip joint and replace it with an artificial hip joint. The new hip joint is made of titanium, ceramic, and plastic. The operation is typically done in a hospital or surgery center.  Hip replacement typically takes between 1 and 2 hours to complete. 

• Recovery:  Many patients are able to go home from the hospital the same day after hip replacement surgery, while some will need to spend just one night in the hospital. Most patients will be allowed to walk on their new hip immediately. Although surgical protocols can vary, most patients don’t require any physical therapy after surgery.  Instead of therapy, I encourage my patients to walk after surgery with the goal of walking 1 mile by two weeks after the operation.  You can expect to be able to drive by 2 weeks after.  Within about 6 weeks, patients can get back to all activities they love. One of the beauties of hip replacement is that there are no restrictions after the operation.  That means you can return to golf, tennis, skiing, or even running.  Modern hip replacements are designed to last a very long time.  Some studies have suggested that hip replacements will last 50 or more years, providing a lifetime of pain-free function.