Hip Arthritis

There are a number of different types of hip joint arthritis; the most common is osteoarthritis which is sometimes called ’wear-and-tear’ arthritis or degenerative joint disease. Arthritis is the wearing of the joint, which includes thinning and damage to the cartilage. As the protective cartilage is worn away, bare bone is exposed within the joint. Bony spurs and cysts also form.

The hip joint is the joint between the femur (thigh bone) and acetabulum of the pelvis and its primary function is to support the weight of the body in both static (e.g. standing) and dynamic (e.g. walking or running) postures. It is a ball and socket joint.

The surfaces of the hip joint are covered in a lubricated low friction cartilage and the joint is made more stable by ligaments, tendons and muscles.

People with hip arthritis typically experience groin and buttock pain which gradually worsens over time. Pain is also often felt in the thigh and sometimes the knee; this is known as ‘referred pain’. Intermittent episodes of more severe discomfort lasting days or weeks are common. Hips that have arthritis gradually become stiff, which can cause difficulty with daily activities such as putting on shoes, getting in and out of cars or chairs and walking up and down stairs. Painful catching and night pain are other common symptoms.

Yes. Many patients with hip joint arthritis benefit from non-surgical treatment. Non-surgical treatments include lifestyle changes such as weight loss, activity modification, medications, and physiotherapy. These measures may reduce pain and improve function, delaying or removing the need for surgery. For this reason, it is strongly recommended that patients with hip arthritis trial non-surgical treatments before undertaking an operation. It should be noted however that most types of arthritis are permanent and progressive. If your symptoms are persistent despite adequate non-surgical treatment, then an operation may be a better alternative.

Weight Loss
Weight loss decreases the force placed through the joint and often results in a significant improvement in symptoms. Professional advice will often help – speak with your General Practitioner or weight loss centre.

Activity Modification
Regular exercise is important to improve muscle condition and also for general health, however high impact activity often causes worsening of arthritis symptoms. Exercises which are often well tolerated by patients with hip arthritis include swimming, cycling, aqua-aerobics and walking. A walking stick (used in the opposite hand to your arthritic hip) often makes walking more comfortable.

There are many medications on the market for the treatment of hip arthritis. Some are more effective in some patients than others . Often a combination of medications taken together is the most effective strategy. Some patients get worsening of pain at certain times during the day or at night – taking your medications around these times is recommended. Some medications (paracetamol, glucosamine) are best taken on a regular basis while others (anti-inflammatory medications, pain killers) should be used for short periods to treat ‘flare-ups’. Patients with inflammatory types of arthritis (for example rheumatoid arthritis) should follow the advice of a rheumatologist.

Paracetamol usually needs to be taken a number of times during the day for best effect. Longer acting preparations for use in arthritic conditions (eg. Panadol Osteo) are now available.

Anti-inflammatory medications (NSAIDs and COX-2 inhibitors)
Anti-inflammatory medications are effective in reducing the symptoms of osteoarthritis. Caution must be taken as they may cause side effects such as stomach erosions, particularly when taken for extended durations. Other side effects include worsening of asthma or kidney troubles. For this reason, anti-inflammatory medications are best used for short periods of time, for the management of ‘flare-ups’. If you have tried one type of anti-inflammatory medication but it was not helpful, trying a different preparation may still be worthwhile. Some types of anti-inflammatory medications are available as once a day (one tablet) preparation.

Pain Killers
Recommended for limited periods of use only. If pain is severe enough to require strong painkillers on a regular basis, then surgery should be considered.

Steroid Injections
Anti-inflammatory steroid injections into the hip joint may provide temporary improvement in symptoms. Injections into the hip joint need to be conducted with either X-Ray or ultrasound guidance. Usually a combination of anti-inflammatory steroid and local anaesthetic is used, and may provide partial symptom relief for 4-6 months. Steroid injections are safe, but marginally increase the risk of infection if a joint replacement procedure is conducted shortly afterwards.

Synvisc Injections (Viscosupplementation)
Synvisc is an injectable medication which improves the quality of the lubricant (synovial fluid) within the joint. Injections into the hip joint need to be conducted with either X-Ray or ultrasound guidance. A single injection provides on average a 30% reduction in pain for 6 – 12 months. A present Synvisc is not listed on the Australian PBS (Pharmaceutical Benefits Scheme) which means that patients bear the full cost of the medication without government assistance. Some health care funds may provide assistance depending on your cover.

Physiotherapy is of significant value in the treatment of some hip disorders. For patients with moderate or advanced hip arthritis, physiotherapy is generally less effective in the long term. Physiotherapy is of particular value when specific problems such as muscle weakness or a tight fibrous band on the outer aspect of the hip are identified.

Glucosamine and Chondroitin
Glucosamine and chondroitin are nutritional supplements. People take them to help build new cartilage. Glucosamine and chondroitin are not regulated as drugs in Australia, so their quality may vary. Minor side effects include upset stomach, diarrhea, and headache. Research studies tell us that more than half the people with osteoarthritis taking glucosamine and chondroitin improve. They have less pain and better movement. But in these studies, the same number of people who do not take the supplements also improve. This means that glucosamine and chondroitin are not the reason that some people improve.

Artificial joint replacements are a reliable and safe way of treating arthritis. For patients who require artificial joint replacement, the alternatives include Total Hip Replacement (THR) or Hip Resurfacing. Some patients with less extensive joint damage may benefit from hip arthroscopy (key-hole surgery) or other joint preserving surgical procedures. Knowing which procedure is most appropriate for an individual patient requires clinical assessment.

Learn more about Total Hip Replacement at SOTRS  

Learn more about Hip Joint Resufacing at SOTRS