AGEING DISEASES

Osteoarthritis of the Hip

Professor Nicola Portinaro explains symptoms, causes, diagnosis and treatment of osteoarthritis of the hip.

What Osteoarthritis of the Hip

Osteoarthritis is a condition quite common in middle-aged people and older. It can occur in any joint such as the knee osteoarthritis, and it usually affects weight-bearing joints such as the hip.

Osteoarthritis of the hip occurs when the cartilage that cushions the ends of the bone becomes worn. This cartilage is very lubricated to decrease friction and wear that may cause joint pain and stiffness.

So it is very important to diagnose this condition as soon as possible and to start treatment accordingly. 

Osteoarthritis of the hip is a chronic disease and it has to be said that there is no cure for it.

But there are anyway many treatment options to manage pain and live a normal life.

 

Osteoarthritis of the Hip Main Causes

Osteoarthritis of the hip is a chronic disease.

There is no specific cause and it is not possible to predict who will develop it, but we can identify factors that may favour its onset:

  • Age (usually people over 50 years old)
  • Family History
  • Obesity
  • Childhood disease such as Developmental dysplasia of the hip or Perthes Disease etc.
  • Acquired conditions such as avascular necrosis 
  • Severe Joint trauma 
  • Repeated stress on the joint caused by a job or a sport 
  • FAI: femoral acetabular impingement

But you can develop this condition even if you do not have any of the risk factors mentioned above.

 

Symptoms of Osteoarthritis of the Hip

Pain around the hip joint is, for sure, the most common symptom. it is typically referred in the groin. Pain can worsen over time and can be worse in the morning. 

Other symptoms may include:

  • Stiffness in the hip joint (so that is difficult to bend do shoe laces or even walk)
  • Sudden flare-ups
  • Grinding sensation (popping or crackling in the joint)
  • Decreased range of motion in the hip (limping)
  • Rainy weather may increase hip pain

In the advanced stages of the disease, other symptoms can be

Patients with advanced arthritis experience a relevant impact on their daily life. This disease may affect their ability to walk, climb stairs, enter or exit a vehicle. 

They may also find themselves fatigued and gain weight as a result of the inactivity caused by pain.

 

Diagnosis of Osteoarthritis of the hip

It is advisable to see an orthopedic surgeon as soon as the first symptoms arise, to have an early diagnosis and start treatment promptly.

The doctor will ask about your symptoms, medical and family history, and he/she will conduct a physical examination.

He or she will check: 

  • your joint and its range of motion plus special tests
  • tenderness around the hip
  • pain with pressure 
  • your ability to move and walk

The doctor may also order diagnostic tests, such as x-rays and occasionally, a magnetic resonance imaging (MRI) scan or a computed tomography (CT) scan. These investigation are useful to better determine the condition of the bone and soft tissues of your hip.

Blood tests are not needed to diagnose osteoarthritis but can be ordered to rule out other kinds of arthritis, such as rheumatoid arthritis (link). 

Treatment

As we said, there is no cure for osteoarthritis. Anyway, there are several treatment options that can help relieve pain and improve mobility and daily life.

Non-surgical Treatment

If the condition is at its early stage, the doctor will recommend a non-surgical treatment.

Non-surgical treatment may include.

  • Lifestyle changes. Reduce high-impact activities such as jogging or tennis and prefer low impact activities such as swimming
  • Diet. If needed, Losing weight can reduce stress on your hip joint
  • Physical therapy. Exercises to strengthen the muscles around your hip and to increase range of motion and flexibility
  • Use of assistive devices such as walking supports, walker, crutches, canes
  • Injection of steroid or jaluronic acid

The doctor may suggest you some drugs and medications to relieve pain, such as:

  • Acetaminophen
  • Nonsteroidal anti-inflammatory drugs
  • Corticosteroids 

Surgical Treatment of Osteoarthritis of the hip

If non-surgical conservative therapy doesn’t work, the orthopedic surgeon may recommend surgery.

Surgery options may be:

  • Hip arthroscopy. In the presence of FAI you may be able to resurface the pathological bone formation of this condition.
  • Hip resurfacing. In this procedure, the orthopedic surgeon removes the damaged bone and cartilage in the hip socket (acetabulum). The femoral head is covered with a metal shell.
  • Osteotomy. The femoral head and/or the socket are cut, and bones are realigned.
  • Total hip replacement (Arthroplasty). In this procedure the orthopedic surgeon removes the femoral head and the acetabulum and replace them with a plastic, metal or ceramic artificial device.

Other treatments / Alternative Medicine

Few other alternative treatments can be taken into account:

Cortisone injections (“cortisone shots”). Corticosteroid medications help relieve pain and inflammation in the joint, temporarily. 

The orthopedic surgeon injects medication using a needle within your joint. This procedure can be repeated three or four times in a year at the most. But you have to bear in mind that this is not a cure for arthritis. It is just a treatment for pain.

Hyaluronic acid injections. This injections help lubricate the hip joint and of may offer pain relief. Hyaluronic acid is indeed very similar to the fluid we have in our joints.

Alternative medicine

In some case, alternative medicine treatments can be useful and promising in the relief of osteoarthritis symptoms.

Acupuncture, for example, it is used in many types of arthritis such as knee osteoarthritis (LINK) as well. 

 

The experience of Prof. Portinaro

Although Prof Portinaro is mainly a Pediatric Orthopedic Surgeon, he is one of the most experienced surgeons in the treatment of hip-related conditions. He has performed thousands of hip surgeries over the years. But he can also recommend more conservative treatment such as Hyaluronic acid injections. 

He uses to perform surgeries such as osteotomy, arthroscopy and hip replacement in both arthritis and non-arthritis patients. 

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