Hip Osteoarthritis

Hip Osteoarthritis

Arthritis is a condition which refers to inflammation of a joint in the body and results in pain and swelling of the joint involved. There are various types of arthritis but osteoarthritis is the most prevalent. Osteoarthritis (OA) is also known as degenerative joint disease or age-related arthritis (incidence increases as people get older).

Osteoarthritis occurs when inflammation and injury to a joint results in the breaking down of the cartilage tissue around the joint. This cartilage degeneration in turn causes the arthritic symptoms of pain and swelling as well as a resultant deformity of the joint. Cartilage covers the ends of bones and acts as a shock absorber and reduces friction between bones within movement of a joint. When the cartilage breaks down, deformity of the articulating surfaces occur resulting in the inflammation of the joint. The main problem with cartilage degeneration is that although cartilage can repair itself to a small degree, the body is not able to regenerate or ‘grow’ more cartilage after it has been injured.

As its name suggests, OA or degenerative joint disease, is a slow degenerative condition and (with the exception of trauma) usually develops over many years.

There are 2 main categories in which OA occurs:

• Primary OA: This is a more degenerative type of OA that affects the spine, hips, knees, fingers and thumbs.
• Secondary OA: This type usually occurs after injury or inflammation to the joint involved. Can also result as a secondary response to another condition that affects the cartilage of a joint (e.g. hemochromatosis).

With regards to the hip joint, OA can affect a person’s gait and their ability to maintain a normal walking style due to the pain and swelling experienced. The difficulty with hip OA is that the pain experienced in the hip varies from person to person and as such is difficult to diagnose. Pain can manifest in the groin, knee, thigh or even the buttocks and can vary from being a stabbing, sharp pain to a dull ache. The hip is also usually stiff in nature.

Causes and symptoms of OA

The specific precursors for OA of the hip is not entirely known but it is widely accepted that injury to the hip joint, being overweight and one’s increasing age are all factors which contribute to the condition.

In addition to these factors, more structural issues can contribute to developing OA. These can include genetic defects of one’s cartilage (inherited) or abnormal growth development of the joint.

Certain activities/sports that involve high impact and excess stress and load (especially shear forces) on the hip joint can also make one more prone to hip OA.

Symptoms of hip OA can be relatively non-specific and generalised so it is always recommended that if you manifest with any of the following symptoms, contact your GP to further investigate the possibility of OA:

• Joint stiffness when getting out of bed in the mornings.
• Joint stiffness after prolonged periods of sitting in a fixed position.
• Any combination of pain, swelling or tenderness in and/or surrounding the hip joint.
• Crepitus (crunching or grinding sound/feeling) of bone rubbing against bone in the hip joint.
• An inability to perform daily activities that involve a degree of hip mobility – e.g. putting on one’s socks.

Treatment for OA

The main focus of the treatment protocol is to improve and maintain the mobility of the affected hip joint. This can be broken up into (a) improving the functionality of the hip joint and (b) pain management. Treatments available include the following:

• Rest from aggravating activities and joint care.
• Loss of any excess weight.
• A prescribed exercise regime.
• Non-drug pain relief techniques to control pain – e.g. breathing exercises.
• In certain cases, a cane or support can be used to offload the affected side.
• Speak to a GP regarding medications to help manage pain. This can include anti-inflammatories.
• Surgery

In terms of surgery, there are 2 options:

• Hip replacement surgery: The hip joint is a ball-and-socket joint and with this surgery, the head (ball) of the femur bone is replaced with a metal ball and the hip socket is relined with a metal shell and plastic liner to ensure smooth articulation.
• Hip resurfacing surgery: This is an intermediary procedure that can provide pain relief while extending the time before total hip replacement is required. In this surgery, the affected surfaces of the hip joint is removed and substituted with a metal sheath and the ball of the femur is also covered with a metal cap. The main advantage of this is that the femur bone is preserved and thereby allows for total hip surgery later on down the line.

What is important to remember is that the main way to prevent hip OA is to try to maintain a healthy weight and participate in a regular exercise regime (maintaining an exercise regime will increase strength and mobility of the hip joint)