Also known as degenerative or “wear and tear” arthritis, osteoarthritis of the hip typically occurs in adults aged 45 and older, when the cartilage that cushions the joint breaks down and eventually wears away. Characterized by pain and stiffness, severe cases can be profoundly debilitating.
Arthritis frequently occurs in individuals who have a family history of the disease and sometimes develops due to subtle irregularities in how the hip developed at an early age. Hip arthritis is more common in patients who are obese. Other factors that may contribute include trauma to the hip and fractures in the bone but many people get hip arthritis who have no risk factors.
- Pain that flares with activity and lessens with rest
- Hip stiffness and reduced range of motion
- Discomfort and stiffness in the groin, buttock or thigh, particularly in the morning
- Walking with a limp
- Knee pain referred from the hip
Rheumatoid Arthritis is an autoimmune disease in which the smooth layer of tissue that lines the joint called the synovial membrane becomes inflamed and thickened. Meant to lubricate the joint, the thickened synovium actually damages the cartilage, causing pain and stiffness.
Treatments for Hip Arthritis
Early non-surgical treatment can be effective at reducing pain and disability and slowing the progression of the disease. Surgery may be considered if the condition is severe.
- Weight Loss – In overweight patients, weight loss can have a very positive impact. The less weight the hip joint has to bear, the better the hip will feel.
- Rest and Activity Modification – Limiting certain activities may be necessary, and learning new exercise methods can help with mobility and flexibility.
- Walking Aids – The use of a cane, crutch or walker will reduce the demand placed on the arthritic joint.
- Physical Therapy – Strengthening of the muscles around the hip joint can help decrease the strain on the hip. Keeping the muscles mobile and flexible is important in maintaining hip function. Physical therapy that includes gentle, regular exercise like swimming, water aerobics or cycling may be beneficial.
- Anti-Inflammatory Medications – Prescription or nonprescription anti-inflammatory pain medications (NSAIDs) are often used to treat pain and inflammation.
If conservative treatments fail to bring relief; if hip pain is impacting normal daily functioning, total hip replacement surgery (arthroplasty) may be recommended.
Hip replacement surgery may be an option if:
- Simple daily activities such as walking or bending are impaired
- Hip pain is significant and prevents sleep
- Stiffness in a hip and or groin limits mobility
- Anti-inflammatory drugs are not effective
- Pain medications are not tolerated
- Other treatments including physical therapy are no longer beneficial
The surgery is most often performed under regional anesthesia. The surgeon removes damaged cartilage and bone, then positions new metal, plastic or ceramic joint surfaces to reconstruct the joint.
An artificial joint is comprised of two basic components: the ball (made of a highly polished strong metal or ceramic material) and the socket (a durable cup of plastic, ceramic or metal). Special surgical cement is frequently used to secure the artificial joint in place.
Sometimes in younger, more active patients, a non-cemented type of prosthesis is used. This prosthesis is designed so that the bone will grow into and integrates with the porous surface of the implant. In some cases, a combination of a cemented ball and a non-cemented socket is used.
Minimal Incision Surgery
Orthopaedic surgeons are constantly working to develop new techniques to improve joint replacement surgery. New minimally invasive and small incision surgery techniques are being developed for total joint replacement. Because less tissue is cut, these techniques may allow for quicker, less painful recovery and a more rapid return to activities.
Illustration reproduced with permission from Fischer S, (interim ed): Your Orthopaedic Connection. Rosemont, IL, American Academy of Orthopaedic Surgeons. Available at http://orthoinfo.aaos.org.org/.