HIP OSTEOARTHRITIS - Arthritis
of the hip
Arthritis of the hip is common, affecting approximately 10% of
the population. The most common cause is Osteoarthritis, but there are
numerous other causes relating to development of your hip as a child
or specific injuries.
Treatment
Hip arthritis is never life threatening, the main aim
of treatment is therefore symptomatic for pain and to try to keep mobility
and range of movement of the joint.
Treatment follows a progression from simple measures to major surgical
intervention.
Simple measures
Exercise – Non-impact
exercise such as walking, swimming and cycling keeps muscle strength
and tone. Hip joint stretches to keep the hip supple are beneficial.
A consultation with a physiotherapist for education and a home exercise
program can be useful.
Walking stick –
Using a walking stick in the opposite hand reduces load in the hip and
usually increases your walking distance. A strong stick of correct length
with a non slip rubber end is best.
Paracetamol – A
simple but safe analgesic when used correctly. Often needs to be used
3 or 4 times a day (1000mg / 2 tablets on each occasion). This can be
safely used by most people at prolonged periods at these doses.
Natural remedies –
Often not proven but some people gain relief from various naturopathic
potions, magnets, acupuncture and the like. This affect may be placebo
but some plant substances have proven anti-inflammatory effects. You
should check the use of these with your local Doctor as some may react
with other medicines or be dangerous.
Glucosamine and Chondroitin Sulphate
– The most common arthritis remedies at the present time. There
is some early evidence that over time they may help to maintain articular
cartilage and slow progression of Osteoarthritis. Nothing can ‘put
cartilage back’ after Osteoarthritis is established. Some people
also report a reduction in arthritis symptoms when taking these substances.
Their main side effect is diarrhoea. They should not be taken if you
are pregnant or allergic to shellfish.
Fish oils – Have
been associated with some improvement in cartilage quality and may be
beneficial.
Anti-inflammatories (NSAID’s)
– Several types of Non steroidal anti-inflammatories are available.
They can be very effective in reducing pain and swelling associated
with osteoarthritis. All these medications have potential side effects
and are not always tolerated. The most common effects are: exacerbating
asthma, stomach upset (ulcers etc), increased blood pressure and ankle
swelling.
Weight loss – There
is no doubt that if you are above ideal weight, weight loss can have
a significant impact in reducing pain from osteoarthritis. Weight loss
can also reduce the risk of anaesthetic complications and wound healing.
Many people after loosing weight no longer need surgery for their Osteoarthritis.
You may be given an ideal weight to attain prior to consideration for
surgery. Consulting a dietician may be beneficial.
Injections – A hip
injection is often used by your specialist to differentiate between
back pain and hip joint pain. An injection is given to ‘numb’
the hip and you then keep a record of the pain experienced. Sometimes
steroids are used to provide longer relief of pain. The procedure is
done under X-ray guidance with a small risk of infection.
Surgery
Arthroscopy – Hip
arthroscopy is usually reserved for a few relatively rare hip conditions
such as loose fragments in the joint or labral tears. It may be used
to help the diagnosis.
Hip replacement –
This is only considered when non-operative options have been exhausted.
It involves replacing the worn out ball and socket joint with an artificial
one. It was the most successful operation of the 20th Century with 98
of every 100 people feeling it was worthwhile. It usually provides lasting
pain relief and improved walking and function. I use and ‘Exeter’
hip replacement manufactured by Stryker. This is a ‘cemented hip’
and has been available since 1970. It has, I believe the best published
results of all hip replacements on the market. About 2% of these hips
will fail in the first 10 years, some quite quickly from infection and
loosening, the other 98% should last beyond 10 years. Over 90% of Exeter
stems from 1970 are working at 30 years.
If your hip replacement fails it can be re-done (revised). This is a
bigger operation, but still very successful.
All hip replacements require regular check ups for EVER. Normally at
1 year, 2 years, 5 years and then every 5 years.
Hip resurfacing –
This may or may not be the future for hip replacement. I believe it
has a place in hip arthritis in young people who get in awkward positions
such as kneeling, crawling etc. It remains under close scrutiny.
In summary
Keep active, keep supple and keep walking. Take simple pain killers
and use a stick. If and when ‘something needs to be done’
we can guide you through the options available.
Jon Conroy BSc, MB ChB, FRCS (Eng), FRCS
(Tr & Orth), MSc
Consultant Orthopaedic Surgeon
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