Hip arthritis

The hip joint is formed where the ball-like upper part of the thigh bone (femur) fits into the cup-like part of your pelvis (the acetabulum). This ‘ball and socket’ structure gives the hip joint a good amount of mobility.

However, this mobility of the hip joint also means that it is susceptible to wear and tear as well as injury and disease. This wear and tear can sometimes result in severe pain and a lack of mobility in the hip.

Covered by soft tissue, muscle and cartilage, your hip is a deep and stable joint. This makes it hard to injure. However, the most common cause of hip pain is arthritis in the joint rather than an injury.

Arthritis is a condition that affects the joints of the body. It can occur in people of all ages, including children.

There are several different types of arthritis, including:      

• Osteoarthritis: This is the most common type of arthritis in the UK, causing degenerative changes in the articular cartilage of a bone. Joint space narrowing is a common symptom of osteoarthritis. ·    
• Rheumatoid arthritis: Caused by the immune system attacking the joints, leading to swelling, damage and sometime a change in the shape of the joint itself. ·       Fibromyalgia: Affects the muscles, ligaments and tendons.
• Gout: Caused by too much uric acid in the body, this normally affects the big toe although it can occasionally also affect the hip.
• Polymyalgia rheumatica: Caused by the immune system, this can lead to inflammation, pain and stiffness in and around the hip joint. While osteoarthritis is the most common cause of hip pain, treatments and medical support are available for these other types of arthritis as well. There is currently no known cure for arthritis, but there are a range of treatments that can help reduce symptoms and manage pain.

Osteoarthritis often develops very slowly, so many people don’t notice the incremental changes it can cause in their joints.

In a healthy joint, the articular cartilage covering the ends of the bones is smooth. Osteoarthritis causes the cartilage to thin, leading to friction in the joint when the bones move over one another.

As arthritis develops, this thinning of the articular cartilage can become so severe that the bones of the joint end up moving directly against one other, with no protective layer between them. When this happens, the pain in the hip can be extreme.

The body is usually very good at trying to repair damage, but osteoarthritis causes cartilage to wear down at a faster rate than the body is able to repair it.

Sometimes the healing process itself can lead to the formation of new bony growths in the joint. Called bone spurs or osteophytes, these hard lumps of bone lead to additional stiffness and pain, further reducing the degree of pain-free movement in the hip

The specific causes of osteoarthritis remain unclear, although there are several factors known to increase the risk of developing it. These include: 

• Previous injury to the joint: A previous injury or operation can increase the possibility of developing osteoarthritis in the joint at a later date.
• Age: While osteoarthritis can develop at any age, it is more commonly seen in people over the age of 50.
• Gender: Women are more likely to develop osteoarthritis than men. It often begins to develop after menopause, although the exact reasons for this are not yet fully understood.
• Weight: Obesity increases the risk of developing osteoarthritis. It increases the load placed on your weight-bearing joints like the knees and hips. 
• Family history (genetics): You may be at an increased risk of developing arthritis if there is a history of it in your family. What are hip arthritis symptoms?

The exact symptoms you experience will vary depending on the type of arthritis you have and how advanced it is. The signs of hip arthritis listed below are intended for guidance. If you have any of these symptoms you should see a doctor who will be able to help give you an accurate diagnosis.

• Pain: Most people first become aware of a problem when they feel hip pain due to arthritis. While we all experience occasional aches and pains, you may begin to notice that you only feel pain in your hip when you move your leg in a certain way, or when carrying out some activities. Arthritis hip pain is often generalised over the whole hip rather than a specific localised pain. The hip arthritis pain location may not focused on the hip. You may experience hip arthritis symptoms in the groin or hip arthritis pain down the leg. The pain may also be worse in the morning or last thing in the evening. 
• Reduced movement: As arthritis develops in the hip joint, it will start to limit and reduce your movements more. As a result some movements may become more difficult.
• Stiffness: You may feel increased stiffness in your hip when moving your leg. As the joint becomes stiffer, it can have the effect of making your movements feel slower.
• Weakness: You might feel like you have lost some strength in your hip or thigh. The muscles surrounding your hip may look thinner than usual.
• Swelling: You may have swelling in your hip as a result of inflammatory changes within the joint. This is known as synovitis and will often settle naturally over time. If it becomes significantly painful, you should see a doctor for advice.
• Grinding: Known as ‘crepitus’, this is a grinding, creaking or cracking felt or heard within the hip joint when it is moved. It is important to note that these symptoms are not exclusively caused by arthritis. Other illnesses, injuries and diseases can also show similar symptoms. However, they are often a good indicator that something is not quite right with your hip.

While many of us may accept a bit of stiffness and mild pain in the hip as a natural result of growing older, pain that is long-term or getting worse should not be ignored.

In the early stages of arthritis, you may not feel the need to see a doctor. However, it is always sensible to seek expert medical advice when you start to lose the ability to carry out certain tasks, or when the pain in your hip reaches a certain level.

Nobody knows your hip pain better than you. When you first see your doctor, they will talk with you about your medical history and what you have been doing to manage the hip pain.

The doctor will examine your hip, thigh and lower back, assessing your range of movement in the joint and the extent of any problems. Hip pain can sometimes occur due to a problem in your back, so this will also be looked at in order to rule out the possibility of referred pain.

Depending on your medical history and the examination, your doctor may arrange for you to have some diagnostic tests to help confirm a diagnosis of arthritis and/or treatment options. These tests may include: 

• X-ray: Where arthritis in the hip joint is suspected, your doctor will usually arrange for you to have an x-ray as this can show clear signs of arthritis in the joint. Well-developed arthritis tends to be more easily seen on an x-ray, while new or mild arthritis may not be as obvious or clear. Often, for a hip arthritis x-ray of your whole pelvis will be done, as this allows your doctor to compare the appearance of both hip joints to one another.
• CT scan: Best thought of as a way of generating a three-dimensional x-ray, a CT scanner resembles a large doughnut. You lie on a table which is then moved so that your hip is inside the scanner. Standing for ‘computerised tomography’, a CT scanner uses a combination of x-rays and computer technology to generate a detailed view of your hip joint from multiple angles. A CT scan is good at showing subtle signs of arthritis that may be missed on a standard x-ray and can also be helpful when planning hip surgery.
• MRI scan: An MRI scanner uses strong magnets rather than ionising radiation. Standing for Magnetic Resonance Imaging, an MRI scan provides your doctor with high-quality images of your hip joint. It is good for showing tendon damage, which can be a common problem with hip arthritis. For the scan, you lie on a table that then moves into the middle of the scanner for the duration of the scan. You will need to keep as still as possible for the scan, which usually takes between 20-45 minutes. The images from any diagnostic scan you have will be examined by a radiologist (a specialist in interpreting diagnostic images). The radiologist will send their report to your doctor as soon as it is done.

The most common complaint from people with arthritis in the hip is the pain that it causes them. While many people can cope with some discomfort, chronic pain can be hard to live with. This can have an impact on mood and psychological wellbeing, as well as physical activity. Stopping the pain, or significantly reducing it, is an important step in helping you to manage life with arthritis.

There are several ways arthritis in the hip can be treated and managed, ranging from ‘do it yourself pain relief’ all the way through to hip replacement surgery.

 Unless your arthritis is at an advanced stage, your doctor will usually start with non-surgical treatments first.

Pain relief

In the early stages, an over-the-counter painkiller, such as paracetamol, can help with hip arthritis pain relief. Analgesia is the medical term for pain relief.

As arthritis develops the pain relief you get from paracetamol may decrease, and your doctor may suggest using a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen. As well as reducing pain, these can also help to reduce inflammation. Some NSAIDs can be purchased over the counter from your local pharmacy, while others will need a prescription.

There are many medicines available that can help to relieve pain, but before taking any medicine, you should ensure it is safe for you to do so. If you are unsure, you should consult a medical professional such as a doctor or pharmacist.

Physiotherapy

A physiotherapist can help to strengthen the muscles around your hip to compensate for the effects of arthritis. Physical therapy may help to restore and maintain function and mobility in the hip for longer than would otherwise be achieved. This can help to delay the need for hip replacement surgery to treat severe arthritis.

Often, people struggling with pain in their hip discover that an easy way to reduce the pain is by lowering their activity levels. However, this can actually add to the problem, as less activity leads to the hip joint becoming stiffer and the thigh muscles surrounding it becoming tighter. As the joint tightens in this way, movement becomes more difficult.

A physiotherapy team will work closely with your consultant and other healthcare professionals to structure a custom exercise plan for you to help keep you as mobile and active as possible, for as long as possible.

They will talk with you about the importance of staying active for as long as possible and will show you exercises you can do to help maintain function in your hip.

Exercise

While hip arthritis causes pain and stiffness in the joint, it is important that you continue to use the hip in order to stop it seizing up completely. There will be limits to what you can do safely and without causing further pain, but hip arthritis exercises are beneficial for long-term health as well as for helping keep your hip moving.

Swimming is one of the best exercises for hip arthritis, as the buoyancy and support provided by the water reduces the stress (also known as the ‘load’) placed on the joint.

Weight loss

If you are overweight, then reducing your weight can help to reduce the pain you feel in your hip as a result of arthritis. Your doctor and physiotherapist, in partnership with a dietician, can help you develop an effective weight-loss programme.

Steroid injections

As arthritis progresses in the hip joint, pain and stiffness usually becomes worse. Painkillers will be having less effective in managing the pain.

Steroid injections (also known as ‘corticosteroid injections’) can be of help in this instance. These anti-inflammatory medicines help to reduce swelling in the hip joint and the surrounding area, reducing pain and stiffness.

These hip injections for arthritis can be given by your doctor, often using ultrasound to ensure the injection is in the correct place.

It will usually take a few days before you start to feel the full effects of the treatment. The effects are short-term, normally lasting for a month or two before wearing off, although some people may find the effects last for longer.

Steroid injections into the hip can be repeated, although most people find that they become less effective over time.

When hip arthritis progresses to the extent it is no longer being successfully managed by non-surgical means, your doctor will probably talk with you about the possibility of surgery on your hip.

Your doctor will discuss the different surgical procedures with you and determine which one will be of most benefit for your condition. One of the most common procedures to treat severe hip arthritis is a total hip replacement: 

Should arthritis in your hip joint develop to the point you are in constant discomfort and have extremely limited movement, a total hip replacement may be advised as the best treatment for you.

With very little pain and a short recovery period, hip replacement surgery is life-changing for many people. It can restore the freedom to move freely, exercise or even just walk to the shops, all pain-free.

During total hip replacement surgery, the damaged and worn bones of the hip joint are replaced with a cobalt/chrome metal joint.

This new artificial hip joint removes the problems caused by the worn articular cartilage of osteoarthritis and is designed to provide friction-free movement. This improves the mobility of the joint, while also helping to reduce the pain and stiffness in the hip joint.

Any type of surgery carries certain risks and complications. Common complications include:

• Allergic reaction: You may have an allergy to the anaesthetic used. You may feel sick for a short time.
• Infection: To reduce this risk you will be given antibiotics for the first 24 hours after surgery.
• Blood clots: The risk of developing a clot is low, around 1-4%. There are well-established treatments available to resolve them should they occur, including aspirin.
• Pain: This can usually be effectively managed with painkillers, and you will be prescribed pain medication after your surgery.

Arthroscopic hip surgery and total hip replacement surgery are common procedures, but there are some specific complications of any type of hip surgery to be aware of:

• Loosening and wear of the artificial hip prosthesis: Just as regular joints suffer ‘wear and tear’, so too do artificial joints. Although this is often a big concern of many patients before surgery, a hip replacement can usually be expected to last for 10 years or more. 
• Stiffness: You should expect the hip to have some stiffness after the operation. This will improve over time with physiotherapy and as your hip recovers from the surgery.      
• Nerve damage: Damage to nerves around the hip can lead to some weakness, numbness or pain in the leg or foot. This usually settles on its own but may be permanent. It is very rare.    
• Lump under the wound: Sometimes, you may develop a lump under the wound after hip surgery. This is caused by a small amount of bleeding under the skin and usually settles after a few weeks.

Your Consultant will discuss any potential complications with you prior to surgery.