Arthritis

Hip Arthritis

Description

Hip arthritis is a leading cause of hip pain and stiffness. Arthritis is the loss of the normal protective cartilage that covers the bones. When this cartilage or "padding" of the bone breaks down and is lost, areas of raw bone become exposed. When large areas of bone are exposed, they grind against each other with standing and walking. This is "bone on bone" arthritis and is usually painful.

Symptoms

Groin pain, limited motion, and weakness are all common symptoms of arthritis. Other symptoms may also occur, depending on the type and severity of the disease, location in the body, and other factors. In osteoarthritis of the hip, the first sign may be pain and stiffness when getting out of a chair or standing or walking for long periods of time. Many people notice that putting on shoes or socks is difficult. The pain is usually felt in the groin and may radiate to the inner part of the thigh or knee. Sometimes the pain radiates to the buttock, but pain on the outer part of the hip is usually not from arthritis. Pain and stiffness in the morning is typical, and in advanced cases, joint pain may even wake you up at night. Additional symptoms may include a sensation of grating or grinding (crepitation) that is felt in the affected joint as damaged surfaces of cartilage rub together. If the arthritis is caused by damaged ligaments, the joint may feel unstable or loose.

Causes

• Osteoarthritis—This progressive condition is caused by excessive use; wear and tear that occurs as part of the aging process; or fractures, sprains, dislocations or other traumatic injuries that damage or destroy the smooth articular cartilage covering the ends of bones. Even when properly treated, an injured joint is about seven times more likely to develop arthritis.
• Rheumatoid arthritis (RA)—This is a chronic, autoimmune disease that causes the immune system to attack and damage normal tissue, including many joints throughout the body. RA often begins in smaller joints, such as those found in the hand and wrist, and it is symmetrical, so it usually affects the same joint on each side of the body.

Diagnosis

To diagnose arthritis of the hip, and the category of disease, your physician may use a variety of diagnostic tools, including patient history, physical examination, blood tests, and X-rays. When X-rays appear normal but arthritis is still suspected, an MRI can show more detail. When arthritis is present in more than one area (the low back and hip) sometimes it is difficult to determine if the pain around the hip is coming from the hip joint itself or if it is coming from the lower back. In these cases, an injection into the hip of pain medication and cortisone may help to make the diagnosis more clear. If the injection takes away the pain, then the pain is likely coming from the hip. If it makes no difference, then it is likely coming from another source.

Nonsurgical Treatment

There are several options for nonsurgical treatment of arthritis, depending upon: how far the disease has progressed; how many joints are involved; your age, activity level and other medical conditions; whether or not the dominant hand is affected; your personal goals and home support structure; and your ability to understand your treatment and comply with a therapy program. Following a prescribed exercise program can also help improve strength and range of motion in the affected joint.

• Medications—This progressive condition is caused by excessive use; wear and tear that occurs as part of the aging process; or fractures, sprains, dislocations or other traumatic injuries that damage or destroy the smooth articular cartilage covering the ends of bones. Even when properly treated, an injured joint is about seven times more likely to develop arthritis.
• Glucosamine and Chondroitin—Dietary supplements or nutraceuticals such as these are also widely advertised. These compounds are the "building blocks" of cartilage, they are not drugs. Originally used by veterinarians to treat arthritic hips in dogs, these in most studies of these nutraceuticals, no difference between placebo and the nutraceutical has been found. (Note: The U.S. Food and Drug Administration does not test dietary supplements, and these compounds may cause negative interactions with your other medications. Always consult your doctor before taking dietary supplements.)
• Injections—These may be used when anti-inflammatory medication is not appropriate. Typically containing an anesthetic (similar to Novacaine) and a steroid, injections can offer pain relief for weeks or even months. Injections can be repeated, but only a limited number of times because of possible side effects, such as lightening of the skin, weakening of the tendons and ligaments, or infection.
• Physical therapy—Your physician or physical therapist may prescribe specific exercises to help you improve strength and flexibility, restore movement, and provide relief from uncomfortable symptoms. Physical therapy is often a key factor in successfully recovering from a wide range of conditions and disorders.

Surgery

When nonsurgical treatment does not provide the desired outcome, a variety of surgical options may be considered. For hip arthritis hip resurfacing or total replacement surgery can greatly improve symptoms. Total hip replacement can be done through different approaches. The appropriate option will depend on a variety of factors, including: the severity of disease; other medical conditions; and your age, goals, activity level, and home support structure. Your orthopaedic surgeon will review surgical treatments with you, and discuss which ones offer the highest potential for long-term relief of pain and allowing you to return to normal activity.

Recovery

Following surgery, a trained therapist will help you maximize your recovery. The length of time needed for recovery varies, depending on the extent of the surgery and individual factors. Most people are able to return to most, if not all, of their daily activities about three months after major joint reconstruction.