Hip Conditions: Osteoarthritis

Hip arthritis is a condition affecting the joints, causing pain and inflammation. It is relatively common and can affect people of all ages. However, it is most common in people over the age of 60. There are over 100 kinds of arthritis, and it is a progressive disease, meaning it cannot be cured and may worsen over time.

The hip joint is shaped like a ball and socket. The “ball” is the femoral head (the top of the thigh bone/femur), and the “socket” is the pelvis (or acetabulum), which is shaped like a cup. It is one of the largest and most important joints in the body as it facilitates movement and walking. Like other joints, it is surrounded by cartilage, muscles, and other soft tissues that provide stability and cushioning.

Hip osteoarthritis is a condition characterised by hip pain, stiffness, and reduced mobility. The firm, rubbery tissue that coats the bone joints, called articular cartilage, becomes worn away. Cartilage enables the smooth movement of the joint, providing a low-friction surface for bones to glide over, as well as providing a protective cushion to prevent the bones from rubbing together. Cartilage can repair itself to some extent, but it does not regenerate once lost. One of the first signs of osteoarthritis is often stiffness or pain in the joint.

It can be difficult to point to just one cause of osteoarthritis of the hip, as many factors come together to increase the risk of developing it.

Wear and tear

Common to all osteoarthritis is the general overuse of the joint. This degenerative process wears the joint down over time, leading to the damage of articular cartilage and cushioning.

Ageing

With age, the risk of developing hip osteoarthritis increases, along with common wear and tear accumulating. The body’s ability to heal reduces, and it is less able to repair damaged cartilage.

Obesity

The hips carry a large amount of the body's weight on them. As a weight-bearing joint, extra body weight puts additional stress upon it, increasing the likelihood of causing damage.

Genetics

There is some evidence that osteoarthritis may have a genetic component. Family history of the condition is often a factor contributing to the risk of developing it.

Previous injury and overuse

Injuries to the hip joint, such as fractures or dislocations, can damage the cartilage and lead to an earlier onset of osteoarthritis. Jobs and sports that involve heavy lifting, repetitive motion, or prolonged periods of standing or walking can put extra strain on the hip joint, contributing to wear and tear over time. Certain sports like football, running, or ballet that put repeated or excessive strain on the hip joint may be contributory factors. Patients suffering from osteoarthritis may be advised to change their lifestyle, moving from heavy lifting at work and switching to sports with less stress on the hips, such as swimming.

Sedentary lifestyle

Conversely to overusing the hip joints, a lack of physical activity can lead to muscle weakness and reduced joint stability, both of which can accelerate the progression of osteoarthritis. Balancing between over and underuse of the hip can be tricky when getting older, and taking preventative steps early and seeking advice is prudent.

Other medical conditions

Conditions like hip dysplasia, where the hip joint is abnormally formed, or avascular necrosis, where the blood supply to the femoral head is compromised, can also lead to osteoarthritis.

Hormonal factors

Some evidence suggests that hormones may play a role in the development of osteoarthritis. For instance, reduced levels of oestrogen after menopause have been implicated as a potential risk factor, especially in women.

Non-Medical interventions

Weight loss and lifestyle modification

Lifestyle modification is always the first piece of advice in treating hip osteoarthritis. For patients who are overweight, one of the best ways to alleviate stress on the joints is to lose weight. Adopting low-impact exercises like swimming or cycling can provide the benefits of exercise without putting additional strain on the hip joint. Of course, suffering from pain and stiffness in the hips can make it extra difficult to lose weight and encourage a more active lifestyle; physiotherapists, in particular, are well-versed in tailoring plans to help patients reach their goals.

Physical activity and exercise

Engaging in physical therapy and exercises aimed at improving joint function can help manage symptoms. A well-planned exercise regimen strengthens the muscles around the hip joint, improving stability and reducing pain.

Assistive devices

The use of walking sticks or walkers can help distribute weight more evenly, thus reducing the stress on the affected hip. Orthotic shoe inserts and other more stable footwear can also help improve gait and reduce pain.

Analgesics

Lifestyle changes should always be considered at all points in a patient’s journey, but over-the-counter pain relievers such as paracetamol or nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for managing mild to moderate osteoarthritis pain. As always, it is highly recommended to consult a healthcare professional before starting any new medication.

Injections

A significant step up in treatments can involve injections to help alleviate pain and inflammation.

Corticosteroid injections can provide rapid but temporary relief from inflammation and pain; they are generally used sparingly due to potential side effects, including cartilage degradation.

Other injections, such as hyaluronic acid injections, aim to supplement the hip’s natural lubrication, potentially improving movement and reducing pain. This is not used by every clinician as the evidence of its effectiveness is conflicting.

Hip arthroscopy

Hip arthroscopy is a type of minimally-invasive orthopaedic surgery where small tools are used to reshape the hip joint

Osteotomy

Hip osteotomy is a surgical procedure that reshapes and realigns the bones of the hip to redistribute stress across the joint. It can be used to treat symptoms of osteoarthritis as well as prevent or delay the need for a hip replacement.

Hip Replacement Surgery

For advanced cases of hip osteoarthritis where other treatment options have failed, total or partial hip replacement surgery may be considered. This involves replacing a damaged hip with an artificial joint that is not well-managed with other treatments.