What is hip joint arthritis?
Osteoarthritis of the hip joint also known as OA hip or hip joint arthritis, like all other forms of arthritis, is characterised by morning stiffness and pain accompanied by intermittent discomfort throughout the day especially on activity. We can distinguish pain around the hip area as follows:
- Buttock pain and pain down the leg is usually from the lumbar spine
- Lateral hip is usually glutius medius tendinopathy or greater trochanteric pain syndrome
- Groin pain, especially with hip flexion and internal rotation is most likely true hip pain
The cartilage that covers the ball on the end of the thigh bone and the cartilage within the socket of the pelvis become thinner and where away and the joint fluid becomes more viscous causing the stiffness within the joint. You can also go osteophyte formation around the edges of the joint and this will eventually lead to significant narrowing of the joint space which can be seen very well on x-ray.
The main risk factors for hip pain include:
- Activity levels
Unfortunately the older you are the more likely you are to get wear in the joints and suffer from osteoarthritis and hip joint arthritis is more prevalent in females. The more overweight you are the more likely you are to develop hip arthritis. The greater your body mass, the greater the load going through the hip will be. We also know that excess body fat is inflammatory in nature and this can also accelerate the loss of joint cartilage and accelerate arthritis. Activity levels are also important to consider. Excessive activity levels may accelerate joint cartilage loss in some people but not in others, but well managed activity levels will control BMI and we also know that increasing and improving activity levels can reduce hip pain 10-20% alone.
How do you treat hip arthritis?
Management of hip arthritis includes many things such as losing weight and increasing activity levels. It is usually best to increase non-weight-bearing activity level such as stationary bike or swimming as this puts less impact loading through the painful hip joint. Physiotherapy exercises to strengthen the muscles around the hip joint such as the hip flexors and glutes as well as some manual therapy techniques to mobilise the stiff and painful hip can also sometimes be useful.
Ultrasound guided injections for hip arthritis
Another form of treatment that can be very useful for mild to moderate hip joint arthritis is injection therapy. The products that would be injected into the hip include corticosteroids and hyaluronic acid (Ostenil plus or Durolane). Traditionally the hip joint would need to be injected under fluoroscopic guidance in a hospital, however the hip joint can be visualised very well on ultrasound. An an ultrasound guided hip joint injection is a very simple procedure to perform in an outpatient musculoskeletal clinic such as Wandsworth physiotherapy. We would usually perform an ultrasound guided steroid injection to help bring pain levels down and this might last for about 3 months. We can also inject hyaluronic acid at the same time, and this has been shown to help to lubricate the hip joint and provide benefit for 6-12 months. You can manage a mild to moderately arthritic joint for a number of years with injection therapy.
The final treatment for hip joint arthritis would be seeing a consultant orthopaedic surgeon and discussing options such as a total hip replacement or hip resurfacing operation. These operations are very common in the older population and outcomes are food as long as you are diligent with your post op physiotherapy and home exercises.