HIP ARTHRITIS

Hip arthritis occurs when the cartilage and eventually the underlying bone wears away or degrades in the hip. The most common form is osteoarthritis. This is commonly referred to as “wear and tear” arthritis but this is not quite correct. Although it becomes more common as people get older or after they experience an accident where the hip is injured, if it was just wear and tear, most people would present with arthritis which was the same on both sides, which it rarely is. If you need a hip replacement, there is about a one in ten chance that you would need to have the other side replaced in your lifetime. Osteoarthritis is a condition that affects the whole joint, not only the bearing surfaces that rub together. The lining of the joint, or synovium, is part of the process and the thick capsule that surrounds the joint becomes scarred and stiff as well. All of these factors can lead to symptoms that cause pain or otherwise affect you.

 

Hip arthritis: the effect of pain

Osteoarthritis of the hip most commonly causes pain. This pain means that you may tend to cut back on or stop doing activities that cause you pain which can be very frustrating and lead to other health problems. The scores that are used to assess how badly you are affected by your hip arthritis you are asked a few questions about pain but most of the questions are about particular activities and how easy you find it to perform these activities. You may have been asked to fill in one of these scores by people that you have seen about your hip. The most common one in use in the UK is the Oxford Hip Score (OHS), this consists of 12 different questions. Although more questions are about activities than pain, the majority of the change (around 80%) seen in the score is actually due to pain. So, if we can reduce your pain, you will be able to do more of the activities you want to do. 

 

Hip arthritis: where is the pain felt?

The pain from osteoarthritis of the hip is typically felt in the groin and may be felt in the thigh too. Less frequently, you may feel pain over the buttock or side of the hip. If the pain goes below the knee, it is very important that we rule out back problems that may be contributing to your pain as this may be due to problems such as a nerve being pressed on in the back.

 

Hip arthritis: when do people feel pain?

The pain is typically associated with activity to start with. You may find that the hip gets painful after sports or walking distances that you used to find no problem. As the osteoarthritis gets worse, you may start to feel pain at rest. You may find that the hip feels like it seizes up if you have been in the same position for a while, such as sat in a chair or when you first get up in the morning. If you are beginning to get pain at rest or that you feel at night in bed, that is a strong indicator that your hip may benefit from treatment. National guidelines say that treatments of hip problems, such as hip replacement, should be considered before you need strong painkillers such as patches or opiates (morphine type painkillers)

 

Hip arthritis: stiffness

As the arthritis progresses, you may find your hip gets stiff. This can be due to the wear of the cartilage but is also due to spurs of bone forming around the hip and the scarring of the soft tissues that we mentioned earlier. It is rare for patients to experience stiffness with no pain but this can happen and if the stiffness becomes bad enough, this can be an indication that treatment is needed on its own.

 

Hip arthritis: giving way

True giving way of the hip, such that you fall to the floor, is relatively unusual with hip arthritis. Most of the time when it feels like the hip is giving way, it is due to episodes of pain that come on suddenly, catching you unawares and as your body tries to protect itself, the muscles spasm or you try to take weight off the hip. If there are true “mechanical” symptoms of the hip, where something locks in the joint or it truly gives way, this may be due to loose bodies in the hip or part of the cartilage and/or bone coming away. When it does occur, this is most often part of severe arthritis but may be part of other problems such as avascular necrosis when the blood supply to the bone in the hip joint is damaged or stops working and the hip joint rapidly collapses. In cases such as these, there tends to be severe pain which may require relatively urgent treatment.

 

Hip arthritis: rheumatoid arthritis

The other main type of arthritis is rheumatoid arthritis. This is a very different kind of hip condition. Rheumatoid arthritis is a type of autoimmune condition where your body’s own immune system attacks the joints causing damage to the cartilage and erosion of bone and soft tissues around the joint. The chances of needing a joint replacement if you have rheumatoid arthritis have decreased a lot over the last few decades as the drug treatments for this condition have improved markedly. If your rheumatoid arthritis has severely affected your hip, or if you have had the condition for a long time, you may end up needing a hip replacement eventually. If you do, it is reassuring to know that despite this being a different condition, excellent results can still be achieved. We may need to alter or temporarily adjust the treatments you take for your rheumatoid arthritis around the time of your surgery. If we do need to alter your medication, we will discuss this with your rheumatologist if needed. Our aim will be to give you the lowest risk of complications such as infection or poor wound healing (which are more common for people with rheumatoid arthritis being treated with medications that affect their immune system) whilst trying to avoid a flare of your rheumatoid arthritis which can be painful and interfere with your rehabilitation.