HIP ARTHRITIS
by DR HARDIK RATHOD- Hip joint is one of the largest joints in the body. It's a ball and socket type of joints. It connects our legs with the rest of the body and play very important role in walking, squatting, sitting crossed legs, getting up from bed, etc.
- The socket is formed by the acetabulum, which is part of the pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone).
- A thin tissue called the synovial membrane surrounds the hip joint. In a healthy hip, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all friction during hip movement.
- Bands of tissue called ligaments (the hip capsule) connect the ball to the socket and provide stability to the joint.
| Anatomy of hip joint | |
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| The socket is formed by the acetabulum, which is part of the pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone). |
In hip arthritis, the smooth articular cartilage wears away and becomes frayed and rough. The shape of ball of femur gets altered. Joint become stiff and movement becomes difficult. |
Common causes of hip pain
- Post-traumatic arthritis: This can follow a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.
- Osteoarthritis: This is an age-related "wear and tear" type of arthritis. It usually occurs in people 50 years of age and older and often in individuals with a family history of arthritis. The cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness.
- Inflammatory arthritis: These are an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage the cartilage, leading to pain and stiffness. Rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and other rare type of arthritis can damage hip joints.
- Osteonecrosis: An injury to the hip, such as a dislocation or fracture, may limit the blood supply to the femoral head. This is called osteonecrosis (also sometimes referred to as "avascular necrosis"). The lack of blood may cause the surface of the bone to collapse, and arthritis will result. Some diseases like lupus, diabetes, some infections can cause this condition.
- Childhood hip disease: Some infants and children have hip problems right from the birth or during the growing period. This can later cause problem in hip joint and sometimes leads to arthritis and joint destruction.
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| (Left) In this x-ray of a normal hip, the space between the ball and socket indicates healthy cartilage. (Right) This x-ray of an arthritic hip shows severe loss of joint space. |
Symptoms of hip arthritis
- A hip affected by arthritis will feel painful and stiff.
- A dull, aching pain in the groin, outer thigh, knee, or buttocks.
- Pain that is worse in the morning or after sitting or resting for a while, but lessens with activity in case of inflammatory arthritis.
- Increased pain and stiffness with vigorous activity in case of osteoarthritis.
- Pain in the joint severe enough to cause a limp or make walking, getting up from squatting or sitting crossed legs difficult.
Treatment:
- Although there is no cure for arthritis, there are a number of treatment options that can help prevent joint destruction.
- Arthritis is often treated by a team of healthcare professionals, including rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and orthopaedic surgeons.
Nonsurgical Treatment:
The treatment plan for managing your symptoms will depend upon type of arthritis. Combinations of treatment methods works best.
- Physical therapy: Specific exercises (mostly non weight bearing) may help increase the range of motion in your hip and strengthen the muscles that support the joint. Regular, moderate exercise may decrease stiffness and improve endurance. Swimming and cycling are a preferred exercise for people with hip arthritis.
- Medicines: Non-steroidal anti-inflammatory drugs (NSAIDs), Corticosteroids, Disease modifying antirheumatic drugs (DMARDs), Biologies are the medicines which can be used to treat underlying arthritis. Controlling the main cause of hip joint inflammation and pain is of utmost importance, following your doctor's advice and take medicines regularly will prevent your joint to damage beyond repair and can avoid surgery.
- Assistive devices: Using a cane, walker, long-handled shoehorn, or Reacher may make it easier for you to perform the tasks of daily living and put the joint in unloading position.
Surgical treatment:
- Total hip replacement: In this procedure, surgeon removes the damaged cartilage and bone, and then position new metal or plastic joint surfaces to restore the function of your hip. Total hip replacement is often recommended when hip joint is damaged beyond repair with medicines
- Synovectomy: Synovectomy is done to remove part or all of the joint lining (synovium). It may be effective if the disease is limited to the joint lining and has not affected the articular cartilage that covers the bones. Generally, the procedure is used to treat only the early stages of inflammatory arthritis.
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| In total hip replacement, both the head of the femur and the socket are replaced with an artificial device. |
Outcome
- Arthritis of the hip can cause a wide range of disabling symptoms. Today, new medications may prevent progression of disease and joint destruction. Early treatment can help preserve the hip joint.
- In cases that progress to severe joint damage, surgery can relieve your pain, increase motion, and help you get back to enjoying everyday activities. Total hip replacement is the best option among them.
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