arthritis Hip joint pain

Basics of hip arthritis

Many kinds of arthritis can affect the hip joint. The most common type of hip arthritis is osteoarthritis, which some people call "degenerative joint disease."

Osteoarthritis occurs when the joint surface cartilage (also called hyaline cartilage or articular cartilage) becomes worn away leaving the raw bone beneath exposed. The cartilage normally serves as a “pad” or a bearing in the joint. Under normal conditions, the cartilage bearing is slicker than a hockey puck on ice. When the bearing wears away, the result is a roughed joint surface that causes the pain and stiffness that people associate with osteoarthritis.
Osteoarthritis of the hip is a serious condition. Osteoarthritis is the most common of the more than 100 kinds of arthritis and the hip joint is the second most commonly affected large joint in the body.

Osteoarthritis is a chronic disease that can takes months to years to appear. While it is not “curable,” it most certainly is treatable using activity modifications, medications, and/or injections. If those interventions don’t work, hip replacement surgery often will relieve the pain associated with hip arthritis.

Osteoarthritis of the hip results in pain, stiffness, and joint deformity. The symptoms of osteoarthritis can affect one’s ability to walk, work, and enjoy life.

For most patients who have mild arthritis, pain can be managed with ice, rest, activity modifications, pills, or joint injections.

Symptoms of Hip Arthritis  

This Hip joint pain and stiffness are the main symptoms of hip arthritis. When it becomes more advanced, joint deformities and leg-length differences can result.he typical pain from hip arthritis is located in the groin thigh or buttock.  The pain is generally worse with weight bearing activities (e.g., walking, standing, or twisting).Some patients report "start-up" pain – an especially bad discomfort upon standing after being seated for a prolonged period of time. This sometimes works itself out after a few steps.Osteoarthritis of the hip is not an emergency. It can however result in disturbing “flare ups ” with increased pain and stiffness. Many patients who experience a sudden flare-up will go to the doctor for care. For many of these patients,  this “acute” set of symptoms will result in the diagnosis of osteoarthritis.

ProgressionEarly in the course of arthritis, symptoms can be intermittent, perhaps related only to particular activities or sustained activity. Rest and avoiding the precipitating activity will improve the symptoms.As arthritis worsens, symptoms can become more persistent or more severe, such thatsimply walking on level ground can result in pain.When arthritis is severe, the pain with activities can linger even after the activity stops. When arthritis is severe, the hip can remain painful even after one stops walking.As the condition worsens it often becomes less responsive to medical treatments such as pills or injections.In many patients with advanced arthritis, particularly if those medical approaches are no longer helpful, surgery can offer relief of symptoms. Some patients with severe osteoarthritis sometimes can benefit from total hip replacement surgery.

Impacts on Daily Life

Daily activities

Osteoarthritis of the hip can affect one’s ability to walk, climb stairs, enter or exit a vehicle, sit or arise comfortably, perform housework and enjoy one’s day-to-day activities.

Even mild to moderate osteoarthritis of the hip can adversely impact athletic performance and enjoyment of sports, particularly impact sports and sports that involve running.

Energy

Many patients find that the chronic pain associated with osteoarthritis of the hip does contribute to fatigue.
Osteoarthritis of the hip does not affect metabolism but some patients attribute weight gain to the inactivity that results from the hip pain caused by osteoarthritis of the hip.

Mobility and independence

Osteoarthritis of the hip can affect one’s ability to walk, climb stairs, enter or exit a vehicle and enjoy one’s day-to-day activities. These things do affect one’s ability to remain independent particularly as the disease reaches its more severe stages.

Fertility and pregnancy

Osteoarthritis of the hip can cause sexual intercourse to be uncomfortable in some patients. However, apart from that, it will not affect a patient’s ability to get pregnant or have children. It is important to note, though, that some medications used to treat arthritis need to be used with care (or not at all) during a pregnancy. It is important to inform one’s obstetrician and family physician about all medications and nutritional supplements that one takes.

Relationships

Osteoarthritis of the hip can affect relationships and social interactions to the extent that it makes getting around more difficult. In some patients with more severe hip arthritis, sexual intercourse can be uncomfortable because of the pain associated with moving the hips that accompanies the condition.

Joint deformity
Osteoarthritis of the hip is associated with joint deformity that sometimes results in a leg-length inequality. These joint deformities, including leg-length inequality, are not readily managed by interventions other than surgery but can sometimes be corrected at the time of hip replacement for patients who elect to have that surgery. Shoe lifts can help patients before surgery who have leg-length inequalities and are sometimes used if the leg length cannot be made equal at the time of hip replacement surgery.

Causes

It is not possible to predict who will get osteoarthritis of the hip. However, there are some risk factors that may increase the likelihood that hips will become arthritic. These risk factors include:

• Genetics - Arthritis often runs in families.
• Childhood hip diseases including developmental hip dysplasia (DDH), Legg-Calve-Perthe’s Disease and slipped capital femoral epiphysis (SCFE) all can predispose an individual to premature hip arthritis. 

Diagnosis

To diagnose osteoarthritis of the hip, a physician will take a thorough history and perform a thorough physical examination first. Following this, simple x-rays taken with the patient standing are an effective way to diagnose this condition.

Diagnostic tests

The simplest test to diagnose osteoarthritis of the hip is the x-ray. Taken with the patient standing up plain x-rays can diagnose the condition with great accuracy.
Very mild arthritis can be seen on a bone scan or an MRI even before it is visible on plain x-rays, but in reality, these tests are seldom helpful clinically for this purpose.

Effects

The diagnostic tests for osteoarthritis of the hip, including x-rays and MRIs, are generally not painful and they are well-tolerated by most patients.

Treatment

Simple steps that can be taken which don’t have much risk include avoidance of the activities that cause symptoms (activity modification) and weight loss (if appropriate). Some patients find nutritional supplements, such as glucosamine and chondroitin, to be helpful. However, the data on these products is somewhat inconsistent. They don’t help everyone.

Self-management

Keeping one’s body weight appropriate and choosing activities that don’t reproduce the arthritic pain are two things patients with osteoarthritis of the hip can do to help decrease their arthritic symptoms.

Managing arthritis pain and fatigue

Several approaches can be used to manage the pain associated with osteoarthritis of the hip including:

Activity modification appropriate kinds of exercise and weight loss when necessary may alleviate some hip arthritis symptoms

Diet

Keeping one’s weight proportional to one’s height can decrease the likelihood of developing osteoarthritis of the hip and can decrease the symptoms of the condition once it has set in.

Exercise and therapy

There is some limited evidence that appropriately-designed exercise programs can decrease the pain of hip arthritis, in particular, earlier stages of the condition. In general, staying fit and height-weight proportional also are helpful.

Medications

Nutritional supplementation (glucosamine and chondroitin) are helpful to some patients although the literature on these supplements is not consistently in favor of their use.