Hip Arthritis

Hip arthritis usually affects patients older than 50 years and is also common in people who are overweight. Some unusual causes of arthritis are:

• Developmental dysplasia – when the hip is dislocated or out of position during infancy, the joint may not develop properly, leading to arthritis and walking problems at a young age
• Legg-Calve-Perthes disease (LCPD) – this is similar to osteonecrosis (reduced blood supply to the bone) but happens during childhood. It can lead to permanent hip damage and early arthritis

In most cases, pain around the hip joint develops slowly and worsens over time. It may feel worse after prolonged inactivity such as upon waking in the morning, or after sitting or resting for some time. It could also progress to the point where it is felt even while you are resting.

Common symptoms may include:

• Stiffness in the hip joint that makes it difficult to walk or bend, leading to limited range of motion and/or limping while walking
• ‘Locking’ or ‘sticking’ of the joint
• Grinding sound during movement (caused by loose fragments of cartilage and other tissue)
• Pain that flares up during or after being active
• Pain in the groin area that radiates towards the buttocks or down to the knee

To confirm if you have hip osteoarthritis, a doctor will examine your medical history and perform a physical examination to check your hip function and range of motion. An X-ray may also be recommended to identify common features such as narrowing of the joint or the presence of spurs at the joint.

Non-surgical treatments for hip arthritis can include:

• Heat to relax and loosen tissues and stimulate blood flow to the area
• Ice to minimise inflammation
• Non-steroidal anti-inflammatory drugs
• Rest to allow the acute inflammation to subside

Hip replacement surgery may be considered in the following situations:

• If arthritis limits your everyday activities such as walking and bending
• If pain continues while resting
• If stiffness limits your ability to move or lift your leg
• If you have little pain relief from non-steroidal anti-inflammatory drugs

Techniques for treating hip arthritis are constantly evolving. In addition to hip replacement surgery which replaces the entire head and hip socket, some patients may be more suited for a procedure known as hip resurfacing.

In hip replacement surgery, the doctor removes the damaged or worn out part of the hip joint. This involves replacing the head of the thigh bone (femur) and the hip socket (acetabulum) with an artificial joint (prosthesis) made of metal or ceramic.

A surgeon will make an incision over the front, back or side of the hip, remove damaged bone and cartilage, and implant the artificial joint.

After the procedure you will usually need to stay in the hospital for a few days – you will be prescribed medication for the pain and encouraged to move your joint as soon as possible, with supervision. You will be given advice on proper care of the incision site before discharge, and the stitches will be removed in a follow-up visit. A physiotherapy routine will help you regain muscle strength and range of motion.

In hip resurfacing, which may be more suitable for some patients, most of the original bone is retained. In this procedure, only the joint surface is shaved and capped. This procedure has several advantages, such as being able to bear weight and function more naturally. There is also a lesser chance of the joint dislocating, which may occur with a full hip replacement.

Both procedures have different risks and benefits. Your doctor will be able to advise which procedure is best suited to your age, the type and extent of your hip arthritis, and your lifestyle, while taking into account your medical history.

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As osteoarthritis is a degenerative disease, it can progress and lead to complications which include:

• bone death (osteonecrosis)
• stress fractures
• bleeding or infection in joints
• deterioration of tendons and ligaments around joints

In addition, the chronic pain from osteoarthritis is also linked to sleep disruption, anxiety and depression, reduced productivity and activity, weight gain and increased risk of falls or injury.