Osteoarthritis of the Hip
What is Hip osteoarthritis?
2.46 million people in England have osteoarthritis (OA) of the hip. 11% of the population aged over 45 years old has the condition.
Arthritis Research UK suggest that only 18% of people with arthritis have a care plan to help them manage their symptoms. Sub-optimal management of osteoarthritis permits people to suffer symptoms unnecessarily.
Not everyone who has arthritis will suffer with symptoms, but those that do can experience pain, stiffness, reduced mobility and function. The experience of OA is often unique to each individual.
Some people may just have pain, whereas others may simply have stiff joints. Typically, symptomatic people with hip OA will have a combination of symptoms. Stiff hips often hinder daily functional tasks like walking, getting in and out of the bath or car, putting on shoes and socks and cutting toenails.
What is happening in hip osteoarthritis?
The first thing people usually think of when they think of arthritis is 'wear and tear'. These two simple words paint a picture of a process of gradual decline of an affected joint. Recent research into the arthritis process shows that actually this view of arthritis is not correct!
Arthritis Research UK proposes that instead we should think of arthritis as ‘tear, flare and repair’.
The hip joint is a ball and socket joint, made up of two bones the 'accetabulum' which is the socket and the 'femur' which is the ball. whe the surfaces of the two bits meet the bones are covered in hyaline cartilage. This special type of tissue is very tough and copes really well with lots of load and force being put through it.
The 'tear' component of arthritis refers to small defecits that occur in the hyaline cartilage exposing the underlying bone. People often think that age is the biggest factor in development of these defecits however this is incorrect! The problem is much more multifactorial than that.
Development of these tears can relate to:
1. Biomechanics- How we use our hip joints and the shape of the joint can both be factors in developing osteoarthritis. Heavier manual occupations such as farming for example has been linked to a higher incidence of arthritis in the hip. Having a shallow hip socket can predispose towards developing hip arthritis.
2. Previous injury or trauma- a previous problem with the hip joint such as a tear of the rim of the joint (which is very common in natural child birth) can predispose to developing osteoarthritis.
3. Genetics- it is thought that there are genetic factors that predispose some people to developing osteoarthritis.
4. Obesity- Having a higher than normal body mass index (BMI) is associated with osteoarthritis in the hip. This is thought to be due to the 'switching on' of inflammation by a group of chemical messengers called adipokines. These chemicals are secreted by fat tissue (which we tend to have more of in our jont soft tissues if we are overweight).
5. Smoking- smoking is linked to poor joint health.
The flare component refers to the inflammation that occurs within the joint when it is overwhelmed by a combination of the above factors.
The repair refers to the fact that the joints have an inate capacity to self repair and try and do this following a flair episode.
The following video explains this in a little more detail.
What can i do about the problem
Osteoarthritis is a long term condition- it usually develops and evolves very slowly (there are some more aggressive types that tend to affect younger people where the osteoarthritis develops quickly, but these are the exceptions not the rule).
Just as with other long term conditions like asthma or diabetes there are steps that can be taken to manage existing symptoms, and lifestyle changes that can be made which will generally improve symptoms.
From time to time people with osteoarthritis can experience flare up of their symptoms and may require additional help or treatment at these times to setle things back down.
Managing existing symptoms
The main ways of managing existing symptoms are looking at medication useage, maintenance exercises, and activity pacing techniques.
The aim of medication in osteoarthritis is to minimise your experience of pain symptoms. For some people dipping in and out of pain relief as required is sufficient to do this, for others a more formal regime of taking medication regularly is required to acheive this aim. National guidance for the use of medication in osteoarthritis suggests that people should try and use paracetamol or a NSAID in the first instance. Because both sets of drugs are unsuitable for some people you should speak to your GP about which approach is right for you.
Here is a short video explaining current guidelines for the use of medication in osteoarthritis.
Maintenance exercises are designed to keep your hip strong and moving well, the following exercises are likely to be useful.
Actvity pacing techniques are useful to consider if either:
you are not able to to complete activities you enjoy because of pain
you can complete activities but you suffer for doing so for a few days afterwards.
Pacing involves breaking bigger activities down into smaller chunks to acheive your goal. The short video below explains how to pace your activities.
Improving existing symptoms
Employing the above management strategies for your existing symptoms should have the net effect of improving your existing symptoms.
Symptoms may also be improved by thinking about lifestyle factors. The key areas where changing lifestyle can be beneficial to joint health are:
stopping smoking, losing weight, and exercising regularly.
Exercising regularly has been shown to have a strong effect on peoples self reported ability to function with arthritis.Here are two short videos on why exercise is good for your arthritis and getting going.
Here at the MSK service we run regular exercise groups to help people get going with exercise to improve their osteoarthritis symptoms. If you are interested in attending pease speak to your GP about an MSK referral.
If you are overweight, using a calorie controlled diet to try and reduce this has also been shown to reduce arthritis symptoms.
Smoking cessation improves not only joint health but will have a positive impact on almost every system in the body.
To find out more about the positive effect that managing your lifestyle can have on your pain visit our lifestyle page.
Managing flare ups
If you experience a flare of symptoms this is usually linked to an episode of inflammation within the joint. It is therefore usual for a flare up to last between 6 and 12 weeks. If you are struggling with a flare it is worth considering your medication based option for managing this. Your GP may prescribe you a short course of medication to help with the flare up. You should also make sure your following all our advice above with regards symptom management. If you are and you are experiencing a very persistent flare a corticosteroid injection into the joint can be helpful to settle things down.Because the hip is a difficult joint to get to this often needs to be done under image guidance. We are happy to see people on a one to one basis for advice during a flare up period. Please discuss an MSK referral with your GP.
Joint replacement for osteoarthritis
Prior to considering joint replacement surgery it is important that you have tried to optimise the management of your arthritis with none surgical treatment methods. the short video below discusses the importance of this.
Whether to go ahead with a joint replacement is a big decision. The NHS has developed a tool to help you explore the issues around this decision. This can be accessed here:
If you would like to discuss hip replacement with us please discuss a referral with your GP.To fill in an Oxford Hip Score to facilitate your assessment click here.
What are patient decision aids (PDA's)?
PDA's have been specially designed to help you explore all the options around the management of your osteoarthritis. The tools will also help you make decisions by taking into account your thoughts and feelings around the risks and benefits associated with particular treatments.
A downloadable /printable version of the page
An exercise guide for your hip.