Osteoarthritis (OA) hip

What is Osteoarthritis (OA) of the hip?

The bony surfaces within a joint are covered with smooth cartilage which allows the bones to move smoothly and painlessly over one another.  The joint also contains a small amount of fluid (synovial fluid) which acts to lubricate the joint.

OA is the most common form of arthritis affecting 8.5 million people in the UK.  OA develops gradually over time causing the joints to become stiff and painful.  Any joint can be affected but it is common in hips, knees, hands, feet and spines. 

In joints affected by OA the cartilage becomes worn and damaged and the bone tissue next to the damage can also be affected and bony spurs develop around the joint edge.  The bony spurs are osteophytes and may be visible on X-ray and the tissues around the joints can also become inflamed (known as synovitis)

Factor that may influence the osteoarthritis development –

  • Age – OA is more common as you age.  This may be because the blood supply and natural repair mechanism become less efficient as people age
  • Obesity – knee and hip OA are more likely to develop or be more severe in obese people.  This is due to the increased loads going through the joints resulting in increased damage
  • Genetics – there may some inherited factors that lead to some people developing OA
  • Gender – women are more likely to develop OA than men
  • Previous damage, deformity or injury – this may include joint infections, fractures or congenital problems such as dislocation

What are the symptoms of osteoarthritis in the hip?

  • Pain, in the groin especially
  • Stiffness and reduced range of movement, this tends to be worse in the morning
  • Poor walking pattern and poor mobility as the OA worsens
  • Severe OA patients may have a classic limp that in turn increases the risks of falls
  • With severe OA you may have difficulty bending to put on your socks and shoes or getting in out of the car
  • In women, restricted hip movement may make sex uncomfortable or painful
  • No symptoms at all – many people may have an x-ray that indicates quite a severe degree of OA but the individual experiences no or only mild symptoms
  • The opposite of the previous point may also be true, x-ray may indicate minimal OA changes yet symptoms are severe
  • Some people may become depressed due to the pain and symptoms and the impact it is having on their work and home life

What test do I need?

X-rays are commonly done to confirm the presence of OA in the hip and knee but not essential if the history provided clearly indicates OA

How can I prevent Osteoarthritis of the hip?

Factors such as aging, family genetics and congenital problems cannot be influenced but keeping healthy, active and avoiding becoming obese will minimise the chances of developing osteoarthritis

What can I do to help my symptoms of osteoarthritis?

Exercise

If possible exercise regularly. This helps strengthen muscles around affected joints, to keep you fit and maintain range of movement of the joint.  None weight bearing exercise such as swimming is better than none at all and most people can manage to regularly walk.

Weight Control

If you are overweight trying losing even a modest amount of weight as this will make a real difference to your symptoms.

Shoe insoles or Orthotics

If insoles are considered to be of benefit your physiotherapist, podiatrist or osteopath will make the necessary arrangements

Walking Aids

If you think a stick would provide some extra support when walking make sure you use it in the opposite hand to the affected part of the body. This will relieve some of the pressure on the affected joints.

Physiotherapy/Podiatry/Osteopathy

Advice on exercise and modification of activities may prove useful if you feel you need addition advice or your symptoms have not improved ask your GP to refer you to PhysioHey

Pain Relief

  • Paracetamol – is commonly used to treat OA and works well to ease the pain, and when taken regularly, helps to keep the pain away, rather than just taking now and again when pain flares-up.  A normal adult dose is two 500mg tablets taken four times a day, there are usually little or no side-effects and can usually be taken longer term without reducing in effectiveness.   If you have never taken paracetamol or are unsure as to whether it can be taken with other medication please speak to a pharmacist in the first instance or GP
  • Co-codamol – is paracetamol combined with codeine another painkiller. They are available in different amounts.  Lower doses are available over the counter from pharmacies but codeine can cause side-effects such as drowsiness and constipation. If you have never taken paracetamol more or are unsure as to whether it can be taken with other medication please speak to a pharmacist in the first instance or GP
  • Anti-inflammatory painkillers – There are many different brands but are generally ibuprofen based and can be used in conjunction with paracetamol or co-codamol for effective pain relief.  However, they do have side-effects including gastrointestinal upset / irritation and kidney damage and should be avoided by some people.  If you have never taken paracetamol or are unsure as to whether it can be taken with other medication please speak to a pharmacist in the first instance or GP
  • Transcutanious Electrical Nerve Stimulation (TENS) – can help ease the pain associated with OA.  TENS works using the ‘pain gate theory’ and the TENS electrical signal serves to block that of the pain signal that is trying to tell the brain that part of the body is in pain.  TENS can be used as part of a longer term pain relief or used to reduce pain enough to allow you to comply with the advice and exercises advised by you physiotherapist.
  • Acupuncture - is a form of ancient Chinese medicine in which fine needles are inserted into the skin at certain points on the body.  Acupuncture is based on the belief that an energy, or 'life force', flows through the body in channels called meridians. This life force is known as Qi (pronounced 'chee').   Practitioners who adhere to traditional beliefs about acupuncture believe that when Qi cannot flow freely through the body, this can cause illness. They also believe that acupuncture can restore the flow of Qi, and so restore health.Some scientists and acupuncturists believe that acupuncture may stimulate nerves and muscle tissue, and that this may be responsible for any beneficial effects and can be used as part of a longer term pain relief or used to reduce pain enough to allow you to comply with the advice and exercises advised by you physiotherapist.

Surgery for OA

Most cases of OA are not severe enough to warrant surgery and can be managed conservatively. But if the OA in a joint becomes so severe, then replacement with an artificial joint may be necessary.  There are many different types of artificial joints and such surgery has become a standard procedure for severe osteoarthritic joints.  This obviously does require an operation and a hospital stay from 48 hours to 5 days following hip replacement surgery, but like any operation joint replacement surgery is not without risk.

Clinical decision making tool

For you to you make a clear informed decision about how to move forward in the management of your OA of the hip please click here for more information.