Hip Osteoarthritis
Osteoarthritis is a normal age related condition that causes joints to become painful and stiff. The hip is one of the joints most affected by osteoarthritis. The aim of this webpage is to provide you with information about the problems faced with age related changes in your hip and suggest a few helpful hints on how to manage your symptoms.
The Hip Joint
The hip joint is a complex ball-and-socket joint that supports the weight of the body and is responsible for movement of the upper leg.
The ball (femoral head) is the rounded top of the femur, commonly known as the thigh bone
The socket (acetabulum) is located in the pelvis.
The femoral head fits into the socket. The ball and socket anatomy allows the leg to move forwards, backwards and side to side. It also allows for internal and external rotation (pointing the toes inward and outward).
Articular Cartilage helps stabilise the hip joint and facilitate hip movement. Both the femoral head and acetabulum are lined with this strong and slippery cartilage, which allows the surfaces of the ball and socket to glide against each other during hip movement.
Osteoarthritis causes the cartilage in your hip joint to become thinner and the surfaces of the joint to become rougher. This can cause swelling, pain and stiffness, but not everyone will have these symptoms.
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Osteoarthritis is a normal age related change that occurs in the joints. When a joint develops osteoarthritis, it affects the cartilage covering the ends of the bones and can cause the development of bony spurs called osteophytes. Additional changes occur to the synovial fluid, causing stiffness in the joint and occasionally the joint space begins to narrow which can further reduce the movement of the joint.
These changes in and around the joint are partly the result of the inflammatory process and partly your body’s attempt to repair the changes which have occurred.
This process is a perfectly normal part of ageing and happens in all joints but tends to happen earlier in joints that carry a lot of weight through them. This is why the hip, and also the knee, are most commonly affected. In many cases there is no pain, however, as this process continues it can increase symptoms of stiffness and pain to become more severe and persistent.
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In hip osteoarthritis, the pain comes on gradually over a period of months or years. However, it could also be triggered by a recent injury. You might find symptoms come and go and that the pain is worse at the end of the day. The painful areas are usually the lower back, buttocks and groin. Some people also feel discomfort from the top of their thigh down to the knee. Sometimes it can even be felt all the way down to the ankle. This can be known as referred or radiating pain.
In addition to hip pain, a person with hip arthritis may experience:
Loss of range of motion, particularly when rotating the hip inward or moving the leg toward the centreline of the body.
Stiffness around the hip, making movements slower or more difficult.
Trouble going up stairs. Changes to the hip’s range of motion may change a person’s natural gait while climbing stairs.
Decreased muscle strength around the hip.
A loss of balance. Balancing on the affected leg may be more difficult than balancing on the unaffected leg.
Limping. In moderate to severe cases of hip impingement, hip pain and other symptoms may cause a person to walk with a limp.
Most people experience a loss of range of motion in the hip. The other symptoms may or may not occur depending on the severity of the arthritis and how long it has gone untreated
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Almost anyone can get osteoarthritis, but it’s most likely if:
You’re in your late 40s or older. Remember it is a normal age related change to the joint surface.
You’re overweight: Being overweight is an important factor in causing osteoarthritis, especially in the hip. It also increases the chances of osteoarthritis becoming progressively worse.
You’re a woman: twice as common in woman as in men.
Your parents, brothers or sisters have had osteoarthritis
You’ve previously had a severe hip injury: repetitive activity or physically demanding jobs can increase the risk. Previous injuries to the ligaments or labrum including surgery can increase the risk of arthritis.
Your joints have been damaged by another disease, for example rheumatoid arthritis or gout.
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There are several ways you can help yourself, including:
Losing weight if you’re overweight
in fact, evidence shows that weight loss through exercise and a healthy diet may reduce your pain and improve your general lifestyle. Losing weight also helps improve your mood, reduces inflammation in the body, can lead to improved sleep and reduces the risk of other diseases.
Exercising regularly (both muscle-strengthening and general aerobic exercise)
Using painkillers (analgesics) or anti-inflammatory creams, gels and tablets.
Reducing stress on the affected joint (for example by pacing activities, using a walking stick or wearing appropriate footwear).
Escape Pain
ESCAPE-pain is a rehabilitation programme for people with chronic joint pain of the knees and/or hips, that integrates educational self-management and coping strategies with an exercise regimen individualised for each participant. It helps people understand their condition, teaches them simple things they can help themselves with, and takes them through a progressive exercise programme so they learn how to cope with pain better.
Robust evaluation shows that ESCAPE-pain:
Reduces pain
Improves physical function
Improves the psychosocial consequences of pain
Reduces healthcare and utilisation costs.
Below is the link which will take you to some very helpful videos, which give simple advice and information to help people learn how to manage their condition.
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If you still have pain after trying self-help measures, your doctor may recommend the following treatments:
Physiotherapy
Steroid injections into the painful joint
Surgery, including joint replacement.
There is minimal strong evidence to support the use of joint injections in a hip with normal age related changes, especially as the effects have a short-term effect. You should discuss this option further with your health care professional especially as there are some side effects and adverse risks involved with a steroid injection. Injection into the hip joint is more commonly used to diagnose if your pain is originating from your hip. Although it may reduce pain, this is only temporary and can cause some adverse risks if you eventually require a hip replacement.
Recent studies have shown that in the early stages of hip OA surgery should not be used. It has frequently shown poor outcomes and in many cases has sped up the progress of the OA.
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Physiotherapy, which encompasses exercise and education, is the best and most effective method to help manage your pain and help you return to your normal function. Your physiotherapist will help you identify any issues through their initial assessment and will help you with a specific individualised exercise program.
Your rehab plan may aim to address the overload at the hip by:
Reducing pain
Strengthening weak structures (above and below the hip)
Correcting the way you move
Improving your movement control
Stretching tight structures
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After an injury you may have heard about RICE (rest, ice, compression and elevation) when managing an injury. However, rest can be harmful and inhibits recovery. Recent research has now advised that we use the acronym POLICE.
Protection
Optimal-Load
Ice
Compression
Elevation
The key term is Optimal-load, this replaces Rest. You may need to speak to your physiotherapist to discuss what your optimal load might be as it is specific to you but will help speed up your recovery process.
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An increase in pain or ‘flare up’ is common with hip osteoarthritis. The key is to manage this effectively and efficiently. By using POLICE this can help reduce the initial pain. During a flare up managing your optimal load is important. You may need to reduce the stresses at the hip or reduce the amount of exercises and daily activities that you do. Over time, gradually increase your activity back to previous levels.
You can discuss optimal load with your physiotherapist.
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As mentioned exercise is one of the first lines in management in a hip with normal age related changes. It is key to ensure you continue to function well by maintaining strength, range of movement, fitness and joint health with increasing evidence showing that exercise can protect the joint from further changes.
The current physical guidelines for activity in the UK are:
75 minutes of intense exercise per week
150 minutes of moderate exercise per week
2 resistance training sessions per week.
When beginning an exercise program, it’s best to start slowly. Some examples of low-impact, non-strenuous exercise include:
Stationary bike
Using a stationary bike on an easy setting allows you to slowly build your strength. Using the bike in your home allows you to avoid traffic and stop when you feel strained. A bike is a more favorable choice than walking due to the less load going through your hip. If you struggle to ride a bike, a set of home pedals is also a good option to get your legs moving.
Water exercises
Freestyle swimming provides a moderate workout. Walking in water up to your waist lightens the load on your joints while also providing enough resistance for your muscles to become stronger. This can greatly improve pain and daily function of the hips.
Yoga
Regular yoga can help improve flexibility of the joints, strengthen muscles, and lessen pain. Some yoga positions can add strain to your hips, so if you feel discomfort, ask your instructor for modifications. A class for beginners is a good place to start.
Tai chi
The slow, fluid movements of tai chi may relieve arthritis pain and improve balance. Tai chi is a natural and healthy stress reducer as well.
Walking
If you have balance problems, using a treadmill (with no incline) allows you to hold on. Walking at a comfortable pace — whether it’s indoors or outdoors — is an excellent low-impact exercise.