Background: Loss of the protective articular cartilage layers of the hip is termed as osteoarthritis – this can be either focal (in one small area) or generalised (widespread and involving a large area).
Signs of arthritis: For most of us pain in the groin, hip or upper thigh starts later in life and commonly progresses over months or years without a clear preceding cause or injury. For some who have had hip trauma or a developmental abnormality in the hip joint arthritis can occur at a younger age. Other signs of hip arthritis include stiffness (particularly in the morning or after periods of rest) and night pain which often disturbs sleep. Normal daily tasks, such as dressing or washing, may become difficult and walking any distance is a challenge. In severe arthritis a limp may develop and you may feel that one leg is shorter than the other.
Diagnosis: Diagnosis is made largely from a thorough history and examination. Xrays will confirm these findings. In focal arthritis and when the X-rays do not give a clear cause an MRI scan may be necessary.
Treatment: The treatment options will depend on your individual goals and needs. In broad terms these are split in to:-
1. Non-Operative Management: Just understanding that our pain is from arthritis may be the necessary reassurance for some. We would always suggest that some simple conservative measures are undertaken to minimise symptoms, however. These are listed below:-
2. Maximal Conservative Treatment: The following are proven to improve the symptoms of arthritis:-
i) Weight loss programme – Weight loss decreases the load carried through our hip joint and can therefore provide an improvement in your symptoms.
ii) Physiotherapy & Strengthening Programmes – Improvements in strength and flexibility restore normal movement to the hip joint. This reduces pain. We can help you to access dedicated physiotherapy classes specifically designed for patients with arthritis, strengthening programmes and water-based “aqua-classes” all of which are proven to help arthritic pain for some patients. A list of recommended physiotherapists is available here– all of whom we have met and visited personally.
iii) Analgesia (Pain-killers) – Your GP may have already started you on simple painkillers. They can play an important role in containing arthritic pain, particularly at night. Injections into the hip joint (steroid or visco-supplementation) are not something that we recommend in the majority of cases though there is some evidence that they can improve symptoms for short periods.
3. Operative Management: If symptoms are significant and affect your life on a regular basis then you may decide on a surgical solution. Hip replacement is an excellent surgical solution for painful arthritis that has become debilitating. It is the most successful orthopaedic intervention with more than 95% of patients experiencing significant improvement.
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