What is arthritis?

Arthritis is a condition that causes inflammation in the joints. This can lead to joint pain, swelling, stiffness, and even loss of joint function. Arthritis can happen in any joint, but it is most common in the weight-bearing joints like the hips or knees. Avascular necrosis, osteoarthritis and rheumatoid are the most common forms of arthritis that affect the hip.

No matter what the cause, arthritis symptoms like stiffness, joint pain, swelling, and stiffness can progress over time. They also tend to get worse with age. Although arthritis is more common in older adults, it can also occur in children, teens, and young adults. If left untreated, arthritis can cause severe disabilities and a decrease in quality of life. People with severe hip arthritis may have difficulty performing simple daily tasks such as walking, bending, tying shoes, cutting toenails, or getting in and driving.

How does arthritis affect hips?

There are more than 100 types of arthritis. However, there are three main types that affect the hip. The type of arthritis that you have will determine the treatment you need.

  • Osteoarthritis, (OA)

Osteoarthritis, the most common type of arthritis, is the most common. The cartilage that cushions the joints gradually wears away, causing friction, pain and inflammation, as well as eventual bone damage. Normal hips are a ball-and socket joint that is lined with smooth cartilage. This allows the joint to move freely and rotate easily. The ball-and socket joint’s smooth cartilage can wear away and the rough surfaces rub against each other. This limits movement and causes pain. Osteoarthritis can lead to permanent or worsening damage to the joint.

  • Rheumatoid arthritis (RA)

Rheumatoid arthritis is another common form of arthritis. It affects the whole body, not just the hip. Rheumatoid is more related to the immune system than wear and tear, as with osteoarthritis. This type of arthritis results in joint swelling and inflammation, which eventually leads to joint destruction. Rheumatoid arthritis is not like osteoarthritis which usually affects one hip. It can also affect other joints.

  • Avascular Necrosis, (AVN).

Avascular necrosis (AVN), which is less well-known, is one of the most common causes of hip arthritis in Asia and Singapore. Avascular necrosis (AVN) is a condition where bone tissue dies due to lack of blood supply. This condition affects the most commonly affected body parts, including the hip joint’s femoral head. The affected bone can eventually fall from tiny cracks if it is not treated. This condition is commonly caused by injuries to the hip joint, excessive alcohol intake, and prolonged and extensive use of steroids (often in treatment of medical conditions).

What causes hip arthritis?

Although the causes of hip arthritis remain unknown, there are some factors that could increase your chances. These are:

  • Ageing in advanced
  • Excessive alcohol consumption
  • Genetics
  • Steroid use for long term
  • Obesity and being overweight
  • Pre-existing damage, injury, or fractures to your hip
  • Repeated strain on the joints from activities that involve the hip, such as sports

What are the signs and symptoms of hip arthritis?

  • No matter what type of hip arthritis you have, these are the signs:
  • The sound or crunching sensation of bone rubbing against each other.
  • Walking with a “swaying” gait (the body tends swing side to side).
  • Hip joint pain that can include pain in the groin or outer thigh and sometimes the buttocks.
  • The intensity or prolonged duration of activity can cause pain in the hip joint.
  • Damage to the bones can cause a shorterening of the affected limb.
  • Stiffness/difficulty/inability to move the hip for daily activities like bending over to tie your shoes.

How can hip arthritis be diagnosed?

In the advanced stages of hip arthritis, X-rays can be used to diagnose it. In the beginning stages of hip arthritis, magnetic resonance imaging (MRI), scans may be required if the X-ray findings do not seem obvious. An X-ray will show a narrowing of the space between your bones and spurring of joint margins. In severe cases, complete destruction of the hip joint may be possible.

Your orthopaedic doctor will conduct a physical exam and ask you about your medical history. The examination will measure the length of your limbs and check the range of motion of your hip.

How can hip arthritis be managed and treated?

Although there is no cure for hip arthritis at this time, there are options that may help you improve your mobility and your quality of life. These treatments aim to improve the function of the hips and manage the pain.

The following treatments are available for hip arthritis:

  • Exercise and weight loss
  • Hip replacement surgery
  • Paracetamol (a non-steroidal antiinflammatory drug) and Celebrex/Arcoxia are some examples of pain medication.
  • You can get physical therapy to increase your hip range of motion
  • Rest and joint care
  • To help reduce weight on the affected hip, canes are used.

Is hip replacement surgery worth considering?

Hip replacement surgery involves the removal of the damaged and arthritic hip joint. The artificial joint is made from metal/ceramic materials with a layer of polyethylene to act as the cartilage. The successful replacement of the hip joint will alleviate arthritic pain, improve function, and lengthen the shortened leg. For those with severe hip arthritis and severely reduced quality of living, hip replacement may be an option.

If you are:

Non-surgical treatments like pain medication, anti-inflammatory medications, physical therapy or exercise are no longer effective in providing relief.

Excessive pain medication is causing side effects like gastric erosion and kidney damage.

Your daily life has become more difficult. It is becoming too painful to do everyday activities like standing, walking, sitting down, bending, or climbing stairs.

  • Even if you aren’t moving, hip pain can still be felt
  • The hip pain makes it difficult to sleep well or get to rest.
  • You feel depressed or anxious because your mental health is compromised.

Although complications of hip replacement surgery are rare, it is important to be aware of the potential dangers.

  • Bleeding
  • Blood clots
  • Heart attack
  • Hip dislocation
  • Infection
  • Nerve injury

General anaesthesia can also cause other problems

Although hip replacement surgery is a great option, you should remember that it doesn’t last forever. A replacement hip can last between 15 and 20 years. You may also need to have follow-up surgeries. The full recovery process will take between 6 and 12 months. While you should be pain-free following successful hip replacement surgery you may need physiotherapy to improve your ability to walk and move with your new hip.

An orthopaedic specialist should be consulted if you have hip arthritis symptoms. They will evaluate your condition, and help you choose the best treatment. You can improve your outlook and avoid surgery by starting treatment early.