TREATMENT OPTIONS FOR HIP OSTEOARTHRITIS
by Bryan T. Chambers, M.D.
Osteoarthritis (OA), of any joint, is an insidious and non-curable disease in which the cartilage, present on the end of each bone in the joint, wears away or deteriorates, as a result of injury, time, work conditions or excess weight. This causes pain, inflammation and swelling. There are several treatments in place to help manage the overall pain, ambulatory issues and stiffness associated with osteoarthritis, also known as degenerative joint disease (DJD). The purpose of this article is to inform readers about the general treatment options available for OA of the hip.
Generally speaking, hip OA presents as pain located in the groin and front of the thigh. Pain on the outside of the hip is usually trochanteric bursitis as a result of a fall, bump or change in the way you walk and does not usually involve the joint itself. Pain starting in the buttock and traveling down the leg and into the thigh and foot is usually associated with lumbar spine issues such as lumbar stenosis. During your visit we will check range of motion, strength and try to reproduce your hip pain. The amount of OA in your hip dictates how far we can move your hip through these motions and how painful these motions are. We will check x-rays of your pelvis, looking for the amount of space present between the head of the femur (ball) and the acetabulum (socket). The space on x-ray is the soft tissue cartilage which helps cushion the two surfaces when you walk or move. The lack of space and presence of bone spurs, coupled with your physical exam, help us determine the severity of your arthritis. After we evaluate your x-rays and perform your physical exam, we can discuss treatment options.
Treatment options for any type of OA are not considered curative, rather pain alleviating, as the disease itself cannot be cured but managed. If you are newly diagnosed with hip OA and have not tried any treatments in the past, we first start with non-steroidal anti-inflammatory medications (NSAIDS). These are more commonly known as ibuprofen, Advil and Motrin. The effects of these medications help with the inflammation process caused by arthritis. We may also try prescription strength anti-inflammatories depending on individual circumstances. We do have to consider other pertinent health issues before we try these such as history of stomach ulcers or previous gastric bypass surgery as these anti-inflammatories are hard on the stomach lining. Each individual has specific needs and is usually taking other medications so we discuss interactions and side effects based on your situation.
The next treatment, or we may pair this with anti-inflammatory use, is physical therapy. With physical therapy, we hope to strengthen the muscles, ligaments and tendons associated with movement of your hip and leg. The stronger you are the more capable you are to work through the stiffness and pain. Formal physical therapy is a great way to achieve modest improvements in strength and mobility. Physical therapists have been trained to specifically work on the muscles and tendons involved with flexing, extending, moving the leg away from the body (abducting), and moving the leg toward the body (adducting). We are frequently asked about aquatic or water therapy for OA and feel this is one of the best ways to work on range of motion because the water takes pressure off of the joints and allows you to move in a more natural way without pain. Therapy may not be appropriate for everyone as those with severe disease may not tolerate the increased activity.
Another treatment, which we frequently use in knee OA, is steroidal injections into the hip joint. With these injections, we hope to alleviate pain and inflammation. Steroid injections vary greatly in effectiveness lasting anywhere from six hours to six months. When we perform steroid injections in the hip, we do so for two reasons. The first is to offer pain relief. The second reason is usually for diagnostic purposes, meaning we sometimes have trouble discerning hip pain from back pain. If the steroid injection takes care of your pain for a few hours to several days, then you truly have hip joint arthritis. If the steroid injection does not help even for a couple of hours, then maybe the pain is coming from your back, as mentioned earlier.
Finally, the last treatment option is total hip replacement (arthroplasty). Total hip arthroplasty (THA) consists of replacing / resurfacing the bony areas in which the cartilage has worn away. The inside of the acetabulum, hip socket, is resurfaced to accept a replacement metal cup. Inside this new cup, a liner, made of a number of different materials, is placed to substitute for the worn away cartilage. The material of the liner is usually decided on a case by case situation so your surgeon will discuss your specific options. The femur, thigh bone, is then prepped by removing the head and reaming out the inside of the bone in order to receive a femoral stem and head to articulate inside the new cup and liner. As mentioned before, all of these pieces have different sizes and configurations and these are decided upon on a case by case situation.
THA has an excellent outcome approximately 95% of the time by offering pain relief and restoring motion lost to the arthritis process. Before we progress to surgery, we always try to exhaust the non-invasive pain relief measures first. When non-invasive measures such as oral anti-inflammatories, physical therapy, and cortisone injections no longer help, the final step is hip replacement. Longevity of the hip replacement varies on a case by case basis based on age, type of work one performs and other health issues. If you are currently experiencing any of these symptoms, discuss your options with your surgeon today.