Hip Arthritis Diagnosis and Treatment
What is Hip Arthritis?
Hip arthritis is a general term used when patients have cartilage loss within the hip joint. When the cartilage that cushions the joints is damaged or lost, symptoms such as pain, stiffness and swelling can occur.
What Causes Hip Arthritis?
The most common cause of hip arthritis is osteoarthritis, or “wear and tear” arthritis. This can happen in anyone, though there can be some genetic predisposition. It is most common in females in the 5th and 6th decades of life, but can occur in younger and older patients as well. Other causes include post-traumatic arthritis (prior fracture or hip injury), inflammatory arthritis (such as rheumatoid or lupus), congenital deformity (such as hip dysplasia or Perthe’s disease), avascular necrosis (AVN, loss of the blood supply to the femoral head), and infectious arthritis.
What Does the Hip Do?
The hip is a ball and socket joint where the thigh bone articulates with the pelvis. The ball is the head of the femur and the socket is called the acetabulum of the pelvis. The hip is surrounded by strong gluteal muscles that power the legs and allow for normal function. The hip generally has a wide range of motion that allows the legs to be placed in a wide variety of positions. It is part of the “core” of the body, and thus its function is essential for even simple activities.
Hip Arthritis Symptoms
Some of the most common symptoms of hip arthritis include:
- Pain that is located in the groin or in the front of the hip
- Pain that occurs deep in the buttocks
- Pain that is typically worse with activity and improves with rest
- Stiffness in the hip that worsens with simple activities such as putting socks and shoes on, squatting down and getting into and out of a car
Pain that is in the low back or located on the side of the hip are typically NOT due to hip arthritis, but could represent back problems or bursitis. As these symptoms worsen, patients become more and more disabled. Arthritis is typically a progressive disease, meaning that it tends to get worse as time goes on. However, patients will sometimes experience “flare-ups” where they will experience a sudden worsening in symptoms for a period of days to weeks.
How is Hip Arthritis Diagnosed?
To diagnose hip arthritis, a physician will typically assess a patient’s symptoms, physical exam, radiographic findings (such as x-rays or an MRI), and occasionally diagnostic hip injections. Physical exam findings include a limp, hip stiffness, and sometimes cracking or popping in or around the hip. When the surgeon moves the hip to the extremes of range of motion, patients experience pain in the groin or buttock. Typically, pain is worst when the hip is flexed and internally rotated.
The most common tests to diagnose hip arthritis include:
- X-Rays: An x-ray of hip arthritis may show a loss of cartilage, where there is bone-on-bone contact between the femoral head and acetabulum. As arthritis progresses, bone spurs (also called osteophytes) begin to form, which leads to impingement, pain, and loss of motion. Frequently, cysts of joint fluid form within the bone around the arthritic joint.
- MRIs: MRIs are sometimes used in cases where the surgeon is concerned about avascular necrosis (loss of blood supply to the femoral head), labral tears, or tumors. Simple x-rays are typically sufficient and MRIs are not needed for straight-forward osteoarthritis. However, an MRI is done in cases where pain is much more severe than one would expect based on the degree of arthritis seen on x-ray.
- Hip Injections: Injections into the hip are sometimes used to aid in the diagnosis of hip arthritis as well. Pain in the hip region can sometimes be caused by back pain that is referred to the hip. In cases where this is a concern, the surgeon may recommend injecting a local anesthetic (numbing medicine like lidocaine) into the hip joint. If a hip injection takes the pain away, even for a short time, then the pain is coming from the hip joint itself. If a hip injection does not help the pain, then it is likely that the pain is coming from somewhere else.
Hip Arthritis Treatment
Your surgeon will take your specific lifestyle needs and past history into account when recommending treatment for hip arthritis. The initial treatment for hip arthritis is almost always non-operative.
Non-surgical treatments for hip arthritis include:
- Oral medications (such as anti-inflammatories or Tylenol)
- Activity modifications
- Weight loss
- Physical therapy
- Gait aids (such as a cane or walker)
- Hip injections
There are potential benefits and risks to all types of treatment, so it is important to work together with your doctor to create a plan that is appropriate to your situation.
Is it Possible to Regrow Cartilage?
There are ongoing studies into technology to regrow cartilage, but there is currently no way to do so within an arthritic joint. Claims that injections or medications can regrow cartilage or cure arthritis are not supported by any scientific evidence.
How Do I Know When it is Time for a Hip Replacement?
You should not undergo a hip replacement unless you have significant pain that keeps you from doing even simple activities. You have tried the non-operative treatment options listed above for at least three months, and you continue to have severe pain and limitations despite these interventions. X-rays or MRI should also show severe hip disease that corresponds to your pain. It is possible to have advanced arthritis on x-rays but minimal pain. Because of this, it is not possible for a doctor to accurately predict how long your native hip joint will last.
What are the Surgical Options for Hip Arthritis?
The only surgical treatment for hip arthritis is a hip replacement. Once a hip becomes degenerative, other surgical options such as hip arthroscopy or osteotomy are generally not advised.
Request an Appointment at ROC
If you are experiencing hip pain or believe you have hip arthritis, contact us to schedule a consultation. Our Joint Replacement Team has extensive experience in treating the full spectrum of hip arthritis, from basic nonoperative treatment to complex revision surgery.