What is it?
The hip is the largest ball-and-socket joint in the body; the ball-shaped head of the femur (thigh bone) fits into the cup-shaped acetabular socket (hip socket). Arthritis, or osteoarthritis, is a painful condition caused by the wearing away of the smooth cartilage that normally covers the ends of the bones inside the hip joint. This causes the bones in the joint to rub together, causing pain and stiffness. Hip arthritis is common, and may occur in quite young patients, and is a leading source of chronic pain and disability in the developed world.
Why does it occur?
Anyone can develop osteoarthritis, but it is more common in people who have other joint diseases, such as rheumatoid arthritis, or those who have had hip problems in childhood like Perthes’ disease or development dysplasia of the hip (DDH, previously called CDH).
Arthritis in the hips is often due to variations in the shape of the hip bones (such as cam and pincer), deformities that cause femoroacetabular impingement (FAI), or is secondary to DDH. It is more common in active people who take part in impact sports, such as running. There is sometimes a genetic element, meaning that it can be more likely to develop if your parents or siblings have had hip arthritis.
What are the symptoms?
Hip osteoarthritis generally leads to pain and stiffness in the hip, which can worsen when walking, running, flexing the hip, or at night. The pain is often felt in the central groin area, but may be felt over outer aspects of the hip, the buttocks, thighs or even the knees. There may be an ache, sudden catching pains, or both. Often the hip stiffens up when at rest, which then becomes painful when the patient stands up and moves about.
How is it diagnosed?
Your surgeon will ask you a series of questions to establish whether you have any risk factors for arthritis, and to appraise the severity of your symptoms. They will also carry out a detailed physical examination of your joints to form a diagnosis which, in most cases, will be confirmed with an x-ray and occasionally further tests, including scans.
How is it treated?
The best course of treatment for hip arthritis will depend on a number of different factors, including your general health, desirable activity levels, and the severity of your symptoms, as well as the affect the arthritis has had on your hip.
For early or minimally symptomatic hip osteoarthritis, non-surgical options include lifestyle modifications and walking aids to help with mobility, combined with simple over-the-counter painkillers, or stronger ones, prescribed by your surgeon. There are also injections, such as steroid or hyaluronic acid injections, that can alleviate many of the symptoms and negate or postpone the need for surgery.
Hip replacement surgery is often indicated to relieve pain and improve function in cases where non-surgical options would have little or no positive effect. Modern hip replacement surgery is highly successful, with many patients eventually forgetting they ever had an pain in their hip. With the right prosthesis, patients can return to high levels of activity, including impact sports such as running. Minimally invasive surgical approaches can be used to reduce postoperative discomfort, and your surgeon will discuss all of these options with you, including the various implant types, their pros and cons, and the risks and benefits of undergoing surgery.
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The One Orthopaedics team specialists
Consultant Orthopaedic Surgeon FRCS (Tr&Orth), Hip and Knee
Consultant Orthopaedic Surgeon FRCS (Tr&Orth), Knee and Hip