How to Best Treat Hip Arthritis

Betty was having trouble with her groin pain especially when walking. Worried that it could be something sinister she finally presented for physio treatment after the medications her doctor prescribed didn't seem to be helping anymore.

We could tell Betty had nasty hip arthritis from the moment she walked into the clinic. A few clinical tests confirmed her diagnosis. We then arranged X-rays to see the severity of her hip arthritis.

Betty then asked us, "What is hip arthritis? What can I do about it?"

Hip arthritis commonly describes the most common for of hip arthritis, which is known medically as hip osteoarthritis.

Hip osteoarthritis is a joint disease that mostly affects your hip joint cartilage. Articular cartilage is the hard slippery surface that covers the sections of bones that move against each other in your hip joint.

Healthy articular cartilage allows your hip joint bones to smoothly and painlessly glide over each other and also helps to absorb any shock forces not dispersed by your hip muscles.

What Causes Hip Arthritis?

In hip osteoarthritis, your top layer of articular cartilage breaks down and wears away. Eventually, your cortical bone that lies under the cartilage, rubs together to cause pain, swelling, grating and loss of hip joint motion.

Muscle weakness, and the resultant hip joint instability associated, is thought to contribute towards the deterioration of your hip joint cartilage. Weaker hip muscles also provide less shock absorption capabilities than their strong counterparts, which increases your hip joint compression forces.

Hip osteoarthritis usually happens gradually over time.

Some risk factors that might increase your likelihood of deterioration include:

Being overweight.

Age.

Previous joint injury.

Muscle weakness.

Stresses on the joints from certain jobs and playing sports.

Poor biomechanics.

Malformed joints or a genetic defect in your joint cartilage.

Hip osteoarthritis is the most common form of arthritis affecting your hip. Unlike some other forms of arthritis, osteoarthritis affects only joints and not internal organs. It is becoming more common with an ageing population. However, it can also occur in younger people, especially where there is a history of hip injury or heavy work.

Some research suggests that early intervention can delay the onset of the hip arthritis and may reduce the number of cases of hip osteoarthritis. There is not currently a cure for hip osteoarthritis.

What are the Symptoms of Hip Arthritis?

Hip arthritis results in hip pain, joint weakness, instability and restrictions of movement that interfere with your most basic daily tasks such as walking, climbing stairs or driving.

Your symptoms can develop suddenly or slowly and may include:

Hip joint pain or tenderness that comes and goes. Typically there will be sharper pains in the groin, and sometimes an ache in the front of the thigh. Many people present with hip arthritis thinking that it is a knee problem.

Hip stiffness, particularly early morning stiffness.

Hip joint movement is difficult, especially inward rotation, movement of the leg across the body and hip extension.

Weak hip muscles, especially during sit to stand, squatting and stair climbing.

Hip joint swelling or deformity can be hard to detect because of the location of the hip joint.

How is Hip Arthritis Diagnosed?

Your initial diagnosis of hip osteoarthritis is usually clinically formed by taking a detailed history of your symptoms and a physical examination looking at the range of movement of your hip joint and any associated pain.

If hip osteoarthritis is suspected, a hip X-ray will assess your hip joint wear and tear, and sometimes a blood test to check for other factors.

In a small number of cases, a CT scan or MRI may be performed.

What’s the Treatment for Hip Arthritis?

PHASE I - Pain Relief & Protection

Managing your hip pain. Hip pain is the main reason that you seek treatment for hip arthritis.

Regular application of ice packs is highly recommended to reduce your hip pain.

NSAIDs or anti-inflammatory drugs (i.e. ibuprofen). Use of these medications should be discussed with your doctor.

Your physiotherapist will use an array of treatment tools to reduce your hip pain and inflammation. These may include: ice, electrotherapy, acupuncture, deloading taping techniques, soft tissue massage and temporary use of a mobility aid (eg cane or crutch) to off-load the affected side.

PHASE II - Restoring Normal Hip ROM, Strength

As your hip pain and inflammation settles, your physiotherapist will turn their attention to restoring your normal hip joint range of motion, muscle length and resting tension, muscle strength and endurance, proprioception, balance and gait (walking pattern).

Hip researchers have discovered the importance of your hip muscle recruitment patterns with a normal order of: deep, then intermediate and finally superficial muscle firing patterns in normal pain-free hips. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs.

PhysioWorks has developed a “Hip Core Stabilisation Program” to assist their patients to regain normal hip muscle control.

Please ask your physio for their advice.

PHASE III - Restoring Full Hip Function

The final stage of your hip arthritis rehabilitation is aimed at returning you to your desired activities. Everyone has different demands for their hips that will determine what specific treatment goals you need to achieve. For some it be simply to walk around the block.

Your physiotherapist will tailor your hip rehabilitation to help you achieve your own functional goals.

PHASE IV - Delaying Hip Surgery

Hip osteoarthritis is a condition that gradually deteriorates even though your pain may come and go in the initial stages.

In addition to your hip muscle control, your physiotherapist will assess you hip biomechanics and start correcting any defects. It may be as simple as providing your will core abdominal exercises or some foot orthotics to address any biomechanical faults in the legs or feet. Your physiotherapist will guide you.

Fine tuning your hip stability and function by addressing any deficits in core strength and balance, learning self-management techniques and achieving the ultimate goal of safely returning to your previous daily or leisure activities!

Your aim for any exercise or physiotherapy program is to delay the deterioration of your hip arthritis. Your best chance is have have strong hip muscles and bones performing activities that don’t traumatise your hip joint surfaces.

PHASE V - Hip Surgery

Hip surgery is usually required as your hip joint arthritis deteriorates and your hip joint becomes permanently deformed. The most common surgical procedure for an arthritic hip is a total hip replacement. Your hip surgeon may also recommend arthroscopic surgery or joint resurfacing.

Your prognosis following a total hip replacement is very good. In most cases, you will have no or considerably less pain plus improved hip function.

You will require a post-operative hip strengthening and rehabilitation program to prolong the life of your new hip and resume your most active lifestyle.

For more information about hip surgery, please your physiotherapist or doctor.

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What Else Can You Do For Your Hip?

Lose Weight

Lose weight. You won’t just look better, you’ll feel better, too. Why? Every extra kilogram you carry around translates to added stress to your hip joints. Excess weight can mean more hip pain, no matter which form of arthritis you have.

Ice it!

When your hip joint is hot and inflamed, applying something cold can decrease pain and swelling by constricting blood vessels and preventing fluids from leaking into surrounding tissues.

Medications

Follow your doctor’s advice. Some medications will be designed for pain relief and others to reduce inflammation. Since most hip osteoarthritis sufferers normally have other medications, it is always wise to check with your doctor before changing.

Exercise - Keep Moving

Exercise helps to lessen your hip pain, increase your hip joint range of movement, reduce fatigue and help you feel better overall.

A well-rounded workout routine for people with hip osteoarthritis includes flexibility exercises to increase your hip joint and muscle range of motion, aerobic exercises to improve your endurance and decrease fatigue, and strengthening exercises to improve your muscle endurance and power.

Your physiotherapist is an expert in the assessment and prescription of hip arthritis exercises. Please ask them what is best for you.

General exercise such as swimming, hydrotherapy, Tai Chi, yoga, pilates, balance and walking programs are excellent if pain-free.

The key is to have a regular daily exercise program. The goal is to keep moving.

Strengthen Your Bones

Ask your doctor to check your bone density. If they are concerned they’ll arrange for a test to check if you have osteoporosis (bone thinning).

Follow their advice or the advice of your dietitian on your Calcium and Vitamin D intake. You need normal levels of both plus some form of weight-bearing exercise to strengthen your bones.

Treat Your Muscles with a Massage!

A quality remedial massage may be just the relief your hip muscles need. Treat yourself to a good rub down with someone you trust. The benefits vary from person to person but may include decreased pain and muscle stiffness associated with your arthritis, increased circulation, and an improvement in your sleep and immune functions. Mentally, massage can also decrease stress and depression.

Besides all it that, massage just feels good!

For more advice, please ask your physiotherapist, massage therapist or doctor.

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