Osteoarthritis of the hip: an expert's overview

Osteoarthritis is a condition which puts a huge strain on patients, both physically and mentally. Leading consultant trauma and orthopaedic surgeon Mr Sam Heaton explains the condition, including the most common symptoms, available treatments and how lifestyle factors can help to alleviate symptoms.

What is osteoarthritis of the hip?

Osteoarthritis is the most common form of arthritis. The hip is the second most commonly affected joint, while the first most commonly affected joint is the knee. A joint is where two bones meet. Your hip joint is a ball and a socket; the ball's on the end of the thigh, the socket's in your pelvis, and the ball fits in the socket.

When the ends of the bones meet, they're covered by a smooth, slippery surface known as cartilage, which allows the bones to rub together without causing any trouble. Osteoarthritis causes the cartilage level to thin, and the surfaces of the bones to become rough, leading to swelling, pain, and stiffness in the hip.

The exact cause of this is unknown. There are several reasons why someone might have arthritis, often due to genetics. Osteoarthritis usually develops in people who are in their late forties or early fifties. The condition can be affected by certain lifestyles, such as having or previously having had a heavy manual job or in the case of a sportsman or sportswoman, having had any injuries in the past. In addition, carrying extra weight can worsen osteoarthritis.

What are the most common symptoms of osteoarthritis?

Symptoms of osteoarthritis of the hip can come on quite quickly, but they usually come on gradually over a period of months or years. The pain is usually in the lower back and the buttocks, and particularly the groin. Some people also feel discomfort all the way down their leg, all the way to their knee, and in some cases, beyond. This is known as referred pain.

If your hips are badly affected, this can make walking, standing and bending very difficult. Your hip may feel like it locks and gets stuck for a few moments. With advanced arthritis, the muscles around the hip become smaller and weaker and they put even more strain on the joint. The best thing to do to prevent these problems is to keep active.

What are the available treatment options, both non-surgical and surgical, for managing hip osteoarthritis?

To treat osteoarthritis, most patients will have started something like exercises, either with or without a physiotherapist, weight loss and painkillers. These aspects are absolutely crucial to begin with.

If these methods have not given you a satisfactory outcome, one option may be a hip replacement.  A hip replacement is one of the most commonly performed surgeries in the world. It's known as the second most successful surgery of all (the most successful surgery is cataract surgery).

A hip replacement gives a lot of pain relief, improves the movement in your hip, and the vast majority of people with a hip replacement do really well following surgery.

Surgical techniques are constantly and most hip replacements now last minimum of 15 years, if not much, much longer. The hip replacement that I use exclusively is the Exeter hip replacement, and the evidence for that shows that 25 years after the operation, 95% are still in place and functioning well.

How can lifestyle modifications and self-care strategies help alleviate symptoms and improve the quality of life for individuals with hip arthritis?

Patients ask me how lifestyle modifications and self-care strategies can help to alleviate the symptoms of their hip arthritis. I get asked about that a lot. The reason is that some people may have to wait a long time for a hip replacement, they may not feel ready, or in some cases, they don't need one, and they want to find other strategies to look after the pain in their hip. The number one strategy that I always recommend is exercise.

Joints need to be exercised regularly to keep them healthy. Some people say things like “oh, you've got arthritis, you must stop”. This is something that I don't agree with. It's extremely important to keep moving if you've got hip arthritis. Whatever your fitness level, exercise should form a core part of your treatment.

It can strengthen the muscles around your hip, improves your posture and helps you to lose weight, which puts a lot less force through your hip joint. Exercise can be done in conjunction with a physiotherapist, who may be able to give specific advice on exercise and tips that will work particularly well for you.

Your physiotherapist may talk about strengthening exercises, including what we call a range of movement exercise. It allows your joints to maintain some flexibility, but you should also engage in aerobic exercises, such as going for a cycle, a swim or a run.

Another important element is weight management. Being overweight increases the strain on your joints. It is not easy to lose weight, particularly when you've got a lot of pain in your joints. However, if you can lose weight, it is a huge advantage.

Finally, you can try to reduce the strain on your hip by pacing your activities; don't overdo things. You shouldn’t take on all physical jobs at once. It is advisable to use a walking stick if necessary, particularly outdoors. I recommend Nordic walking poles, which people often use for hiking.

What are the long-term implication of hip or arthritis and how do I know when I have to look for surgical intervention?

Engaging in exercise, using painkillers, being a healthy weight and leading an active lifestyle will all improve the symptoms of hip arthritis. However, if these treatments haven't worked for you, you may benefit from hip surgery. Surgery is usually recommended if the hip pain is substantially impacting your quality of life. For example, if the hip pain is affecting your sleep, limiting your walking distance or causing you to require a walking aid at all times.

In addition, some patients may become reliant on analgesia. I see a lot of patients who have got really bad arthritis, which heavily impacts their mental health, as well as the health of their family around them. They don't sleep very well and become permanently grumpy.

Undergoing a hip replacement, as well as relieving your hip pain can help a lot of the physical and psychological symptoms which are associated with a bad hip.

If you are suffering from osteoarthritis of the hip and would like to book a consultation with Mr Heaton, do not hesitate to do so by visiting his Top Doctors profile today.