HIP OSTEOARTHRITIS: A CONCISE OVERVIEW

Hip osteoarthritis is a degenerative disease. It is of two types

Primary or Idiopathic in which no cause can be determined.

Secondary. Any disease or disorder that disturbs the bio-mechanics of the hip joint or directly damages the cartilage of the hip will lead to secondary osteoarthritis.

• Perthes disease
• Congenital dislocation
• Slipped capital femoral epiphysis
• Avascular necrosis
• Coxa plana
• Infection
• Fractures and dislocations of the hip

Main symptoms include

• pain in the hip, that is brought on by movement and is relived by rest
• stiffness and muscle spasm may be present
• pain may also be felt in the knee joint of the same side (referred)
• the limb may be shortened
• movements of the hip may be restricted, in one or more directions

Radiographs of the hip joints, taken in two planes can confirm the diagnosis, and are helpful in ruling out other conditions, that can mimic hip osteoarthritis. They will show thinning of the cartilage ( decrease in space between the head and acetabulum ), change in the density of the adjacent bone and new bone formation (osteophytes).

HIP JOINT OSTEOARTHRITIS

Goal of treatment is

• Relief of pain
• Correction of any deformity
• Maintaining mobility

Guidelines of treatment will be decided by

• Severity of the disease
• Expectations of the patient
• Presence of associated diseases and disorders

In early and mild disease, I prescribe simple analgesics, use of heat and easy exercises, to maintain mobility and provide pain relief. Weight loss is also helpful in reducing the load across the hip joint. Load can also be reduced, by using a cane in the opposite hand while walking.

NSAIDS (non steroidal anti-inflammatory drugs as aspirin, diclofenac, ibuprofen) Main role of drugs is to reduce inflammation and provide pain relief. They do not alter the progression of the disease. They have many side effects. They should be used as sparingly as possible. Most dangerous is Gastric ulceration and bleeding. I prescribe proton pump blockers (reduce the chances of gastric ulceration) along with NSAIDs to my patients. If I don't prescribe proton pump blockers then eventually almost all patients do complain of stomach pain, burning and nausea.

Tramadol hydrochloride is a centrally acting analgesic (it acts on the central nervous system). It is useful in patients in which NSAIDs are contraindicated. It does not cause gastric ulceration, bleeding and kidney damage. It has significant drug interactions hence should be used under careful medical supervision. Its combination with paracetamol is as effective as NSAIDs.
In my experience the practise of YOGA, can provide immense relief, in patients of hip osteoarthritis. Various asanas (poses) that can help in hip stiffness are

• BHARADVAJASANA (CHAIR TWIST POSE and it's variants)
• MARICYASANA (STANDING TWIST)
• TRIKONASANA (TRIANGLE POSE and it's variants)
• PARSVAKONASANA (LATERAL ANGLE POSE)
• VIRBHADRASANA (WARRIOR POSE)
• PADANGUSTHASANA (LEG RAISING POSE and it's variants)

Learn the different poses of yoga from a certified yoga trainer in your area.

Various osteotomies ( surgical procedure in which a cut is made in the bone, bone pieces are then realigned and then fixed with plate, nail or fixator ) have been described in text books for hip osteoarthritis. Now they are only indicated in hip joints that are maligned, and are yet to develop osteoarthritis. This is to significantly delay, or prevent the onset of hip joint osteoarthritis in such patients.

In today's modern world, total hip replacement has become the gold standard, in the treatment of hip osteoarthritis. With the availability of superior materials, and better designs in implants, the survival of the artificial hip has increased tremendously. If at all revision surgery is required, that too, is now much easier. So if your doctor recommends hip replacement, then go ahead. Today it's the best choice.

Frequently Asked Questions

What is the role of glucosamine, hyaluronan and diacerein in hip osteoarthritis?

Glucosamine, hyaluronan and diacerein have low efficacy in this disease. They are not recommended.

How long is a replaced artificial hip joint expected to last?

More than 20 years in surgery performed by expert hands.

What about the new technique of surface joint replacement (ASR)?

The new technique is showing promising results but long term (above 20 years) follow up is yet to come. It is better for young patients as it preserves more bone than total hip replacement.

Go from Hip Osteoarthritis to Hip pain