43 million Americans have some type of arthritis. Arthritis is damage and thinning of joint cartilage. Cartilage is found on the ends of almost all bones. It is the glistening surface that allows the joint to move easily, with little or no friction. Generally, how much arthritis hurts depends upon the amount of cartilage that is lost. The pain occurs because the joint lining (synovium) becomes inflamed and irritates the hip and also because bone is rubbing on bone
Arthritis is usually progressive – once you have it, it gets worse. How quickly this happens, and how much pain it gives, is different for each patient.
Types of Arthritis
The word “arthritis” is a catch-all term. Generally, there are two cause of arthritis:
- Osteoarthritis – By far, this is the most common type. Its common name is “wear-and-tear arthritis”. In most cases, the cause is unknown. There are some known causes, usually due to a long-term childhood problem, after trauma, or with loss of blood-supply to the bone.
- Rheumatoid disease and similar systemic problems (gout, lupus, psoriasis, ankylosis) also cause arthritis of the joint, resulting in cartilage destruction
A Quick Hip Anatomy Lesson
The hip is a ball-and-socket joint. The ball (femoral head) and the socket (acetabulum) are covered by cartilage, a glistening substance that allows smooth, painless movement of the joint.
Causes of Hip Pain Other than Arthritis
Even more common than arthritis, are soft-tissue problems about the hip. These include:
- Bursitis – Inflammation that usually hurts on the side of the hip
- Tendonitis – Inflammation that can occur in many spots around the side and front of the pelvis, hip, and thigh.
- Broken hip – Can happen in the elderly, but also in athletes and in trauma situations
Hip Arthritis Pain Characteristics
The most common pain associated with arthritis is groin pain. Certainly, arthritis can also hurt elsewhere around the hip, include the front of the thigh, going down toward the knee, in the buttock region, and even on the side of the hip, where bursitis is much more common.
Pain is usually most with activity, but as arthritis becomes more severe, pain can be present at rest or even keep a person awake at night.
Pain in the buttock, or going down the back of the leg is most commonly caused by a spine problem. It is very common to have hip disease and back disease at the same time and Dr. Mathews may want to differentiate between the two with other special x-rays or examinations.
Other Common Findings with Hip Arthritis
- Limp – Arthritic patients will notice that they have developed a limp. Very often, family members and friends will notice it even before the patient does!
- Stiffness – The gradual loss of cartilage causes the hip to become stiff. As time progresses, it can even lose more motion and not straighten or bend fully. This has a tremendous impact on function.
- Leg shortening – As arthritis causes thinning of joint cartilage, the leg loses length. This happens very slowly, and the spine and pelvis usually are able to adjust
- Difficulty with activities of daily living – Patients with hip arthritis specifically complain about an inability to do the things they “used to be able to do”. This is a very important reason for seeking out treatment, as today people are living longer and enjoying activity into their nineties and even older. Common complaints are trouble putting on socks and shoes, difficulty picking up objects, trouble with stairs, difficulty getting in and out of chairs and automobiles, decreased walking distances, and even loss of sleep.
Treatment of Hip Arthritis
Unfortunately, once it’s lost, our bodies cannot re-grow cartilage of the same caliber. Research is heading this way, and some cartilage transplantation and re-growth treatments exist, especially about the knee, but only for very young patients with small areas of cartilage loss. These are in development stages and may one day within the next century become primary treatments for all patients. For now, treatments that control the pain and inflammation (especially in patients with mild or moderate arthritis) are our only way of treating patients without surgery.
- Taking it easy – It is important to remain active, as the benefits on the heart and lungs greatly outweigh any arthritis problems. Scientific studies have shown that active people have a better general well being and better results. But, be easy on your bad hip. When you have a choice, take a car, instead of walking. Use an elevator instead of stairs. Use a cart when golfing. Play doubles tennis instead of singles. Picking “hip-friendly” activities can help you maintain an active lifestyle. These include “weightless exercise”, such as swimming, and pool therapy. Bicycling is also better for patients with hip arthritis. Avoid impact-type activities. Try not to overdo it if you are having significant pain.
- Cane – Canes help take weight off the arthritic joint. Ask your doctor to draw the physics diagram that shows how a cane can help you – and why you should use it in the opposite hand.
- Losing weight – The hip can absorb 3 – 5 times your body weight with every step. So if you weigh 200 lbs, that hip joint can see ½ ton of weight (1,000 lbs) every time you take a step! Scientific studies have shown that weight loss helps with arthritis pain. Exercise is painful with arthritis, but with a good diet and medication regimen, and hip-friendly exercises, many patients are able to cut down on their weight.
- Physical Therapy – Therapists can often help by strengthening the muscles about the hip joint. This helps take some of the stress off the joint itself, and thus help with pain and limp.
- Medications – These pills are not only painkillers, but they help with inflammation! – So they help with pain in two ways. Unfortunately, they don’t cure or slow down arthritis. There are many options:
- Over-the-Counter – (Aspirin, Bufferin, Advil, Motrin, Ibuprofen, Aleve) These are easy to get, and safe, especially if you follow the directions on the bottle. They are helpful for many patients with arthritis.
- Tylenol – By itself, this is not an anti-inflammatory medicine. It is an analgesic (pain reliever). So it can be safely taken with the others, and is a great way to add to pain relief.
- Prescription Anti-inflammatories – (NSAIDS)(Naprosyn, Voltaren, Clinoril, Feldene, dozens of others). These are the most commonly used second-line medications, for those patients who do not get relief from the over-the-counter medicines. If one doesn’t work, there are many others to try.
- Newer Prescription Anti-inflammatories (COX-2-specific)(Celebrex)– These protect the stomach more and are commonly used medications
- Major Occasional Anti-inflammatory Side-Effects
- Stomach irritation / Stomach ulcer – Ulcers and gastritis can cause bleeding and be life threatening – so if stomach pain, vomiting, or black stools develop, stop them and call your doctor immediately
- Easy bruising, bleeding – These medications can cause some thinning of the blood, and you may notice easy bruising. Also, they must be stopped several days before surgical procedures.
- Increased blood pressure – Celebrex has been shown to rarely cause increased pressure or leg swelling.
- Sulfa Allergy – Patients with Sulfa allergy cannot take Celebrex.
- If on one of these medications for more than 3 months, you need to let your medical doctor know – he needs to do special tests for your liver and kidneys every few months
- Try not to smoke, drink alcohol excessively, or use cortisone if on one of these medications or on Tylenol
- You will be unable to take these medications without your medical doctor’s OK if you take blood pressure pills, aspirin, diabetes medicines, diuretics, digoxin, lithium, blood-thinners, phenytoin, methotrexate, barbiturates, or certain herbal medicines.
- Glucosamine / Chondroitin Sulfate – These supplements are currently very popular. Science is not sure how they work. They are “natural” substances that can be found in the human body. The ones that are sold in the store are made from animal products (crab, lobster, shrimp shells)(tracheas, shark cartilage). These supplements may help with pain, although recent studies are not clear. Studies have shown them to be safe.
- Recommended doses: Glucosamine 1500 mg and Chondroitin 1200 mg daily
- Ask your doctor or pharmacist for a well-trusted brand with a reliable doses
- Make sure it has a reasonable price – Be careful about how many pills you get, and the doses!
- Alternative / Complimentary Medicine – Acupuncture and massage have been shown to help patients manage the pain associated with arthritis, and certainly are relatively safe options for the patient with mild arthritis of the hip.
- Cortisone injection – Although cortisone is helpful in many joints, its use in the hip is not realistic. Unlike the knee or shoulder, access to the hip with a needle needs x-ray guidance. It requires an involved process done by an interventional radiologist at an imaging center. Occasionally, in the right patient, hip injections can be tried. They do work very well for other problems around the hip.
- Joint fluid supplements (“lubricants”) (Supartz, Synvisc, and others) – These are a short series of injections that are given weekly. They are very popular in the news today and are used quite often in our office. They are “natural substances” which are made from rooster combs. Not much is known about their effectiveness in hip arthritis. Once again, the logistical difficulties and lack of good scientific studies in the hip do make them less realistic in the hip joint. However, in the right patient, they can be attempted.
- Arthroscopy – Although not as common as in the knee, arthroscopy of the hip can be useful to remove loose bodies or to treat tears or inflammation in the lining of the hip joint. It is a quick procedure, with a very fast recovery.