Hip arthritis is a condition where there is wear and tear or thinning of the hip cartilage.
The protective and shock-absorbing functions of the cartilage are lost, leading to severe pressure on the hip joint itself. Patients often experience debilitating hip pain, stiffness and walk with a limp with hip arthritis.
Types and Causes of Hip Arthritis
Osteoarthritis of the Hip
Osteoarthritis is a common disabling condition that causes joint pain and stiffness caused by the gradual erosion of cartilage. Hip osteoarthritis is a common form of osteoarthritis that causes restricted locomotor activity and functional disability and may progress to the point where joint replacement is needed.
Stages of Osteoarthritis of the Hip
There are four stages for hip osteoarthritis.
Grade 1: mild joint space narrowing and subtle osteophytes
Grade 2: definite joint space narrowing, with some osteophytes and sclerosis, especially in the weight-bearing acetabular region
Grade 3: significant joint space narrowing, small osteophytes, some sclerosis and cyst formation. Some patients may develop deformities of the femoral head (CAM) and acetabulum (Pincer)
Grade 4: the obliteration of joint space with the above features plus large osteophytes and increased deformity of the femoral head and acetabulum. The patient’s leg may be shorter on the affected side
Inflammatory arthritis of the hip
Inflammatory arthritis of a hip describes a hip problem that is part of a bigger or systemic condition. These autoimmune conditions reflect the result of the immune system attacking your body instead of protecting it. It is unclear why this actually happens.
Rheumatoid Arthritis (RA) of the Hip
Patients with RA present with joint pain, stiffness and deformities throughout their bodies in early adulthood. Affected joints include their fingers, spine, hips and knees. The synovial lining in their joints thicken, swell up and destroy the articular cartilage of the joint itself. These patients are co-managed with a Rheumatologist who would prescribe DMARDS (Disease Modifying Anti-Rheumatic Drugs) to control or slow down the progression of their disease.
Psoriatic Arthritis of the Hip
Psoriasis is a systemic skin condition characterised by a rash with itchy, scaly patches affecting the knees, elbows, trunk and scalp. Inflammation caused by psoriasis can impact other organs and tissues in the body. One in three people with psoriasis may also develop psoriatic arthritis affecting their hips and knees.
Ankylosing spondylitis (AS)
AS is an inflammatory arthritis that causes calcification of tendons and ligaments of the spine and pelvis. The bones in the spine to fuse, causing patients to experience stiffness and pain in the lower back and hips. Patients may also get early arthritis of the hip due to AS.
Hip Arthritis Due to Avascular Necrosis (AVN)
AVN of the hip is a progressive disease caused by a vascular insult to the blood supply to the hi (femoral head). The cause of this is multi-factorial, including high alcohol intake, chronic steroid use, certain medication like chemotherapy, pregnancy, trauma (see below) and deep sea diving. Due to the lack of good blood supply to the hip bone, the bone collapses and causes its overlying cartilage also to lose its form and function. Without timely treatment, patients may eventually have end-stage hip arthritis.
Post-Traumatic Hip Arthritis
Some patients experience trauma to the hip due to a fall from height, road traffic accident or a simple fall at home. They may sustain fractures of their hip or acetabulum which may require surgery. Despite these best efforts, the blood supply to the injured bones may be compromised and this leads to AVN as described above. Even with surgery, the articular surfaces of the fractured bones may not be restored perfectly due to the extent of the injury. This uneven surfaces of the hip may also lead to arthritis of the hip joint.
What causes hip pain?
Every day, we go about our daily routines and do not give much thought about our hips. The hip is a ball and sock joint, lined by smooth and slippery cartilage. Basic movements such as walking, stair climbing, sleeping, and visiting the washroom requires all sorts of movement using our two hip joints.
Like the rubber tyres of a car, the cartilage in our hips will thin and wear out over time. This may occur at varying degrees and stages for different people, depending on a myriad of factors including age, body weight, genetics, a history of trauma or infection, use of chronic steroids and other medication, and high alcohol consumption.
What are some of the clinical symptoms?
We may start to develop pain in our hips or limp as we walk when the cartilage in our hips wears out (osteoarthritis, inflammatory arthritis, infection), or when the bone supporting the cartilage collapses (Avascular necrosis), or if our hips are misaligned (hip dysplasia, post-traumatic).
When the cartilage begins to thin, the hip starts to hurt with normal movement, stiffness, and a loss of function sets in. Patients often have abnormal gait despite painkillers.
Muscle sprains around the hip are also associated with strenuous physical activity and can be remedied with adequate rest, simple medication and stretching. If the pain worsens or significantly affects your daily activities or quality of life, you are advised to seek medical help.
Speak to our orthopaedic surgeon if you have pain and troubles with your hips. We are here to help you on your journey.
Risk Factors for Hip Arthritis
Most patients develop arthritis in their 50s or later. This is often related to general wear and tear after many decades of use. While some patients are overweight, there are also others who have optimal weight and yet develop hip OA.
Patients with inflammatory arthritis are at higher risk of developing hip arthritis at an earlier age. Those who are diagnosed early may be screened for hip arthritis earlier in life and may be started on physical therapy or medication sooner to prevent the progression of their disease.
Hip dysplasia is a developmental condition where patients’ hips are too shallow and prone to instability. These patients may experience hip pain and instability earlier in life. Patients present with no specific symptoms such as back or buttock pain or early fatigue with simple physical activities. A weight-bearing x-ray and an orthopaedic surgeon with knowledge of hip dysplasia are required to diagnose this condition.
How is hip arthritis diagnosed?
Patients often see a doctor, physiotherapist or orthopaedic surgeon for their hip pain. After a thorough discussion and clinical examination, the medical practitioner will often organise an x-ray of the pelvis and hip to diagnose hip arthritis. If the x-ray images are inconclusive for arthritis, an MRI scan will be done to analyse the structures of the hip better.
Hip Arthritis Treatment
Treatment for hip arthritis will depend on the cause of arthritis and how severe it is.
After the diagnosis of arthritis is made, Dr Mizan will prescribe some anti-inflammatory medication and a course of physiotherapy to improve your pain as well as the function of your hip. In the early stage of hip arthritis, injections into the hip may alleviate your symptoms and allow you to return to an active lifestyle. These hip injections include anaesthetic, steroids or lubrication medication.
In the lateral stages of the disease, hip replacement surgery may be required to replace the worn-out parts of the hip.
Surgery for Hip Arthritis
This surgical technique involves removing the worn-out parts of the hip and replacing them with specialised implants. This surgery aims for patients to return to their active lifestyle and enjoy continued employment, sports, holidays or simply go about their daily activities without hip pain and disability.
Your orthopaedic surgeon will analyse your latest x-ray or MRI scans of the hip and conclude that the cartilage (shock absorber) and labrum (stabiliser) of the hip are worn out. This leads to very rough and painful movements in your hip. At this point, you have already experienced the following symptoms:
Deep-seated hip pain and stiffness
Walking with a limp or waddling gait (your body swinging from side to side when walking)
Having to use a walking aid
Difficulty putting on clothes and socks
Difficulty cutting your toe nails
Difficulty with daily activities like climbing stairs
Pain killers becoming less effective
The hip replacement surgery takes about two and a half hours. The 10cm skin incision is located in your groin at the front of your hip. The muscles are pushed aside so that we may access the hip. The worn-out bones and cartilage are carefully removed using specialised equipment. Implants are then put in their place that best fits your bone shape and size. During surgery, your orthopaedic surgeon will move your hip about to simulate daily activities such as sitting in a chair, squatting and sleeping on your side. This is to ensure your hip is stable and does not dislocate when you go about your daily activities. We also ensure both legs are of the same length by clinical measurement and using x-rays.
Dr. Mizan’s patients are able to walk on the same day as their surgery. Under the watchful eye of our physiotherapist, his patients can walk using a walking frame and stick around their hospital room. Our minimally invasive techniques allow accelerated walking and physiotherapy after surgery.
Most of his patients are discharged the day after surgery once they are deemed to be safe on their feet. Dr Mizan always encourages the patients to walk as much as possible after their surgery. They are allowed to return to their favourite sporting pastimes, such as brisk walking, swimming, tennis and golf. Patients are also allowed to squat and kneel after their hip replacement surgery. To improve their confidence, Dr Mizan will guide them to perform these movements and exercises in the safety and comfort of his clinic room in the presence of their family members or caregivers.
Hip replacement surgery performed in a patient with arthritis affecting both hips
Dr Mizan often explains to patients and their loved ones that a hip replacement is often the start of a new and refreshing phase of their life. This is especially so since many of them would have experienced years of hip pain and crippling disability. We encourage our patients to live an active and healthy life after hip replacement surgery.
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