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Guide to Arthritis
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|What Is Hip Arthritis?
Osteoarthritis is the most common cause of hip arthritis. Osteoarthritis is a degenerative joint disease which over a number of years wears always the cartilage of the joints and bones. It causes inflammation, pain and eventually restricted movement. Another common cause of hip pain is rheumatoid arthritis where the joint lining becomes inflamed, swollen and sore to touch. Eventually the joints may become permanently deformed. Other types of arthritis which can affect the hips include ankylosing spondylitis (which specifically affects the spine and the sacroiliac joint); and lupus. Hip arthritis generally affects people over the age of 50 and those who are obese. Losing weight usually reduces pressure on the hips and symptoms can improve. Genetic tests shows that those who inherit the HLA-DRB gene are at greater risk of developing rheumatoid arthritis. If your parents or siblings develop hip arthritis, you also have a greater risk of doing so. Additionally any traumatic injuries to the hip bones, such as a fall, accident or sport injury significantly increases the risks of hip arthritis in later years.
What Are The Signs?
Symptoms of arthritis tend to worsen as the disease progresses. However most patients will still report good and bad months. Wet and cold weather often aggravates the condition, so it may be worse in winter. Classic signs of hip arthritis include:
1. Joint pain which increases with movement.
2. Pain which is a dull ache that originates in the groin area and radiates to the outer thigh and buttocks.
3. Stiffness of the hip, particularly first thing in the morning.
4. A limp develops as you walk.
Other useful articles on arthritic pain: Read about the causes of arthritis and see books on arthritis for a range of self-help guides.
How Is It Diagnosed?
An arthritis diagnosis is usually achieved by taking the patient’s medical history, performing a physical exam and taking X-ray images (image). As hip pain can be caused by other conditions, these will need to be ruled out. Other possible causes include:
Injury: Resulting from a trauma which has not healed.
Lower Back Problems: Such as herniated discs and sciatica.
Tendonitis: Inflammation of the tendons which join the bones to the muscle.
Muscle Pulls: These can cause pain around the hip and pelvis, such as hamstring strains or groin pulls.
Hip Osteonecrosis: Interruption of blood flow to the hip bone (head of the femur), so that the bone gradually dies. A hip trauma such as dislocation or fracture can cause this condition. It often progresses to arthritis.
Hip Bursitis: A bursitis is the fluid filled sac which allows muscles and bones to glide smoothly over each other. If it becomes inflamed it can cause similar symptoms to arthritis.
Other Possible Causes: Shingles and infections.
During the physical exam your doctor will ask you to move your hip in various directions to monitor your range of motion. He will note:
1. Which if any motion causes pain.
2. If one or both hips are affected.
3. If there is any sign of swelling in the hip or thigh area.
4. Any signs of infection such as redness, warmth and fever.
A radiography (X-ray) will need to be taken. This is a relatively accurate way (an MRI scan would be even better) to check if there is any thinning or erosion of the hip bones, or if there is any loss of joint space or fluid in the joints. It should also be able to determine which type of arthritis is present. Some blood tests may also be taken.
What Non-Surgical Treatment Options Are There?
Most people with hip arthritis will say that the more they walk, the more the hip will hurt. So the question is - should they completely limit their physical activity? While it makes sense to cut back on activities which seem to aggravate pain (for example taking a lift instead of taking the stairs or avoiding long walks) not all exercise should be curtailed. Studies show that becoming completely sedentary does not slow down the progression of arthritis and may in fact only worsen the disease. A 1992 study by the Annals of Internal Medicine showed that patients who forced themselves to remain active with hip arthritis fared better in the long run those who did not. The most recommended form of exercise is swimming as water removes stress on the hip. A stationary or mobile bicycle is the next best option. If you do not have access to either, walking as much as you can tolerate will also help. Always discuss any new exercise program with your doctor or physiotherapist first. See also, natural treatment for arthritis.
Although it may feel a little embarrassing to begin with, walking with a cane will help relieve stress on the hips. The cane should be held in the opposite hand from the side with the hip problem and it should be the correct length for your height. A medical supply store can help you choose the correct walking stick. Other arthritis equipment such as a long shoehorn or reacher may help you cope with everyday living.
Maintaining a healthy body weight - that is a body mass index (BMI) less than 25 - will help to minimize stress on the hip joints. If you are overweight, every one pound of body fat you lose equates to 3 pounds of stress reduction on the hips. Furthermore, if you are planning a hip operation, obesity can increase the risks of complications, so your doctor will advise you to lose weight. Although it may be more difficult to lose weight when you are not active, if you follow a strictly calorie controlled diet plan, it is still quite possible.
Steroid or cortisone injections which are injected directly into the hip joint can be effective in reducing pain for up to 6 months. The injections need to be directed accurately and are only usually given by a rheumatologist. If a joint is very deep an extra long needle will need to be used in combination with an x-ray for guidance. Therefore is not always carried out as an office procedure.
Intramuscular gold injections are another alternative. They can reduce inflammation, pain, swelling and stiffness in the joints of people with rheumatoid arthritis. Gold, or its brand name Myocrisin is a disease-modifying anti-rheumatic drug (DMARD). It is a compound that contains gold, but it is not pure gold. It has the added benefit of dampening the underlying disease, which means it does more than just treat the symptoms. However unlike cortisone injections, gold injections do not work immediately, in fact they can take up to 3 months to show benefits.
Over the counter medications such as ibuprofen, paracetamol and aspirin are always a first line of defense in dealing with a 'flare-up'. Stronger anti-inflammatories are also available on prescriptions. See arthritis treatment.
Sulfasalazine and methotrexate are DMARDs prescription drugs which can help to halt the progression of the disease. They are considered a second line of defense after less potent medications have been tried. They are often used for treating rheumatoid arthritis, ankylosing spondylitis and lupus. The drugs can take 6 to 8 months to work, and while they may halt progression of arthritis they rarely lead to complete remission.
If non-surgical options fail to provide enough pain relief or if movement is severely restricted, surgery is the next option. Which type of surgery you consider will depend on your age, the severity of the deterioration of the hip joint and the type of arthritis you are diagnosed with. All surgeries are carried out by an orthopedic surgeon.
Hip Replacement Surgery
Also called total hip arthroplasty, hip replacement surgery involves removing the diseased hip joint and replacing it with an artificial one (prosthesis). The prosthesis consists of a ball made of ceramic or metal and a socket lining of plastic, metal or ceramic. The implants are designed to be biocompatible which means they will not be rejected by the body. Following arthroplasty surgery and rehabilitation, the patient should enjoy pain relief and restored motion to the hip. Each year about 330,000 Americans and about 50,000 British undergo total hip replacement surgery. It is usually performed on adults over 65 and on more women than men. Generally the outlook for patients after surgery is quite good. They experience a return of mobility and better quality of life which can last from 10 to 20 years, sometimes even longer. While high impact activities such as jogging or basketball may never be recommended, over time most patients should be able to ride bikes, play golf and swim quite comfortably.
When Is It Recommended?
Hip replacement surgery is a serious operation which has potential complications. For this reason it is only normally on considered on patients who:
1. Have persistent pain, despite taking prescription medications.
Experience pain which is aggravated by walking, even when they use a walking stick.
2. Have sleeping difficulties because of pain.
3. Incur pain when they sit or rise from a chair.
4. Cannot enjoy or participate in everyday family life because of stiffness and pain.
Potential Complications Of Surgery
About 400 to 800 people die every year in America of pulmonary embolism within 3 months of hip replacement surgery. This is a blood clot which manifests in the leg vein and travels to the lungs. Most patients will be given blood thinning medications after their procedure to prevent this occurring. Wearing elastic stocking and exercise will also be recommended.
An infection may occur at the site of the surgical incision or deeper on the tissues near the new implant. It is usually treated with antibiotics. If a major infection persists near the implant it may require new surgery and replacement prosthesis.
There is always a danger that healthy parts of the hip joint may suffer a fracture during surgery. Small fractures will heal on their own but larger ones may need corrective surgery and bone grafts.
To avoid the new joint becoming dislodged after surgery patients are advised to avoid bending more than 90 degrees and crossing their legs for a period of time. If the joint becomes dislodged they may be fitted with a brace to keep the hip aligned. If it keeps dislodging it will need to be stabilized by further surgery.
Although rare with newer implants, the prosthesis may become loose over time causing pain. Another rare complication is where the implant breaks after a few years. Surgery will be required in both instances to fix the problem. If you are relatively young and active when you undergo surgery there is a chance, due to wear and tear, that you may need another implant 20 years or so down the line.
Sometimes ossification takes place where the tissues around the joint harden. This is not usually painful but it can make movement more difficult. It is usually treated with either medications or radiation therapy.
Partial Hip Replacement
Medically termed hemiarthroplasty, this surgery involves only replacing the ball or femoral head of the hip joint with a prosthesis. It is usually performed to fix a hip fracture due to trauma, or where arthritis has only damaged part of the hip joint.
What Is Hip Resurfacing?
Also called metal hip resurfacing arthroplasty, this procedure has been developed as an alternative to total hip replacement surgery. In the operation metal caps (which look like tennis balls cut in half) are fitted over the damaged area of the ball of the hip joint socket. In other words, it is resurfaced rather than replaced. The damaged hip socket is then fitted with a metal prosthesis, similar to that which is used in a conventional hip replacement. In most instances doctors are still recommending total hip replacements because statistics show they can last decades. There is still no long term data for hip resurfacing. However younger people may be recommended resurfacing because the operation leaves more bone intact. This can make it easier to perform a total hip replacement if they need it in later years.
How Much Does Surgery Cost?
If you are not insured, the average cost of a total hip replacement is usually between $32,000 and $45,000. However some hospitals do offer uninsured patients a discounted rate which can reduce costs to between $20,000 and $23,000. Most hip replacement surgery is covered by health insurance unless it is experimental or specifically excluded from the policy. Even then however there will still be out of pocket expenses which are on average $3,000. Included in the overall cost you should expect an orthopedic surgeon to perform the initial evaluation, take a medical history and X-rays and possibly other tests such as an MRI scan to check bones and tissues. The doctor will advise you on any surgery preparation such as blood tests and losing weight. The procedure will be performed and several days rest in hospital is also covered.
Note: When deciding on a surgeon always choose one who is certified by the American Board of Orthopedic Surgery. Ideally choose one who specializes in performing hip replacements.