Osteoarthritis

What is osteoarthritis of the hip?

Osteoarthritis is often referred to as 'wear and tear'. It's a degenerative disease and is the most common form of arthritis, affecting the cartilage in the joints. It can occur in any joint, but it's mostly found in the knees, hip and spine, causing pain, stiffness and weakness in the affected area.  

When osteoarthritis is present in the hip, the cartilage between the pelvic bones (the acetabulum) and the upper end of the thigh bones (the femur) becomes thin. The acetabulum is the socket of the hip joint and the femur is the ball.

The cartilage that covers the ball and socket of the hip is known as articular cartilage. This is a smooth substance that is designed to protect the joints and bones in the area, creating a cushioning effect and reducing friction. 

The thinning of the articular cartilage can cause the bones in the hip joint to rub against each other. The cartilage frays and becomes rough. As this protective layer reduces, the joint doesn’t move as it should and the bones in the ball and socket of the hip start to rub together, causing pain. The damaged bones then begin to grow outwards, forming bone spurs that may cause stiffness. 

What causes hip osteoarthritis?

There are two classifications for hip osteoarthritis:

• Primary osteoarthritis: Where the condition has no known cause (more common)
• Secondary osteoarthritis: When there is an underlying condition or it is the result of an injury, such as misalignment or trauma to the hip joint

You can suffer osteoarthritis in your pelvis if some of the following risk factors apply to you:

• Age: Osteoarthritis is more likely to occur as people get older because joints wear down over time. It predominantly affects adults aged over 50.
• Activity: Sports and job roles that put strain on your joints can lead to wear and tear
• Family history: In some cases, there is a genetic link. You may be at a higher risk if your parents or grandparents have been diagnosed with hip osteoarthritis
• Obesity: Being overweight can place more strain on your joints. 

Conditions that can lead to secondary osteoarthritis are linked to improper growth of the hip joint and include hip dysplasia and congenital hip dislocation, suffered at birth. 

How is a hip osteoarthritis diagnosis confirmed? 

To receive a hip osteoarthritis diagnosis, a full medical assessment is carried out. Your consultant will ask you about the pain you're experiencing, such as its severity and when it began. They'll also ask about any activities that make the pain worse, as well as any periods where you might feel stiffness in the joint. 

Your consultant will also complete a thorough physical examination of your hip joint. This will include an assessment of your joint’s range of movement and an evaluation of other potential causes for pain in this region. 

Our specialist radiologists will carefully evaluate your hips for features of osteoarthritis and other causes of hip pain. You might also have an MRI scan to confirm the hip osteoarthritis diagnosis. This test shows changes in soft tissues, including worn tendons and muscles and signs of thinning cartilage. 

You can get an appointment with one of our hip specialists for the next working day and, if necessary, have imaging done on the same day. 

What are the treatment options for hip osteoarthritis?

If you've received a hip osteoarthritis diagnosis, there are different treatment options available. The treatment you receive will depend on how advanced your symptoms are. Whatever symptoms you're experiencing, you'll first and foremost be advised to keep the joint mobile. From there, there are different treatment options available:

Self-management

Most symptoms of hip osteoarthritis are treated by modifying the way you move, changing your diet and exercising the hip joint. These include:  

• Pacing your activities throughout the day
• Adapting activities that you find difficult or that cause you pain
• Avoiding both low seating and sitting in one position for long periods
• Wearing supportive footwear with cushioned soles

Physiotherapy

There are also physiotherapy exercises you may be able to do to strengthen your hip muscles. Your physiotherapist will work with you to create a plan that suits your needs. It will factor in the level of osteoarthritis you have and how mobile you are. 

Pain management

Painkillers and steroid injections can also help relieve symptoms. Your doctor will take into account the amount of pain you're in and any other medical conditions you have before deciding on the painkillers that would be most effective. Some of these include paracetamol or non-steroid anti-inflammatory drugs such as ibuprofen. If the pain is severe, stronger painkillers such as codeine may be recommended. You may experience side effects from taking these, including drowsiness. Your consultant will discuss this with you.

In some cases, treatment for hip osteoarthritis can involve steroid injections. These contain an artificial version of the natural hormone cortisol and are applied to the hip joint. They can help reduce inflammation and pain in the affected area.

Surgery 

If these initial measures don't work, the next step in the treatment process for osteoarthritis in the hip is surgery. There are different types of surgery available and the procedure you undergo will depend on your condition. Your consultant will keep you informed of your treatment options at every stage and advise you on what happens before, during and after surgery. 

Hip arthroscopy

A hip arthroscopy is a minimally invasive procedure that is usually used as the first stage of hip surgery. An arthroscope, which is a small surgical camera, is used to allow your consultant to see inside your hip joint. During this procedure, tiny cuts are made to your hip to allow access for the camera and additional surgical instruments, if required.

An arthroscopy is used to diagnose and treat a range of hip problems, including osteoarthritis, without major surgery. It's usually a day case, which means you won’t need to stay in hospital overnight, and you will be given painkillers and crutches to help with mobility.

Hip resurfacing

Surgery usually lasts around 2 hours and can be performed under general or spinal anaethesia. During hip resurfacing, the surgeon makes an incision in the thigh. This is so they can access the hip joint. They then dislocate the ball (the femoral head) from the hip socket (acetabulum) and use surgical instruments to trim the head of the femur. This process reshapes the ball joint of your hip.

Next, the surgeon fits the femoral head with a metal covering. This keeps the head and neck of the thigh bone in place. A tool is used to remove the cartilage that lines the socket in your hip joint and the socket is then fitted with a metal shell, which is held in place by the friction between the bone and the metal. Your surgeon then positions the ball back into the socket and closes the incision with stitches. 

After surgery, you will remain in hospital for between three and five days to recover. During this time, you will be encouraged to walk around with the aid of crutches. The physiotherapy team will also give you a set of exercises designed to strengthen the joint. As well as doing the exercises, you will need to use crutches or a walker when you go home.  

Hip replacement surgery 

Your consultant may recommend this option if your hip joint is particularly worn. In hip replacement surgery, the worn joint is replaced with a prosthesis. The consultant will advise on the type of prosthesis that is most suited to replace your hip. This is a long-term solution that restores mobility in the pelvis and relieves pain.

Surgery can be performed under general or spinal anaesthesia according to patient preferences and medical background. During a total hip replacement, the damaged femoral head is removed and replaced with a prosthetic. This comprises a metal stem that sits in the hollow centre of the femur. A metal or ceramic ball is placed at the top of the stem and replaces the damaged femoral head. A metal socket replaces the damaged cartilage on the surface of the acetabulum, and screws or a type of cement are used to hold the socket in place.

To ensure the prosthetic ball glides in the new socket, a spacer is added between the ball and socket. This is usually ceramic, metal or plastic. Once the new prosthetic ball and socket are in place, the surgeon checks the condition of the muscles and tendons surrounding the hip joint. They will then use stitches to sew up the incision.  

You'll stay in hospital for a one to two days following the operation. Our physiotherapy team will encourage you to stand up and walk with the help of crutches. You'll also be given exercises to strengthen your hips and legs. After you've been sent home, you'll need to use crutches, a walker or walking sticks for a few weeks.