- Non-Surgical Treatment for Hip Pain
- Hip Pain Treatment Without Surgery
- The Future of Hip Pain Treatment Without Surgery
- International Hip Dysplasia Institute
- Delaying or Preventing Hip Pain
- Lifestyle Modifications
- Complementary and Alternative Treatments
- Short course of prednisolone may help distinguish between RA and hand OA
- Steroid Injection for the Hip
- Hip pain
- When to see a doctor
- Treatment Options for Hip Pain
- How to manage hip pain
- Physical therapy
- Hip arthroscopy
- Hip arthroscopy procedures
- Hip arthroscopy and anesthesia
- Postoperative equipment
- Osteoarthritis of the Hip (Hip Arthritis)
- Additional Resources
- Research on osteoarthritis of the hip
- Summary of hip arthritis
Non-Surgical Treatment for Hip Pain
Dull, aching hip pain can make a flight of stairs, a dropped set of keys, or a low chair feel like torture. Fortunately, there are several non-surgical treatments you can try to reduce hip pain and, in many cases, they come with few side effects or complications.
Hip Pain Treatment: Medications
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin, and Nuprin) and naproxen (Aleve) and prescription NSAIDs such as meloxicam (Mobic) and etodolac (Lodine) among several others, can help with hip pain from arthritis. They work by inhibiting prostaglandins in the body, which contribute to inflammation.
Another treatment option is one of the disease-modifying anti-rheumatic drugs (DMARDs). These medications, such as methotrexate (Rheumatrex, Trexall) and etanercept (Enbrel) can help slow down the progress of certain kinds of inflammatory arthritis, such as rheumatoid arthritis. While NSAIDs are typically effective soon after you take the drug, DMARDs won’t have a noticeable effect for weeks or months after you begin the treatment.
Your doctor may recommend a corticosteroid such as prednisone or methylprednisolone (Medrol), anti-inflammatory drugs that can be taken orally. Corticosteroids are typically only used as a treatment in people who have severe arthritis or aren’t getting benefits from NSAIDs or DMARDs. These medications have side effects like weight gain, osteoporosis, increased blood pressure, and high blood sugar, among others, and are not typically recommended for long-term use.
Hip Pain Treatment: Injections
Sometimes corticosteroids are given by injection to lower the inflammation that is causing the pain. Doctors inject the medication directly into the hip joint; this approach may have a somewhat lower risk of oral corticosteroids’ side effects. Corticosteroid injections can be repeated at various intervals. A non-corticosteroid medication called hyaluronan (Synvisc, Euflexxa) can also be injected to lubricate a painful joint.
Hip Pain Treatment: Physical Therapy
Working with a physical therapist can help with everything from increasing strength and range of motion in the hip to maintaining muscle tone.
Some people with hip pain go to a physical therapist in addition to taking medication, while some get physical therapy with the goal of eventually stopping the medications, says Pattianne Ruppel, MPT, a physical therapist at St. Charles Hospital in Port Jefferson, N.Y.
A physical therapist starts with an evaluation of your posture, flexibility, joint mobility (how easily your joints move), strength, gait (the way you walk), and leg lengths, explains Ruppel. When one or more of these areas are weak, it can lead to pain.
Once your physical therapist has determined what’s causing your pain, she develops a plan to fix the problem. Typically, someone who has arthritis in the hip will get physical therapy for six to 10 weeks, two to three times a week, Ruppel says. In addition to the exercises you do with a physical therapist, it’s also vital that you follow the home exercise program recommended by your therapist to get the best results.
Hip Pain Treatment: Supportive Aids
When hip pain makes it difficult to walk, you may need help from a cane or a walker. This is especially important when it becomes unsafe for you to walk without assistance. “If you’re losing balance or having a tremendous amount of pain in your hip and are unable to bear weight on it, we recommend a cane or walker,” Ruppel says.
If you’re having trouble doing other daily activities, such as putting on your shoes or bending over, you can try using tools specifically designed to help, such as a long shoehorn or a device that can help you reach things that are far away.
While nobody wants to live with hip pain, medications, injections, physical therapy, and supportive aids can all help relieve the pain without risking the complications from surgery. Work with your doctor to come up with the best treatment plan for you.
Hip Pain Treatment Without Surgery
The Future of Hip Pain Treatment Without Surgery
Many already know that weight loss is commonly cited as a simple way to relieve hip pain without surgery. But, did you know that the wrong food choices create inflammatory patterns that cause systemic damage to the body (including our joints) over time? Eating processed foods high in sugar and other refined carbohydrates feeds into inflammatory processes. In my article on thyroid and weight loss, I describe how junk food wreaks havoc on the endocrine system via inflammatory processes and feeding unhealthy gut flora. As it turns out, this same inflammation is also linked to chronic degenerative diseases (inflammation, obesity & chronic disease).
One interesting point in regards to food and inflammation is unhealthy gut flora. Unless you live under a rock, you’ve heard of “probiotics” (gut flora): living bacteria living inside our bodies that help us digest food and absorb proper nutrition. Each type of gut flora specializes in helping digest a particular type of food like fat, protein or carbohydrates. Here is where the danger lies: overgrowth of the type of gut flora that help us digest refined carbohydrates like sugar and processed foods cause damaging inflammation in the body. In this way, eating junk food indirectly contributes to joint-damaging inflammatory processes.
Clearly, there’s a lot more at work here than just shedding a few pounds. Even still, according to an article published by Harvard University, losing 10-15 lbs made a significant difference in determining whether obese young people develop osteoarthritis later in life. Taken together, reducing weight means less strain on our joints while healthier food choices reduce cartilage-damaging inflammation in hip joints.
Prolotherapy For Hip Pain
Prolotherapy is a fascinating process that can be used for hip pain treatment without surgery. What makes prolotherapy so unique is that it triggers the body’s own natural healing process and actually causes cartilage, ligament and other connective tissue to regrow. “Prolotherapy” got its name by truncating its longer title, “proliferative therapy” together. To proliferate means to rapidly increase or multiply and in this case refers to the rapid cell growth that occurs with prolo. Prolotherapy repeatedly stimulates the body’s own natural healing process, all without doing any actual joint damage.
The process is minimally invasive and involves making small injections in and around the hip joint, each injection site is stimulated to regrow cartilage and ligament tissue. The result is that the avascular soft joint tissue regenerates over time, reducing hip joint pain while also regrowing the cartilage damaged by osteoarthritis. Prolotherapy stands in sharp contrast to temporary stop-gap measures for treating hip pain and osteoarthritis like cortisone shots or ibuprofen because prolo causes real joint healing while cortisone and ibuprofen only offer a temporary fix with long-term consequences.
How does Prolotherapy work?
The cartilage, ligaments and tendons associated with joints are all “avascular”, meaning that they lack blood vessels. Joint tissue not having their own blood vessels means that healing is slow and often incomplete due to limited resources. In contrast, muscles are highly vascular and have numerous blood vessels supplying plenty of nutrients to facilitate rapid repair. For this reason, bruised muscles generally heal whereas joint damage may accumulate over time because they don’t completely heal.
So, what do bruised muscles have to do with how prolotherapy works? As it turns out, a lot. When muscles are bruised, cells and blood vessels break, spilling nutrients and other materials out into the interstitial tissue surrounding each cell. This spilling of material triggers the body’s natural healing response. In this way, muscles have multiple advantages in healing quickly when compared to joints and connective tissue. The most commonly known cause of muscles ability to heal rapidly is of course the fact that muscles have a lot of blood vessels to supply plenty of raw materials for healing to take place. The other reason muscles heal quickly is that bruising strongly signals the body to aggressively repair itself.
Prolotherapy is so effective at causing cartilage repair without surgery because it mimics the conditions of a muscle bruise inside of joint tissue without causing any actual damage. In each prolotherapy session, I inject a small amount of a sterile dextrose and anesthetic solution into the affected hip joint, simulating the conditions present at the site of a bruise on muscle. When muscles are bruised, glycogen (sugar stored inside muscles) leaks out and triggers the body to repair the damage. Since the injection and sterile dextrose and anesthetic solution do not damage the joint while also stimulating the body’s natural healing, each injection session during the prolotherapy series causes a small amount of cartilage regrowth that rebuilds the joint over time. This progressive, natural joint repair is a much safer alternative to relieving hip joint pain as compared to cortisone shots and NSAID pain relievers because it works by simply encouraging the body to repeatedly repair itself.
PRP: Platelet Rich Plasma Therapy For Hip Osteoarthritis
In a similar, albeit more advanced, process to prolotherapy, PRP (Platelet Rich Plasma) Therapy is a regenerative medicine process that stimulates the body to heal itself from within. PRP is so effective a new treatment that the US Library of Medicine has recently recommended it as a top treatment choice for osteoarthritis (Source: National Institute of Health, PRP for Osteoarthritis).
To understand PRP, you must first understand blood platelets. Well-read readers probably know that blood platelets are tiny blood cells that are responsible for stopping bleeding by stimulating the blood-clotting response. However, blood clotting is only a temporary solution to stop the leak, it’s not a permanent solution to the injury. For this reason, platelets do so much more than simply stop the leak. When platelets are activated at the site of an injury, they release special growth factor hormones that initiate a localized healing response in the body tissues immediately surrounding the injury site.
The problem with hip cartilage injuries and degradation is that, as we mentioned above, joints don’t have blood vessels in them. This means that hip pain results in no blood platelets being activated at the site of the joint damage. No platelets means no growth factor hormones to stimulate the healing response. With today’s medical technology, it’s a simple procedure to take a small sample of the patient’s blood, use our on-site lab to separate out the platelets in a “Platelet Rich Plasma” and introduce those platelets into the joint. PRP is so revolutionary because we use platelets (and the growth factor hormones within them) from your own body to powerfully stimulate your body’s own natural healing response. Gently encouraging your body to heal itself using substances already present in your body is truly the holy grail of medicine; the serious negative side-effects of standard medications or hip replacement just don’t apply to PRP.
International Hip Dysplasia Institute
Delaying or Preventing Hip Pain
Sometimes pain can be tolerated, but pain is usually a signal that something needs to be corrected rather than endured. When pain from hip dysplasia is severe, you should consult your doctor about definitive treatment by PAO surgery or a total hip replacement (THR). Ignoring pain too long as a young adult can cause more damage to your hip and eliminate the possibility of corrective surgery to restore your hip function.
The type of arthritis caused by hip dysplasia is called osteoarthritis. This means the smooth joint surface is wearing out like the tread of a tire wears out on a car. If the tire is out of balance, then the wear is faster than a well-balanced tire. Once the tread is gone, then it’s time to replace the tire. Tire treads often wear out with an uneven pattern and rotating the tires helps move the good tread into a better position so the tires last longer. For dysplastic hips it’s often possible to correct the imbalance with surgery and move the good cartilage into a better position to prolong the life of the hip surface and delay the onset of osteoarthritis.
When hip preservations surgery is not an option, there are a few steps you can take to help delay total hip replacement or to relieve pain until surgery is performed. Unfortunately, there aren’t any long-term cures for hip dysplasia other than surgical management.
Medications and cortisone injections can decrease the inflammatory component of your hip pain. Hip dysplasia causes swelling and irritation of the joint lining in addition to the pain from the thin joint surface or torn labrum. Medications may decrease the inflammation and help relieve pain, especially the nighttime pain that occurs when the hip is at rest. Some herbal remedies also act like medicines and these will be presented as Alternative Treatments.
If you have hip pain but do not currently need surgery, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) include over-the-counter medicines like ibuprofen (Advil) and naproxyn (Aleve) can relieve inflammation and provide pain relief. While these medicines can provide short term relief, the anti-inflammatory effect may need three or four days of steady medication to have full effect. The instructions on the Aleve website say that you can take one or two tablets every 12 hours for a maximum of 10 days, but you should see a doctor if you plan to continue longer than that. There are also prescription anti-inflammatory medicines that your doctor can prescribe if you need more time or if you have side effects from over-the-counter medications. Your doctor can explain these medications to you and discuss recommended dosages.
Narcotic medications are not recommended for chronic hip pain because of the risk of dependency or addiction. This is especially true for hip dysplasia because current surgical techniques can produce long-term relief and return to activities.
Injections into the hip joint are often used to relieve pain and delay surgery. Recent developments include injections that may preserve or restore the hip cartilage. At this time, none of these techniques has been shown to provide long-term relief. While these advances may be useful for other causes of arthritis, there is little likelihood that people with hip dysplasia will benefit because the socket and ball will still be inadequate to support hip forces during walking.
Injections into the hip joint may be done by experienced physicians who are familiar with anatomical landmarks, but some physicians prefer to use ultrasound or fluoroscopy to guide the needle into the hip joint.
Cortisone Injections: These are the most commonly recommended injections to provide temporary relief that lasts from three to six months in most cases. Cortisone is a type of steroid that has strong anti-inflammatory effects. One problem is that multiple cortisone injections may soften the cartilage and increase the rate of deterioration. For that reason, most doctors try to avoid more than three hip injections of cortisone a year. There is a slight risk of infection with any injection but cortisone shots do not increase the risk of infection when a total hip replacement is eventually performed. However, it’s generally recommended to avoid cortisone shots in the months prior to total hip replacement surgery.
Hyaluronic Acid Injections: Hyaluronic Acid (HA) is a joint lubricant that’s found in normal joint fluid. Some benefits from HA injections have been reported for other joints, but hip joint studies have compared HA injections to cortisone injections. In almost all these studies, the cortisone injections gave better relief that lasted longer than HA injections.
Prolotherapy: Prolotherapy consists of injection of highly concentrated dextrose sugar water into a joint, tendon, or ligament to stimulate the healing process or to decrease pain. Platelet rich plasma or stem cells are occasionally added but generally, the sugar water alone is used. Prolotherapy causes inflammation that “jump starts” the healing process. This is thought to stimulate growth factors that are necessary for healing of ligaments, tendons and cartilage. Some success has been noted for tendon and ligament damage, and some studies of osteoarthritis have shown improvement in symptoms. No studies for labral tears have been published. Like other injections, prolotherapy does nothing to correct the underlying cause of joint deterioration from inadequate bone support of hip dysplasia.
Platelet Rich Plasma Injections: Platelet Rich Plasma (PRP) is a concentration of growth factors from a person’s whole blood. A sample of blood is taken and put into a centrifuge to isolate these growth factors and then the blood is returned to the patient while the PRP is injected into a site that needs additional stimulation. There is no evidence that this helps osteoarthritis caused by hip dysplasia. In one study PRP was used for patients undergoing arthroscopic labral repair but the authors found no benefit from this additional stimulation.
Stem Cell Injections: Bone Marrow Mesenchymal Stem Cells (BM-MSCs) are a person’s own bone marrow cells that can become into almost any type of cell including cartilage. These are concentrated from bone marrow and injected into the arthritic joint. Often three injections are performed one week apart. This is a generally safe procedure, but it is still experimental because results are questionable. There may be some benefit for joints with small segments of cartilage damage, but BM-MSC will not restore the bone alignment that causes arthritis from hip dysplasia.
Lifestyle modifications can help delay surgery or recover from surgery. These include weight management, moderate exercise, adequate sleep, avoidance of harmful substances, stress management, proper nutrition, and heat therapy. Many books have been written about this subject, but here are some that may be specific to those with hip dysplasia.
Body weight management: Losing a few pounds is the most beneficial lifestyle modification you can make. Even five pounds can damage the hip joint and make a big difference in comfort. The reason is that muscle leverage on the hip increases the force pressing the ball into the socket. One pound of body weight magnifies the joint pressure by three to five pounds. So, losing five pounds can decrease the painful forces by an equivalent of 15 to 25 pounds.
Another way to think about it is that body weight acts like a nutcracker and increases the pressure on your hip a lot more than you think because the hip joint is not directly under the center of your body. The hip muscles work hard to keep your pelvis level when walking. When your hip is in pain, the pelvis may dip so the pressure on the hip joint decreases.
Sports activities and exercise: Running, stair climbing, and impact sports are not recommended for people with hip dysplasia.
Moderate exercise and strengthening is preferred to maintain muscle balance long as there isn’t too much load put on the hip joint. Swimming is an excellent activity that maintains cardiovascular fitness and upper body strength in addition to low impact hip exercise. Other activities like rowing, cycling, or tennis may be possible in moderation, but these can be difficult for arthritic hips because of stiffness and stress across the hip joints. Sports like golf and bowling are unlikely to damage the hip but there may be pain in certain positions.
Movements of the hip and gentle stretching exercises are recommended because motion may help lubricate and nourish the joint surfaces. Tai Chi is excellent for flexibility and balance. Walking with a cane in the hand opposite the sore hip can also provide some physical activity in later stages of painful hip dysplasia.
Depending on the level of dysplasia, you may benefit from one or two visits with a local Physical Therapist to teach you the correct way to exercise without causing damage to your hip.
Adequate sleep: This may be difficult if you’re having pain at night. Acetaminophen (Tylenol) is least likely to interfere with normal sleep patterns compared to NSAIDs such as aspirin, ibuprofen (Advil) or naproxen (Aleve). Regular bed time with adequate time for sleep is important for repair processes and for stress relief. More time in bed may be needed along with an occasional daytime nap to make up for lost sleep due to pain.
Exposure to daytime light during the day and avoiding blue light prior to bedtime have been shown to help people fall asleep and have better sleep patterns. You can read about this in the Harvard Health Letter. Computer screens, TV screens and hand-held digital devices emit blue light that can be decreased by adjusting some of these devices. Blue-blocking glasses, screen filters, and special light bulbs can also decrease blue-light exposure to help restore natural sleep patterns.
Avoidance of harmful substances. This applies most often to cessation of cigarette smoking. Any tobacco products or nicotine in any form, causes serious health consequences to your entire body including joints, ligaments, bones and muscles. Cigarette smokers have more complications after surgery than non-smokers. Cessation of smoking prior to surgery helps avoid complications, but the minimum time required isn’t known. At least two months seems to be the minimum in some studies, but longer is better, including no smoking after surgery too.
Alcohol in excess is also harmful to joints and interferes with successful surgery. Three or more servings of alcohol per day increases the risk of infections, bleeding and heart problems after surgery.
Stress management and proper nutrition are healthy practices regardless of hip dysplasia. Mindfulness training and medication techniques can help decrease stress and help muscle relaxation.
There is growing interest in the role of Vitamin D supplementation and anti-inflammatory diets in the management of joint pain. However, the benefits for osteoarthritis caused by hip dysplasia is uncertain compared to inflammatory joint problems such as Rheumatoid Arthritis. The Arthritis Foundation has provided some tips for an anti-inflammatory diet that may help decrease pain.
Heat therapy: Heating pads can help tense muscles relax. Surface heat may also help relieve pain temporarily by providing skin sensations that are more pleasant than joint pain. However, there is little likelihood that surface heat can improve deep circulation to the hip or change the underlying problem of the bone alignment.
Summary of Lifestyle Modifications. Except for weight loss and activity restriction, there are few lifestyle modifications that can slow the process of joint deterioration that results from hip dysplasia. Unfortunately, the underlying problem of hip dysplasia is that the bones are not supporting the joint surface adequately. This causes excessive pressure in areas that wear out faster unless the bones are re-aligned or replaced surgically.
Complementary and Alternative Treatments
There are no known alternative treatments to prevent or cure osteoarthritis. Some people do experience temporary pain relief from symptoms when using alternative treatments, though studies have not shown evidence that this changes the long-term outcome of osteoarthritis.
Acupuncture is sometimes tried for pain relief. Acupuncture is a traditional Asian practice in which small needles are inserted into the patient and manipulated by the practitioner. The theory of treatment is to improve the flow of energy throughout the body however there is no evidence to support this mechanism.
In 2009, the British Medical Journal published a review of thirteen studies of acupuncture that concluded there was little difference between real, sham, or no acupuncture for relief of pain. Those who report pain relief may be experiencing a placebo effect.
Avocado-Soybean Unsaponifiables (ASUs)
ASUs are supplements made from a specific type of oil from avocados and soybeans. ASU supplements are thought to slow down cartilage wear and to encourage the growth of healthy cartilage in hip and knee joints.
The oil in the supplements is more concentrated than what is consumed when eating avocados and soybeans. There is some evidence that ASUs may relieve symptoms of arthritis, but the effect may be short term.
Ginger is an edible root often used in cooking as a seasoning. In the context of alternative medicine, ginger is sometimes recommended to settle an upset stomach or to reduce inflammation and its resulting pain. Ginger can be purchased as a supplement, or ginger can be made into a tea.
Ginger contains compounds called gingerols that have anti-inflammatory properties. There is some evidence that ginger has a moderate pain relieving effect for osteoarthritis.
(Caution) Ginger might interfere with some blood-thinning medications. So if you are taking a blood thinner, check with your doctor before taking ginger supplements. Side effects from ginger supplements can include heartburn or diarrhea. (Caution)
Glucosamine and Chondroitin
Randomized controlled studies have shown that these supplements do not promote the growth of cartilage or improve joint health. It is still possible to buy these supplements, but they will not improve the health of your hip joint.
(Caution) People who are allergic to shellfish should not take glucosamine. Glucosamine and chondroitin can interfere with blood-thinning medicines. (Caution)
Tai Chi and Yoga
Tai Chi and yoga are traditional disciplines with movements than can help promote strength, flexibility, and balance. Staying active is good for you as long as you do not push your joints to the point that you are in pain or you get injured.
Look for teachers who are willing to work with any limitations that you may have. Some experienced teachers can suggest ways to modify exercises so that they are less strenuous.
(Caution) Though these exercises can improve your muscle strength, posture, and overall health, they cannot change the bone structure of your hip joint. (Caution)
Other Herbal Remedies
Numerous herbal remedies have shown anti-inflammatory properties including Curcumin, Boswellia Extract, Fish Oils, UC-II, Resveratrol, and more. For more information about alternative medicines, including studies, see the National Center for Complementary and Alternative Medicine at the National Institutes of Health or the Cochrane Reviews. The Cochrane Collaboration is an independent organization that reviews primary research in health care.
One of the most common problems our patients have is “hip pain”, but what do patients truly mean when they say hip pain? There are multiple conditions which can cause pain in and around the hip, buttock, and thigh and the location of your pain is useful in determining the cause.
Patients describing groin pain are most often suffering from osteoarthritis of the hip joint. This is a condition which occurs when the cartilage covering the ends of your bones becomes worn out in places. Patients with arthritis describe a dull aching pain in the groin which tends to be worse after activity and usually improves with rest. As the arthritis progresses, the pain may become more pronounced at night. Pain in the groin will often lead to a limp and a decreased ability to move the leg and patients will often find it difficult to perform duties which require bending at the hip such as putting on their shoes and socks.
If you find that you are experiencing similar symptoms, your doctor will probably want to do some tests. These include a physical exam to check your range of motion, which is diminished or lost as arthritis progresses. They will also take x-rays of your hip joint which may show things such as narrowing of the joint space between the socket of your pelvis and the ball of your femur, or bone spurs also called “osteophytes” which are formed in arthritis and can be a cause of your pain.
If your doctor determines that you have arthritis in your hip there are non-invasive treatments they will suggest. A combination of Tylenol and NSAIDs is the best for treating the pain associated with arthritis of the hip. This provides good pain control and decreases the inflammation in the joint which is responsible for most of the pain. Narcotics are not a good choice for this condition. Your doctor may suggest an injection into your hip joint which cannot be done in the office but can be scheduled in the hospital. Assistive devices such as a cane, walking stick, or walker are also helpful to take some of the pressure off the hip or provide balance if you feel unsteady. Your doctor may also give you a prescription for physical therapy or a home exercise program aimed at stretching and strengthening the muscles around your hip. The best types of exercises for patients with arthritis are stationary bikes, elliptical machines, or swimming/walking in a pool as these activities are not impact loading and so are the easiest on your hips. If these conservative treatments fail, your doctor may talk with you about surgical replacement of your hip.
Outer thigh pain
Patients describing outer thigh pain are usually experiencing trochanteric bursitis. This is a condition in which the bursa, which is a fluid filled cushion between the thigh muscle, called the iliotibial band, and the thigh bone, becomes inflamed and painful. The pain associated with this is localized over the side of the upper thigh but can radiate into the buttock or down to the knee, and is very tender to touch. Most patients will say the pain is worst when trying to get up from a sitting position, after walking for a long time, or at night when patients say they cannot lay on their side.
If you are describing this type of pain, your doctor will most likely be able to reproduce it by pushing against the outside of your thigh. They may still want to take an x-ray of your hip to make sure there are no bony problems on the inside which could be causing your pain.
The treatment for this consists largely of controlling the inflammation in the bursa which causes the pain. Taking a short course of NSAIDs and icing the painful spot helps decrease the pain. Your doctor may suggest physical therapy or a home exercise program which stretches the iliotibial band. They may offer an injection of a steroid into the bursa itself which can be done in the office and can be very helpful in relieving symptoms.
Thigh pain which radiates to your buttock or past your knee
When patients describe symptoms such as thigh pain that radiates into their buttock, lower back, or down past the knee there is always a chance that this pain is coming from the patient’s back. This pain can be severe and can be worsened by activity, sitting, coughing, or sneezing, and patients will often say they have a hard time finding a comfortable position to sit in. Patients will say that lying on their back with a pillow under their knees provides some relief. This radiating pain, called sciatica, is usually due to irritation of the nerves in your low back which provide the sensation and muscle function to your legs.
To check your back, your doctor will test how well your spine moves, he will check your reflexes and the strength in your legs, and he will usually get x-rays of your back.
Most sciatica, although it can be incredibly painful, is relatively short lived and will improve with conservative management in about three to four weeks. Your doctor may send you to therapy or give you a program to work on stretching and strengthening your core and back muscles. He may also prescribe a short course of oral steroids such as prednisone or a Medrol dose pack. If these do not improve your pain, your doctor may order an MRI to further investigate the source of your pain.
No matter the location, “hip” pain is a treatable condition that needs to be investigated fully by your doctor and treated conservatively before surgical intervention is considered. Here at Three Rivers Orthopedic Associates, we have many highly qualified physicians who will evaluate you and try to help alleviate your hip pain. Call us at 412-782-3990 to schedule an appointment.
By Julia Grunebach PA-C
Short course of prednisolone may help distinguish between RA and hand OA
A short course of prednisolone may help rheumatologists differentiate between patients with rheumatoid arthritis and osteoarthritis, a proof of concept study shows.
However, the investigators caution that a positive response to the 3-day steroid course does not confirm a diagnosis of rheumatoid arthritis (RA).
For many years, rheumatologists have been using short courses of prednisolone in unclear clinical situations to differentiate between inflammatory and non-inflammatory arthritis, according to the investigators led by Uta Kiltz, MD, from Rheumazentrum Ruhrgebiet, Herne, Germany.
Dr. Uta Kiltz
“The basic idea is that RA is due to inflammation, whereas OA is either not based on the same pathophysiology, or at least not to the same degree,” they wrote.
The pilot part of the TryCort study involved 15 patients with confirmed osteoarthritis and 15 with rheumatoid arthritis who were given 1 g of paracetamol (acetaminophen) a day for 5 days, and on days 3-5, they were given a 20-mg dose of prednisolone (Arthritis Res Ther. 2017;19:73. doi: 10.1186/s13075-017-1279-z).
Results showed that the patients with RA had greater improvements in their pain scores (0-10 on a numerical rating scale), compared with OA patients. The mean percentage improvement in pain scores at day 5 was 52.3% in the RA group and 22.0% in the OA group.
The research team considered that a 40% improvement in pain scores was the best choice between sensitivity and specificity regarding a diagnosis of RA.
At this 40% improvement cut-off, the “pred-test” was positive in 11 patients with RA and in four patients with OA (P = .012), with a sensitivity and specificity for a diagnosis of RA of 73.3% for both measures.
In order to validate the test, the researchers enrolled 95 patients with pain in their fingers and hands but without a clear diagnosis. These patients completed the 5-day intervention, and then at week 12 a rheumatologist diagnosed 47 as having RA and 48 were thought to not have RA.
The patients with diagnosed RA had a higher reduction in pain scores during the treatment with prednisolone, compared with patients without RA.
The authors concluded that the pred-test “performed well” but not “perfectly well.”
“We are aware that the pred-test without confirmation of other surrogate markers is not helpful in clinical decision-making processes,” they said. “We, therefore, recommend use of the test in light of other confirming factors, such as history, physical examination, imaging, and laboratory results.”
The test could be used to triage patients from primary care to rheumatologist care, they suggested.
The study was financially supported by Rheumazentrum Ruhrgebiet. The authors declared no conflicts of interest.
Steroid Injection for the Hip
Concerns about steroid injections in the hip
There are some concerns that cortisone can cause the cartilage in your hip joints to break down over time. For this reason, your doctor may limit the number of steroid injections you can get. You should spread out the injections at least every six weeks and have them no more than three to four times per year, according to the Mayo Clinic.
In addition to relieving pain, steroid injections are sometimes used to diagnose pain. If the injection fails to provide relief, then your doctor knows that the source of pain is from somewhere other than your hip.
What to expect from a steroid injection
Your doctor performs a steroid injection in the office as an outpatient procedure. The doctor uses a specialized type of X-ray, known as a fluoroscope, to project an image of the inside of your hip onto a screen. This allows them to see where to place the needle.
You lie on an exam table in a position that lets your doctor access your hip joint. The doctor cleans the skin and applies a local anesthetic to numb the area. They guide the needle into your hip joint while watching on the screen. They then inject a dye to make it easier to see where to inject the steroids.
After injecting the medication, you stay in place for 10 minutes. You’ll then move your hip to let the doctor know if you still feel pain. You will likely experience some soreness at first as the numbing agent wears off. Once the steroids take effect, you’ll notice the pain wears off. This can take two to seven days, according to the U.S. National Library of Medicine.
How long a steroid lasts varies from person to person. You can expect it to provide relief for weeks or months.
Common conditions requiring a steroid injection
Hip pain and inflammation are the general symptoms doctors treat with steroid injections. There are several conditions that can cause hip pain. These include:
- Labral tear
- Injury or trauma to hip
- Overuse or misuse of hip joint
Medically reviewed by Drugs.com. Last updated on Apr 10, 2019.
Hip pain is a common complaint that can be caused by a wide variety of problems. The precise location of your hip pain can provide valuable clues about the underlying cause.
Problems within the hip joint itself tend to result in pain on the inside of your hip or your groin. Hip pain on the outside of your hip, upper thigh or outer buttock is usually caused by problems with muscles, ligaments, tendons and other soft tissues that surround your hip joint.
Hip pain can sometimes be caused by diseases and conditions in other areas of your body, such as your lower back. This type of pain is called referred pain.
Hip pain may be caused by arthritis, injuries or other problems.
- Juvenile idiopathic arthritis (formerly known as juvenile rheumatoid arthritis)
- Osteoarthritis (disease causing the breakdown of joints)
- Psoriatic arthritis
- Rheumatoid arthritis (inflammatory joint disease)
- Septic arthritis
- Bursitis (joint inflammation)
- Hip fracture
- Hip labral tear
- Inguinal hernia
- Meralgia paresthetica
- Advanced (metastatic) cancer that has spread to the bones
- Bone cancer
- Avascular necrosis (death of bone tissue due to limited blood flow)
- Legg-Calve-Perthes disease (in children)
- Osteomyelitis (a bone infection)
When to see a doctor
You may not need to see a doctor if your hip pain is minor. Try these self-care tips:
- Rest. Avoid repeated bending at the hip and direct pressure on the hip. Try not to sleep on the affected side and avoid prolonged sitting.
- Pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) may help ease your hip pain.
- Ice or heat. Use ice cubes or a bag of frozen vegetables wrapped in a towel to apply cold treatments to your hip. Conversely, a warm bath or shower may help prepare your muscles for stretching exercises that can reduce pain.
If self-care treatments don’t help, make an appointment with your doctor.
Seek immediate medical attention
Ask someone to drive you to urgent care or the emergency room if your hip pain is caused by an injury and is accompanied by:
- A joint that appears deformed
- Inability to move your leg or hip
- Inability to bear weight on the affected leg
- Intense pain
- Sudden swelling
- Any signs of infection (fever, chills, redness)
How does arthritis affect the hips?
The hip is commonly affected by arthritis, particularly osteoarthritis (OA). You may notice pain in your hip, groin, buttock and/or thigh areas, felt as sharp pain or an ache. It is often most noticeably when you walk, climb stairs, stand up from a seated position, squat and/or first get out of bed in the morning.
There are many things that can help you manage arthritis of the hip. The first steps are regular exercise, weight loss and using medicines wisely
What can I do?
There are many treatments that can be helpful for arthritis of the hip. Here are some tips.
Find out what type of arthritis you have
Learn about the type of arthritis you have and your treatment options. Ask your doctor about creating a tailored management plan (GPMP) and team care arrangement (TCA) for you. This includes subsidised care from a team of healthcare professionals such as physiotherapists, dietitians, and others. Your local Arthritis office may also run self management courses to help you develop skills to manage your symptoms, communicate with your healthcare team and lessen the impact of arthritis on your life.
Being overweight can lead to more pain and damage to hips and knees affected by arthritis. Lose any extra body weight if you are overweight to lighten the load on your sore joints. See a dietitian for help if you are finding it difficult to maintain a healthy body weight.
Regular exercise is one of the most important treatments for arthritis of the hip. It helps to reduce pain and maintain your general health. To protect your sore joints, try low-impact activities, where there is less weight going through your hips and knees such as swimming, cycling and walking. You could also try:
- Water exercise: buoyancy of the water takes pressure off your hips and you may find you can move more freely than you can on land. See Water exercise for more information.
- Strengthening exercises: Exercises to strengthen the muscles around your hip can also help reduce pain. See Strength training for more information.
- Tai chi: Studies show that tai chi can help reduce pain and stiffness for people with arthritis. See Tai chi for more information.
If you have hip pain, you are more likely to have weakness and tightness of certain muscles in the hip and leg. If possible, consult a physiotherapist or exercise physiologist for advice about a program to suit you. See Physical activity for more information about exercise.
Your doctor may recommend certain medicines to help reduce your hip pain, depending on what type of arthritis you have and your medical history. Talk to your doctor or pharmacist about medicines and the best way to use them for your condition. See Medicines for more information
Recent research has shown that understanding how pain works and how you respond to it can help you prevent pain controlling your life. Activities such as pain coaching, cognitive behavioural therapy from a psychologist, or mindfulness are effective for many people. More information is available at www.painhealth.csse.uwa.edu.au or mindspot.org.au/about-pain. See Dealing with pain for other tips for coping with pain.
Aids or supports
Walking sticks or canes may help reduce the load on your hip and lessen pain. Always use the walking stick on the opposite side to your sore joint (if your right hip is affected, use the walking stick in your left hand). See a physiotherapist for advice about any of these aids or supports.
This interactive website is for people with osteoarthritis and provides information and tools to help you manage your condition. Experts provide information via text and videos and its weekly check-ups can help you track your osteoarthritis so you can see what works for you.
If your hip pain is severely affecting you quality of life, despite trying the treatment options listed above, your doctor may recommend hip surgery. See Surgery for arthritis for more information.
There are many other treatments for hip arthritis that are either untested or have been shown to provide little benefit.
- Glucosamine and chondroitin. The results from studies of glucosamine sulfate and chondroitin sulfate are unclear. See Glucosamine and chondroitin for more information
- Herbal therapies. There isn’t much evidence to prove that certain herbal therapies are useful for arthritis of the hip. See Complementary therapies for more information.
- TENS, ultrasound, laser. These treatments may be used by a physiotherapist. TENS or laser treatment are unlikely to provide benefit for hip arthritis. See a physiotherapist to trial a TENS machine (a machine that applies very mild electrical pulses to block pain messages going to your brain) before buying one as not all people will find it beneficial. Ultrasound may provide some small benefit for some people.
- Acupuncture. The latest evidence does not support the use of acupuncture for hip arthritis.
- Platelet-rich plasma (PRP) and stem cell injections. Trials are underway to assess whether these have any benefit. At this time, there is not enough evidence to recommend their use due to their cost, risks, and the lack of standards and understanding about their use.
CONTACT YOUR LOCAL ARTHRITIS OFFICE FOR MORE INFORMATION AND SUPPORT SERVICES..
Treatment Options for Hip Pain
- How to manage hip pain
- Physical therapy
- Hip arthroscopy
- Hip arthroscopy procedures
- Hip arthroscopy and anesthesia
- Post-operative equipment
Minimally invasive surgery techniques including arthroscopy have revolutionized treatment.
Non-surgical treatment should always be considered first when treating hip pain. With some conditions, it is possible to resolve the pain with rest, modifying one’s behavior, and a physical therapy and/or anti-inflammatory regimen. Such conservative treatments have been successful in reducing pain and swelling.
How to manage hip pain
If you find yourself with hip pain, it’s important to consult a physician. An examination will help to determine what’s causing the soreness, since hip pain can actually come from locations other than the hip, such as the spine, pelvis or leg. While waiting to see a physician, there are some modifications and exercises that may provide some relief.
Anti-inflammatories, commonly known as non-steroidal anti-inflammatory drugs (usually abbreviated as NSAIDs or NAIDs) are used primarily to treat mild to moderate pain associated with inflammation. This inflammation may be the result of muscular tears, bursitis, tendonitis, arthritis, labral tears, or synovitis. Anti-inflammatories are also used as a first line treatment in conjunction with a strengthening program. Post-operatively, they are prescribed as well.
Physical therapy is an integral component to the multi-faceted team approach of examining and treating hip pain. The importance of physical therapy is to assist in gaining an understanding of the underlying causes of hip pain and then to collaborate with a team of physicians in order to design a comprehensive treatment approach. Rehabilitation is useful in many ways. It may be used as a non-invasive approach to treatment, whereby surgery for the patient is not or no longer indicated.
The hip joint is a very deep joint surrounded by almost 30 muscles. Physical therapy aims to strengthen these muscles, increase flexibility, maintain range of motion of the joint, and decrease the associated inflammation. In the case of a labral tear, physical therapy will not heal the tear. With the appropriate muscular training and activity modification, however, the condition may become asymptomatic and therefore require no surgery.
If operative treatment is inevitable, a pre-operative physical therapy program will provide the ability to address nearly all underlying joint problems or muscle imbalance, which ultimately leads to a better outcome. Additionally, in the event of surgery, post-operative therapy is essential in educating the patient regarding daily activities and in providing an appropriate recovery course. Physical therapy is an integral component in the management of hip pain.
Injections are commonly prescribed to help relieve a patient’s pain as well as to diagnose the direct cause of the pain.
Following an injection of a numbing drug into the joint, immediate relief from pain will help confirm that the joint is the source of pain. If complete pain relief is achieved while the hip joint is numb, the joint is likely to be the source of pain. If not, further consideration of a possible cause is needed.
- Intra-articular Injections is an ultrasound-guided cortisone injection made directly into the hip joint that can provide relief. Ultrasound-guided cortisone injections using dedicated high-resolution ultrasound equipment are very precise and allow a radiologist to target the injections directly into an area, maximizing therapeutic outcomes. Following the injection, pain relief varies from patient to patient. Some may feel relief from pain within two to five days. If a patient feels no relief within ten days following the injection, the patient is unlikely to gain any additional improvement and further diagnostic testing may be needed to identify other options for relief.
- Psoas Injection, which are performed under ultrasound, are often prescribed when the diagnosis is thought to be a symptomatic psoas tendon, which runs outside of the hip joint. In some cases, this diagnosis is difficult to make, as a painful psoas tendon often results in compression and tears of the labrum. As a result, pain relief following a psoas injection will only occur outside of the hip joint. If there is involvement of the labrum, which is inside the joint, additional evaluation is recommended.
- Trochanteric Bursa Injection injections is prescribed for patients who present clinically with bursitis on the outside of their hip, and for whom physical therapy and an anti-inflammatory regimen has not provided relief.
What is hip arthroscopy?
Recent advances in the development of surgical equipment have allowed orthopedic surgeons to treat conditions that were traditionally either ignored or treated with an open procedure. Now, with just a small incision, a surgeon can insert a pencil-sized optical device into the hip joint, which relays an image to a large video monitor in the operating room, allowing a surgeon to see into the joint and correct problems.
What happens during a hip arthroscopy?
Hip arthroscopy, or a “hip scope,” is a minimally-invasive procedure. The use of an arthroscope means that the procedure is done using 2-3 small incisions rather than a more invasive “open” surgery that would require a much larger incision. These small incisions, or “portals,” are used to insert the surgical instruments into the joint. Occasionally, a third or fourth incision may be required depending upon the procedure. Excellent visualization of the entire joint is possible.
The patients are placed supine (on the back) and traction is applied under the guidance of fluoroscopy to allow for the placement of instruments. The amount of force needed to distract the hip varies from patient to patient, with every effort made to minimize the amount of traction. This practice decreases the amount of neuropraxia that develops post-operatively.
Through the second opening, surgical instruments are inserted to shave tissue, cauterize structures, or remove pieces. On occasion, holes may be drilled into patches of bare bone where the cartilage has been lost. This technique, called “microfracture” or “picking,” provokes localized bleeding and encourages the formation of fibrocartilage (repair cartilage). Saline is pumped through the joint during the procedure to improve visualization and flush out debrided tissue. For more information, see Arthroscopy of the Hip.
Hip arthroscopy procedures
When the inflamed synovial lining of the hip joint causes disabling pain, it may have to be removed via a synovectomy. By inserting heat-generating radio frequency probes inside the joint capsule, the inflamed tissue is then removed.
Treatment of labral tears
The location, chronicity, and vascularity of the injured fibrocartilage determine the way that labral tears are treated, with the goal of preserving as much healthy labral tissue as possible.
- Labral Debridement: If the quality of the labral tissue is poor, a debridement of the labrum is performed. This is done with the use of a rotating shaver in the joint that “trims” away involved tissue.
- Labral Refixation: If the quality of the labral tissue is adequate, an anchor is placed into the bone (acetabular rim). The suture attached to the anchor is then fed around the labral tissue and tied down to the acetabulum. This refixation procedure should make it possible for scar tissue to grow down the acetabulum and remain there once the suture dissolves.
- Partial Psoas Release: From inside the hip joint, the psoas tendon is brought into view by making a small window in the hip capsule. The lengthening of the tight tendon begins first, followed by a cut to release it, which allows the tendon to fill in with scar tissue, ultimately resulting in its lengthening.
- Acetabuloplasty (Rim Trimming/Decompression): Anterior over-coverage secondary to a pincer lesion can be treated arthroscopically. This lesion is usually associated with a flattened, degenerative or cystic labrum. Pincer lesions require bony resection, which can be performed using a motorized burr. Resection of the rim lesion oftentimes leads to destabilization or requires detachment of the labrum in order to fully visualize the extra bone. Following the rim resection, unstable, but healthy, residual labral tissue is refixed to the acetabular rim using arthroscopic suture anchoring techniques.
- Osteochondroplasty (CAM decompression): With visualization of the Cam lesion, a motorized burr is introduced and the removal of the Cam lesion is performed to recreate a spherical femoral head. A resection of less than 30% of the head neck junction is recommended to preserve the load bearing capacity of the femoral neck, and therefore decrease the risk of a stress fracture. Fluoroscopy is often used to assist in determining the amount of bone in need of resection.
Hip dysplasia procedures
- Osteotomy: The femur is surgically reshaped and repositioned to restore a more normal anatomy. This allows for normal hip motion and alleviates the impingement. Some osteotomies can be performed via minimally invasive procedures that use small incisions. An osteotomy that involves cutting the bone (and usually an open procedure, not an arthroscopic one) is a technique where the anatomy of the femur or socket is altered to relieve pain and prolong survival of the joint by reducing the abnormal loads on the cartilage.
- Arthrotomy: This is a procedure where the joint is opened to clean out bone spurs, loose bodies, tumors, or to repair fractures.
- Iliotibial Band (ITB) Release: An ITB release is performed in patients with symptomatic (painful) snaps. This is performed by accessing the lateral space in the hip. Once the ITB is visualized, a cut is made to lengthen the tissue.
- Trochanteric Bursectomy: A trochanteric bursectomy is a simple procedure in which a motorized shaver is placed in the peritrochanteric space (outside of the hip) to debride the inflamed bursal tissue.
- Gluteus Medius Repair: In the majority of cases, the procedure is completed arthroscopically; however, the size and/or location of the tear may warrant an open procedure. The tendons are visualized and an anchor(s) is placed into the greater trochanter of the femur while a suture is passed around the tendon. The tendon is then pulled down to its normal anatomic position and tied over the bone. The procedure is very similar to that of a rotator cuff in the shoulder.
- Removal of Loose Bodies/Tumors, (PVNS/Synovial Chondromatosis), Chondral Repair/Debridement, Chondroplasty: Performing a chondroplasty consists of removing loose fragments of cartilage, often associated with arthritis. The cartilage is taken out of the joint by a motorized shaver or a grasper depending upon the size of the fragments.
Hip arthroscopy and anesthesia
There are two options for anesthesia with arthroscopy: general or regional. Regional is the preferred option, as it allows for pain control immediately following surgery, and tends to minimize anesthetic side effects including, but not limited to, nausea, vomiting, pain at the site of insertion, spinal headache, and so on. Some patients that have spine pathology or bleeding disorders may not be candidates for a regional block. In this case, general anesthesia is recommended.
We are the premier department in the world for the practice of regional anesthesia for orthopedics.
In the majority of hip arthroscopy cases, when a regional anesthesia is used, a spinal block is used rather than an epidural. A spinal block and epidural differ both in where the medication is administered into the spine as well as in the duration of its effect. For long cases, which will require an anesthesiologist to continually dose a patient over time, an epidural is warranted. For cases when a procedure should not exceed three hours, a spinal block is typically adequate. An anesthesiologist speaks with each patient prior to a procedure in order to make sure the patient is adequately informed. To learn more, read about Anesthesiology Frequently Asked Questions.
- Crutches: Crutch time varies, but is usually anywhere from 2-4 weeks. Gluteus medius repairs require 6 weeks on crutches, as does a microfracture procedure. Learn more about hip rehabilitation.
- Continuous Passive Motion (CPM) Machine: The CPM machine is a postoperative treatment method that is designed to aid recovery following joint surgery. For most recovering patients, attempts at independent joint motion causes pain and therefore the patient avoids moving the joint, which can lead to tissue stiffness around the joint and the formation of scar tissue. Ultimately, this may limit a patient’s range of motion and require physical therapy to restore the lost motion. The CPM machine moves the joint without the use of a patient’s muscles. The CPM machine is typically used for 4 hours/day for 4 weeks. A machine can be ordered through the Hip Preservation Service and can be delivered to the hospital on the day of surgery.
- Brace: A brace is worn for 2 weeks following surgery to prevent extreme flexion and extension of the hip, and is only worn during weight bearing activities using crutches. Due to the configuration of the brace, it must be worn over clothes. The brace, which is purchased through insurance, can be ordered by the Hip Preservation Service and delivered to the hospital on the day of surgery.
- Ice machine: The ice machine is a rented ice cooling system that is ordered by the Hip Preservation Service and delivered to the hospital on the day of surgery. It is to be used 4-6 times a day for 20-30 minutes at a time.
Back to Hip Preservation Service
Osteoarthritis of the Hip (Hip Arthritis)
If surgery is being considered to manage osteoarthritis of the hip, visiting with a fellowhip-trained, high-volume hip replacement surgeon would be a reasonable step to consider.
Managing arthritis pain and fatigue
Several approaches can be used to manage the pain associated with osteoarthritis of the hip including:
- Activity modification appropriate kinds of exercise and weight loss when necessary may alleviate some hip arthritis symptoms
- Nutritional supplementation (glucosamine and chondroitin) are helpful to some patients, although the literature on these supplements is not consistently in favor of their use
- Non-narcotic pain tablets (acetaminophen/Tylenol), or over-the-counter non-steroidal anti-inflammatory drugs, if medically appropriate, sometimes are helpful
- Prescription strength, non-steroidal, anti-inflammatory drugs (NSAID) are useful for some patients, though, in general, long-term use of these drugs is discouraged
- Arthritis unloader braces or hip sleeves are helpful for some patterns of arthritis
- Joint injections (corticosteroid or “cortisone” injections) might help
- Total hip replacement surgery may be used if non-operative interventions don’t suffice.
Keeping one’s weight proportional to one’s height can decrease the likelihood of developing osteoarthritis of the hip and can decrease the symptoms of the condition once it has set in.
Exercise and therapy
There is some limited evidence that appropriately-designed exercise programs can decrease the pain of hip arthritis, in particular, earlier stages of the condition. In general, staying fit and height-weight proportional also are helpful.
- Nutritional supplementation (glucosamine and chondroitin) are helpful to some patients although the literature on these supplements is not consistently in favor of their use.
- Non-narcotic pain tablets (acetaminophen/Tylenol) or over-the-counter, non-steroidal, anti-inflammatory drugs, if medically appropriate, sometimes are helpful.
- Prescription strength, non-steroidal, anti-inflammatory drugs (NSAID) are useful for some patients, though, in general, long-term use of these drugs is discouraged.
- Joint injections (corticosteroid or “cortisone” injections) might help.
- Narcotic painkillers, in general, whether in pill form (oxycodone Tylenol #3 Vicoden Percocet Lortab etc.) or patch form (Duragesic fentanyle etc.), should be avoided for the treatment of osteoarthritis of the hip.
Hip replacement is a surgical procedure that decreases pain and improves the quality of life in many patients with severe arthritis of the hips.
Typically, patients undergo this surgery after non-operative treatments (such as activity modification anti-inflammatory medications or hip joint injections) have failed to provide relief of arthritic symptoms.
Surgeons have performed hip replacements for over four decades ,generally with excellent results. Most reports have ten-year success rates in excess of 90 percent.
Learn more about total hip replacement surgery.
Joint injections can be effective at relieving the symptoms associated with osteoarthritis of the hip. Broadly speaking, there are two kinds of injections:
- Corticosteroid injections (“cortisone shots”) – These injections have been used to relieve arthritis symptoms–including pain swelling and inflammation–for over 50 years. Despite this, there have been surprisingly few well-designed scientific studies to determine which patients might benefit from this treatment or how long the relief might last.
Just the same, cortisone shots are commonly used–and often are successful–in helping to relieve arthritis symptoms temporarily. Some patients are able to use them to get enough pain relief to hold off joint replacement surgery for months or even years. Cortisone shots are a treatment for pain; they do not alter the course of arthritis and they do not cure the condition. In general, they are more commonly used for arthritis of other joints than they are for arthritis of the hip joint.
- “Viscosupplement” injections – These are any of several compounds that are made up of hyaluronic acid which is a component of normal joint fluid. Some of the common ones include Synvisc Hyalgan Supartz and Orthovisc. They are given as a series of injections usually weekly for 3-5 weeks. There is some disagreement as to how and whether they work. Read more details on JBJS Article – Corticosteroids VS. Hylan GF20 in pdf format (0.13MB). They are FDA-approved for managing the pain associated with arthritis of the knee but they are not, as of December 2007, FDA-approved for use in the hip joint.
Hip arthritis patients who have perceptible leg-length inequalities can be managed with a shoe lift either inside the shoe (typically if the difference is <1/4”) or built onto the outside of the shoe (if the difference is larger).
Alternative remedies and treatments
Nutritional supplementation (glucosamine and chondroitin are the most common forms of this) is helpful to some patients though the science on this is not entirely supportive of their effectiveness.
There are some studies to suggest that acupuncture can decrease the pain associated with osteoarthritis of the hip.
Although there is little “hard science” on this point, most hip surgeons and rheumatologists (doctors who treat arthritic conditions non-operatively) believe that patients with osteoarthritis of the hip should consider avoiding impact sports such as running in order to avoid increasing the rate at which the disease progresses.
It is important that patients with osteoarthritis of the hip avoid decreasing their activity level and it is important that they remain fit. However this often does require some modification of exercise programs – running and walking programs are usually poorly tolerated by (and not recommended for) patients with osteoarthritis of the hip. Stationary bike, swimming and water aerobics usually are well-tolerated and they are recommended.
Looking for a “light duty” alternative to heavy manual labor is one good approach for coping with osteoarthritis of the hip.
Many patients who work at desks find that prolonged sitting in one position is associated with stiffness and pain upon first arising so periodically standing stretching or moving the hip through an arc of motion can be helpful at minimizing this “start-up” pain.
For some patients, particularly those who cannot tolerate surgical interventions for medical or other personal reasons, use of a cane crutches or a walker can be of use.
For more information about arthritis contact the Arthritis Foundation (www.arthritis.org).
For more information about orthopedic surgery contact the American Academy of Orthopedic Surgeons (www.aaos.org).
Research on osteoarthritis of the hip
Medical researchers continue to look into the causes and best treatments for symptoms of osteoarthritis of the hip, which is very common and sometimes disabling.
There is considerable research being done into the medical management of osteoarthritis which is increasing awareness of the complications and problems associated with use of non-steroidal anti-inflammatory drugs (NSAIDs), including their effects on the kidneys, the stomach, and the heart.
There is considerable research being done studying the surgical approaches for this condition, including newer approaches for total hip replacements and newer implants.
Other surgical interventions, including osteotomy (cutting and re-orienting the bones around the hip) and arthroscopy (using a surgical camera and small motorized shavers to “clean up” the raw bone ends), also are topics of surgical research that may someday be relevant to patients with hip arthritis.
Summary of hip arthritis
- Osteoarthritis of the hip is common and can result in severe hip joint pain and disability. as a result of this condition, several hundred thousand people each year in the U.S. undergo total hip replacement.
- Most people with osteoarthritis of the hip can be managed without surgery.
- The cause of osteoarthritis of the hip is not known but some risk factors include obesity, severe hip trauma, and acquired conditions in adulthood, such as osteonecrosis (avascular necrosis) and genetics.
- There are many other kinds of arthritis that can affect the hip. It is important to make sure that the correct diagnosis is made as some of these other conditions are treated very differently.
- The diagnosis of osteoarthritis of the hip is usually very straightforward and is made in almost all cases by a physician taking a thorough history, performing a physical examination, and getting x-rays with the patient standing up.
- Patients usually seek care for the typical symptoms of hip arthritis, including pain located in the groin thigh or buttock. The pain associated with osteoarthritis of the hip is generally worse with weight bearing (walking standing) or twisting. Stiffness and leg-length inequality are other symptoms.
Facts and myths
Following are several misconceptions about osteoarthritis of the hip.
MYTH: Osteoarthritis of the hip is usually the result of “overuse.”
FACT: Osteoarthritis of the hip is NOT usually the result of “overuse.” There have been studies of long-distance runners that show that they are not more likely to get arthritis than more sedentary individuals.
MYTH: Osteoarthritis of the hip is a “normal result of aging.”
FACT: Many older people – in fact most – DO NOT develop arthritis of the hip and many younger people do experience osteoarthritis.
MYTH: Osteoarthritis of the hip is just “aches and pains.”
FACT: Osteoarthris of the hip is NOT just “aches and pains.” Osteoarthritis of the hop is a condition whose biology, x-ray appearance and clinical symptoms are defined.
MYTH: Not much can be done for osteoarthritis of the hip.
FACT: While it is not “curable”, it most certainly is treatable using activity modifications, medications, injections and if those interventions, don’t work hip replacement surgery often will relieve the pain associated with hip arthritis. In fact, there are exercise programs that can alleviate the pain in mild arthritis, a variety of medications can be helpful for moderate arthritis, and severe arthritis of the hip is very commonly successfully treated with hip replacement surgery.
Edited By Seth S. Leopold M.D., Professor, UW Orthopaedics & Sports Medicine
Last updated: Janurary 9, 2015
If you would like to schedule an appointment with Dr. Leopold to discuss hip arthritis or hip replacement, please contact Elaine Anderson at [email protected] or by phone at (206) 598-7467.