Treatment of a worn out hip joint
The most common cause of hip joint damage is simple wear and tear, when the lining of the joint (the cartilage) starts to wear away. This is known as osteoarthritis of the hip joint. This usually occurs spontaneously, but may also be as a result of previous injury or problems with the joint. The lining of the joint may also be damaged by a number of other medical conditions, such as rheumatoid arthritis or childhood hip problems.
Because the hip joint is located deep in the groin, pain from hip damage is often felt at one or more of a variety of sites, including the buttock, groin, side or front of the thigh, the knee and occasionally as far as the front of the shin. Sometimes the pain is only felt in the knee, even though the hip is the cause of the problem. This is called ‘referred pain’.
If the joint is worn and damaged, there are a number of things that can be done to minimise any pain or stiffness (see below). Hopefully, with these measures, surgery can be put off for many years, or may never become necessary. It is only when people have pain or immobility that is seriously affecting their quality of life, despite these measures, that surgery should be considered.
Non surgical treatments:
Because they are readily available without prescription, many people fail to think of Paracetamol as something that can help the pain from a damaged hip joint. In fact, paracetamol (2 tablets taken regularly 3 or 4 times a day), can be highly effective in limiting hip pain and helping you to maintain or improve activity. The key is to be take them regularly over a period of time. Taken like this they are much, much more effective at keeping pain at bay, than if you just take them when the pain is bad. The other major advantage of paracetamol is that, if taken in this way, it is uncommon for the drug to cause any side effects, and it can be safely combined with most other drugs, including anti-inflammatory medication.
Another group of medicines that can be very helpful are the anti-inflammatories (NSAIDs), such as Ibuprofen (Brufen, Neurofen), Diclofenac (Voltarol), Celecoxib (Celebrex); and many others. These help to reduce inflammation, and thus pain, in the hip. They are more likely to cause side effects than paracetamol, or react with other medicines (although they can safely be taken along with Paracetamol). Because of this, you should discuss their use with your GP or pharmacist before taking any of the anti-inflammatories, particularly if planning to use them regularly.
If, despite these measures, pain is still a problem, there are a number of further options, including stronger pain killers, a TENS machine or acupuncture. Your GP will advise you accordingly.
Cartilage protectants / lubricants
A number of substances have been shown to either reduce the rate of wear of the lining of joints, or help in their lubrication. They can help to reduce pain and the rate of further deterioration. The two most effective substances appear to be glucosamine (which is often combined with a similar agent, chondroitin) and fish oils (such as cod liver oil). Not everyone can take these (diabetics, for example, should not take glucosamine), so you should seek advice from your pharmacist before taking them.
The more someone weighs, the more force goes through each of their hips when they walk. Because of the way we walk, the force in each hip can be equivalent to 3 or 4 times our body weight. So, if you are 3 stone overweight, 9 stone of extra force go through your hip with every step! The good news is, every pound of excess weight you lose means 3 or 4 times less force at the hip joint. The advantages of weight loss are therefore obvious, and many people find that their joints markedly improve when they lose weight. If you find losing weight difficult, there are many clubs or groups who will help, or your practice nurse may be able to advise you.
In addition, if you are significantly overweight and hip replacement surgery becomes necessary, you run a higher risk of complications. If this applies to you, do try to lose weight to minimise this risk.
Walking or hiking stick
Using a stick in the hand opposite to your bad hip (i.e. left hand, if it is your right hip, and vice versa) helps to reduce the force in the hip joint as you walk (by as much as 60%). It will also support you if your hip feels as though it will give way. Many people dislike using a stick as they feel it is a sign of weakness. In fact, it is a very sensible and effective way of keeping mobile and active, and minimising pain from your hip. Some people feel less self conscious, particularly when out walking, with one of the newer hiking sticks, which can be purchased from outdoors and country clothing shops.
Shock absorbing heel pads
An absorbing heel pad in the shoe (available from most chemists or sports shops) can help reduce some of the impact and jarring on your hip as you walk. A good pair of training shoes will have a similar effect. In addition, a heel pad can help correct any difference in your leg lengths if wear in the hip has shortened one leg. Your physiotherapist can help fit you with a heel pad if you prefer.
It is important to keep your hip joint mobile, and your muscles strong and flexible to help to minimise joint stiffness, immobility and pain. We advise most patients to see a physiotherapist for advice on suitable exercises (as well as advice on many other issues, including the correct fit and use of a stick and heel pads, if appropriate). Swimming in particular is good exercise, we encourage you to walk regularly within the limits of your pain. High impact sports such as running or squash are best avoided with worn joints.
The ARC is the Arthritis Research Campaign, and is a registered charity. They provide information on all aspects of care for people with joint problems of any severity. Free advice and information booklets can be obtained from them via the internet, or post, at www.arc.org.uk or The Arthritis Research Campaign, Copeman House, St Mary’s Court, St Mary’s Gate, Chesterfield, Derbyshire, S41 7TD (Tel: 0870 850 5000).
The role of surgery:
Although the most appropriate operation in the vast majority of cases is to replace the worn parts of the joint (a hip replacement), in a few special cases other options may be indicated. These include operations to remove tissue from in or around the joint (arthroscopy or debridement procedures), or realign the joint (osteotomy). Your surgeon will be familiar with all these options and will discuss them with you if you are one of the few where they may help.
There is no upper age limit to hip replacement, provided a patient’s general health permits the surgery. Nor is there a lower age limit, although younger and more active patients need to be aware that they are more likely than others to wear out their artificial joint, and may require revision surgery in the future.