We compiled a list of some frequently asked questions about treatment for hip arthritis and hope you find it useful!
Will exercise help an arthritic hip?
Yes. Exercises strengthen the muscles around the hip joint. Weak muscles mean higher forces across an arthritic hip joint, and more pain. That is why regular, light aerobic exercise helps to relieve pain from arthritic hips. Recommended exercises include walking, swimming, elliptical exercisers, and similar activities.
Reasonable levels of exercise will not accelerate the wear and tear of an arthritic hip joint. Stronger and more conditioned muscles reduce the loads placed on the hip, and relieve pain. Exercise may help postpone hip replacement surgery.
One caveat: If exercise hurts, then refrain from that activity and try another form of exercise.
Does a cane help with an arthritic hip?
Yes. A cane in either hand helps, but is most effective if used in the hand opposite the painful hip. A cane reduces the load across the arthritic hip, thereby relieving pain and improving walking ability.
Will injections into the hip joint ease arthritic pain?
Yes, cortisone injections placed into an arthritic hip will ease pain temporarily. For mild cases of arthritis the injections may help for many months. However, injections cannot build up cartilage or otherwise cure arthritis.
Cortisone injections can also help pinpoint the source of hip pain, if there is any doubt where hip pain is coming from. If hip pain is really from hip arthritis, and not referred from a bad back or another source, then cortisone injections should relieve pain, even if temporarily.
Hip joint injections require X-ray imaging to guide the needle into the hip joint. This is why such injections must be done in a special procedure room, equipped with X-ray imaging equipment. If done in the clinic, these injections can be guided by ultrasound technology.
Lubricant injections that are marketed as “visco-supplementation” can help arthritic hip joints temporarily. However, they are more commonly used for treating arthritic knees.
Research to alleviate the pain and inflammation of hip arthritis is ongoing and exciting, such as injections using gold nanoparticles with mild radioactivity.
Is there surgery for hip bursitis?
Yes, if injections in the hip bursa do not work reliably, there is an arthroscopic technique, done as outpatient, that works very well using only a couple of small holes made in the skin. Pain relief is predictable with this small operation. Again, this applies to hip bursitis, which is very different from hip arthritis.
What else, other than surgery, can help an arthritic hip?
If possible, avoid stairs and concrete floors; weight lifting; deep bending at the hip; and repetitive impact exercises such as jogging, golf, and racquetball. Reasonable exercises include walking on a treadmill, swimming, low-impact activities, and upper-body conditioning. There are no effective braces for hip arthritis.
Will arthroscopic surgery help hip arthritis?
In mild or early hip arthritis, yes. Mild hip arthritis can result in hip cartilage tearing; this condition, called a torn labrum, can be addressed with hip arthroscopy. Arthroscopy refers to an outpatient operation, involving small skin openings through which a small camera and surgical instruments are introduced to trim torn pieces and clean up the joint. At the same time, the surgeon can remove bone spurs that physically impinge against each other, causing pain and stiffness.
But, if the arthritis is too advanced, then arthroscopic surgery may not be too helpful.
One benefit of arthroscopic surgery is the ability to look directly inside the joint and understand the extent of arthritic damage. With this information, a surgeon can advise on further treatment.
What is osteotomy of the hip?
Osteotomy refers to cutting bone and realigning the leg, to relieve the pain of an arthritic hip. By altering biomechanics favorably, the loads across the ball and socket joint are lessened. Osteotomy was once a commonly used surgical option in young patients, back when hip replacements were not suitable for young and active people.
In cases where the socket or ball is mis-shapen since birth and the arthritis is diagnosed early, osteotomy can help, especially in young patients. The surgeon can cut the femur and the pelvis to create a more aligned hip joint, thereby slowing the progress of arthritis.
Osteotomy is a complex, major procedure, and requires special skills that we offer in our practice. The goal of osteotomy in such cases is to preserve the patient’s own hip joint. Few patients are candidates for such a procedure, because in most instances, hip arthritis has progressed enough that a hip replacement is more desirable.
What is a hip fusion?
This is another hip operation that was more common in the past. It involves eliminating the hip joint, by surgically welding, or fusing, the ball to the socket. By eliminating movement in the hip joint, pain is relieved without using implants.
Hip fusion is also called an arthrodesis. Increased movement in the back and knee usually compensates for the stiff hip after the fusion.
Hip fusion is nearly obsolete now, since hip replacement surgery is so durable and predictable. But back in the days when hip replacements were not quite as advanced, hip fusion was worth considering for young patients.
Does weight loss help relieve arthritic pain?
Yes. Biomechanical studies show that body weight is multiplied 2 to 3 fold across the hip joint. Losing excess body weight relieves arthritic pain by unloading the joint. Weight loss also decreases surgical risks should hip replacement be necessary.
Will chiropractic manipulations help hip arthritis?
For some patients, chiropractic manipulations seem to help arthritic pain. Alternative remedies, such as glucosamine, vitamins, oils, yoga, hypnotism, herbal supplements, heat packs, ice packs, massage, aromatherapy, aqua therapy, prolotherapy, and acupuncture might also help. Use these remedies if you feel that they are helpful, and if you are familiar with their proper use.
If you are scheduled for surgery, stop all alternative medications and vitamin supplements at least 10 days before surgery. This is to avoid excess bleeding and risky interactions with the anesthetic drugs.
What about injections for hip bursitis?
Injections to the outside of the thigh are commonly used to treat hip bursitis. These injections do not enter the hip joint, and do not need X-ray guidance for accurate placement.
Hip bursitis is not related to hip arthritis. Bursitis is a local inflammation in the tissues near the hip joint, caused by muscles and tendons rubbing against each other. The pain from hip bursitis is located on the outside of the thigh, making it hard to walk or lie on that side. Hip arthritis, in contrast, is deterioration and inflammation of the ball-and-socket joint itself.
A visit to the doctor can usually help determine if you have bursitis or arthritis.
Should I use pain medicine for hip arthritis?
Medicines such as aspirin, acetaminophen, ibuprofen, naprosyn, and other anti-inflammatory drugs can be taken for a long time, within proper dose range. These medicines are not addictive. Your primary physician should monitor any possible side effects, especially if you take such medicines regularly.
Alternative remedies, such as glucosamine chondroitin, are available over the counter. These can help arthritic hips and can be used without risk of addiction.
Narcotic drugs can also relieve pain, but can create dependence and related psychological problems. Long-term use of narcotic drugs before surgery will make pain relief after surgery more difficult. If you regularly require narcotic medicines to control hip pain, it may be time to consider hip replacement surgery.
Why not replace the hip instead of trying nonsurgical measures?
Patients who invest the time to understand all options will know what to expect, and usually have the most satisfying outcomes. Nonsurgical treatment can give you time to learn more about hip arthritis and assess all treatment options.
Also, nonsurgical means of pain relief can work for a long time, at least for some patients; hip replacement surgery should be the last step.
Will arthroscopic surgery buy some time with an arthritic hip?
It could, depending on the extent of arthritis. In mild cases, with cartilage tears in the hip joint causing catching and pain, arthroscopy can buy time before a hip replacement. But if X-rays show advanced hip arthritis, arthroscopic surgery will probably not have any lasting benefit.
What is a hip resection, or Girdlestone, procedure?
This refers to a removal, or resection, of the diseased hip ball, and replacing it with nothing. Historically, this operation was done for conditions like tuberculosis of the hip, long before the days of modern hip replacement. The infected bone would be removed, and the hip cavity would be left empty.
Over time, the empty hip cavity would fill with scar tissue and the leg would shorten by a couple of inches, making walking very difficult. But, removal of the infected ball would give the patient a chance at healing the tuberculosis infection, and relieve pain.
Today, a Girdlestone resection in the hip is done very rarely. Circumstances in which the procedure is considered include a serious infection that cannot be eliminated otherwise, severe bone loss from multiple failed operations, muscle paralysis, or advanced cancer.