Hip Preservation Clinic

Hip Arthritis

CONDITIONS

Defining Arthritis

Arthritis is defined as chronic joint inflammation and cartilage degeneration. The most common type of arthritis is osteoarthritis, which has a strong genetic component and involves painful and progressive loss of surface cartilage. Other less common forms of arthritis include:

  • Inflammatory or autoimmune (i.e. rheumatoid, lupus, psoriatic)
  • Gout and pseudo-gout
  • Septic or infectious

Common Arthritis symptoms include night pain, reduced range of motion, pain in external rotation and pain after prolonged sitting. The hallmarks of osteoarthritis include radiographic signs such as asymmetric cartilage loss, bone spur formation and cyst formation, with other indicators including progressive stiffness and deformity of the joint leading to loss of motion. Arthritis is diagnosed by combining clinical symptoms (pain, stiffness, swelling, deformity) with radiographic (x-ray) findings (joint space loss, bone spur formation, cysts).

Arthritis
Figure 1: Normal joint space with healthy cartilage between ball & socket.

Figure 2: Same hip 3 years later showing advanced arthritic conditions with narrowed joint space between ball & socket due to cartilage loss.

Hip Arthritis Diagnosis

Arthritis is diagnosed by combining clinical symptoms (pain, stiffness, swelling, deformity) with radiographic (x-ray) findings (joint space loss, bone spur formation, cysts). Occasionally, patients will present with radiographic evidence of arthritis and have minimal clinical symptoms. Even if the x-rays show “bone-on-bone” arthritis, the treatment is always guided by the clinical symptoms and not the radiographic findings.

Hip Arthritis Treatment

There are many different treatment options for hip arthritis, all of which aim to reduce pain and improve function. Conservative treatment options include:

  • Use of anti-inflammatory medication (i.e. ibuprofen, naproxen, acetaminophen)
  • Activity modifications (transition to low/no impact)
  • Use of a cane, walker, or other ambulatory aid
  • Weight loss when appropriate
  • Low-impact physical therapy for muscle strengthening and conditioning
  • Various injections aiming to reduce joint inflammation and prevent further cartilage deterioration (see PRP section)
  • Patients with mild arthritis may have other less invasive treatment options available to them, including PRP injections and minimally invasive hip arthroscopy. These joint preserving options provide good short to medium term (2 – 5 year) relief and may enable patients to maintain a high level of activity before hip replacement surgery is the only option.

When these measures fail to provide sufficient pain relief, the next step is to discuss hip replacement surgery. The most reliable way to definitively treat severe hip arthritis is through a hip replacement or hip resurfacing. Postponing THR, if an option, would prevent the need for early life activity modifications and may enable the patient to utilize future and better hip implants that were not yet available before. 

Drs. Mei-Dan and Lee and the hip team will help you learn about what these procedures can do for you so you are equipped to make the best decision for your hip joint.