Hip arthritis

The word arthritis comes from two origins The first is “arthro”, which is Latin for joint, and the second is “itis”, which is Latin for inflammation. Combined, arthritis simply means inflammation of a joint. All joints have the ability to be inflamed and the hip is obviously no exception.

There are many causes of hip arthritis.  Whilst the most common is so-called osteoarthritis, a mechanical wearing out of the joint, we also have rheumatoid arthritis, psoriatic arthritis, post-traumatic arthritis and other forms of inflammatory arthritis associated with hemosiderosis, avascular necrosis (death of the ball on the upper end of the thigh bone), ochronosis and other rare maladies.All forms of arthritis do have several common features. Typically, the hip joint becomes painful with most pain being localised to the groin. Sometimes the pain will radiate from the groin down the front of the thigh bone as far as the knee.  This is due to the fact that the hip joint is supplied by one branch of the obturator nerve. It is the so-called anterior division. The posterior division runs down the thigh as far as the knee. Whilst the hip joint might be sending the painful messages back to the brain, there are times when the brain can’t tell whether it is the anterior division or the posterior division which is delivering the messages.  The brain sometimes is tricked into thinking that the knee is the problem.  In fact, there are well-recorded cases where patients have undergone operations on the knee when really the primary problem was in the hip!

In addition to pain, patients with hip arthritis also note restrictions in range of motion of the joint.  Typically, the joint loses the ability to abduct (go out to the side), internally rotate (turn the foot inwards), and fully extend or straighten backwards. 

These features combine to limit how far the patient can walk, give rise to difficulties doing up shoes and putting on socks, and give rise to difficulties climbing in or out of a car, ascending or descending steps and engaging in sexual intercourse. 

The diagnosis of hip arthritis is made from the clinical symptoms provided by the patient, the features noted at the time of clinical examination (restrictions in movement and pain with specific provocative manoeuvres) and x-ray or radiographic features.  Sometimes blood tests can be of assistance, as can more complex scans such as computerised tomographic (CT) scans or MRI (magnetic resonance image) scans. 

With all conditions orthopaedic, the treatment programmes can be divided into two groups.  The first is the so-called non-operative approach. 

This includes pain relief, weight loss, the ingestion of anti-inflammatory analgesic agents, the use of a walking stick, crutches, wheelchair or moped or injections of cortisone or other lubricants into the joint. 

The second arm is of an operative nature.  There are many operations available.  They can include telescopic procedures, laser procedures and even transplantation procedures.  Joint replacement, at the end of the surgical line, is often the only option left when patients present with advanced hip arthritis.