Numerous people suffer from hip discomfort due to hip osteoarthritis in the course of their lives. As a result, they are significantly limited in their quality of life. The resulting effects also significantly impair the performance of a professional job. This also results in significant economic damage.
What is hip osteoarthritis?
Schematic diagram difference between healthy joint, arthritis and osteoarthritis. Click to enlarge. Hip osteoarthritis is a disease of the hip joint in which the cartilage layer between the acetabulum and femoral head shows wear. The wear and tear usually occurs due to age. However, it can also occur due to injury or disease. The cartilage tissue acts as a protective lubricating layer to prevent the bones from rubbing against each other in painful abrasion. The cartilage mass is an elastic connective tissue that has a water-storing property. Through the natural aging process, elasticity and water storage recede. Analogous to the visible skin change due to the formation of wrinkles, a change also occurs inside the body. The joint cartilages become smaller and rougher. The loss of cartilage height also causes a reduction in cushioning capacity. The progression of this degenerative development process causes a functional limitation of the hip joint. In addition, increasing pain sets in when weight is placed on the affected joint. The duration and intensity of the pain can vary. Temporarily, the symptoms may even subside before pain reappears, which subsequently occurs at night even without weight-bearing.
Causes
The cause of hip osteoarthritis can be of various types and cannot always be clearly diagnosed. In the vast majority of cases, the natural aging process forms the reason for the disease. Hereditary factors such as congenital deformities can accelerate this process. In addition, diseases such as rheumatism, gout, bacterial infections as well as necrosis of the femoral head and osteoporosis can be the causal cause of coxarthrosis. Accidents can also lead to hip osteoarthritis. A pelvic fracture or a fracture of the neck of the femur with joint impairment can be triggers for the onset of the disease. This changes the natural statics of the joint and causes a higher cartilage load. Drugs can also be responsible for osteoarthritis of the hip joint. Persistent, one-sided overloading of the hip joint over a longer period of time can promote hip arthrosis. Considerable, permanent overweight equally leads to this overload effect. Furthermore, a cause for triggering hip arthrosis can be a lack of exercise, which leads to insufficient blood supply to the cartilage. In this case, the production of cartilage lubricant is reduced by a disturbance of the passive metabolism.
Symptoms, complaints and signs
Hip osteoarthritis begins with barely noticeable symptoms. At the beginning, mild pain occurs, which is noticed by the affected person mainly during physical exercise. After a short time, the pain also occurs during periods of rest. Activities such as getting out of the car or climbing stairs become increasingly difficult and are finally no longer possible. Then the joints also hurt at rest and at night, and the pain often radiates to the knees and lower back. Osteoarthritis of the hip joints manifests itself primarily through start-up pain in the hip area, which subsides after a few steps. In advanced stages, joint pain, groin pain and pain at rest occur. The mobility of the thighs is severely limited – often the legs can only be bent, stretched or spread with great effort. Externally, hip osteoarthritis can be noticed by the sluggish, often swaying gait. Those affected move much more slowly than usual and also have to take regular breaks. In individual cases, hip arthrosis may be manifested by redness and swelling in the hip area. Accompanying the physical symptoms are usually also psychological complaints such as increased irritability or depressive moods.
Diagnosis and course
Limitations in hip function, often accompanied by painful sensations in the leg, back, or buttocks, indicate hip osteoarthritis has begun.If osteoarthritis is suspected, the patient is first questioned in detail about his or her lifestyle and medical history in order to find out about possible hereditary factors, overloading, injuries or nutritional errors. This is followed by a physical examination to determine hip mobility. Existing deformities in the joint and capsular swelling can already be palpated. With the help of specific examination techniques, movement-dependent pain can also be specifically diagnosed. Further information can be obtained by means of imaging examination procedures. X-rays provide a revealing image of the hip joint in several planes. The detection of changes in the joint space is a clear indication of cartilage abrasion. In addition, ultrasound examination for supportive visualization of the soft tissues may be helpful in establishing the diagnosis. Specific, precise information about the distribution and vitality of articular cartilage is provided by magnetic resonance imaging or hip arthroscopy through a small camera probe. To determine whether a bacterial infection could be causative for hip osteoarthritis, a blood test must be performed. If hip osteoarthritis causes start-up pain, for example after getting up in the morning or after sitting for a long time, this pain and stiffness usually disappear after some movement. With advanced disease, only shorter distances can be managed. Limping may also occur during walking. The pain occurs more and more frequently as overuse pain and eventually presents itself even at rest. As cartilage wear progresses, complete hip stiffness eventually occurs.
Complications
Hip osteoarthritis causes pain and limits the patient’s movement. The quality of life is significantly reduced by the disease and the daily life of the affected person is made more difficult. In most cases, certain activities or one’s own work can also no longer be performed. These restrictions not infrequently lead to mental illness or depression. Due to hip osteoarthritis, pain occurs mainly in the hip and in the joints. This pain can also spread to other regions of the body and thus lead to pain in the back, for example. It is not uncommon for patients to suffer from gait disturbances and severe restrictions in everyday life as a result. Some affected persons need a walking aid or are dependent on other people in their everyday life if this is restricted by the hip arthrosis. Furthermore, the pain can also occur at night in the form of pain at rest, leading to sleep problems. The treatment of the hip arthrosis can be done by different possibilities and can alleviate the complaints. Further complications do not occur. As a rule, treatment is causal, so that, for example, patients with excess weight must first reduce it. Furthermore, prostheses can also be used. Life expectancy is not reduced by this disease.
When should one go to the doctor?
If hip or joint pain is noticed that increases in intensity over time, hip osteoarthritis may underlie the condition. A doctor should be consulted as soon as the symptoms first appear. If gait disturbances or other movement restrictions occur, a serious illness can be assumed, which must be clarified promptly. The affected person should quickly talk to the family doctor and consult an orthopedist for further clarification. If pain occurs even during light physical exertion, a doctor must be consulted on the same day. Patients suffering from rheumatism, gout or osteoporosis are particularly susceptible to developing hip osteoarthritis. So are people who have had a severe bacterial infection or suffer from femoral head necrosis. Medication, lack of exercise and a generally unhealthy lifestyle are also possible triggers of the disease. Anyone who counts themselves among these risk groups should go to the doctor immediately with the symptoms mentioned. In case of doubt, the emergency medical service can be contacted first.
Treatment and therapy
Treatment of hip osteoarthritis can be joint-preserving therapy or joint replacement, depending on the patient’s established findings. In joint-preserving therapy, there should be a significant reduction in previous cartilage wear.In addition, regeneration of the joint surfaces and cartilage growth should be achieved. If the patient is significantly overweight, a diet and change to a balanced diet is advisable in any case. In the case of one-sided, permanent overloading of the hip joint or insufficient exercise, behavioral corrections must also be made. If medications taken have caused the arthrosis, they must be discontinued. On the other hand, taking painkilling and anti-inflammatory medications can be helpful and relieving. Technical measures such as orthopedic shoes, crutches or bandages can also be beneficial in treating the condition by altering the load and misalignment. Likewise, physical treatment measures such as heat or cold therapy and physiotherapy can be supportive. For temporary relief of symptoms, injection therapy with hyaluronic acid can be promising. In an advanced stage of the disease, only surgical measures can help. Limited cartilage damage can often be repaired by hip arthroscopy. In this procedure, broken pieces of cartilage are removed so that they cannot cause further abrasion. In addition, the roughened, torn cartilage is smoothed. This leads to a soothing of the synovial membrane and to the abatement of hip pain. In the case of more advanced joint destruction, the joint is replaced by hip prostheses in the course of an operation. Cementless or cemented prostheses can be used.
Prevention
A number of things can be done to prevent the condition with an eye toward its causes. Reducing body weight by five kilos can lead to a reduction in the risk of osteoarthritis of almost 50 percent in a severely overweight person. The diet should contain a lot of green vegetables and little red meat. Pleasure toxins should be avoided altogether. A reasonable load of the hip joint in the occupation and with the sport as well as purposeful gymnastic exercises or swimming are meaningful preventive measures. Incorrect postures and overloading should be avoided. Typical movement restrictions and pain should be noted at an early stage and examined by a doctor. Many people suffer from hip arthrosis, especially in old age, in which wear and tear of the cartilage layer takes place. This results in painful movement restrictions. If this development process cannot be stopped, only a joint replacement will help.
Aftercare
In the case of hip osteoarthritis, comprehensive medical treatment is initially required. Follow-up care includes regular visits to the doctor. The specialist in charge will first examine the hip and have a discussion with the patient. This allows him to get an idea of how the disease is progressing and, if necessary, take further steps. Often, medication must be adjusted or further surgery initiated. In the case of chronic diseases, therefore, ongoing treatment is necessary. Individual symptoms such as the onset of pain or the typical joint and groin pain require comprehensive follow-up care. For example, persistent pain can be relieved by physical therapy or simpler measures such as acupuncture and massage. For the most part, these practices serve as support when conservative treatment options have been exhausted. If negative disease progression with persistent walking difficulties and poor posture becomes apparent, appropriate preparations must be made. The patient will need aids such as crutches, and it is often the case that it will also be necessary to change jobs and make changes in the household. The follow-up care of a hip arthrosis is carried out by the responsible orthopedist or family doctor. After a surgical intervention, consultation should also be held with the treating surgeon. At the beginning, a doctor should be consulted every two weeks. If the latter finds no complications, the appointments can be reduced to every month, then to every three months and finally to every six months.
What you can do yourself
To prevent additional pain or severe progression of the disease, avoid overloading and overuse of the skeletal system. Carrying or lifting heavy objects should be refrained from. Care should be taken with footwear to ensure that it does not have high heels or is too tight. A rigid posture over a longer period of time is also not conducive to good health.Balancing movements and correction of one-sided body positions are helpful in alleviating the discomfort. The hip, pelvis and back should be adequately protected from exposure to cold and drafts. Affected persons should observe and pay attention to their own stress limit in the case of osteoarthritis. Sporting activities should be geared to this, but should not be completely discontinued if possible. Body weight should be kept within the normal range. A healthy and balanced diet helps to strengthen the skeleton and stabilize the immune system. For seated activities, care should be taken to ensure an ergonomic sitting position. At the same time, sleep hygiene should be optimized for a balanced night’s rest. The body needs sufficient rest and recovery phases, which should be firmly integrated into everyday life. Selected physiotherapeutic exercises can support the skeletal system and alleviate symptoms. Exercise sessions should be performed regularly and as directed by trained personnel.
