Dr Chan Ying Ho Henry
Arthritis refers to inflammation of the joint, resulting in pain, swelling, stiffness and loss of the joint function. Arthritis can occur in any joint of the body but most often develops in weight-bearing joints such as the hips and knees. Two of the most common types of arthritis that affect the hip are osteoarthritis, rheumatoid arthritis and avascular necrosis.
Regardless of the cause, symptoms such as joint pain, swelling and stiffness usually progress over time and worsen with age. While arthritis is more common in adults over the age of 65, it can also develop in children, teenagers, and young adults. When left untreated, arthritis may cause serious disabilities that will reduce the overall quality of life. Patients suffering from severe hip arthritis may find it difficult to perform simple daily activities such as walking, bending over, tying shoelaces, cutting toenails or getting in and out of a car.
There are over 100 types of arthritis, but there are 3 main types that most commonly affect the hip. Your treatment will depend on the type of arthritis you have.
Osteoarthritis is the most common form of arthritis. The smooth cartilage that cushions your joints wears away gradually, causing friction, pain, inflammation and eventual damage to the bones. The normal hip is a ball-and-socket joint lined with smooth cartilage that allows the joint to move and rotate easily. If the smooth cartilage wears away, the rough surfaces of the ball-and-socket start to grind against each other, limiting movement and causing pain. Over time, osteoarthritis will worsen or permanently damage the structure of the joint.
Rheumatoid arthritis (RA)
Another common form of arthritis is rheumatoid arthritis, which affects the entire body and not just the hip. Rheumatoid arthritis is related to an immune system response rather than wear and tear like with osteoarthritis. This type of arthritis causes swelling and inflammation of the joint capsule synovial lining, eventually destroying the joint. Unlike osteoarthritis, which tends to occur only in one hip, rheumatoid arthritis typically occurs in both hips at the same time (and possibly other joints).
Avascular Necrosis (AVN)
While less commonly known, avascular necrosis (AVN) is one of the prevalent causes of hip arthritis in Singapore and Asia. AVN is a condition that results from the death of bone tissue due to a loss of blood supply. The femoral head, part of the hip joint, is the most common body part affected by this condition. If left untreated, the affected bone may eventually collapse from the formation of tiny breaks. This condition is often caused by injuries to the hip joint, overconsumption of alcohol, or prolonged and excessive use of steroids (often for treatment of medical conditions).
The causes of hip arthritis are currently unknown, but there are certain factors that may increase your risk for this condition. These include:
Regardless of the type of hip arthritis you may have, the symptoms are:
Hip arthritis can be diagnosed with X-rays in the advanced stage. Magnetic resonance imaging (MRI) scans may be needed in the early stages when the X-ray findings are not obvious. The X-ray will reveal a narrowing space between the bones in your joint and the spurring of joint margins, and in severe cases, total destruction of the hip joint with limb shortening.
During your physical examination, your orthopaedic surgeon will ask about your medical history and symptoms, and perform a physical examination. This will include checking the range of motion in your hip to determine its level of functionality, as well as a measurement of the limb length.
There is currently no medication that can cure hip arthritis, but there are treatment options available that can help improve your mobility and quality of life. The goal of these treatments involves improving the function of the hip and managing the pain.
Treatments for hip arthritis include:
Hip replacement surgery is a procedure in which the arthritic and damaged hip joint is replaced with an artificial joint made of metal/ceramic materials, with a special plastic (polyethylene) layer in between to act as the new cartilage. A successfully replaced hip joint will relieve arthritic pain, restore function of the hip, and lengthen the shortened limb. Hip replacement is a good option for those suffering from severe hip arthritis, with significantly reduced quality of life.
You should consider hip replacement surgery if:
While complications from hip replacement surgery are generally minor, it's important to know the risks involved:
While hip replacement surgery has its merits, it's important to note that a replacement hip doesn't last forever (15 – 20 years on average) and you may need follow-up procedures. Full recovery from the surgery will also take anywhere between 6 – 12 months, and while you will most likely be pain-free after a successful hip replacement surgery, physiotherapy will be required after surgery to help you walk better and learn to move with your new hip.
If you are experiencing symptoms of hip arthritis, it is recommended to consult an orthopaedic specialist to evaluate your condition and discuss your treatment options. Starting treatment as soon as possible can help improve your outlook and eliminate the need for surgery.