Osteoarthritis of the Hip (Hip Arthritis): "Degenerative Joint Disease" can cause pain, stiffness, and cartilage breakdown
Edited By: Seth S. Leopold, M.D.
Last updated Friday, January 18, 2008
Management and treatmentTreatment Simple steps that can be taken, which don’t have much
risk, include avoidance of the activities that cause symptoms (activity
modification) and weight loss (if appropriate). Some patients find nutritional
supplements such as glucosamine and chondroitin to be helpful; however, the
data on these products is somewhat inconsistent. They don’t help everyone.
Should those interventions not be satisfying, in
consultation with one’s physician, the next steps might include
over-the-counter pain remedies such as acetaminophen (Tylenol) and
over-the-counter anti-inflammatories such as ibuprofen (Advil, Motrin) or
naproxen (Naprosyn), among others. However, these pills are not for everyone,
and if one hasn’t used them before, one should consider consulting one’s family
physician first. Sometimes, prescription-strength non-steroidal
anti-inflammatory drugs (NSAIDs) can be prescribed, but again, this must be
done in consultation with a physician, and these drugs do have risks and side
effects associated with them.
In general, narcotic pills (“painkillers” like Tylenol #3,
Vicoden, Percocet, oxycodone) and narcotic pain patches (fentanyl, Duragesic)
should be avoided for most patients with osteoarthritis of the hip.
Joint injections, including intra-articular corticosteroid
injections can be helpful for some patients;
however, in general, these appear to be less useful for hip arthritis than they
are for arthritis in other joints, in part because of the difficulty of
injecting the hip joint accurately.
Patients
with severe arthritis who have tried the above remedies sometimes can benefit
from total hip replacement surgery.Self-management Keeping one’s body weight appropriate and choosing
activities that don’t reproduce the arthritic pain are two things patients with
osteoarthritis of the hip can do to help decrease the arthritic symptoms.Health care team Several kinds of health care providers participate in the
management of osteoarthritis of the hip, including:
- Family
physicians and internists
- Rheumatologists
- Physical
Medicine and Rehabilitation Specialists (Physiatrists)
-
Orthopaedic
Surgeons
Pain and fatigue
Several approaches can be used to manage the pain
associated with osteoarthritis of the hip, including:
- Activity
modification, appropriate kinds of exercise, and weight loss when necessary may alleviate some hip arthritis symptoms
- Nutritional supplementation (glucosamine and chondroitin) are
helpful to some patients, although the literature on these supplements
is not consistently in favor of their use
- Non-narcotic pain tablets (acetaminophen/Tylenol) or
over-the-counter non-steroidal anti-inflammatory drugs, if medically
appropriate, sometimes are helpful
- Prescription strength non-steroidal anti-inflammatory drugs (NSAID)
are useful for some patients, though in general, long-term use of these
drugs is discouraged
- Arthritis unloader braces or hip sleeves are helpful for some patterns of arthritis
- Joint
injections (corticosteroid or “cortisone” injections) might help
-
Total
hip replacement surgery may be used if non-operative interventions don’t
suffice.
Diet Keeping one’s weight proportional to one’s height can
decrease the likelihood of developing osteoarthritis of the hip, and can
decrease the symptoms of the condition once it has set in.
Exercise and therapy There is some limited evidence that
appropriately-designed exercise programs can decrease the pain of hip
arthritis, in particular earlier stages of the condition. In general, staying
fit and height-weight proportional also are helpful.Medications - Nutritional
supplementation (glucosamine and chondroitin) are helpful to some patients,
although the literature on these supplements is not consistently in favor of
their use
- Non-narcotic
pain tablets (acetaminophen/Tylenol) or over-the-counter non-steroidal
anti-inflammatory drugs, if medically appropriate, sometimes are helpful
- Prescription
strength non-steroidal anti-inflammatory drugs (NSAID) are useful for some
patients, though in general, long-term use of these drugs is discouraged
- Joint
injections (corticosteroid or “cortisone” injections) might help
Narcotic
painkillers, whether in pill form (oxycodone, Tylenol #3, Vicoden, Percocet,
Lortab, etc. or patch form (Duragesic, fentanyle, etc.) in general should be
avoided for the treatment of osteoarthritis of the hip.Surgery Hip replacement is a surgical procedure that
decreases pain and improves the quality of life in many patients with severe
arthritis of the hips. Typically, patients undergo this surgery after
non-operative treatments (such as activity modification, anti-inflammatory
medications, or hip joint injections) have failed to provide relief of
arthritic symptoms. Surgeons have performed hip replacements for over four
decades, generally with excellent results; most reports have ten-year success
rates in excess of 90 percent. Total hip replacement surgery is covered in much
greater detail elsewhere on this educational website.Joint aspiration Joint injections can be effective at relieving the
symptoms associated with osteoarthritis of the hip. Broadly speaking, there are
two kinds of injections:
1. Corticosteroid injections ("cortisone shots") These injections have been used to relieve arthritis
symptoms--including pain, swelling, and inflammation--for over 50 years.
Despite this, there have been surprisingly few well-designed scientific studies
to determine which patients might benefit from this treatment, or how long the
relief might last.
Just the same, cortisone shots
are commonly used--and often are successful--in helping to relieve arthritis
symptoms temporarily. Some patients are able to use them to get enough pain
relief to hold off joint replacement surgery for months or even years.
Cortisone shots are a treatment for pain; they do not alter the course of
arthritis, and they do not cure the condition. In general, they are more
commonly used for arthritis of other joints than they are for arthritis of the
hip joint.
2. "Viscosupplement" injections. These are any of several compounds that are made
up of hyaluronic acid, which is a component of normal joint fluid. Some of the
common ones include Synvisc, Hyalgan, Supartz, and Orthovisc. They are given as
a series of injections, usually weekly for 3-5 weeks. There is some
disagreement as to how and whether they work. Read more details on JBJS Article - Corticosteroids VS. Hylan GF20 in ( ) pdf format (0.13MB).. They are FDA-approved for
managing the pain associated with arthritis of the knee, but they are not, as
of December 2007, FDA-approved for use in the hip joint.Splints or braces Braces and splints are not generally effective for
management of hip arthritis.
Hip arthritis patients who have perceptible leg-length inequalities can be
managed with a shoe lift, either inside the shoe (typically if the difference
is <1/4”) or built onto the outside of the shoe (if the difference is
larger).Alternative remedies Nutritional supplementation (glucosamine and chondroitin
are the most common forms of this) is helpful to some patients, though the
science on this is not entirely supportive of their effectiveness.
There
are some studies to suggest that acupuncture can decrease the pain associated
with osteoarthritis of the hip.Surgery for hip arthritis at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call the Bone & Joint Surgery Center at 206-598 - BONE(2663) or Eastside Specialty Clinic at 425-646-7777 to make an appointment.
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