Hip pain: common causes and treatments
We're very interested in our hips. One of the most active forums on the Patient.info site is the hip replacement discussion group, so there's clearly a huge need for relief from the pain caused by arthritic hips. And these days, that relief could just come sooner.
Joint pain is an occupational hazard of getting older. Like any machine, no matter how efficient, time and use take their toll. Joints are junctions between two bones. The adjoining bone ends in many joints are covered in a tough, smooth material called cartilage, which lets the bones glide smoothly over each other. These joints are lubricated by thick fluid, and surrounded by a strong capsule.
In the UK alone, 8.5 million people live with joint pain, and hips are prime candidates. There have been concerns about 'metal on metal' hip replacements, wearing out faster and causing complications. These are no longer used. Pain in your hip can come from your lower spine, which is also prone to arthritis. Your doctor will check this out.
Common causes of hip pain
Osteoarthritis is the most common cause of joint pain. Your joints go through constant wear and tear, and keep repairing themselves. Sometimes, the repair process can't keep up with the damage and osteoarthritis develops. Wear and tear increases with age and weight. Injury or deformity of your joints - from a break, a joint infection or other damage - also makes you more prone to osteoarthritis. Women suffer more often than men, and it can sometimes run in families.
Rheumatoid arthritis is the second most common kind of arthritis. It's an autoimmune disease - your body's immune system attacks itself. Often many joints are affected at the same time, but in the early stages it tends to cause hand and foot problems. Osteoarthritis, by contrast, most commonly affects hips, knees and spine.
Osteoarthritis causes pain, stiffness and loss of mobility, especially in the mornings. Cold and damp weather can make it worse. Your joint may look a little larger, but won't be hot, red or acutely swollen. Your doctor should be able to make a diagnosis on the basis of your symptoms and examining you. He may send you for an X-ray, to show how advanced the bone and cartilage changes are. X-ray changes don't always match the severity of your symptoms - if your doctor is considering surgery or isn't sure of the diagnosis, you may be referred for a scan called an MRI. This gives a 3D view of all the structures in and around your hip. Many of my patients worry that once they have osteoarthritis, it will keep on getting worse and worse. In fact, symptoms often wax and wane, and you may go for months or years with no worsening of symptoms.
Treatment for hip pain aims to relieve stiffness, mobility and disability, as well as pain. Exercise is absolutely key to keeping your joints mobile and delaying disability. Your doctor may refer you to a physiotherapist, who will give you specific exercises to do - but you must exercise on your own, too. Walking (with well-padded shoes to prevent jarring), cycling and swimming are all ideal. Exercise can also help keep your weight down - hugely important for reducing the load on your joints.
Painkillers, either as tablets or as topical gels, can help. So can walking aids or home adaptations - you may be referred to an occupational therapist, who specialises in these. If your symptoms get worse and you're getting pain even at rest, you may be referred for hip replacement. This usually involves replacing both the 'ball' (at the top of the thigh bone) and the 'socket' (in your pelvis bone). Hip 'resurfacing' can be used as an alternative for some patients. It's a less major procedure but it's only suitable if you have strong bones. It tends to be reserved for under-65s.
Hip replacements on the rise
When I first qualified, hip replacements were very much seen as a 'last resort', and surgeons weren't at all keen to operate on younger folk. But that's changing fast, with a 76% increase in hip replacements in England in the last decade (up from just over 10,000 to almost 18,000 a year in the last 10 years). Demand for hip replacements has risen across the board over this period, from nearly 90,000 to over 120,000 a year in England. That's partly because we're living longer as a population; and it's partly because as the world's population gets heavier, we put more strain on our joints, particularly weight-bearing joints like hips and knees.
But the rise in hip replacements among younger people is partly good news. Hip replacement techniques, and the artificial joints used, are improving. That means that while in the past you could expect a new hip to last for 10 years before wearing out, now it might be 20 years. People are recovering more quickly after procedures too, often out of hospital within three days and off crutches within six weeks.
Hip replacement can be done under general anaesthetic, or using an epidural, where your lower body is numbed. Like all surgery, there are possible complications, including ending up with legs of different lengths, dislocation of the hip and damage to the blood vessels or nerves around the joint. However, on average you have a 99%+ chance of avoiding complications.
About 90% of people never need further 'revision' surgery, but it's important to look after your new hip - any repeated surgery can be more tricky. With the right precautions, your new hip should last for 20 years.
With thanks to 'My Weekly' magazine where this article was originally published.