Hip is the Second Most Common Joint Affected By Arthritis

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Hip pain from arthritis is one of the common conditions seen not just among elderly but also among people, especially women in their 40s and 50s. Arthritis, a progressive disorder, typically starts gradually and gets worse with time. Such patients who often find difficulty in walking feel stiffness, or pain ranging from sharp pain to dull ache in hips. In India after knee joint, hip is the second most common joint affected by arthritis. To the contrary, in the western world, hip arthritis is more common than in Indian population.


To describe it in simple terms, Dr Ishwar Bohra says Arthritis occurs when the joint space of your hip is narrowed and the soft tissues surrounding it start to shrink and tighten. The condition may arise due to various reasons such as wear and tear of joints over time or due to tough training regime, being obese as well as due to genetic or hereditary reasons.


The treatment of hip arthritis is based on factors such as the cause of arthritis, how early the condition is diagnosed, age of the patient, medical history (if any), etc.
Main Causes Of Hip Arthritis


1- Primary - Osteoarthritis (OA is not common in India though)


2- Secondary (commonly diagnosed)


Avascular Necrosis of femoral head
Post Traumatic (Secondary Arthritis)
Post Infection (Septic Hip)/Post tubercular


3- Inflammatory Arthritis


Rheumatoid Arthritis
Ankylosing Spondylitis
Systemic Lupus Erythematosus
Psoriatic Arthritis


4-Congenital - Congenital Dislocation of Hip


5-Others Causes - These include:


Childhood diseases ( Perthes, SCFE)
Haemophilia/Sickle Cell Anemia/Malignancies
Metabolic Diseases


Osteoarthritis- This is most common form of arthritis seen especially in elderly people. Osteoarthritis means “arthritis of the bone” and it is often a result of wear and tear of the joints. Though it is also caused due to structural problems with the hip joint, advancing age, obesity, hip injury, etc. Common symptoms of osteoarthritis is joint stiffness after you sit for a long time, pain, swelling, inability to move normally, etc. The changes in osteoarthritis usually occur slowly over many years thereby causing a permanent damage to the joint. Thus, it's important to seek timely treatment for osteoarthritis.


Rheumatoid Arthritis - Rheumatoid arthritis (RA) affects your entire body and not just the hip joint. It affects people of all age groups including children and is commonly seen in women than men. The cause of inflammation in RA is due to an immune system response rather than wear and tear. The condition causes pain and swelling in both the hips unlike osteoarthritis that occurs only in one hip, and eventually, it leads to deterioration of the bone and cartilage of the joint. Besides pain and swelling, RA also causes weakness and fatigue.


Avascular Necrosis - Avascular Necrosis is the condition where the bone tissue dies or collapses due to lack of blood supply to the bones which if left untreated leads to joint pain and arthritis. If the process involves the bones near a joint, it often leads to collapse of the joint surface.
Although it can happen in any bone, avascular necrosis most commonly affects the ends (epiphysis) of the femur, the bone extending from the knee joint to the hip joint. It's commonly seen in people between the age group of 30 and 60 years.


Ankylosing Spondylitis - It is a chronic inflammation of the spine and sacroiliac joint (the joint where the spine meets the pelvis). The condition may affect people of all age groups, including children, but typically its onset is between the ages of 17 and 35. Unlike RA, Ankylosing Spondylitis is more common in men than women.


Post Traumatic – Some injuries such as fracture of acetabulum, neck femur, neglected trauma, malunited fracture, complex non reconstrctable hip fracture, etc can damage the cartilage or the bone, thereby changing the mechanics of the joint and making it wear out more quickly.


Post Infection- Post septic hip (Tom’s Smith Hip) and Post TB arthritis is very common in India. Such infectious arthritis is often caused by bacteria, viruses or fungi spreading through the bloodstream to the joint.


Treatment


Non-Surgical Options


Based on your diagnosis, your surgeon will prescribe the type of treatment that is appropriate for your condition.
Non-Surgical treatment for arthritis of the hip may include:

  • Anti-inflammatory medications
  • Corticosteroids, injections to block the inflammation in the joint
  • Physiotherapy or exercise programs to improve flexibility and muscle strength
  • Swimming is an excellent exercise for Ankylosing arthritis
  • Weight reduction in case of overweight patients
  • Devices such as canes/walkers to make it easier to walk

Surgical Options


Many people with arthritis of the hip are candidates for surgery. Surgery can help to reduce pain, enhance quality of life, and improve an individual's ability to perform everyday activities with no restrictions.

  • Minimally Invasive Hip Replacement Surgery: It is an appropriate treatment option if the hip joint is severely damaged or if pain and swelling reduces motion in joints and affects quality of life. Hip replacement surgery is one of the most successful modern orthopaedic surgical procedures and it is performed with smaller incisions which means quicker recovery. During a hip replacement surgery, the surgeon removes damaged cartilage and bone from the hip joint and replaces them with man-made parts (Prosthesis).
  • Computer Assisted Hip Replacement / Dual Mobility THR – This is a high performance hip replacement implant surgery suitable for patients undergoing complex total hip replacement. It is well suited for sports persons/athletes, etc., as it offers outstanding stability. The minimally invasive surgery allows patients to perform a high level of activity, it offers better results and quick recovery, fewer postoperative restrictions, etc.

- Dr Ishwar Bohra
Senior Consultant Joint Replacement &Arthroscopy Surgeon
BLK Super Speciality Hospital New Delhi

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