Hip
At Activemotion we help you with surgery with an artificial hip joint if your arthrosis genes cannot be treated with medication and training.
Good to know about Hip-teds Arthrosis
Last updated July 2018
What is osteoarthritis of the hip joint?
Osteoarthritis of the hip joint occurs later in life and will be able to cause both strain and rest pain as well as the difficulty. The disorder is very common, and in addition to the fact that it occurs more frequently by ove weight, there is also a hereditary moment. The cartilage degenerates and “branched” and you will initially try with training and painkillers. In severe debilitating cases where relief and pain management are insufficient, hip surgery may be considered.
The hip joint consists of the hip bowl, which is part of the pelvic bone, and the hip ball of the femur. Both the hip bowl and hip ball are “covered” with smooth cartilage, which ensures that the movements take place with the least possible resistance.
Osteoarthritis (arthritis) in the hip is, as the name tells, abrasions in the hip joint, usually caused by high age. The articular cartilage loses its elasticity and cohesiveness and can no longer draw fluids and nutrients from the joint liquid.
Doctors sometimes use the term coxarthritis. Medical history and findings at the medical examination will give the doctor a suspicion of the diagnosis, and it is confirmed by an X-ray.
How common is osteoarthritis in the hip?
The hip joint is the joint of the body where osteoarthritis occurs most frequently. In the elderly, wear changes are often seen on X-rays. But only a small proportion of these patients have symptoms. So osteoarthritis detected by X-ray, does not mean significant genes. Approximately 90% of people over 65 years of age who complain of hip pain have arthrosis of the hip joint. Every year you operate approx. 9,000 people with hip prostheses in Denmark, and of these, 15% are re-operated again at a much later stage.
Why do you get osteoarthritis in the hip?
Osteoarthritis is a degenerative condition that destroys and breaks down the joint. At first, it is the articular carcass that is destroyed. The smooth bruising surface, which is between the hip bowl and the hip ball of the femur, will gradually become uneven. By walking, frictions appear in the joint. When the cartilage is worn out, the rubbing on the now exposed bone increases, causing pain. Later calcifications are formed, movement deteriorates, and the joint becomes stiffer.
A distinction is made between primary (age-related) and secondary hip osteoarthritis. The following conditions increase the risk of having secondary osteoarthritis of the hip: overweight, previous fracture of the hip bone or femur, congenital malformations of the hip, hip inflammation – e.g. rheumatoid arthritis or Bechterew’s disease or undergo Calvé-Legg-Perthe disease, and other rarer diseases. Work that requires prolonged standing, lifting or moving heavy objects predisposes to hip osteoarthritis. The same applies to athletes who compete in weight-bearing sports – most exposed are runners at the elite level.
What are the symptoms and signs of osteoarthritis of the hip?
Gradual pain develops in the groin, in the front and side of the thigh. The pain often radiates down towards the knee. The pain often comes when you need to start walking. They become less intense after you have walked a few minutes, but then get worse again after some time. Greater strain on the legs increases the discomfort. Gradually, pain develops in rest and at night. If you have pain at night, the condition is advanced. The walking distance gets shorter, they are lagging and have to use cane.
What symptoms should be paid special attention to?
The strain-related pains are characteristic, but nocturnal pain can also be part of the symptom picture. The restriction of movement is typical, and there are many chores that become almost impossible to perform. The sick leg is shortened as the cartilage surface almost disappears.
See animation about osteoarthritis of the hip
How does the doctor make the diagnosis?
It is typical of osteoarthritis of the hip that you get starting pain when walking, which decreases, and then worsens with continued walking. When examining the hip, the doctor finds that the movement is impaired, especially by rotation inwards and outwards. Blood tests have no impact on making the diagnosis, but may be considered to rule out other causes. X-rays of the hip show characteristic changes and confirm the diagnosis.
How to treat osteoarthritis of the hip?
The purpose of the treatment is to relieve pain and other discomfort, as well as to maintain or better function in the hip.
What can you do yourself?
If possible, you should lose weight if you are overweight. This can be especially important up to an operation where you need to insert an artificial hip. Avoid long-term standing work, heavy lifting, heavy suitcases and shopping bags. It is an advantage to lie on the stomach or on the side with pillow between the legs, to avoid shrinkage in the muscles around the hip joint. The hip joint should be kept smoothly in case of unloaded exercises. Physical activity is recommended in the form of cycling and swimming. Using crutches/stick, on the opposite side of the painful hip, can be useful for many.
Medicine
Medications only relieve the symptoms and do not affect the course of the disease. In the first instance, prescription-free painkillers should be used. One should most often begin with paracetamol. If this is not enough, one might consider supplementing with so-called gout medicine (though only for short periods of time) or morphine-like medications.
Arthritis medication on prescription provides good pain relief. But it can cause discomfort and sometimes serious side effects from the stomach (bleeding stomach ulcers). If you use this type of medicine and get stomach discomfort, you should contact your doctor.
You may be able to use gastric ulcers with rheumatic medicine – if necessary, if necessary, with your doctor. If you have severe pain at night and cannot sleep because of them, you may consider codeine combined with paracetamol.
Operation
Inserting hip prosthesis (artificial hip joint) is the best treatment for people with severe discomfort of osteoarthritis of the hip, where medication and other treatment have not been able to reduce the debilitating discomfort from the hip. Usually, both the joint head is replaced on the femur and the hip bowl in the hip bone – a so-called total hip prosthesis is inserted. There are several variants of hip prostheses on the market. But the orthopaedic surgery departments have standards for which prosthetics are used for the different forms of osteoarthritis. Some prosthetics disappear from the market and some new ones are added, but they are followed in registries so that you can follow the development and ensure that prostheses with lower shelf life can be taken out of the market.
There is no knowledge that can say with certainty when the best time for surgery is. Possibly the effect is better in previous surgery than previously thought. But the more inconveniences you have with osteoarthritis, the more gain you can expect from surgery. Annually, approx. 9,000 operations for osteoarthritis of the hip joint.
The results of prosthetic surgery in the hip are good. Over 90% of the artificial hip joints work well after 10 years, and about 80% of patients are satisfied. After 20 years, 70% of hip prostheses continue to operate. Improved surgical engineering means that the procedure today is less than before. There are fewer complications, you get on your feet faster after the procedure, and the hospital stay is shorter. The risk of surgery due to problems with the prosthesis was found to be about 1% per year in two studies.
After surgery, follow a rehabilitation program or self-training program that is planned by a physiotherapist. The duration of this depends on the need, but the rehabilitation can go on for several months after surgery. The time it takes before achieving maximum reduction of pain and improvement in function after inserting total prosthesis can be up to 12 months. However, most people have faster rehabilitation.
Physiotherapy
Physiotherapy is important both before surgery and after the procedure. It is usually a physiotherapist who is responsible for rehabilitation. However, no evidence has been provided that certain exercises are superior to others. See the Physiotherapist as your supervisor and remember that you need to train and keep you going.
How are the long-term prospects?
Without surgery, with time, a gradual worsening of the condition usually occurs. But many still do well with painkillers and do not need surgery. The result of prosthetic surgeries is usually very good. In some, muscle shrinkage and function loss of the hip may occur. A rare time, the prosthesis can loosen – especially in the long term. Inflammation may occur after surgery, it is seen in about 1% of the operated patients.
After the operation with total hip prosthesis, hip fracture occurs, where the femur prosthesis component falls out of the artificial hip bowl. It occurs in 2-5% of those operated. In those cases, the patient should briefly be hospitalized and the hip should be put in place in a shortened anaesthetic.
How to avoid getting or to worsen osteoarthritis of the hip?
Osteoarthritis often has a hereditary moment, so prevention can be difficult here. But overweight is a risk factor, and slim people with hip osteoarthritis are less often in need of surgery than people with high body weight.
Indication for artificial hip joint detection