Around 10 million people in the UK have arthritis, largely those aged over 65. There are several different types of arthritis, although the two most common are osteoarthritis and rheumatoid arthritis. Arthritis causes pain and inflammation in one, several or all of the joints in your body. These symptoms are caused by the cartilage that covers the bones in your joints wearing away, which consequently increases the friction between your bones, causing bone damage.
Hip arthritis is most often caused by osteoarthritis and affects around one in 10 UK adults aged over 45. However, hip replacement surgery is not usually needed — in every 1,000 cases of hip osteoarthritis in the over 45s, only around one to four individuals will need hip replacement surgery.
There is currently not enough evidence to accurately predict who will develop hip arthritis in later life. However, there are known risk factors. Hip arthritis tends to run in families. This may, in part, be due to genetics affecting the quality of cartilage in your joints.
Any injury or trauma that causes a fracture in the ball and socket joint of your hip or a dislocation of your hip joint can also increase your risk of hip arthritis, which is called secondary osteoarthritis.
In rare cases, arthritis in adults can be caused by avascular necrosis, where the blood supply to the top of your thigh bone is disrupted. This damages the thigh bone and its surrounding cartilage and can be caused by excessive use of steroids, drinking too much alcohol for several years, radiotherapy to treat cancer, as well as certain health conditions, including sickle cell anaemia and Gaucher's disease.
Inflammatory conditions, such as systemic lupus erythematosus, also increase your risk of hip arthritis.
Risk factors that occur in childhood
Several childhood hip diseases can increase your chances of developing hip arthritis in adulthood. These include developmental dysplasia of the hip (DDH), Perthes’ disease and slipped femoral epiphysis.
DDH is present from birth and is caused by the socket of the hip joint not developing properly. The socket is consequently too shallow to tightly hold the top of the thigh bone. In severe cases, the thigh bone can fall out of the socket (dislocate).
Perthes’ disease usually affects children aged between five and eleven years old and occurs when the blood supply to the top of the thigh bone is disrupted. This causes damage to the top of the thigh bone. Although the thigh bone will eventually heal, it can cause problems with the hip joint in adulthood.
Slipped femoral epiphysis usually affects teenagers, more commonly boys who are overweight. The top part of the thigh bone (epiphysis) in children is not fully fused with the rest of the bone and can therefore slip out of place. If left untreated a slipped femoral epiphysis can cause a deformity in the top of the thigh bone, which increases the risk of osteoarthritis in adulthood.
The main symptom of hip arthritis is pain in the groin and front of the thigh. Sometimes this pain can radiate to the knees and occasionally to the outer thigh area and buttocks.
In the early stages of hip arthritis, pain usually comes and goes, and often occurs on activity, such as brisk walking, running or walking up and down the stairs. As hip arthritis progresses, the distance you can comfortably walk becomes shorter.
In the advanced stages of hip arthritis, you will experience pain even at rest. In severe cases, this may wake you up at night and you may find it difficult to turn over in bed.
Other symptoms of hip arthritis include joint stiffness. You may notice that it’s difficult to reach your feet and struggle to put your socks and shoes on.
In most cases, hip arthritis can be treated without surgery. This involves avoiding high-impact activities, performing hip strengthening exercises and physiotherapy. Losing any excess weight to reduce the strain placed on your hips will also help. If needed, you can also try using self-help aids eg a walking stick, crutch or walking frame with wheels to retain your mobility, and extra-long shoe horns to help you put on your shoes.
To relieve your pain, you can take over-the-counter painkillers, such as paracetamol and ibuprofen. If your pain worsens or becomes more persistent, you can see your GP for stronger painkillers, such as prescription naproxen. However, the long-term use of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, is not recommended, as they can cause side effects including heartburn and stomach ulcers.
If oral painkillers aren’t enough, your doctor may recommend steroid (hydrocortisone) injections to provide temporary relief from your hip pain. However, as steroid injections into your joint are invasive, they are not recommended for severe hip arthritis and in mild to moderate cases, are only recommended two or three times per year in the same joint.
Platelet-rich plasma (PRP) injections and viscosupplementation gel injections are also being investigated for the treatment of hip arthritis. However, there is currently not enough evidence to determine if they are effective.
When all non-surgical treatments haven’t been effective in controlling your hip pain and your hip arthritis is significantly affecting your quality of life, your doctor may suggest hip surgery.
The ability to manage hip pain varies from person to person. You will, therefore, need to have a discussion with your doctor about how you’re coping and whether your hip pain is affecting your ability to walk, work, sleep and enjoy your leisure time.
Your doctor will also need to take scans of your hip to help assess the progression of your hip arthritis before recommending surgery. This is usually an X-ray, although occasionally a CT scan or MRI scan may be needed.
You will need to be medically fit enough to undergo surgery and understand the risks and benefits. Your doctor will discuss these with you so you can make an informed decision based on your health, pain management and what you hope to achieve after surgery.
Surgery to treat hip arthritis is effective, however, if you have hip surgery at a younger age, say in your forties or fifties, you are more likely to need further hip surgery later in life.
Hip arthroscopy is a type of keyhole surgery, which means small cuts are made into your hip through which surgical instruments can be passed as well as a thin, flexible, telescope-like tube with a light and camera on the end (arthroscope). Hip arthroscopy can be used to remove damaged tissue to help relieve hip pain.
Hip replacement surgery is used to remove worn or damaged parts of your hip joint and replace them with an artificial joint. This will reduce your hip pain and improve your mobility.
After your hip surgery, your care team will encourage you to start moving within 24 hours of your surgery. A physiotherapist will help you do this, showing you how to sit up, get out of bed and stand safely.
If you are an older person, you may need to use a walking frame at first to help you walk around. However, your care team will support you to transition from a walking frame to crutches before you go home. They will also ensure that you can independently manage stairs, get out of bed, shower and dress before you are discharged.
In most cases, you will need to stay in hospital for two to three days after your surgery. During your recovery in hospital and at home, you will need to perform daily physiotherapy to gradually improve your mobility. After around four weeks, you will usually be able to walk unaided. However, this will depend on your fitness and muscle strength — you may need crutches for longer, even several months.
It usually takes around six weeks before you can drive again, particularly if your hip surgery was on your right hip, which is needed to properly perform an emergency brake — a prerequisite for returning to driving. If your hip surgery was on your left hip, you will likely need four to six weeks to regain clutch control. However, if you drive an automatic car and have had surgery on your left hip, you may be able to drive again after two to three weeks.
After two to three months, most of your recovery will likely be complete. However, your muscles should continue to strengthen and depending on your fitness and muscle strength before surgery, it can take up to a year to regain full mobility and strength of your hip.
Every surgery comes with risks, such as bleeding and infection, with rarer complications including deep vein thrombosis and pulmonary embolism.
The risk of infection after hip replacement surgery is rare, occurring in less than one in a hundred cases. In most cases of infection, it is superficial and clears after cleaning the wound and completing a course of antibiotics. In rare cases, when a deep infection sets in, further surgery is needed to remove the infected artificial joint and replace it with a new one.
During hip surgery, there is a risk of breaking a bone in the hip joint, and after surgery, there is the chance that one leg may end up slightly different in length to the other leg.
During the first one to two months of your recovery, there is also a 2–3% chance of hip dislocation while your tissues aren’t fully healed. You can minimise this risk by following the advice from your care team during your recovery, especially in the first six weeks. This will include avoiding sitting on low chairs and avoiding any twisting movements.
Hip replacement surgery is very successful, with a failure rate of just one percent per year in the first 15 years after surgery. So, after 10 years, this means around 95% of hip replacements are still working well, reducing to 80–85% after 15–20 years and around 78% after 20–25 years.
You are therefore more likely to need further surgery after a hip replacement if you are younger due to the greater number of years of use after surgery.
In the last 10 years, recovery from hip replacement surgery has considerably improved thanks to a range of measures. This includes helping patients better prepare for surgery, in terms of their fitness and other health issues, and providing better pain management. Getting patients moving sooner after surgery and providing effective education on managing their recovery before they go home has also helped.
The materials used in hip replacement surgery have also improved, with the use of highly cross-linked plastics for sockets, which are more resistant to wear.
At Spire Healthcare, we have also adopted the latest advance in hip replacement surgery, with a number of our hospitals offering Mako. This pioneering robotic technology helps surgeons more precisely place the artificial hip joint during surgery. This reduces complications after surgery, such as dislocation and impingement, and it is hoped will also improve hip function in the long term.
Mr Ahmad Mobeen Ismail is a Consultant Orthopaedic Surgeon at Spire Manchester Hospital, specialising in sports injuries, knee injuries, knee arthroscopy, hip and knee arthritis, and hip and knee replacement. He has further advanced his expertise by visiting centres of excellence in orthopaedic surgery in the US and Europe to learn new techniques. His current interests lie in promoting short-stay hip and knee replacements via minimally-invasive surgery and new techniques for pain control and rehabilitation.