The hips don’t lie

There comes a point when even the strongest over-the-counter painkillers are no longer touching that nagging pain in your hip. Your favourite sport or activity leaves you in agony, or worse, you are limping and having difficulty sleeping.

If this is the case, it is time to visit the GP. Stronger analgesics may be prescribed and advice given (see below) or you may be referred for a formal assessment. For many, the advice they receive could be enough, but for those whose quality of life is being severely affected, a hip replacement might be the answer.

Hip pain

There are multiple causes of hip pain, from an infection to a problem with the bony structure of the joint or cartilage, fractures or even tumours.

For many people, osteoarthritis is the problem. This develops in joints that are injured by repeated overuse from performing a particular task, playing a favourite sport or from carrying around excess body weight. As well as pain in the hip, it can cause pain in the groin, thigh, knee and even radiate to the shin.

People will feel stiff, have difficulty climbing stairs, getting in and out of the car or bending to tie their shoelaces. They may also develop a limp.

Often the pain is worse after activity, but a severely arthritic hip will be painful all the time, disturbing sleep patterns and leading to exhaustion, irritability and poor performance at work.  

Red flags: If there is sudden, severe and unremitting pain from the hip, especially accompanied by weight loss, loss of appetite, a temperature and night sweats, see your GP urgently to rule out a fracture, infection or tumour.

What to expect from the GP visit

A GP may prescribe stronger pharmacy-only painkillers and ask you to keep a diary of symptoms to see what relieves or exacerbates the pain. Advice on moderating the amount of high impact sport will be given as this could make the hip joint deteriorate quicker.

Weight loss could also be recommended as up to four times the body weight goes through the hip joint with walking. And you will be advised to stop smoking - tobacco impairs the delivery of oxygen rich blood to bones and tissues.

You might also be referred to a musculoskeletal service run by physiotherapists for a formal assessment.

The assessment

A thorough examination to define the source of the pain will be carried out and could include investigative X-rays. If the hip is not sufficiently arthritic to require surgery, you will be given a programme of exercise, with advice on smoking and weight reduction (if necessary) and encouraged to use a stick in the opposite hand, especially when walking outdoors.

Those with progressive symptoms of arthritis will be referred to a consultant to be assessed for a hip replacement.

The operation

Before the operation, patients can enrol in a 'joint school' where they will be given advice on the operation and what to expect, how they can help themselves before the operation and how they can aid their own recovery afterwards. 

A physiotherapist will teach exercises that you can begin before you are admitted to hospital. This will start to prepare your muscles and soft tissues to receive your new hip replacement and also give you the confidence to start them as quickly as possible after your operation.

The better the muscle strength before surgery, the better and quicker the recovery.

Getting back to normal

The average length of stay in hospital after a hip operation is two to five days and you will be encouraged to walk with crutches soon after surgery. You will be discharged from hospital with two sticks.

At two to three weeks you could progress to one stick.

Around six weeks most patients can return to driving and to gentle daily duties.

Getting back to sporting activity will depend on the patient, but in general, by two months you could be gardening, bending and kneeling, swimming, cycling, running and playing golf. Skiers should wait at least six months before heading to the slopes, and only then on the advice of their consultant. However, there is no guarantee that you will return to your sporting peak, but seeking early help will ensure you don’t miss out on your favourite activity for too long.

Advice from Mr Khalid Drabu and Mr Benedict Rogers, Orthopaedic Consultant Surgeons of Spire Gatwick Park’s new Hip Service. Enquiries can be made by contacting Spire Gatwick Park Hospital on 01293 778 906.