(Keywords: hip arthritis, osteoarthritis, chiropractic, Femoro Acetabular Impingement Syndrome, Developmental Hip Dysplasia )
Osteoarthritis is wear-and-tear within joints, and is the most common type of arthritis of the hip. The protective cartilage over both the ball and the socket, known as the acetabulum, the roof covering the ball of the hip, is progressively worn away, leaving the bare bone exposed within the joint.
So, who is prone to hip arthritis? There are a number of conditions that predispose one to getting hip arthritis. Like a short leg, or an old injury, say in a car accident.
There's always the possibility of getting an infection in the hip, like TB and there are several hereditary conditions that make one prone.
The good news is that there's much to be done. If you start taking evasive action early enough.
Osteoarthritis typically affects patients over 50 years of age, although it can and does start in younger people too, particularly if they are obese or have certain genetic conditions that make them predisposed. For example,
1. Femoro Acetabular Impingement Syndrome
FAIS is almost certainly genetic, as siblings are more than twice as likely to have the condition, but trauma could play a part. The very sporty child... ballet, yoga, gymnastics, football... Extra bone is laid down in and around the hip in the young person. The key early sign is stiffness, without pain in the young hip, and of course continuing progressively and relentlessly as we age, if nothing is done.
Can your teenager pull his knee all the way to the chest? If he pulls the knee towards the opposite shoulder, is there pain in the groin or hip?
Routinely now I examine every hip, as much can be done to treat this not uncommon condition, and prevent hip arthritis. An ounce of prevention ...
It is imperative - for many reasons - that we do not allow the growing child to also become obese. The prevalence of painful degenerative osteoarthritis in the hip then becomes much, much higher.
FAIS comes in two forms: Pincer and CAM
The other form of FAIS is the CAM deformity - a bump on the neck of the hip. It tends to rip into the labrum of the hip causing pain in the groin. Sometimes in the clinic we find a mixed hypermobility with a CAM deformity - the result is pain in the groin or side of the hip.
Untreated and carefully managed the likelihood of hip arthritis increases greatly. Aggrating factors are a short leg, as in this case file... Hypermobile hip dysplasia CAM FAIS
2. Developmental Hip Dysplasia (DDH)
Whereas Femoro Acetabular Impingement Syndrome refers to too much coverage of the ball of the hip, in Developmental Hip Dysplasia you have too little coverage.
The end result is much the same. Both lead to Hip Arthritis if the conditions are not detected early and carefully managed. Inter alia this means that the sports of choice are cycling and swimming, as long distance running and hiking, ballet and heavy athletics will just give way to injury, pain and ultimately a Hip Replacement.
The child with hip dysplasia who also has the yen to run is a problem. A good friend of mine, at 54 is in a wheelchair much of the time, or walks with two crutches, and is on daily morphine. He's had his third hip operation now, and the surgeons say they can do no more. He was very sporty as a child ... why didn't somebody warn his parents?
Moderate and severe cases will subluxate and dislocate from birth and so DDH is normally detected by the conscientious pediatrician. Your chiropractor too, if s/he treats Colic Chiropractic may do some of these tests: Hip Dysplasia Ortholani Galeazzi ...
3. Mixed FAIS DDH
Very occasionally both Femoro Acetabular Impingement Syndrome (which typically causes stiffness) and Developmental Dysplasia of the Hip (INCREASED range of motion, just the opposite of FAIS) may coexist in the same hip.
The symptoms are the same: pain in the groin, often spreading down the front of the thigh towards the knee. There may be increased or decreased range of movement.
Mixed FAIS DDH gives a
higher chance of getting hip arthrtis, but this is not necessarily so.
What is vital to distinguish between these true hip conditions, and
those such as Meralgia Paresthetica and Maignes syndrome that cause
REFERRED pain from the back. Operating on the spine of a patient with
Mixed FAIS DDH is doomed to failure. Read on...
MIXED FAIS DDH ...
4. Slipped Capital Femoral Epiphysis ...
Another important condition which occurs predominantly in young girls (5:1) is the Slipped Capital Femoral Epiphysis (SCFE) syndrome. Unless carefully managed it leads inevitably to debilitating early osteoarthritis. Catching it early is essential, which is what chiropractors are trained to do.
SCFE usually presents with pain in the thigh and knee, typically in a young obese teenager. Delay in the diagnosis leads to an ever increasing slip of the growing end-plate of the hipbone, and high risk of morbidity. It occurs in roughly 1/ 1000 children, but eight times higher in obese adolescents.
Your child has groin, thigh, knee pain? Don't buy into the 'growing pains' myth. Get him/ her to a skilled musculo-skeletal therapist. Early diagnosis is essential, as the results of surgery for severe slips are not good:
Long-term follow-up study of one hundred and twenty-one patients with SCFE.
Boyer DW; Mickelson MR; Ponseti IV
J Bone Joint Surg Am 1981 Jan;63(1):85-95.
We evaluated 121 patients who had had slipped capital femoral epiphysis twenty-one to forty-seven years after the diagnosis was made.
The results were very good in most of the eighty-three hips with the slip left unreduced.
Fifty-four hips that were treated by procedures designed to improve the alignment of the slipped femoral head had more complications and less favorable results , but in general, these were the more severe slips.
However, there were enough slips of comparable severity that were treated unreduced to suggest that the long-term results, even in moderate and severe slips, were better after in situ fixation than after operative and manipulative treatment (as performed between 1915 and 1952). Twelve of the thirteen hips with acute slips were reduced (the thirteenth was one of the eighty-three unreduced hips) and aseptic necrosis developed in three, while nine had good results.
Certainly what is vital is that the child with hip/ groin/ upper thigh/ knee pain has an X-ray to establish the diagnosis, getting all weight off the hip with the use of crutches, and cessation of all sport. Otherwise... severe, early hip arthritis.
5. A Short Leg: LEG LENGTH INEQUALITY
Research has now proved that a short leg is one of the causes of hip and knee arthritis. Scientists speculate that mechanical factors, including joint instability and malalignment from a short leg, contribute to the progressive degeneration of the hip and knee cartilage.
Tip Whilst a simple heel lift to correct a leg length inequality is important, depending on the scoliosis caused by the short leg, this has to fitted by an expert. We of course recommend your chiropractor!
Health is additive. A transverse position in utero causing a hip dysplasia, plus a short leg leads inexorably to hip arthritis.
HIP DYSPLASIA CaseFile ...
Effect of glucosamine sulfate on hip osteoarthritis:a randomized trial. The effectiveness of glucosamine sulfateas a symptom and disease modifier for osteoarthritis is still under debate.
OBJECTIVE: To assess whether glucosamine sulfate has an effect on the symptoms and structural progression of hip osteoarthritis during 2 years of treatment.
INTERVENTION: 2 years of treatment with 1500 mg of oral glucosamine sulfate or placebo once daily.
6. Perthes Disease
Never neglect the limping child, mostly in the 5-12 age bracket. The first sign of Perthes disease is pain in the hip, and a marked limp. Remember, Growing Pains is a non-existent mythical disease. Never dismiss your child’s hip or groin pain as ‘growing pains’ – prompt and correct management of Perthes is absolutely essential to prevent devastating early hip arthritis. Ignore your limping child and you may be condemning him or her to a nightmare of early hip arthritis. Early as in thirty odd.
I have two patients who had undiagnosed Perthes disease in the hip as children. Both have had multiple hip replacements, the first before thirty. Both are now fifty odd, the one permanently on crutches, the other in a wheel chair.
The limping child. Take note! And, "growing pains" is a euphemism for "I don't know." It doesn't exist.
NB. Your child may present with KNEE pain. Always ask about the hip.
Other factors that can contribute to developing hip arthritis include traumatic injuries to the hip and pelvis, as in serious falls and motor vehicle accidents.
It's dangerous getting out of bed in the morning! However, even more people die in bed! Seriously though, most falls in the home occur in the bathroom and on the stairs. (See our newsletters for extensive coverage of safety in the bathroom and on the stairs - sign up at the bottom of the page.)
FROM THE COAL FACE
'Doctor, my neighbour has twisted my arm into coming to see you. I'm afraid I don't think you can help, but I'm desperate.'
'Tell me about your problem, Mr S.' Mr S was a 75 year old man. He walked with a slight limp, but it was not that obvious. He used no stick.
'I can't walk. I get pain spreading down the front of my thigh towards the knee. It started about 20 years ago, but is now getting much worse.'
'Have you seen your doctor?'
'Yes. He sent me to a neurologist who says that I have lumbar stenosis which is causing the pain in the leg. He wants me to have an operation. He says nothing else will help.'
'Well, let's examine you, and see what we can find.'
'Is there any point? How can you open up the canal when it's too small and tight for the nerves.'
'First an examination, Mr S. Then the diagnosis and thoughts about treatment.'
Mr S did indeed have lumbar stenosis - but that wasn't the cause of the pain in his leg. A two minute examination revealed very limited flexion, adduction and internal rotation of the hip. Both he and I were astonished just how much chiropractic could help his condition. Within a few months he could sleep through the night without pain and walk for half an hour. It gave him a new lease of life.
The neurologist hadn't
examined his hip, and made assumptions and presumptions. Which made an ass of him! Am I an ass occasionally? Absolutely, there is no doctor who isn't. Indeed, there are plenty of neurologists, chiropractors, surgeons who graduated in the bottom half of the class! 50% of us! Luckily I can claim to be an "upper 50%er!" Not top 10%er though!
* Flattening of the head of the hip bone.
* Loss of the joint space.
* Sclerosis - white bone being laid down.
* Cysts forming in both the head and/or the acetabulum.
Cysts within the ball of the hip? Nope, one of the most beautiful photos taken from the Hubble telescope of the halo of light around a star in the Milky Way. It's been called Starry Night , so named because it reminded astronomers of the Van Gogh painting.
What is the treatment for hip arthritis?
"Hi, I'm a 52 yr old female diagnosed with severe osteoarthritis of the hip last year. I first realised all was not well last year when, after bathing I attempted to stand upright with feet together and noticed that my right knee protruded a fair way. The medical treatment i have received to date has been very lacking and I've been very unimpressed.
It was recommended to me by a good friend to see her chiropractor and I readily agreed as I was in a lot of pain with a very pronounced limp. And after only a couple of sessions, the pain and the limp are virtually gone. I now only attend on a as and when basis and the relief is almost immediate. i cannot thank my chiropractor enough for the help and advice he has given me.i dread to think what sort of condition I would be in by now had i not consulted him. i have found your website invaluable for information on my affliction. Many thanks.
I have no regrets: I am brutal in the practice. Every obese person needs to be told clearly, very clearly, at least once, that obesity WILL, INEVITABLY, WILLY-NILLY lead to severe disability and pain in older age, and often starting much sooner. Thereafter I hold my tongue. I too have my vices ... for which I too will pay!
Find me an obese seventy
year-old not suffering from disabling hip, knee or ankle arthritis. Not
too mention high blood pressure, diabetes ... Weight loss can be
achieved, it much be achieved - or face the consequences. It can be
FREE WEIGHT LOSS PROGRAMS >>
It's all about
Right Choices ...
For a simple three minute test of fitness ,
click here: KASCH PULSE RECOVERY TEST >>
For more information on NSAIDs click here ANTI INFLAMMATORY DRUGS >>
Never, ever take two anti-inflammatories simultaneously. Like aspirin and Ibuprofen.
NEVER! Read more: DUAL ANTIINFLAMMATORY DRUGS ...
Complications of hip surgery
Total hip replacement is of course major surgery. Apart from the dangers of the anaesthetic all the risks that pertain to major surgery are relevant. In the main the risk of a embolism to lung, heart or brain.
Added to that is the risk of prosthesis failure. In 2011 DePuy Orthopaedics voluntarily recalled their total hip replacement orthotic and their hip resurfacing orthotic. Described as the Rolls Royce of hip implants it soon became evident that the hip failure rate was unacceptably high at 12%.
May, 2013: Du Puy is facing at least 6,000 lawsuits in the USA, over a 1,000 in the UK and 170 from South African alone.
"I now suffer chronic pain in my pelvis and stomach since hip replacement surgery in January 2011. I was a very active person... now I'm forced to take anti inflammatory drugs for the rest of my life."
Sarna Coetzee (after a DePuy hip implant was fitted.)
In short, if your hip is "a bit stiff" take it now, today, to your Chiropractor. Start to exercise it EVERY day, make the changes recommended on this page and Lady Luck will be given a big helping hand and perhaps you can avoid Hip Arthritis and major hip surgery. Do it!
It's been proved that exercise class benefits arthritis ... EXERCISE CLASS BENEFITS ARTHRITIS ...
Osteoarthritis is a disease of hyaline cartilage, the very hard super-smooth lining of the bones in a joint. It is a vulnerable tissue as, unlike bone itself and muscle for example, cartilage has no blood supply of its own. It's dependent on movement of the joint, and a healthy supply of certain substances and oxygen in the fluid swishing about in the joint.
Many foods have been scientifically proved to help, and I list only four here. A chicken bones extract that you can easily make at home; a fish bouillon which you can read about at our How much fish oil page; interesting facts about strawberries (it's spring in Holland and we've just enjoyed the first fruits of the harvest, guaranteed to reduce arthritis, improve your eyesight, reduce cancer...!); growing butternut squash ...
IMPORTANT CONSIDERATIONS @ HIP ARTHRITIS
Orthopaedic surgeon, Jonathan Cluett, states that stopping smoking before hip arthritis surgery is a must. It is generally recognised that smoking is one of the prime reasons for a poor outcome from all surgery - simply too little oxygen for the tissues to heal.
I was yesterday consulted with a new patient with severe low back and leg pain. He is now having difficulty urinating, and can't lift his heel from the ground. The first surgery was a botch, the second much better and for a month he had much less pain. But nobody warned him to stop smoking (so he says anyway), and now it's a real mess. With inadequate oxygen those tissues never had the chance to heal properly. He's looking to chiropractic for a miracle. Those we do at once, the impossible takes a little longer!
I've spelt it out to him: Stop smoking or I won't accept you as a patient, because we won't win. We may not anyway.
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Have a problem that's not getting better? Looking for a different slant on your pain? Pose a question ...
Your own unresolved problem. Pose a question ....
Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no X-rays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.