Hip Arthritis

Keywords; hip arthritis, osteoarthritis, Femoro Acetabular Impingement Syndrome, Developmental Hip Dysplasia

This is a long page; it's a complex subject and I won't insult by a few platitudes about how much chiropractic can help. If you don't have the time right now, rather come back later. If you have significant hip and groin pain, then make the time. Degenerative changes in the lower limb aren't just painful; they're also disabling and that's even worse.

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 to the degenerative changes found in the hip, and seen almost daily at the chiropractic coalface.

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.


The frustrating part is that sometimes this degenerative change in the hip starts in young people for no obvious reason. They don't have a short leg, nor are they overweight. Currently their diet is fine, though one has no idea of what they were fed on as children, or whether changing from breast milk to formula too soon could have been the cause.

Childhood trauma is lost in the mists of time, but they don't have one of the genetic conditions like hip dysplasia. Perhaps exposure to chemicals, either plant toxins like pesticides on food, certain prescription drugs or even the fun drugs that young people are fain to experiment with these days.

I think vaccination is an unlikely cause, as most of the children are vaccinated and don't have this unexplained, premature degenerative change in the hip that some young people get.

It's probably totally fanciful, an anecdote, but I've noted that folk with tattoos, particularly those with huge sharp claws, pincers and daggers seem to get pain in the area. I've seen no research, so best forget that.

But there are certainly conditions, that certainly predispose one to hip arthritis


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 ...


Glucosamine Sulphate

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.

CONCLUSION: Glucosamine sulfate was no better than placebo in reducing symptoms and progression of hip osteoarthritis. International Standard Randomised Controlled Trial Number: ISRCTN54513166


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.

7. Trauma

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.)

What are the common symptoms of hip arthritis?


  • Pain and stiffness , particularly in the groin, with activities such as walking. A limp is common.
  • Flexion of the hip (pulling the knee to the chest, and particularly towards the opposite shoulder becomes stiff.) Try pulling first one knee to the chest, and then the other. Are they equal? Now rotate the hip. Still the same? Another movement that is lost, but one which is difficult for the patient to detect, is internal rotation.
  • Disabling pain in the sacroiliac joint ANATOMY is often a major feature of the condition. Even more than the pain in the groin, it is the fixation in the SI joint that may lead to disabling pain hip and thigh pain.
  • Vague ache referring down the front of the leg towards the knee. Often misdiagnosed as a knee problem, but in fact is actually a referred pain from the hip.


Chiropractic Help

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, sir. He was a seventy five 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 twenty years ago, but it's 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. My own doctor wants me to have a hip replacement operation. He thinks 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? He was a regular doubting Thomas.

First let's have an examination and only then the diagnosis and thoughts about treatment.


He 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. His own house doctor was more knowledgeable than the neurosurgeon; or, perhaps the latter could only see the dollar signs. 

Both the patient 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 one occasionally? Absolutely, there is no doctor who isn't. Indeed, there are plenty of neurologists, chiropractors and surgeons who graduated in the bottom half of the class. Fifty percent of us. Luckily I can claim to be an upper fifty but not in the top ten though.

One of the important sayings in healthcare is, remember the patient can have two diseases. He did, one in his back and one in his hip.

The decision whether to have a total hip replacement or not is not easy. The cost is enormous, and perhaps you don't have insurance, so it's out of the question, anyway. Perhaps you have had prior issues with an anaesthetic, or high blood pressure, or simply your gut feel that it's not for you.

Chiropractic may well be part of the solution, and I have had very few patients over the years who have not responded at all to chiropractic, but the progress is likely to be limited depending on how advanced your hip arthritis is. If obese you will certainly have to lose weight and you will have to look to your diet.

The alternative is a disabling and painful hip.


X-ray


Notice:

* 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.

J


  • Weight Loss is the most important first step in the treatment of hip arthritis. Significant weight loss will save many patients from the knife. While weight loss is never easy, the inevitable deterioration and pain, loss of independence, and threat of surgery should motivate you to get the extra kilograms of butter off. It can be done. Weight loss in the obese helps reduce not only the pain of this degenerative condition, but it reduces the progressive nature of knee arthritis too. Consider our free Weight Loss Programs. They work!
  • 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 done! FREE WEIGHT LOSS PROGRAMS >>

  • Accept that activities that cause pain should be limited. This is perhaps easy for the older person, but in young people, not being to dance, or jog is difficult. The alternative sadly is an early hip replacement.
  • It's all about Right Choices ...

  • Cycling and aquacise are good options for hip arthritis, knee arthritis too: Knee arthritis and exercises ...
  • Walking is always good, but obviously the distance and terrein will be limited by how advanced your hip arthritis is. Walking benefits ...
  • For a simple three minute test of fitness , click here: KASCH PULSE RECOVERY TEST >>

  • Use of a stick in the hand opposite to the affected hip reduces the demand placed on the hip arthritis joint.
  • Chiropractic treatment of the sacro-iliac joints, best done using a ‘Thompson Drop technique’ can make a very significant difference. The usual side-posture chiropractic techniques have to be modified. Report immediately if your chiropractor's treatment gives sharp stabs of pain in the groin.
  • Read more: SACROILIAC JOINT TREATMENT …

  • Mobilisation of the hip by YOU the patient on a daily basis is extremely important. It reduces the stiffness, and helps increase the flow of nutrients into the joint, and removes toxic waste products that build up in the joint.
  • Your chiropractor should do cross friction of the joint capsule and surrounding muscles, in particular the Adductor magnus. It will be painful.
  • Mobilising using a Mulligan Mobilisation belt is also very beneficial for hip arthritis.
  • Specific stretches and strengthening exercises are vital in the management of hip arthritis. Hip exercises ...
  • Chicken bones broth is better still for the inflammatory hip conditions.
  • Non-steroidal Anti-Inflammatory Drugs (NSAIDs) are commonly prescribed for hip arthritis. They have a place but used on a long term basis have serious side effects for the stomach, heart, kidneys and liver.

  • 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 ...

  • Surgery for hip arthritis sometimes simply cannot be avoided. Done by an expert surgeon many people’s life styles have been dramatically improved. Just look at the fabulous Tom Watson! It is of course major surgery, and the risk of a fatty embolus to the heart, lungs and brain as well as the risk of dementia should the anaesthetic not go well, all must be weighed.

• For more medical information about HipReplacement ...

• For more about the danger of developing " Anaesthetic Alzheimers " disease after surgery, click here: ANAESTHETIC ALZHEIMERS



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.)



PREVENTION

It's been proved that exercise class benefits arthritis; exercise class benefits arthritis is now beyond debate.

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 progressive hip arthritis and major hip surgery. Do it.

Does diet have a place in the management of hip 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 totally dependent on movement of the joint for a healthy supply of certain nutrients and oxygen in the fluid swishing about in the joint.

Even if you have normal movement of the joint, if the diet does not contain those necessary nutrients, and adequate oxygen, or is high in inflammatory dietary foods, then you may still get arthritis in the joints.

Smoking of course limits the oxygen in the blood stream by about 20 percent, and thus every tissue in the body.


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 unexpectedly include arthritis prevention; it's spring in Holland and we've just enjoyed the first fruits of the harvest, guaranteed to reduce degenerative joint disease, and also improve your eyesight, and reduce cancer; and freshly ground flax seed is the richest vegetable source of omega three.

One food has been proved to promote arthritis, but only if it's found in excess. Polyunsaturated fatty acids are part of the essential diet. You can't live without them.

But if your diet has too many polyunsaturates, raising the omega 6 to 3 ratio, then it becomes strongly inflammatory in joints, muscles, blood vessels and organs.

The solution is to eat some seed oils, especially cold extracted if you can find them, but most of your vegetable oil should come from the olive which is very low in polyunsaturated fatty acids.

There is growing interest in the role of capsaicin, the heat in chilis, as an a natural anti inflammatory and painkiller. Jalapenos are my favourite; they have many other beneficial properties incidently.

A few jalapeno plants, covered with their bright red fruit, will provoke interest and discussion in any flower bed. Read more at anti inflammatory chili.


IMPORTANT CONSIDERATIONS @ HIP ARTHRITIS

Smoking

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; there's 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 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.


On the lighter side of hip arthritis

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Interesting challenges of the day

1. Mrs D, a 78 year old woman has very severe sacroiliac joint pain, and even more severe cramps in her right leg. There are two problems; she is on two diuretics but no slow K. Taking her temporarily off one diuretic and adjusting the SIJ brought 50 percent relief within four days. 

2. Mr S, a 48 year old man, has right low back pain, groin pain and a numb feeling in his lower leg when he sports. For six months he's been off football. He too has two problems; a very treatable lumbar facet syndrome and a very serious blocked artery in the groin; it's called intermittent claudication. Smokers beware.  

3. Mr S looks like the leaning tower of Pisa; he has a slipped disc at L5 making him lean towards the opposite side. It's called the postero lateral disc hernia; we'll fix it, but he has to stop for a week or two. Antalgias are serious so take them seriously. 

4. Mrs V too has  two conditions; a chronic low grade sciatica giving her an ache in the right leg, and a threatening Morton's neuroma. She's glad I'm back in Holland; chiropractic fixed it before, and we'll fix it again. 

5. Mrs W is one of the lucky ones, says her doctor. I agree. He says only 40% of patients with lumbar stenosis have a successful operation. We fixed a nasty slipped disc three years ago, but it came back two years later; the surgeon did a fine job but she has a weak ankle now giving her subtalar joint pain; it's routine stuff. 

6. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment of the new strain by my colleague has fixed the pain in the lower back, but there's some residual numbness in the lower leg; no soaring tomorrow alas.

7. This lady is a 86 year old woman with a 63 scoliosis. Chronic lower back has been her lot in life but she's well pleased with chiropractic and comes for chiropractic help once a month; some conditions you can never cure.

8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.

9. A 61 year old man with upper cervical pain yesterday; it's not severe but also not getting better of its own accord. He's afraid it may turn very acute as when I treated him three years ago. Since then it's been fine. 

10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.

13. Mrs B has had one of the nastiest of conditions; vertigo caused by a disturbance in the inner ear. Falling repeatedly and vomiting she consulted her doctor but medication didn't help. After two sessions of the Epley manoeuvres she was 50 percent better. After two weeks 75 percent improved. No longer vomiting all falling. She's not enjoying the Brandt Daroff home exercises.

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?


Interesting questions from visitors

CLS writes:

Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

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 xrays, 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.


You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.