HIP ARTHRITIS

aka OSTEOARTHRITIS

Osteoarthritis is a wear-and-tear type of arthritis. It is the most common type of hip arthritis. The protective cartilage in both the socket, known as the acetabulum, and the ball of the hip is progressively worn away, leaving the bare bone exposed within the joint.

Who develops hip arthritis?

Another genetic condition is Perthe’s disease which effects children mostly in the 5-12 age bracket. Never dismiss your child’s hip or groin pain as ‘growing pains’ – prompt and correct management of Perthe’s is absolutely essential to prevent devastating early hip arthritis.

Weight loss in the obese helps reduce the pain of this degenerative condition, and reduces the progressive nature of the condition.

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.

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. Prevention is the key, which is what sports minded chiropractors are trained to do.

SCFE usually presents with pain in the lower thigh and knee, typically in a young teenager, 12-14, who is obese. Delay in the diagnosis leads to an ever increasing slip, and high risk of morbidity. It occurs in roughly 1/ 1000 children, but significantly higher (8x) 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 is not good:

Slipped capital femoral epiphysis. Long-term follow-up study of one hundred and twenty-one patients.

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 (149 involved hips) 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.

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 sacro-iliac joint 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.

FROM THE COAL FACE

'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.

X-ray

* 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 the acetabulum.

What is the treatment for hip arthritis?

• Weight Loss is the most important first step. 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 kilograms of butter off. It can be done. The less weight the joint has to carry, the less pain you will have.

• 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.

• Walking is always good, but obviously the distance and terrein will be limited by how advanced the arthritis is. For a simple three minute test of fitness, click here.

• Use of a stick in the hand opposite to the affected hip reduces the demand placed on the arthritic 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.

• Mobilisation of the hip by you the patient on a daily basis is extremely important. It reduces the stiffness, and helps 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. An 8 foot, blue nylon belt used to mobilise the joints of the body. For more information on the Mulligan belt click here.
  
  
• Specific stretches and strengthening exercises are vital.

• 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.

For more information about hip replacements.
For more about the danger of developing Alzheimers after surgery click here.

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