What is Arthritis?

Arthritis is when a damaged joint produces pain. 

Most joints in the body are synovial joints - where 2 bones whose ends are covered in cartilage. Usually, the joint is held together by ligaments and its capsule. The capsule is lined with a synovial membrane.  This membrane produces synovial fluid to keep the cartilage alive and healthy. 

The cartilage can be damaged by infection, inflammation ,abnormal forces such as trauma, cancer, radiation, or general wear and tear.

Joint cartilage helps cushion and spread forces, as well as provide almost frictionless movement.  Without cartilage, the bone ends cannot cope with day to day forces

The below images represent a joint. The one on the left is normal with healthy cartilage capping the bone end. The middle picture represents early arthritis where the cartilage is thinning, and bone is exposed.  The right hand picture shows more severe arthritis, with the 2 bone ends contacting each-other with no bone in-between. Bone spurs have grown to limit movement in the damaged joint.  The bone has started to fail, and a cyst is growing. This cyst is not cancerous, but usually contains fat.

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Bone

Healthy cartilage

Bone grinding on bone

Exposed bone

Bone spur

Thin cartilage

Cyst

What's happening in my hip?
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OA tear.png

Bone Spurs

Labrum

Torn labrum

Damaged cartilage

The hip on the left is a normal hip.  You can see the end of the femur is covered in healthy cartilage. The labrum (In yellow) is a ring of cartilage that surrounds the acetabulum, and on the left, it is smooth and healthy.

On the right hand side there is osteoarthritis.  The cartilage on the femur is damaged. There are bone spurs (osteophytes) on both the femoral and acetabular side of the joint. the labrum is torn.

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This X-ray image shows arthritis.

 

X-rays show bones, but soft tissues such as cartilage cannot be seen. 

 

When you compare the two hips, you can see that there is a gap between the femur and acetabulum on the left hip (the one on the right hand side of the image). This gap represents cartilage.

On the right side, the cartilage has completely worn away, and there is no gap visible.

How does arthritis affect me?

The main problems with hip arthritis are pain and stiffness

Pain

Hip arthritis is usually felt in the groin.  Patients sometimes feel that they are suffering from a groin strain that they can't get rid of.  The pain can radiate down into the knee or even into the calf.  It can be a dull ache that gradually gets worse.  The pain can be made worse with movement , feeling like a pinching pain in the groin.  The hip pain usually gets worse over time. It can be intermittent, and most patients report good days and bad days.

Stiffness.

As the joint damage progresses, the body tries to limit the movement.  Hip rotation is often one of the first movements to go, then it usually flexion becomes limited.  People experience difficulty cutting their toenails,  doing their shoes up,  and then putting socks on.

Sometimes there is little pain, and mainly stiffness, and at other times pain is the only feature.

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How can arthritis be treated?

It is impossible to reverse the cartilage damage.    People have tried all sorts of techniques to rebuild cartilage, but they do not seem to provide a good long term solution for most people. Sometimes, cartilage can be patched - see hip arthroscopy page.

The treatment for arthritis symptoms is like a step ladder.

The first step or rung, is usually without surgery.

 

Simple pain killers such as paracetamol or ibuprofen if you can tolerate it.  Physical therapy and regular exercise - especially low impact,  and can help.

Weight loss can be really useful if you are overweight.

Shoewear -  damaged cartilage finds impact difficult.  You can reduce impact by wearing shoewear that reduces the shock of your heel striking the floor.  Good examples include inserting a Gel insole into your shoes, or wearing a gel running shoe.

Behaviour Modification- Try to avoid the activity that produces the pain.  Sometimes this is relatively easy, and sometimes impossible.

More information can be found here

https://www.nhs.uk/conditions/osteoarthritis/

Ladder Against Blue Wall

Do Supplements Work?

A healthy diet and lifestyle are very important in reducing symptoms .  There has been controversy about Glucosamine and Chondroitin. Initial studies showed that they did not work, but there is growing evidence to show that they decrease symptoms, and may slow arthritis down

https://pubmed.ncbi.nlm.nih.gov/30982220/

Most studies show that a high daily dose of Glucosamine of 1500mg per day work the best for most people, especially if it is combied with Chondroitin. Anecdotally, I have found many patients get benefit from these supplements.

NICE do not support the use of supplements.

Other supplements which some people have found useful include Omega 3 oils, Selenium and Turmeric.

Pills

What is the place for hip injections in osteoarthritis?

A cortico-steroid can be injected into the hip, which may give some temporary relief.  The amount of time that it works can vary - from a few weeks up to a few months. Unlike a knee or shoulder injection, hips are a deeper structure, and more difficult to get into.

Complications of injections include,

Skin discolouration  / fat atrophy where the needle enters

Steroid flare - about 1 in 5 patients get pain in the joint for up to 24 hours This happens quickly after the injection. If this happens, you need to rest, keep well hydrated and take pain relief

A joint injections - this hapens to between 1 in 8,000 to 1 in 15,000 patients.  It usually happens around day 9 to 11 following the injection.  Patients usually develop high fevers, and severe pain in the joint.  If this happens, you need to go to a hospital as soon as possible.

Allergic reactions - Very rare

Steroids can also increase the risk of developing an infection in a hip replacement

Usually, osteoarthritis will progress, and symptoms get worse.  It is then a matter of putting up with the pain and stiffness, or undergoing hip replacement surgery.