Hip Arthritis

Hip arthritis is the degeneration of cartilage at the hip joint.
The cartilage forms a lubricated, low friction articulation that allows the bones to move inside the socket joint.
When cartilage is damaged or lost, the bones rub against each other, causing pain, pressure and swelling (inflammation) and limiting your ability to move freely.
Arthritis is one of the most common causes of hip pain.
Arthritis is a progressive disease that usually starts gradually and worsens over time. The oldest person who Dr Markham has ever operated on and with great success was for a hip replacement of a 107 year old patient.

There are five main types of pathologies that most commonly affect the hip:

• Osteoarthritis (includes post-traumatic arthritis)
• Rheumatoid arthritis
• Seronegative spondyloarthopathies (includes Ankylosing spondylitis, Psoriatic arthritis, Systemic lupus erythematosus)
• Avascular Necrosis
• Fractures that can compromise the hip blood supply

The causes of hip arthritis vary depending on the type.
The most common reason is wear and tear of the hip joint due to age.

The osteoarthritis burden in Australia is growing,1 partly because of population growth, population ageing, and high rates of obesity and sports‐related knee injuries.2
Joint replacement is an effective treatment for people with advanced osteoarthritis; the number of procedures performed in Australia increased markedly during 2003–2019, and is projected to rise further.
In 2022, osteoarthritis: prevalence increased substantially with increasing age, from 10% among people aged 45–54, to 30% of those aged 75 and over; was more common among females compared with males (10% and 6.1%, respectively).
A developmental hip deformity, known as a CAM lesion, can lead to tears in the cartilaginous labrum in the hip joint. This may require surgery, time off sport and lead to early hip arthritis.
Some professional footballers have had to undergo hip replacement in their 40s – much earlier than the general population.
“Hips arthritis that is untreated can be devastating on quality of life,” says Dr Philip Markham, Specialist Joint Surgeon from SJS Orthopaedics.
“Pain at night can lead to a lack of sleep, poor mobility and limping during the day, difficulty with flexibility and even interference with intimacy and sexual activity too,” he says.

• Symptoms of hip arthritis may include pain located at the groin, side or back of the hip joint
• Stiffness, clicking noises when moving the hip, and weakness.
• Pain that usually is initially worse in the morning or after inactivity and lessens with activity (but then deteriorates again after prolonged activity)
• Difficulty walking or limping
• Pain that gets worse with intense or prolonged activity
• Stiffness or limited range of motion in the hip
• If your hip is severely affected, walking, standing or bending may become more difficult.

• Osteoarthritis pain in the hip can appear gradually over months or years. However, pain can also be caused by a recent injury.
• You may find that the pain symptoms come and go.
• The pain is usually in the lower back, hips and groin.
• Some people also feel discomfort from the top of the thigh to the knee.
• This can be referred to as referred pain or radiating pain.

• Your medical history, including where you feel pain and whether you sometimes limp.
• Physical examination, especially to check hip mobility
• Radiographs or X-rays to determine if there are any abnormalities in the joints
• Blood tests to identify antibodies that may be associated with specific types of arthritis (only if needed).

Depending on the severity of the arthritis and the patient’s age, there are various treatment options for hip arthritis.
Treatments include non-surgical or surgical, or a combination of both.

Non-surgical treatments:

• Regular exercise to strengthen the muscles around the hip
• Losing weight to reduce stress on the hip joint
• Changing your activities to avoid stress on the hip
• Walking with assistive devices
• Medications to control inflammation

Surgical treatments:

• Hip replacement
• Hip realignment surgery has a limited role in paediatric patients with developmental hip abnormailities
• Hip arthroscopy has no role in treating established hip osteoarthritis

• Stem cell injections for hip arthritis are an experimental technique.
• When stem cells are injected into arthritic hips, it’s thought they may induce regeneration and healing of damaged cartilage.
• Autologous conditioning serum (ACS) is a treatment that may improve the condition of osteoarthritis (OA).
• “Although these treatments are promising, they are still largely experimental,” says Dr Markham who does not offer the novel treatments within his practice.
• “Arthritis Australia’s position statement is that stem cell therapies may pose serious risk to health including ectopic tissue formation (growth of body tissue in the wrong place, infection and allergies.”