The most common hip arthritis is osteoarthritis. This condition is characterised by progressive loss of the cartilage of the joint. As the cartilage is worn, bone is exposed leading to inflammation and pain. Most hip arthritis occurs in people above the age of 50 years. However, some younger people in their 20s and 30s develop this condition early. In difficult cases, we consider injections for hip arthritis. So, what are your injection options?

Causes

In general, we think there are many potential causes of hip arthritis. First, increased age and weight are the leading causes. Other potential causes include traumatic injuries to the hip joint and abnormally shaped joints such as hip impingement or hip dysplasia. Finally, there may be a genetic influence meaning osteoarthritis runs in the family.

Symptoms 

women with greater trochanteric pain syndrome

Common symptoms include pain in the hip or groin worse in the morning and after activity. In some cases, pain may present in the knee often confusing doctors. Moreover, the hip may feel stiff and lose its mobility. As the disease worsens, people might find they walk with a limp.

It is important to understand that progression is not necessarily steady. In fact, some cases do not progress at all. Moreover, by keeping fit and active, you reduce the chances of progression.

We suggest you see a doctor for a full assessment to rule out other causes of hip and groin pain. Examples of other causes include pain from the lumbar spine, sacroiliac joint degeneration, and hip tendonitis.

In most cases, a plain X-ray of the hip confirms the diagnosis and rules out other diseases. If an X-ray is normal, then other imaging such as MRI might help. However, in most cases, these more expensive tests are not necessary.

Causes of hip arthritis

Overall, there are many causes and risk factors for developing hip arthritis. Some of these causes include:

Treatment 

Overall, treatment of hip arthritis should start with simple steps and then progress to more invasive steps leading up to surgery. Not all these steps will be appropriate for every person. However, you should explore these safer options as many are effective.

  • Weight Loss: Probably the most important treatment but also under-rated. If you lose weight, then you have less load on the hip joint. Also, reducing fat mass decreases inflammation in the joint.
  • Activity modification: In some cases, reducing or stopping activities such as football or running can help manage pain.
  • Exercise: We know that building the strength of the muscles around the hip and pelvis will reduce the load on the diseased hip joint.
  • Improve diet: Not only is a healthy diet conducive to weight loss; but a healthy diet rich in antioxidants will lower inflammation in the body and the joint.

Can I run with hip arthritis?

Generally, we recommend exercise therapy to help symptoms and exercise tolerance. There are over 12 high-level studies that show that a formal exercise program consisting of a combination of aerobic, resistance, and balance training improves hip symptoms.

Occasionally, flare-ups of pain occur within the first 6 weeks of starting a new program. But don’t be put off by episodes of short-lived low-level pain.

Exercises that help hip arthritis include resistance exercises, Yoga, swimming, cycling, and golf.

Similarly, you should think of running like other exercises. We allow running if the pain during or after running is low-level and lasts for less than 24 hours.

More invasive interverventions

Next, more invasive interventions need to be considered if control of pain is not achieved with simple measures.

Injections into the hip joint can improve pain and function. There are a number of options as outlined below.

Surgery is often an option for those people who struggle with pain despite a period of non-invasive treatment. Options for surgery include:

  • Hip arthroscopy: Keyhole surgery is generally NOT recommended for the treatment of hip arthritis. If we do keyhole surgery for hip arthritis, then we know that these people do worse and often go on to replacement surgery earlier than those who do not.
  • Hip resurfacing: Some younger patients are opting for a resurfacing rather than a full replacement. There are advantages to resurfacing including less dislocation risk and an easier revision procedure. However, over 60 years, women and those with inflammatory arthritis should consider a standard hip replacement.

More about injections for hip arthritis

Generally, hip joint infections form a small part of the overall management of hip arthritis. Nevertheless, compared to surgery, injections are less invasive and help a sizeable number of people. So, what are the options?

Cortisone 

Cortisone is a powerful anti-inflammatory that reduces inflammation in a hip joint. However, studies suggest that cortisone provides only a small and short-term effect. In addition, there are increasing concerns that cortisone can worsen arthritis. Overall, it should only be used if hip pain is severe or you need to provide information about the source of pain.

Also, you should be cautious about having a cortisone injection just prior to a hip replacement. Recent research suggests an increased risk of infection if a replacement is done within 6 months of injection. Also, multiple cortisone injections increase this risk more. As infection of a hip replacement can be devastating, we need to be cautious about injecting cortisone just before surgery.

Hyaluronic acid 

Hyaluronic acid is a natural substance in joints, bones, and tendons.

Injecting hyaluronic acid into a diseased joint reduces inflammation and improves the function of the joint. We suspect it works by improving the synovial fluid in the joint. However, unlike cortisone, it is not harmful to the joint surface.

Nevertheless, there is much debate about the usefulness of hyaluronic acid injections for hip arthritis. Recent studies suggest a small effect, which may be no different from other drugs. One reason for the smaller effect is the type of hyaluronic acid used might be important. We think that using a high molecular weight high cross-linked hyaluronic acid is better. An example of a high molecular weight hyaluronic acid is Durolane. A study using Durolane in hip arthritis found excellent results for one injection using ultrasound.

Platelet-rich plasma 

PRP

Platelet-rich plasma or PRP comes from whole blood. The blood is spun in a centrifuge separating the plasma for the red and white cells. This plasma, containing a high concentration of platelets, is injected into the hip joint. We think that PRP works by changing the environment of the hip joint.

While there is good evidence for PRP in knee arthritis, the data is lacking for hip arthritis.

Stem cells 

PRP in knees

Stem cells are the new rage in the musculoskeletal world. We obtain these cells from bone marrow or fat through a short medical procedure. The stem cells are then extracted from other cells and injected into the hip joint. To date, there has been no good evidence to support the use of stem cells for hip arthritis.

Final word from Sportdoctorlondon about injections for hip arthritis

Hip arthritis can be debilitating for most active people. It is important to try simple treatments first. Currently, we recommend at least 3 months of rehab before considering other interventions. Notwithstanding the general lack of evidence, we think a trial of either a hyaluronic acid injection or 1-2 PRP injections would be reasonable. You should speak to your doctor about these options.

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Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

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