Osteoarthritis of the Hip

Osteoarthritis of the hip develops slowly and often involves both sides of the body. Men are more frequently afflicted than women. Osteoarthritis of the hip can cause insidious pain in the groin or inguinal region and, on occasion, pain in the side of the buttock or upper thigh. Often, osteoarthritis of the hip can cause you to walk with a limp. You will find that the pain is aggravated when you are moving, and relieved when you rest. Proper gait training, walking aids, and medication can be very effective in controlling symptoms.
 
What is Osteoarthritis?
Osteoarthritis (OA) is most commonly marked by degeneration of the cartilage, which is the resilient connective tissue that lines the ends of the bones and forms the surface of the joint. Normal cartilage absorbs shock (which might otherwise injure the hard bones) and allows movement of the joints along its smooth, slightly lubricated surface. In addition to cartilage damage, the bone may enlarge (called hypertrophy) at the ends, and there may be some changes in the synovial membrane, a thin tissue that lines the capsule surrounding the joint. Abnormal projections of bone, called osteophytes, may develop as well.
 
The joints most commonly affected by osteoarthritis include knees, the smaller joints of the fingers, the hips, the joints of the big toes, and those of the lower part of the spine. Osteoarthritic involvement of the wrists, elbows or shoulders is rare, except after severe injury. The degeneration of the joint may occur as a result of injury or trauma to the joint, rheumatoid arthritis, occupational overuse, obesity, or metabolic diseases.
 
OA is the most common form of arthritis. It may first appear without symptoms between 20 and 30 years of age and is present in almost everyone by the age of 70. Symptoms generally appear in middle age. Both men and women are equally affected by osteoarthritis, which is also called degenerative joint disease (DJD). However, under age 45, the prevalence of osteoarthritis is greater among men, where over age 55, the prevalence is greater for women. Approximately 40 out of 100 people are affected.
 
Symptoms:

• Gradual and subtle onset of deep aching joint pain
• Worse after exercise or weight bearing
• Often relieved by rest
• Limited movement
• Grating of the joint with movement
• Painful bony growths in the joints
• Pain often centered in the groin
  NOTE: There may be no symptoms.

Treatment:
A treatment program should have the following goals: easing pain and discomfort, reducing or preventing disability, and helping you continue your usual activities as independently as possible. Most doctors begin by recommending a combination of medicine plus exercise and rest. Medicine can be very helpful in reducing pain. If you can move without pain, or with less pain, you will be able to keep moving better and longer.
 
Regular exercise helps strengthen the muscles that support the joints. The stronger those muscles are, the more comfortable you will be. Rest is also necessary, to relax the muscles and to keep you from overusing painful joints. With rested muscles, you can exercise better, too. Therefore, a good balance of exercise and rest is needed.
 
Your particular treatment program will also depend on which and how many of your joints are affected, how far the disease has progressed, and what you want to do and can do. Your program will be individualized — that is, tailored specifically for you. It may not be the same as someone else’s. You and your doctor will work together at finding the right combination for you, so be sure to say something if you think any part of the plan is not helping. Changes can be made. You may want help from others, too, such as a nurse or physical therapist. Talk about these possibilities with your doctor.
 
First line treatment includes modification of activity and use of an anti-inflammatory medicine. Sensitivity of the stomach and intestines many times makes prolonged use of the anti-imflammatory medicines difficult. When the condition becomes particularly severe, then surgery is indicated. The most common procedure is Total Hip Replacement which aims at resurfacing both the cup (acetabulum) and ball (femoral head) surfaces. A frequent misconception of patients is that they are too old for this type of surgery since it is extensive. However, the vast majority of patients undergoing hip replacement surgery are easily within the retirement age group and usually do excellently.

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