Osteoarthritis

Osteoarthritis is the most common type of arthritis, affecting 8.5 million people in the UK. It develops gradually over time, causing joints to become stiff and painful.

Osteoarthritis can affect any joint but commonly affects the knees, hips, hands, feet and spine.

With osteoarthritis of the hip you're likely to have pain mainly in the front of your groin, but sometimes around the side and front of your thigh, buttock or down to your knee.

What is Osteoarthritis?

The bony surfaces of a joint are covered with smooth cartilage that allows the bones to move smoothly over each other.

A joint also contains a small amount of fluid (synovial fluid) that helps lubricate the joint (like oil in an engine).

In joints with osteoarthritis, the joint cartilage does not regenerate in its usual manner. The bone tissue next to the cartilage can also be affected and extra bone growth can develop around the joint edges. These extra bony areas are called osteophytes and may be seen on X-rays.

The joints and the tissues around the joints can also become inflamed. This inflammation is called synovitis.

Osteoarthritis can remain very stable and not change over many years. For some people it can progress but predicting this is very difficult.

Factors that may play a role in the development of osteoarthritis include:

• Obesity - Osteoarthritis is more likely to develop, or be more severe, in overweight people. This is thought to be linked to the inflammatory processes caused by being overweight and not just due to the extra load carried through the joints.
• Age - Osteoarthritis becomes more common with increasing age. Its is much less common in younger populations.
• Genetics - There may be some inherited tendency for osteoarthritis to develop in some people but we still do not have clear answers to what triggers these genes in some people but not others.
• Gender - Unfortunately women are more likely to develop osteoarthritis than men.
• Old injury - Previous damage or deformity, for example this may include previous joint infection, a previous fracture (break in the bone) around a joint, or problems from the way your hip developed as a child can increase the risk of having arthritis.

What are the symptoms of osteoarthritis of the hip?

• Pain - Particularly in the groin but sometimes around the side and front of your thigh, buttock or down to your knee.
• Stiffness - Limitation in full movement of the joint is typical. The stiffness is usually worse first thing in the morning but tends to loosen up after half an hour or so. You may also have difficulty in putting on shoes and socks and getting in and out of a car.
• Weakness - Pain can prevent muscles working well and eventually make them weak. This can make you more vulnerable.
• Poor mobility - Problems walking, including a limp and the overall distance you can manage.
• Poor sleep - Generally your symptoms may affect your ability to work and carry out tasks around the home.

In women, restricted movement of the hip can make having sex difficult and painful.

Some people may get down or even depressed because of their pain and other symptoms.

In some cases no, or only very mild symptoms may occur even when X-ray changes indicate some degree of osteoarthritis.

The opposite can also be true. That is, you may have quite severe symptoms but with only minor changes seen on the X-ray.

Do I need any tests?

An X-ray is commonly done to confirm the presence of osteoarthritis in the hip and assess its severity but is not essential for a working diagnosis. Conservative treatment can start without an X-Ray so imaging is not always needed. As mentioned above, the images do not always match the clinical picture so the main focus is on how it feels to you.

How can I prevent osteoarthritis of the hip?

• A healthy active lifestyle will help minimize the chances of developing osteoarthritis.
• Avoiding being overweight will also reduce your chances of getting arthritis (of the hip but elsewhere too).
• Keeping active will maintain strong muscles around the joint to support and the joint and will help maintain joint mobility.

General measures to help treat osteoarthritis

Exercise

If possible, exercise regularly. This helps to strengthen the muscles around affected joints, to keep you fit, keep your weight healthy, and to maintain a good range joint movement. Watch the videos at the bottom of this page for advice on exercises that can help with hip pain.

A lot of people find swimming is ideal as it is not weight bearing but any exercise is better than none.

Many people can manage a regular walk.

Weight control

If you are overweight, try to lose some weight. Even a modest weight loss can make quite a difference. This is a self referral team that may be able to help on this front (https://www.livelightersheffield.com/)

Shoe insoles

Cushioning or supportive insoles can help towards pain relief in some cases.

Walking aids

If you have osteoarthritis of your hip or knee, when walking, try using a walking stick or poles. Hold it in the hand on the opposite side of the body to the affected joint. This can help to ease symptoms in some cases and if it enables you to do more activity then it is worth trying.

Physiotherapy

Sometimes advice or treatment from a physiotherapist can be helpful. This can be accessed via your GP practice.

Simple painkillers

Over the counter pain relief may be beneficial. Check with your Pharmacist or GP if you are unsure whether over the counter pain relief is suitable for you.

Other therapies

Some people have found that transcutaneous electrical nerve stimulator (TENS) machines help to ease pain from osteoarthritis but collectively the research does not lend enough support to this to enable it via the NHS.

Similarly, acupuncture may also help some people but is not available on the NHS for hip pains as not enough benefit above placebo has been shown.

Surgery for osteoarthritis

Many people with osteoarthritis do not have it badly enough to require surgery.

However, osteoarthritis of a joint may become severe in some cases. Hips can be replaced with artificial joints of which there are numerous kinds.

Hip replacement surgery has become a standard treatment for severe osteoarthritis. However, like any operation, joint replacement surgery is not without risk.

If you think your hip pain is severe enough that you would consider surgery then discuss this with your GP practice.

Exercise videos

Summary

Posterior pelvic tilt

Bridging

Side lying exercises

Stretches

Summary