Could your hip pain be due to arthritis?

Do you suffer from:

• A limited range of motion in your hips?
• Hip pain when performing your normal activities?
• Stiffness in your hips?

If you answered “yes” to any of these questions—especially if you are over age 50 or have had a traumatic hip injury—you could have hip arthritis.

Many people with hip arthritis find that their symptoms don't always progress steadily. You might have good days and bad days. Perhaps this is why hip arthritis is not often diagnosed early.

“Most patients with hip arthritis present when they're at a fairly advanced stage when there are relatively few things that can be done—unlike knees, where we can often detect arthritis early,” says Daniel Zanotti, MD

Dr. Daniel Zanotti answers questions about hip arthritis

Does hip arthritis affect just older adults?

“No. We see patients of all ages with hip arthritis.

• There are congenital or birth issues that can lead to hip arthritis in 20- and 30-year-olds.
• There's a condition called avascular necrosis, where the ball of the hip joint starts to deteriorate over time. That can be caused by multiple factors such as excessive drinking or chronic steroid use—for example, among asthma patients.

“However, most hip arthritis patients are over age 50 with osteoarthritis caused by normal wear and tear.”

Can a hip injury lead to arthritis?

“Yes. Hip arthritis can also be caused by trauma. People in any age group who have suffered hip injuries in car accidents, for example, are at a higher risk for developing post-traumatic arthritis.”

Are runners more prone to hip arthritis?

“We haven't really found an association between excessive running and hip arthritis. Runners are slightly more prone to knee arthritis than anything else.

Are some people genetically predisposed to hip arthritis?

“Hip arthritis seems to be more genetically related, although there isn't a direct genetic cause. There appears to be a pre-disposition to it in some families.”

What makes hip arthritis a challenge to treat?

“Hip arthritis is difficult to treat because:

• There are fewer treatment options—mainly anti-inflammatory medications, hip resurfacing or total hip replacement to replace the ball and socket. That's very different than knees, where we have different types of injections, braces and inserts that we can offer.
• It's hard to brace or put any apparatus on your hip—those things don't work very well, as opposed to a knee brace that can provide good relief.
• The hip is a very difficult joint to inject. There's not much space in it, like there is in the knee, so cortisone injections are often not an option, either.”

Is surgery always necessary in treating hip arthritis?

“No. We try to treat people in a conservative manner. If you can avoid surgery, it's always the best thing. Even the best hip replacement has a finite life span and can wear out over time.”

Can physical therapy help relieve hip arthritis?

“Physical therapy can be helpful—any time you can strengthen the muscles around the pelvis or the hip, it does seem to help a little bit, but it generally doesn't provide lasting pain relief.”

When do you recommend surgery for hip arthritis?

“We try to keep our hip arthritis patients as functional as possible, but when their hip pain makes them unable to do the things they need to do, they become candidates for hip surgery.”

Does hip surgery always involve total hip replacement?

“No. The Center for Orthopedics is one of only a few orthopedic practices in the U.S. to offer hip resurfacing

What is hip resurfacing?

“Hip resurfacing is a groundbreaking procedure that relieves hip pain by reshaping the head of the thighbone or femur and ‘resurfacing’ it with a metal cap—much like capping a tooth—rather than removing and replacing it as in hip replacement surgery.”

What are the options for hip replacement?

“If you aren't a candidate for hip resurfacing, hip replacement can help you get back to living a normal life. Today's hip replacements are made of various materials, including metal, ceramic and plastic.”

What are the components of a replacement hip?

“The hip is a ball-and-socket joint. Traditionally, a hip replacement involved a metal ball, a metal socket and a plastic spacer in between. This is still the most common method and it's extremely successful. But the plastic wears down over time and can cause some erosion in the bone as well.

“Newer techniques with ceramic eliminate the plastic piece—so it's a ceramic ball, sometimes with a plastic cup. Other times, the cup is ceramic. And with a metal-on-metal hip replacement, there's a metal ball and a metal socket with no plastic in between.

“The goal with the newer hip replacement techniques is to eliminate the plastic spacer which has traditionally been shown to wear out over time.”

What are the advantages and disadvantages of metal hip replacements?

“Metal hips are very nice because you can put a very large ball in with a smaller metal socket, and mechanically, that has a much smaller chance of dislocating.

“However, there have been some studies showing that metal particles can wear off over time and can cause some increased levels in the bloodstream that may be harmful in pregnant women and other groups of people. But in general, metal-on-metal hips wear more slowly and have a lower dislocation rate than other options.”

What are the pluses and minuses of ceramic hip replacements?

“Ceramic materials are extremely hard, so they wear down much less than other types of surfaces. But sometimes the harder the material, the more prone it is to crack or break. One of the criticisms of ceramic hips is that they're actually more likely to break—and you can develop squeaking in your hip.”