Osteoarthritis of the Hip: What You Need to Know

Osteoarthritis (OA) of the hip is one of the most common forms of arthritis. This condition can cause pain and stiffness that present challenges to simple routines, from putting on shoes to getting out of a car, and may limit more active pursuits. Treatments can keep pain in check, lessen the impact on daily life, and help you stay active.

In this article, Jeffrey K. Lange, MD, a Mass General Brigham orthopaedic surgeon, reviews a range of treatment options for hip pain. Dr. Lange treats patients at Brigham and Women’s Hospital, Brigham and Women’s Faulkner Hospital, and various outpatient locations. 

What causes osteoarthritis of the hip?

Hip arthritis occurs when cartilage in the hip joint wears away, leaving less protection for the bones, which may become damaged. Bone-on-bone rubbing can result in pain around the hip joint. Why comparable activities lead to cartilage breakdown in one person and not another is still not fully understood. But many paths can lead to the same result:

• Traumatic injury. Cartilage and other hip joint structures that are damaged (by an accident or sports injury) may lead to additional degeneration.
• Genetics. Osteoarthritis seems to run in families.
• Extra weight. The stress of carrying extra weight on joints exacerbates wear and tear.

It’s possible to preserve hip health, even once degeneration begins. Here’s how:

• Switch from high impact sports (running or tennis) to ones that put less stress on hips (cycling or swimming).
• Lose extra weight to reduce pressure on joints.
• Fully address any injuries when they occur.

First steps in osteoarthritis treatment

If you have hip or groin pain, or joint stiffness, contact your primary care provider (PCP). They can check for other conditions, including rheumatoid arthritis (RA), a different type of arthritis with roots in the immune system that affects the whole body.

If arthritis causes symptoms, your next visit may be with an orthopaedic surgeon to evaluate your condition and decide on next steps. These early treatment options may help keep you active and comfortable:

• Exercises or physical therapy to strengthen hip and leg muscles and improve flexibility and range of motion
• Medication. Your surgeon may recommend over-the-counter pain relievers like NSAIDS (nonsteroidal anti-inflammatory drugs, such as naproxen and ibuprofen) or prescription medications.
• Injections of corticosteroids and other therapeutics

For some patients, hip replacement surgery can be delayed by procedures that preserve the hip joint, including:

• Arthroscopy: Surgeons make a small incision and use tiny cameras and small instruments to repair hip abnormalities that contribute to wear and tear.
• Surgery around the hip (osteotomy): Surgeons reshape bones to address problems in bone anatomy that contribute to wear and tear, while preserving the hip’s general structure.

Hip replacement surgery for osteoarthritis

If you and your doctor decide that a total hip replacement is your best option, you are in good company. And success is high: Most people who have total hip replacement experience satisfactory relief. Over 90 percent will not need further treatment in the 10 years after surgery.

“Hip replacement is one of the real triumphs of recent medical history because patients generally do so well,” says Dr. Lange. The basic principles of hip replacement surgery have remained relatively unchanged, though with some modifications, in recent years. But each year of experience has shown how to improve results, including faster recovery.

“In our latest iteration, it’s not the technology or the technique that’s so different,” said Dr. Lange. “It’s our ability to get people moving afterward.”

Although symptoms tend to worsen with time, you needn’t rush into surgery. “I tell patients to really maximize their non-operative therapies first,” Dr. Lange said.

Getting the best results from hip replacement surgery

Patients who ultimately need total hip replacement benefit from years of experience and success in hip replacement, also called hip arthroplasty. The procedure removes damaged bone from the hip socket and the femoral head and replaces it with new joint surfaces (made of metal, plastic, or ceramic). A range of options relate to the location and size of the incision and other aspects of the surgery.

Patients can now optimize their health before and after surgery with prehab and control pain following surgery. Both approaches help patients get on their feet and out of the hospital faster. They can return to activities that had been limited by arthritis.

Optimizing health before hip replacement surgery

According to Dr. Lange, the goal of pre-surgery preparation is to address patients’ overall health. This includes control of diabetes and blood pressure, good nutrition, and possible use of vitamin D supplements (all with a doctor’s guidance), plus whatever muscle conditioning is possible.

“The common thought is that if someone is better conditioned both medically and physically, they will have a better outcome, and clinical studies are demonstrating this again and again,” said Dr. Lange.

Dr. Lange and colleagues also recommend that patients get all the right support in place before surgery. This might include arranging adequate aid at home for after surgery, choosing a physical therapist if needed, and making needed changes to the home (such as having proper handrails on stairs and in bathrooms).

With all these elements in place, recovery and rehabilitation can move along smoothly.

Hip replacement recovery

Advances in pain control after surgery enable physical therapy to begin just a few hours later. Beyond the physical benefit is the emotional boost of feeling less like a patient and more like a person who is on the way to resuming activity.

This is a major change from a decade ago, when hip replacement patients entered the hospital on a Monday and often stayed multiple days. “Now many people can go home the day after surgery,” said Dr. Lange. “We regularly start physical therapy in the hospital the same day as the surgery. You might be walking a mile in a few weeks.”

Once you and your doctor agree that total hip replacement surgery is your best option, it is reassuring to know that you have leeway in deciding when to have the operation. And you have time to make sure you are in good condition for surgery.

“This is not an emergency. Osteoarthritis of the hip is limiting potentially, but it is not a dangerous condition. For as long as you are comfortable, it’s a win for you not to have surgery,” Dr. Lange said. “But if you need surgery, the hip replacement is a tried-and-true surgery. It can really help you improve pain, function, and quality of life.”