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How to Survive Hip Arthritis by Dr. Derek Ochiai

The most common form of arthritis in the hip is osteoarthritis, the “wear-and-tear” arthritis that damages cartilage over time and can cause painful symptoms in those starting middle age.

Hip arthritis is typically felt in the groin thigh or buttocks, not where you would think you would have pain.

Is hip arthritis degenerative and what are the long term treatments or surgical options?  When should you see a specialist?

We had an opportunity to speak to Dr. Derek Ochiai, board certified orthopaedic surgeon and sports medicine expert in Arlington, VA, about all things related to hips – from aging to sports injury.

The conversation that we had we Dr. Ochiai follows ..

What are the common signs of hip arthritis?

One of the first signs is STIFFNESS. Things like putting on socks or getting into a car become more difficult. Another is PAIN. Hip arthritis pain is usually in the front of the hip (like where a front jeans pocket would be). As arthritis progresses, LIMPING becomes more frequent and more noticeable.

What are the primary causes behind hip arthritis?

One cause of hip arthritis is aging. Articular cartilage is not meant to last forever. Even a thousand years ago, average life expectancy was around 40 years old, so there has been no evolutionary pressure for cartilage to last past that long. The cartilage starts to get thinner, which puts more pressure on the remaining cartilage, and then that can wear out too.

Another cause of hip arthritis is FEMOROACETABULAR IMPINGEMENT (FAI). This is an important cause, because if this is recognized and treated, hip arthritis progression can be delayed. Typical patients with FAI may have the same presenting symptoms as listed above (hip stiffness, groin pain, etc) but they do not have arthritis. They have a shape of their bone that causes increased pressure in their hip, and this abnormal shape can be treated with hip arthroscopy (cameras and small instruments inside the hip joint).

How do you diagnose that it is hip arthritis?

Initial diagnosis starts with the patient’s history and physical examination. Some questions typically asked:  How long has the pain been going on? What positions are most painful (typically with hip arthritis, sitting for long periods of time is painful). Where is the location of pain?

On physical exam, the clinician will check for decreased range of motion, especially compared to the other side.

X-rays are typically diagnostic, as they show decreased joint space and possibly arthritic spurs (bone spurs).

MRI is rarely necessary for diagnosis.

Is hip arthritis degenerative?

Hip arthritis usually progresses, but the RATE of progression can be influenced by treatment. One of the best treatments is weight loss. Weight loss decreases the pressure that the hip joint experiences, and can make the hip last longer.

What are the long term treatments or surgical options?

There are several treatments for hip arthritis. Weight loss and activity modification can lessen pressure on the hip joint. Physical therapy (and home exercises) can help with some of the symptoms of arthritis. Cortisone injections can help alleviate pain. Ultimately, hip replacement (when necessary) can be curative.

What are the exercises or diets for people suffering from hip arthritis?

Exercises that focus on core/gluteal strengthening is the most beneficial for decreasing symptoms. Moderate aerobic exercise can help with weight loss.

Is walking helpful for hip arthritis?

YES, moderate walking is good for hip arthritis, as it can help with weight loss.

DO’s & DON’Ts in hip arthritis ..

I tell my patients that ANY EXERCISE or activity that doesn’t cause sharp pain is great to do.

When should you seriously consider hip replacement?

There are reasonable benchmarks, like the patient cannot walk a city block without stopping because of pain. They cannot sit for more than 30 minutes at a time. They have to use a cane to walk comfortably. Beyond that, if you’re having anterior hip pain and stiffness, you should really talk to an orthopaedic surgeon, to see what your options are. As stated above, if the pain is from FAI, then there is a possibility of minimally invasive treatment such that hip replacement may not be necessary in the future.

I hope you found these information useful. If you want to know anything else, you may ask us in the comments below.

You may also reach out to Dr. Ochiai directly through his website or by following him on Twitter @DrDerekOchiai

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