In this, the second blog in a series about hip pain and osteoarthritis, Mr Simon Newman discusses non-operative strategies for hip arthritis.
“I’ve got arthritis in my hip but I don’t want an operation – what are my options?”
If you have an arthritic hip, hopefully this question has crossed your mind before signing up for a hip replacement. For a variety of reasons, a hip replacement may not be right for you at the moment. For some, the arthritis is at a stage where the pain and movement restriction is not too problematic, for others surgery may not be convenient or some just simply do not want to have an operation. So, what are your options?
A warmer climate is known to help alleviate arthritis symptoms, unfortunately for most of us relocating to the Caribbean or Mediterranean is not a realistic option. Fortunately, there are still lots of things you can do to help cope with or reduce your hip arthritis symptoms.
Keeping active is really important, exercise such as cycling or swimming has been shown to help reduce the symptoms of even severe hip arthritis. It can be painful to start with, but if you persevere then real benefits can be achieved. If you enjoy walking, then using a stick or walking poles can help you cover more ground with less discomfort. The input of a physiotherapist or osteopath can be helpful in improving your strength and mobility.
Losing weight is probably the most important lifestyle change you can make. However, as this author can testify, achieving and maintaining weight loss is difficult. It can surprise people that exercise is of relatively little importance in losing weight, diet is by far the main issue. Joining an organisation such as Slimming World (www.slimmingworld.co.uk) or WeightWatchers (www.weightwatchers.com) can be the most effective way of achieving the desired weight loss.
Dietary supplements are heavily marketed at people with arthritis. Common ones, and certainly not an exhaustive list include: chondroitin, glucosamine, cod liver oil and turmeric. There is relatively little strong research evidence for most of these supplements, but in most cases they are safe to take, though they can have side effects – for example turmeric is a blood thinner and supplements should be stopped two weeks before surgical procedures. It is worth discussing any supplement you are considering taking with your GP or a surgeon.
Sleep disturbance is a common issue for people with arthritis. To minimise the impact of your arthritis try and get into a good routine at bedtime. Avoid drinking, especially alcohol, in the hours before you go to bed, avoid watching screens just before and whilst in bed, time your painkillers so you take a dose 20-30 minutes before you go to bed and consider sleeping with a pillow between your legs.
What is the best painkiller for arthritis? Paracetamol is the first line painkiller as it is generally safe for most people, though many find it is not terribly effective at relieving arthritis pain. Non-steroidal anti-inflammatory medications like ibuprofen or naproxen are more effective, though carry more side effects in particular irritating the stomach lining or impairing kidney function so if you are taking them regularly this should be with the guidance of your GP. Opiate painkillers like codeine, morphine or tramadol have been used for arthritis pain, though their effectiveness is short lived and they are very addictive. Consequently we now avoid the regular use of these medications in managing arthritis.
Injections may be a good option for some people, these can be performed using x-ray or ultrasound to guide the needle into the hip joint. Most injections are a mixture of local anaesthetic and steroid, the steroid reduces inflammation and can help with pain. How long the injection produces pain relief is unpredictable and may vary from weeks to several months. Steroid injections are relatively safe, though there are small risks of infection, facial flushing and softening of the bone in the hip, so it is not advisable to have injections too often.
There are various other substances that are being offered for injection into the hip, these include hyaluronic acid, stem cells and platelet rich plasma (PRP). Research has suggested that hyaluronic acid does not appear to be particularly effective in hip arthritis. Some studies have shown improvement in symptoms for around 6 months by using PRP when compared to hyaluronic acid in hip arthritis. There is currently no quality clinical evidence for the use of stem cell injections in hip arthritis.