Osteoarthritis of the hip

 Hip pain is often associated with osteoarthritis of the hip joint. Hip replacement surgery is not always necessary! Thanks to Orthokine ® therapy, professional rehabilitation, and ultrasonic precision, it is possible to alleviate hip pain and increase joint mobility. The clinic for regenerative medicine SPORT-MED (Dr Jan Paradowski) also offers stem-cell therapy (MSC - Mesenchymal Stem Cells). The most important thing for every patient is to understand the causes and symptoms of their condition as well as the possible treatment methods. If we find that surgery is necessary, we perform minimally invasive procedures or as a last resort, we choose the right implant. Read the article to find out more about your condition. To find out more about stem-cell therapy, click here

Contents:

1. Hip pain – osteoarthritis of the hip
2. What is the cause of hip pain/osteoarthritis of this joint?
3. What causes hip pain?
4. Symptoms of chronic osteoarthritis of the hip
5. How can osteoarthritis be treated?

Hip pain – osteoarthritis of the hip

The hip joint is the second most likely joint to suffer from osteoarthritis (after the knee joint). The condition affects 25-30% of people aged 45-64, 60% of people over the age of 65 and more than 80% of people over the age of 75. Osteoarthritis of the hip joint is characterised by progressive wearing of the joint cartilage. When the cartilage that protects the bone is worn by joint inflammation, the exposed part of the bone is susceptible to joint injury. 

What is the cause of hip pain/osteoarthritis of this joint?

Osteoarthritis is inextricably linked with wearing of the joint cartilage. Many factors cause the cartilage to wear. The main ones are:

• genetic predisposition – a person's susceptibility to developing arthritis can be inherited from their parents.
• obesity – in this case there are two significant factors: 
  • Too much pressure on the joint due to excessive weight
  • the substances produced by body fat that travel through the blood stream to the joint damage it through biomechanical cellular processes. 
• injury – bruising or breakage of the hip joint that damages joint cartilage or changes the anatomical relations. Unfortunately, we tend to make light of minor injuries that often lead to bruising of the cartilage. It is difficult to diagnose. However, if caught early, it is possible to act accordingly to prevent the cartilage from beginning the long, and often unnoticeable deterioration process leading to irreversible damage. As a result of damaged cartilage, other changes develop that are the symptoms of osteoarthritis. Breakages are often associated with great force, again leading to bruising of the cartilage or anatomical changes to the joint. Incorrect biomechanics cause the cartilage to wear quickly.
• age – degenerative changes of the musculoskeletal system increase with age.
• professional sport, especially when practised incorrectly (unnecessary loads, bad technique when running, hitting a ball with a racket, lack of proper muscle and body regeneration, lack of physical preparation to practise a given sport, improper diet or supplements etc.)
• musculoskeletal imbalance connected with curvature of the spine, spinal disc herniation (slipped disc), a ‘block’ in the sacroiliac joint, abnormalities of the feet etc.
• lack of physical activity – a seated or standing lifestyle causes the muscles and tendons to weaken, which puts too much pressure on the ligaments and leads to improper biomechanics of the joint. Immobility also prevents the cartilage from lubricating, which only works properly when it moves  – see ‘bone cartilage’ article 
• work related strains – improper position at work, immobility (office work) or too much pressure (physical workers)
• hormonal imbalance, e.g. thyroid problems
• rheumatic diseases – intensify the process of inflammation which makes the degenerative joint disease progress quickly

What causes hip pain?

Osteoarthritis is characterised by chronic inflammation which causes continuous and irreparable damage to all the internal structures of the joint (mainly the cartilage) as well as the tissue surrounding the joint (tendons, ligaments – causing contractures that limit the mobility of the joint). Pain is caused by damage to the articular cartilage which subsequently exposes the underside of the bone, which is very sensitive. The cartilage initially becomes soft, which is called chrondomalacia. Tiny cracks form in the cartilage. As a result, the cartilage becomes thinner causing the surfaces to rub together. This eventually leads to full-thickness cartilage loss which causes the bone to be exposed. This is called Grade 4 chondromalacia. 

The damaging inflammatory process of the hip also affects other structures, not just the cartilage:

• the synovial membrane, which in order to protect itself, produces an excess of joint fluid. However, the fluid is inflamed which damages the joint from the inside,
• the ends of the bones become weakened and overused. As a result they become deformed and osteophytes, i.e. bone spurs, begin to form. They can be seen clearly on X-rays and are also visible on ultrasounds,
• the acetabular labrum, the fibrous structure around the socket of the hip joint which improves its stability,
• the joint capsule, which swells and constricts, limiting mobility,
• the ligaments and tendons surrounding the joint contract as a result of limited mobility (sitting or standing at work, not enough intense sporting exercise) or as a result of overuse (professional sport), also cause problems with joint mobility.

Symptoms of chronic osteoarthritis of the hip   

At the beginning, the symptoms are not so intense and are revealed through weakening of the limbs. Next comes hip pain, which gets worse during movement and better (but not necessarily) when resting. Pain is the first and most important symptom for people suffering from osteoarthritis. Symptoms of degenerative joint disease intensify as the condition gets worse.  It is interesting that the symptoms do not always get worse over time. Sometimes, patients have what we call ‘good and bad months’ when the symptoms get better or worse, this can be because of changes in the weather for example. It is important to understand that comparing the symptoms of the disease on the basis of individual moments may not be indicative of the general development of the disease. Imaging techniques such as X-rays and ultrasound can give us a better picture of the development of the disease.

The most common symptoms of osteoarthritis of the hip joint are:

• Hip pain – at the beginning occurring during physical activity, then later also occurring during rest (e.g. sitting in a deep armchair)
• Rigidity, limited mobility of the hips – flexion contracture. Professional rehabilitation that follows protocol specific for the degenerative disease plays an important role here. The doctor and physiotherapist must take into consideration the above-mentioned musculoseletal imbalances. 
• A feeling of paresis when moving.

It is important to begin with physical exams and X-rays to assess the health of patients with degenerative hip diseases. This can be a good reference point to use when assessing later tests and establishing the development of the disease.

How can osteoarthritis be treated?

Luckily, there are many ways to treat osteoarthritis. What is more, the drastic developments made in orthopaedics in recent years have opened up new speculative methods of treating osteoarthritis. More and more we are able to put off or avoid surgical hip replacement altogether by administering modern conservative methods, mainly Orthokine® therapy and growth factors (platelet-rich plasma) - exploiting the natural abilities of the body to slow down the progression of degenerative disease and strengthen bone cartilage. 

Orthokine® Therapy 

Orthokine therapy is the only treatment to be relatively free from side effects and it tackles inflammation just as well as steroid blockers – which has been proven by clinical studies. It acts locally – inside the joint exactly where the inflammation is located. The safe therapy allows for completely natural, biological treatment. The substance is taken from the patient’s own blood. The increased anti-inflammatory proteins block the inflammatory receptor (Interleukin-1), slowing down the degenerative process and alleviating pain. The platelet-rich plasma facilitates the regenerative processes of the articular cartilage. This method is well known and commonly used all over the world, mainly in Germany, Austria, and the USA.

To find out more about Orthokine® therapy, click here. 

Platelet-rich plasma with growth factor injections 

A completely safe, biological therapy that uses a substance taken from the patient’s own blood. It uses the body's natural ability to regenerate tissue and bone cartilage. It belongs to the group of modern treatment methods of osteoarthritis and other diseases which do not cause systemic or local side effects.

To find out more about PRP therapy, click here.

Stem-cell therapy

Dr Jan Paradowski also uses stem-cell therapy to treat hip pain. We are the only centre in Poland to use modern biological therapies in conjunction with mesenchymal stem-cells (MSC), which often allows patients to avoid surgery or function with their own joint for a longer period of time.  If necessary we are also able to perform minimally invasive arthroscopic procedures on the hip in conjunction with stem-cell therapy. We improve mobility and alleviate pain. We restore the ability to perform daily activities. 

Physiotherapy

Loosening contracted muscles and strengthening and stretching the muscles around the hip joint helps to reduce pressure on the joint. Preventing muscular atrophy is an important element of maintaining full hip function. Physical therapy such as TENS nerve stimulation, ultrasound, cryotherapy or iontophoresis is often used in conjunction with the therapy. 

Pharmacology

There are many medications (NSAIDs – non-steriodal anti-inflammatory drugs) that are available on the market that help alleviate pain and treat inflammation. Prescription drugs include diclofenac, ketoprofen – Ketonal, and non-prescription drugs include ibuprofen. They work well to alleviate pain and slow down the degenerative process. A disadvantage of them are the side effects, which can include gastric and duodenal ulcers, bleeding from the gastrointestinal tract, nerve damage and blood clots.  Anti-inflammatory drugs are the main cause of bleeding from the upper gastrointestinal tract in the USA, which can often be fatal. This is why it is important to locally block the inflammation without causing side effects thanks to Orthokine ® therapy. 

Hyaluronic acid joint injections – viscosupplementation.

This involves injecting a solution into the affected joint which increases the viscosity of the joint fluid. It also reduces friction between the surfaces of the articular cartilage which slows down the wearing process. All procedures are done under the guidance of ultrasound which allows us to precisely administer the medication which determines the effectiveness of the therapy.

Steroid joint injections – joint blocks

Steroids are powerful anti-inflammatory drugs, but they also cause many serious side effects. It can cause arthrofibrosis and irreparable damage to the articular cartilage. Systemic side effects include hormonal disturbance, diabetes, and impaired glucose tolerance. Steroid blocks should only be used by people who suffer from severe joint pain and are scheduled to have joint replacement surgery (within a few months). 

Orthopaedic appliances

Specific hips appliances do not play an important role but it is worth thinking about other parts of the musculoskeletal system, e.g. the feet and knees etc. Patients who suffer from an advanced degenerative disease, especially rheumatic diseases, are often given orthopaedic balls that relieve the affected joint when the patient walks.

Hip replacement surgery

Hip replacement surgery has many advantages as well as serious disadvantages. An advantage is that in most cases it restores mobility and alleviates pain. However, it is important to remember that surgery is a last resort for people who suffer from an advanced degenerative disease. An artificial hip will never function as well as your own, even when the surgery is performed successfully by an orthopaedic surgeon. 

Risks of hip replacement surgery include:

- surgical risks: pulmonary embolism and ischemic stroke – which are both life-threatening complications. Risk increases with age and the presence of other internal illnesses: high blood pressure, diabetes, atherosclerosis, kidney failure, circulatory collapse. A very dangerous complication is early postoperative infection. The suppurating bone often causes the body to reject the prosthesis leading to its removal. There are a few surgical solutions to this problem but the consequences are very serious.  

- later risks of allografts: Bone infections around the prosthesis caused by its later rejection, which means it has to be removed and replaced with a temporary prosthesis (called a spacer) or we remove the infected prosthesis and leave the limb without a hip joint (hanging hip procedure).

In summary, surgery should only be a last resort when non-surgical procedures, such as Orthokine® therapy and rehabilitation have been unsuccessful or when the deformation is too advanced. 

To sum up, Orthokine® is the only treatment to be relatively free from side effects and it tackles inflammation just as well as steroid blockers – proven by clinical tests. It acts locally – inside the joint exactly where the inflammation is located. This safety allows for completely natural, biological therapy. The substance is taken from the patient’s own blood. The increased anti-inflammatory proteins block the inflammatory receptor (Interleukin-1), slowing down the degenerative process and alleviating pain. The platelet-rich plasma facilitates the regenerative processes of the articular cartilage. This method is well known and commonly used all over the world, mainly in Germany, Austria, and the USA.