Non-Surgical Treatments
Many patients with hip joint arthritis benefit from treatment without surgery. Non-surgical treatments may reduce pain and improve function, delaying or removing the need for surgery. For this reason, I strongly recommend patients with hip arthritis trial non-surgical treatments before considering an operation.
It should be noted however that most types of arthritis are permanent and progressive. While non-surgical treatments may assist in improving your symptoms, the condition will remain. If your symptoms are persistent and problematic despite adequate non-surgical treatment then an operation may provide better symptom relief.
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RECOMMENDED NON-OPERATIVE TREATMENTS FOR HIP ARTHRITIS
Weight Loss
Weight loss decreases the force placed through the joint and often results in a significant improvement in symptoms. Professional advice will often help - speak with your General Practitioner or weight loss centre.
Activity Modification
Regular exercise is important to improve muscle condition and also for general health, however impact activity often causes worsening of arthritis symptoms. Exercises which are often well tolerated by patients with hip arthritis include swimming, cycling, aqua-aerobics and walking. A walking stick (used in the opposite hand to your arthritic hip) often makes walking more comfortable.
Medications
What medications are most effective in the treatment of arthritis differs between patients. Often a combination of medications taken together is the most effective strategy. Some patients get worsening of pain at certain times during the day or at night - taking your medications around these times is recommended. Some medications (paracetamol, glucosamine) are best taken on a regular basis while others (anti-inflammatory medications, pain killers) should be used for only a short duration of time to treat 'flare-ups'. Patients with inflammatory types of arthritis (for example rheumatoid arthritis) are referred to a rheumatologist for specialist advice on the specific medications used to treat these conditions.
Paracetamol
Paracetamol usually needs to be taken a number of times during the day for best effect. Longer acting preparations for use in arthritic conditions (eg. Panadol Osteo) are available from your pharmacy without presecription.
Glucosamine
Reasonable evidence supports the use of glucosamine sulfate in the treatment of osteoarthritis, particularly in the early stages. The dose needs to be 1500-2000mg per day on a regular basis. Many different preparations of glucosamine are available - check the strength and type of glucosamine carefully before you buy. There is greater evidence supporting the use of glucoamine sulphate than glucosamine hydrochloride. Glucosamine sulphate should not be taken by patients with a seafood or sulphur allergy or mothers who are pregnant or breast feeding. Chondroitin is sometimes added to glucosamine preparations, however generally these preparations are more expensive and at present there is limited evidence supporting the additional use of chondroitin.
Fish Oil/ Krill Oil
Have mild anti-inflammatory activity by mechanisms alternative to prescription anti-inflammatory agents. Benefits have not been clearly proven for the management of hip arthritis however fish oil is generally safe and may have other health benefits.
Anti-inflammatory medications (eg Ibuprofen, Naprosyn, Celebrex) - "NSAIDS"
Anti-inflammatory medications are effective in reducing the symptoms of osteoarthritis, but may cause side effects such as stomach erosions, particularly when taken for extended durations. Other side effects may also include worsening of asthma or kidney troubles. For this reason, I would generally recommend anti-inflammatory medications are used for shorter durations of time, for the management of 'flare-ups'. If you have tried one type of anti-inflammatory medication but it was not helpful, trying a different preparation may still be worthwhile. Some types of anti-inflammatory medications are available as once a day (one tablet) preparation. Some anti-inflammatory medications require presecription however a variety of different types are also available over the counter.
Pain Killers (eg Panadiene Forte, Codiene, Tramadol, Morphine)
Recommended for limited periods of use only. If your pain is severe enough to require strong pain killers on a regular basis, then surgery should be considered.
Therapeutic Steroid Injections
Anti-inflammatory steroid injections into the hip joint may provide temporary improvement in symptoms. Injections into the hip joint need to be conducted with either X-Ray or ultrasound guidance. Usually a combination of anti-inflammatory steroid and local anaesthetic is used and may provide partial symptom relief for 4-6 months. Steroid injections are safe, but marginally increase the risk of infection if a joint replacement procedure is conducted shortly afterwards.
Visco-supplementation Injections
Synvisc is an injectable medication which improves the quality of the natural joint lubricant (synovial fluid) in the face of athritis. Injections into the hip joint need to be conducted with either X-Ray or ultrasound guidance. A single hip injection provides on average a 30% reduction in pain for 6 - 12 months. A present Synvisc is not listed on the Australian PBS (Pharmaceutical Benefits Scheme) which means that patients bear the full cost of the medication without government assistance. Some health care funds may provide assistance depending on your extras cover.
Physiotherapy
Physiotherapy is of significant value in the treatment of some hip disorders. For patients with moderate or advanced hip arthritis, physiotherapy is may assist in strengthening and endurance of the surrounding muscles which support the joint.
This information has been written by Dr Patrick Weinrauch for the purposes of patient education. The details provided are of general nature only and do not substitute for professional recommendations based an individual clinical assessment.
