Hip osteoarthritis
How does hip osteoarthritis develop?
Hip osteoarthritis, also known as coxarthrosis, occurs when the joint cartilage is worn down faster by the actual load than it can genetically withstand. This imbalance between the load-bearing capacity of the cartilage and the actual load causes the cartilage to wear down continuously.
This actual load is increased by obesity, accidents, congenital malalignment (hip dysplasia), sports or occupations that emphasise the joints and natural ageing (loss of elasticity and water storage of the cartilage) and thus promotes cartilage loss, i.e. osteoarthritis.
The wear and tear of the cartilage is called osteoarthritis. We distinguish between different stages of osteoarthritis (cartilage damage). Damage to the joint cartilage can occur superficially in the form of small cracks, but can also affect the entire cartilage in the hip joint. This results in the rough, painful surface of the bone.
Cartilage damage is divided into four stages:
(from left to right)
Stage/Grade I: Soft cartilage
Stage/Grade II: Rough surface with cracks
Stage/Grade III: Deep cracks in the cartilage that extend to the bone
Stage/grade IV: Complete consumption of the cartilage with exposed bone; this is also referred to as bony baldness
A special feature of cartilage is that, unlike bone, it has no pain fibres (nerves) and so damage to the cartilage is only perceived when it reaches the bone.
Find out more about osteoarthritis here.
What symptoms can hip osteoarthritis cause?
Hip osteoarthritis can manifest itself differently in each person. Most sufferers experience different types of hip joint pain (initial pain, pain on exertion, inflammatory pain) and limited hip mobility.
How is hip osteoarthritis diagnosed?
Severe hip joint pain, a restriction of hip mobility and increasing gait instability and thus increasing risk of falling must be carefully investigated. After asking the patient personally when and how the pain occurs, a comprehensive clinical examination of the hip joint is carried out to assess and localise pain, movement restrictions, leg length discrepancy and muscle strength.
This is followed by a radiological examination of the hip joint. If anything is unclear, an MRI (magnetic resonance imaging) can also be carried out in order to better assess the cartilage situation in the hip joint.
Once all examinations have been completed, the results are discussed in detail with the patient and possible therapies (conservative or surgical) are explained and further steps are finally decided.
How is hip osteoarthritis treated?
Interview with Dr Oberholzer
Conservative treatment methods
Alternative treatments for hip osteoarthritis
- Anti-inflammatory and pain-relieving medication
- Medication and substances (dietary supplements) for strengthening cartilage
- Medical training therapy/physiotherapy
- Injections into the joint with lubricants (hyaluronic acid) and anti-inflammatory medication (cortisone)
- Aids such as walking sticks, insoles, health shoes
- Changes in lifestyle with regard to sport, obesity, diet, etc.
These measures can reduce pain and slow down the progression of cartilage wear and tear. Unfortunately, osteoarthritis itself cannot be stopped or cured.
Here you will find a detailed overview of all the conservative methods recommended and offered by PD Dr Andreas L. Oberholzer at our specialist centre.
Surgical treatment methods
If the hip problems persist despite these conservative measures and the quality of life decreases accordingly, it is time to consider a hip joint replacement (artificial hip joint).
Thanks to the muscle-sparing, minimally invasive surgical method, the new artificial hip joint is inserted from the front in a tissue-sparing manner. The stabilising hip muscles are only pushed to the side and not partially severed as in the past.
This procedure has the advantage that there is less pain, less blood loss and faster convalescence is possible. As a result, the quality of life can be improved immediately.
Interview with Mr Eggensperger (former patient) about his hip operation
Frequently asked questions
What restrictions are common?
The main symptoms are pain and restricted movement as well as gait instability with a corresponding risk of falling. The pain can occur during exertion, at rest or during movement and is typically undulating in intensity. The pain-free intervals become shorter as the osteoarthritis progresses. In addition, there is inflammation of the hip joint with swelling of the affected joint, restriction of movement and shortening of the muscles as well as deformation of the joints with increasing misalignment and even the inability to walk. Mobility in the hip joint decreases more and more, which increasingly restricts those affected in everyday life, for example when putting on socks or shoes, cutting toenails, getting in and out of the car, climbing high stairs, etc. Over time, arthrosis pain and its consequences (unsteady gait, restricted movement) dominate life. Patients lose their independence and are severely restricted in their habits. They become more and more dependent on painkillers and aids (walking stick, insoles) and need outside help to cope with everyday life.
How does osteoarthritis of the hip manifest itself?
The osteoarthritis process often progresses gradually over several years. Osteoarthritis means that areas of the joint are no longer covered with protective cartilage. In contrast to cartilage, bone has pain receptors and thus causes joint pain that is dependent on load. The progression of osteoarthritis leads to typical undulating pain during exercise (climbing stairs), at rest and especially at night. As the disease progresses, the joint becomes deformed and increasingly stiff. This further restricts the mobility of the hip joint. This can be seen, for example, in the fact that it becomes increasingly difficult to put on socks or shoes and it is no longer possible to cut toenails due to the lack of mobility. Gait instability and the risk of falling increase over time.
Why does osteoarthritis pain occur at night?
The natural slackening of the muscles just before falling asleep causes the hip to rotate outwards. If two rough areas now interlock due to osteoarthritis, this interlocking is broken up by the slackening of the hip muscles, which causes pain. In addition, we move several times during sleep, which puts strain on the hip and can cause pain.
What to do if you have severe osteoarthritis pain?
The following can be done for severe osteoarthritis pain: Firstly, the joint should be protected and sports that strain the joint, such as jogging, should be avoided. In addition, the temporary intake of anti-inflammatory medication and painkillers, physiotherapy to loosen up the muscles and gait training, good footwear with shock-absorbing soles and, if necessary, insoles to support the arch of the foot are recommended. Taking cartilage-supporting medication to strengthen the remaining cartilage and "lubricating injections" directly into the affected joint can also help. Despite pain, the arthritic joint should continue to be moved in order to alleviate muscle shortening, joint stiffness and pain. The following applies here: all clearly guided movements, such as cycling, should be prioritised. Furthermore, a healthy and balanced diet and weight should be taken into account. If you lose a few kilograms, the hip joint is subjected to six times less strain when standing normally and the load-dependent pain decreases accordingly. If all these conservative measures are of no use and the osteoarthritis pain in the joint continues to increase and worsen your quality of life, the affected joint should be examined further by a specialist.
Is heat good for hip pain?
Hip osteoarthritis is a chronic and therefore permanent inflammatory strain on the hip joint that is accompanied by pain. In this situation, heat can help to alleviate osteoarthritis pain and relieve muscle tension and stiffness around the affected joint. For example, a thermal bath can provide good relief from osteoarthritis pain.
Conversely, cold helps with sudden pain caused by an accident or an injury to ligaments, muscles, bones or wound pain after an operation. Cold therapy reduces the activity of anti-inflammatory substances. But be careful: In the case of inflamed joints, short-term cold therapy can cause increased pain due to the reactive stimulation of blood circulation.
Book a consultation appointment
We guarantee rapid, expert clarification and advice as well as treatment using the most modern methods.
PD Dr Andreas L. Oberholzer is a recognised expert in hip complaints and has extensive experience in the field of artificial hip joints.
Book your appointment directly online here or call us on +41 44 388 16 16. You are also welcome to come to us for a second opinion.
PD Dr Andreas L. Oberholzer
FMH specialist in orthopaedics and trauma surgery. Areas of specialisation: Knee, hip and foot surgery.