What is the Best Treatment for Hip Arthritis?

The hip joint is protected by a capsule with a special lining and filled with lubricating fluid to reduce friction when the bones move. Rheumatoid arthritis pain and other conditions cause the lining to become swollen, which causes pain and limits movement.

NYU Langone doctors recommend maintaining movement to protect the hip joint. Low-impact activities like swimming, yoga, cycling and tai chi can offer a cardiovascular workout without putting too much stress on the joints.

Physical therapy

The hip joint bears the weight of your entire body, so too much stress on it can cause pain and damage the cartilage. To help protect the hip, muscles around it must be strong and healthy. We may recommend lifestyle changes, such as losing weight or using a cane or walker to decrease the amount of stress on your hips while walking.

Your doctor will assess your hip and your general health to see what’s causing your pain. They’ll ask about your symptoms, such as when they started and what makes them worse. They’ll then examine your hip, paying special attention to the area where the pain is located. They might also suggest a test to find out what’s causing your hip pain, such as an X-ray or MRI scan.

X-rays show the condition of your hip bones but they’re not as good at assessing soft tissues in and around the joints. They can show problems such as a torn acetabular labrum (the thick ring of cartilage around the socket) or osteoarthritis.

Osteoarthritis is a common condition that causes the ends of your bones to rub together, which can lead to pain and stiffness. Cartilage is a tough, smooth tissue that helps joints move easily by reducing friction between the bones. But when cartilage becomes thinner, it can wear out and make the surfaces of the bones rough, which can cause pain. If there’s a lot of friction, it can also lead to bone spurs — small bumps on the edges of bones.

Medications

A variety of medications can help ease pain from hip arthritis. Simple over-the-counter painkillers, such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs), may reduce mild to moderate pain. Stronger NSAIDs and other medications, such as corticosteroids and disease-modifying antirheumatic drugs, are available by prescription.

Arthritis occurs when cartilage deteriorates and narrows the space between bones, causing friction as they move. The most common type of hip arthritis is osteoarthritis, which usually develops gradually and worsens over time. Other types of hip arthritis include rheumatoid arthritis and lupus, which are caused by an overactive immune system that attacks healthy tissue. These conditions usually cause pain in both hips and can affect other joints in the body.

Medications can relieve inflammation and stiffness, but they won’t change the damage to the hip joint or reverse it. Some people find that avoiding activities that aggravate the condition helps with pain management. Exercises that don’t put a lot of stress on the hips are often recommended, such as walking, swimming, and cycling. Using assistive devices, such as canes, crutches, or walkers to help with balance and stability can also improve mobility and independence.

Changing your diet to include more vegetables and less meat can lower cholesterol and other fats, which may reduce inflammation. People with RA and other types of hip arthritis should take a medication called methotrexate, which suppresses the immune system and can slow down progression of the disease. If hip swelling and inflammation are severe, a doctor can prescribe steroid injections directly into the inflamed joint or bursa.

Occupational therapy

The hip joint is a ball and socket type joint. It consists of the ball-shaped end of the thigh bone (femoral head) that fits into the socket in the pelvis called the acetabulum. This joint is lined with smooth cartilage which helps it move easily. If the cartilage thins or becomes rough you can develop hip osteoarthritis. This is also known as wear and tear arthritis or degenerative joint disease. The symptoms include pain and stiffness in the groin or buttock. This is usually felt after sitting or standing for long periods of time and can get worse with certain movements such as climbing stairs. Other symptoms can include crepitus, which is the cracking or clicking sound you hear when moving your hip.

The first step is to see your doctor. They will examine your hip to find the cause of your pain and ask you about your daily activities and what makes your pain better or worse. They may refer you for physiotherapy or occupational therapy to help with movement and managing your pain.

Over-the-counter pain killers such as acetaminophen and ibuprofen can be helpful to relieve the pain. You may need stronger prescription medication such as antirheumatic drugs and biological response modifiers. Medications may also include injections of hyaluronic acid, which occurs naturally in the body and helps to lubricate the joints. However, this treatment isn’t available on the NHS and there is limited evidence that it works.

Surgery

For people whose hip arthritis is causing serious problems with everyday activities, surgery can help. Common procedures include osteotomy and joint replacement surgery. Osteotomy involves reshaping the hip joint so that healthy parts of the joint bear more weight and relieve pain and stiffness. Joint replacement surgery replaces the damaged parts of the hip with artificial parts to reduce pain and improve function.

Your doctor will want to rule out other causes of your hip pain before starting treatment. This might include an x-ray or an MRI scan. MRI uses radio waves to build up a picture of the soft tissue inside your hip. It’s particularly useful for diagnosing the painful condition trochanteric bursitis, when inflammation causes a bursa at the top of your thigh bone to become swollen, hot and painful. It’s also important to check for a hip problem called avascular necrosis, which reduces the flow of blood to the ends of bones, making them collapse (see the Specific hip conditions section).

For short-term hip problems, your doctor might prescribe painkillers or anti-inflammatory medications. You may also be advised to lose weight and change your activity level to avoid straining your hips. You might also be given a cane or walker to support your hips while walking. If your hip pain is caused by a hip injury, you might be told to rest and exercise with a physiotherapist to repair the damage.