Osteoarthritis of the hip (Coxarthrose)
Cause | Symptoms & pain | Diagnosis | Conservative treatment methods | Surgical treatment methods
Osteoarthritis of the hip, also called coxarthrosis, develops when the joint cartilage is worn away more quickly through the actual stress than it is genetically able to withstand. The cartilage is steadily worn down by the imbalance between the ability of the cartilage to withstand stress and the actual stress.
This actual stress is increased by obesity, accidents, congenital malformations (hip dysplasia), sports or occupations which stress the joints and natural ageing (loss of elasticity and water reserves of the cartilage), leading to the loss of cartilage: arthrosis.
The wearing away of cartilage is known as osteoarthritis. We differentiate between different stages of osteoarthritis (cartilage damage). The damage to the joint cartilage can appear as small tears on the surface, or involve the entire cartilage in the hip joint. This exposes the rough, painful surface of the bone.
Cartilage damage is divided into four stages:
Stage/Grade I: Soft cartilage
Stage/Grade II: Rough surface with tears
Stage/Grade III: Deep tears in the cartilage down to the bone
Stage/Grade IV: Complete depletion of the cartilage with exposed bone: this is known as bone on boneOne feature of cartilage is that it contains no pain fibres (nerves) - in contrast to bone - thus damage to the cartilage is only noticed when it goes to the bone.
Learn more about osteoarthritis.
Osteoarthritis of the hip may be experienced differently by each person. For most patients, various hip joint pains (pain when initiating movement, when bearing loads or inflammatory pain) and restrictions in the mobility of the hip are the primary focus.
In the final stage of osteoarthritis, the bone is no longer covered by the protective, smooth cartilage. The exposed joint bone has a rough surface. If two rough joint surfaces come into contact, they interlock. This causes blockage of the joint. This blockage, caused by the rough surfaces of the bones locking together, must be released by an initial movement. This breaks the delicate bony connections, causing the typical start-up pain which then passes again after a few steps.
Another pain typical for osteoarthritis is stress-related pain, felt as a dull ache around the hip joint, partially radiating into the upper thigh. In contrast to the cartilage, the exposed bone in the joint possesses pain fibres. These are activated when bearing loads. As stress on the hip joint is greater going downhill, the pain is also greater at these times.
A further pain typical of osteoarthritis can be caused by inflammation of the joint. This arises through continual rubbing of the rough surfaces. Think of sandpaper. This exposes abraded cartilage and bone which irritate the mucosa (synovium) of the joint. This leads in turn to increased production of joint fluid, effusion, overheating and pain which gradually worsen.
Restriction of movement
In the final stage of osteoarthritis, the bone-forming cells of the exposed bone are stimulated by the pressure and the cartilage-bone abrasion. The activated bone cells build new bone to distribute the pressure over a larger area. However, the newly formed bone is soft and leads to deformation of the hip joint (for example) with resulting restrictions of movement. The joint thus grows gradually stiffer. These restrictions of movement lead to increasing difficulty with everyday activities such as: Pulling on socks and shoes, cutting toenails or climbing into the car.
The following additional consequences can occur in advanced osteoarthritis of the hip:
- Deformation of the joint (shortening of the leg ➞ pelvis obliquity ➞ back problems)
- Unstable gait with a risk of falling
- Restricted movement (e.g. difficulty pulling on socks/stockings)
- Muscle tension, muscle shortening and muscle weakness
Strong hip joint pain, restricted hip movement and increasingly unstable gait with resultant risk of falling must be investigated carefully. After questioning the patient personally regarding when and how the pain occurs, there is a comprehensive clinical examination of the hip joint to assess and localise the pain, movement restrictions, differences in leg length and muscle strength.
This is followed by a radiological examination of the hip joint. In the event of uncertainty, MRI (magnetic resonance imaging) can also be performed to assess the cartilage situation in the hip joint better.
When all examinations have been completed, the results are discussed with the patient in detail, potential therapies explained and the next steps decided.
Conservative treatment methods
If the osteoarthritis of the hip joint is not yet too advanced, it can be treated with shoe inserts, shoes with cushioning soles, walking sticks, physiotherapy, medications against the inflammation and pain as well as cartilage-supporting medications or dietary supplements. Lifestyle changes may also be required with respect to food and sports which are gentler to the joints (hiking, swimming, cycling, etc.). It is important to keep the arthrotic joint in motion with sports such as cycling, swimming, etc. which do not overly stress the joints.
Weight reduction is of course helpful in the event of obesity. Otherwise, injection of lubricant, injection of cortisone or a therapy using your own blood (autohaemotherapy) may help to reduce the arthrosis pain.
Overview of the conservative treatment methods available:
- Anti-inflammatory and pain-relieving medications
- Medications and substances (dietary supplements) to strengthen the cartilage
- Medical training therapy /physiotherapy
- Injections of lubricants into the joint (hyaluronic acid) and anti-inflammatory medications (cortisone) or injections of your own blood (PRP therapy)
- Aids such as walking sticks, inserts, orthopaedic shoes
- Lifestyle changes in regard to sport, obesity, diet, etc.
These measures can help to reduce the pain of osteoarthritis and slow the progression of the cartilage abrasion. However, the osteoarthritis itself cannot be stopped or corrected by these conservative measures.
Injections into the hip joint are performed under X-ray or ultrasound for control as the hip joint is well packed by the surrounding musculature and enclosed in a tough joint capsule. This technical support is required to ensure that the syringe does indeed enter the hip joint and delivers the contents to the affected hip. We therefore work with a radiology centre which administers the appropriate injections.
Injections with hyaluronic acid
The hyaluronic acid product is a synthetic lubricant manufactured for joints. These injections into the joint reduce the abrasion of the arthrotically changed cartilage surfaces. The joint can then move better. In addition, the lubricant means the joint is less irritated, reducing osteoarthritis-related joint inflammation, which reduces the osteoarthritis pain in turn.
The effectiveness of the lubricant injections is dependent on the stage of the osteoarthritis. Many patients recover a good quality of life thanks to these lubricant injections. Initially, three injections of lubricant are given overall, at intervals of one week. As these require X-ray or ultrasound support, the injections are administered in a radiology centre. The effect of the lubricant injections persists for a certain time. If the response is good, the injections can be repeated at any time.
The costs for this treatment are not reimbursed by health insurance. The price for a lubricant injection to treat osteoarthritis of the hip is around CHF 130.
Injection of cortisone
Cortisone is made in our own bodies and used to relieve inflammations (among other things). This property is exploited. The synthetic cortisone is injected into the affected joint. This cortisone dissolves slowly and thus has a longer effect, temporarily relieving the osteoarthritis pain. Unfortunately, cortisone also has side effects. It attacks the bone and cartilage and weakens the tendons. Cortisone also suppresses the body’s immune system, increasing the risk of infection. Despite the local injection of cortisone into the joint, a portion of this can also enter the circulation and trigger corresponding, temporary effects. We therefore administer the cortisone injection with great caution.
So that the contents of the cortisone injection correctly enter the affected hip joint, this requires support with either X-rays (image converter) or ultrasound. We therefore work together with a radiology centre.
Platelet-rich plasma (PRP) therapy enhances the body’s ability to heal wounds using messenger substances in blood plasma and blood platelets (thrombocytes). A special process generates the PRP from around 15 ml of your own blood. This is then injected into the hip joint to be treated in the same session. The plasma lubricates the hip joint and the platelets deliver the body’s own wound-healing factors. These have an anti-inflammatory effect and promote tissue healing.
Ensuring that the PRP obtained is indeed delivered to the affected hip joint requires support from X-rays (image converter) or ultrasound. Unfortunately, we are therefore unable to offer PRP for osteoarthritis of the hip. The PRP we obtain must be injected into the affected joint immediately. The time lost during transport to a nearby radiology centre would be too long. The plasma would clot and become ineffective. If you wish to undergo this therapy and it is also indicated in your case, we can refer you to specialists and institutes.
If hip problems persist despite these conservative measures and the quality of life suffers accordingly, it is time to consider a hip replacement (artificial hip). Thanks to minimally invasive surgical methods which protect the muscles, the new artificial hip is implanted from the front to protect the tissues. The stabilising hip muscles are simply pushed to the side, not partially cut through, as previously. This has the advantages that there is less pain, less blood loss and reconvalescence can be faster. This can increase the quality of life immediately.
We will be pleased to give you a private consultation
Our doctors have extensive experience and expertise in joint and sport surgery. PD Dr Andreas L. Oberholzer is a certified hip expert with broad experience in the field of osteoarthritis of the hip.
We guarantee a fast, specialist investigation and consultation as well as treatment with the latest options. You can also ask us to provide a second opinion.