It is a common belief that arthritis is a disease of old age. But the bitter fact is that it may not always be associated with elderly people. This phenomena is more common in hip joints where the arthritis may set in between 20s and 40s causing problems in mobility.
These is the most productive period of life, and the disease may progress rapidly and may even be crippling. There is usually an underlying cause that leads to this arthritis process. In females, this may happen due to rheumatoid arthritis.
This disease involves multiple joints, but a group of joints may be more affected than others. In males, this may happen due to Ankylosing spondylitis, which again affects multiple joints, but hip and spine are the most severely affected areas.
Causes of damage
Damage to the blood supply of head of the femur in the hip (known as Avascular Necrosis or AVN) due to various reasons may cause weakening of the head. Such a bone can start collapsing in normal routine activities and cause a deformed head.
Such a deformed ball results in pain while walking and leads to limping. Often this is also associated with reduction in movement and patient may not be able to squat or sit in cross legged position. The leg gradually becomes short once the collapse increases causing discrepancy in length of both the limbs.
The most common reason for AVN may be traced to excessive consumption of alcohol, excessive intake of steroids, or a previous injury around the hip joint. You should consult your orthopaedist to analyse the reason for your problem and also formulate plan on management.
Need for assessment
If you have hip pain, you need to get blood tests and X-rays to assess the extent of the disease and find the cause of your problem. These investigations should be done after consulting your doctor.
X-rays are generally a good guide to what’s wrong with your hip, however it may be difficult to get complete assessment of X-rays especially in early disease, where the changes in the bony architecture may not be easily visible. Magnetic Resonance Imaging (MRI scans) are a great tool to assess the disease process and formulate plan of treatment.
Treatment plan
Once the complete assessment is done, the treatment plan is outlined based on the problems faced and the amount of pain and disability the patient has due to arthritis.
In early disease, the treatment starts with changes in the lifestyle and anti inflammatory medicines. Patient should avoid sitting on the floor and squatting. They are motivated to maintain their muscle strength and hydrotherapy and swimming are a good way to maintain movement and stamina without further damaging the already diseased joint.
A good physiotherapy protocol is formed to give them better quality of life in future. In cases of proven Rheumatoid Arthritis and Ankylosing Spondylitis, a Rheumatology specialist opinion is helpful to give them course of Disease Modifying Medicines. They help in control of the arthritis and delay the surgery to a certain extent.
When there is damage to the blood supply, medicines to reduce the blood coagulation may be effective. The aim of the non operative management is to maintain the hip strength and flexibility, and even after taking all the precautions, the disease may progress gradually to a level where a surgical intervention is needed.
When the arthritis gets worse, the patient may have to undergo some surgical intervention to be able to mobilise and lead pain free life. Although difference types of surgeries are available, you may have to head to total knee replacement in severe disease.
The results of the procedure are very predictive and patients lead nearly normal and productive life after undergoing the surgery. They get pain free range and mobility and good quality of life after surgery.
The prosthesis and bearing surfaces have also evolved over decades and the invent of Ceramic and Oxynium heads have given us hope for increased survival of the replaced joint for longer term.
And the newer cement-less designs have better integration into the bone and enable to get fixation without cement, thereby nullifying cement related problems.
If you have hip problems in early age, do visit your orthopaedic surgeon to find a right solution. Timely treatment could help delay surgery and maintain good quality active life.
