Doctor Says

Wear and tear of hip joint a possible cause

Your symptoms are consistent with a problem with the hip joint. A typical patient would describe the pain as being located in the groin, with the pain radiating down the front of the thigh to the knee.

Due to the pain, the hip stiffens. With hip stiffness, people develop a limp when walking.

Other symptoms are difficulty in climbing stairs, boarding buses and getting up from a chair, inability to squat, and difficulty in putting on socks and shoes.

The person will prefer to avoid using the affected leg. This leads to muscle weakness and atrophy, and he then feels that the leg is weak.

Over time, the person may also notice that the painful leg appears to be shorter than the other leg.

Considering your age and symptoms, the most likely diagnosis is osteoarthritis of the hip joint.

The hip joint is a ball-and-socket type. The ends of the bones are covered with cartilage, which minimises friction when the hip joint moves and rotates.

If the cartilage is damaged or thinned out, friction develops when the joint moves. This causes pain and inflammation.

If this process continues, bone spurs (osteophytes) develop within the joint, causing hip stiffness.

After thinning of the cartilage, the ball becomes flattened. This loss of height leads to leg shortening.

This process of "wear and tear" of the joint is termed osteoarthritis.

According to the US Centres for Disease Control and Prevention, this condition affects up to 30 per cent of people above the age of 60.

Osteoarthritis of the hip may be due to a misshapen hip at birth (dysplasia), trauma, inflammation-like rheumatic arthritis, infection or poor blood supply to the bone (osteonecrosis).

To diagnose the problem, the person usually has to go for an X-ray scan of the hip joint. An X-ray of the lower spine is usually done too, as there is often a link between hip and lower spine problems.

In some cases, a magnetic resonance imaging (MRI) scan of the hip may be required to see subtle changes in the bone or joint. Blood tests are done to rule out inflammatory blood disorders such as rheumatoid arthritis, gout or infection.

The initial treatment for this problem involves a few modalities.

For a start, if you are overweight, losing weight will decrease the force applied to the hip joint. Avoiding high-impact activities, squats and lunges will decrease the pressure on the joint.

The use of a cane for walking will also help relieve joint pressure.

A course of anti-inflammatory medications will help with the swelling and irritation of the hip joint.

Physiotherapy and aqua-therapy will strengthen the hip muscles and keep the joint mobile to help prevent stiffness.

Injections to the hip joint do not provide prolonged pain relief and are usually reserved for diagnostic purposes to confirm that the pain is originating from that joint.

If there are associated ligament (labral) tears or loose fragments within the hip joint, keyhole surgery (arthroscopy) for the hip can repair the labrum and remove the loose bodies.

If the cartilage damage or osteoarthritis is advanced, then keyhole surgery will not provide good results.

For advanced osteoarthritis which has failed to improve with conservative treatment measures, a total hip replacement is a good option.

The surgery involves replacing the diseased ball with an artificial one, and resurfacing the cup with a plastic liner. This provides excellent and predictable pain relief and return of function.

Patients typically begin walking with the help of a walking frame the day after the operation, and are discharged from hospital on the fourth or fifth day.

Dr Andrew Quoc Dutton

Medical director of Singapore Medical Group's Orthopaedic Group

A version of this article appeared in the print edition of The Straits Times on December 22, 2015, with the headline 'Wear and tear of hip joint a possible cause DoctorSays'. Print Edition | Subscribe