There are many kinds of arthritis that can affect the hip joint and make it difficult to do everyday activities.
The most common type is osteoarthritis (OA), a non-inflammatory arthritis. Also known as degenerative arthritis, OA is associated with aging-related wear and tear or trauma; it is not a result of the body's altered immune response. OA typically causes painful symptoms in middle-aged people.
Inflammatory arthritis refers to any type of arthritis caused by an overactive immune system. These types of arthritis are also known as autoimmune disorders. Unlike osteoarthritis, inflammatory arthritis affects people of all ages, often showing signs in early adulthood. These diseases mostly affect the joints but can also affect other organs, such as the eyes, lungs, heart, gastrointestinal (GI) tract, and skin.
These are common types of inflammatory arthritis that can cause symptoms in the hip joint:
- Rheumatoid arthritis
- Ankylosing spondylitis
- Psoriatic arthritis
Less common types of inflammatory arthritis affecting the hip joint include:
- Systemic lupus erythematosus
- Reactive arthritis
- Inflammatory bowel disease-related arthritis
- Juvenile inflammatory arthritis (JIA)
- Arthritis induced by immune checkpoint inhibitors (chemotherapy)
There are also types of inflammatory arthritis that are not autoimmune in nature. These diseases can also cause symptoms in the hip joint:
- Gout (uric acid crystal disease)
- Pseudogout (CPPD - calcium pyrophosphate dehydrate deposition disease)
- Septic arthritis (caused by a viral or bacterial infection)
- Lyme arthritis (caused by Lyme disease)
Although there is no cure for inflammatory arthritis, there have been many advances in treatment, particularly in the development of new medications. Early diagnosis and treatment can help patients maintain mobility and function by preventing severe damage to the joint.
The hip is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone).
A slippery tissue called articular cartilage covers the surface of the ball and socket. It creates a smooth, low-friction surface that helps the bones glide easily across each other. The surface of the joint is covered by a thin lining called the synovium. In a healthy hip, the synovium produces a small amount of fluid that lubricates the cartilage and aids in movement.
These are the most common types of inflammatory arthritis that affect the hip joint.
In rheumatoid arthritis, the synovium thickens, swells, and produces chemical substances that attack and destroy the articular cartilage covering the bone. Rheumatoid arthritis often involves the same joint on both sides of the body, so both hips may be affected.
Ankylosing spondylitis causes inflammation of the spine and large joints, including the hips, resulting in stiffness and pain. it can cause erosion of the sacroiliac joint and fusion of the spine (bamboo spine).
Psoriatic arthritis is a form of arthritis that affects some people who have psoriasis — a skin disease that causes red patches with scaling.
- Joints in psoriatic arthritis can be red, swollen, and warm.
- Sausage-like swelling can occur in fingers and toes.
- Changes in nails, like pitting, can be seen.
- Some patients have pain in the tailbone (coccyx).
In a person with inflammatory arthritis, the body's immune system lacks the ability to self-regulate, and the immune system turns on itself. The tissue invasion of immune cells causes inflammation where it is not needed, and the production of chemicals causes damage to the affected tissues.
The exact cause of inflammatory arthritis is not known, although there is evidence that genetics plays a role in the development of some forms of the disease.
Inflammatory arthritis may cause general symptoms throughout the body, such as fever, loss of appetite and fatigue. A hip affected by inflammatory arthritis will feel painful and stiff. There are other symptoms, as well:
- A dull, aching pain in the groin, outer thigh, knee, or buttocks
- Limited range of motion
- Pain that is worse in the morning or after sitting or resting for a while, but lessens with activity
- Pain in the joint severe enough to cause a limp or make walking difficult
Patients with suspected inflammatory hip arthritis should be seen by a rheumatologist. This is a physician that specializes in patients with autoimmune diseases.
Patients with long-standing inflammatory arthritis or those who do not respond to medical treatment will end up with joint destruction, which can lead to joint replacement.
During your initial examination, your doctor will ask questions about your medical history and your symptoms, then conduct a physical examination and order diagnostic tests.
During the physical examination, your doctor will evaluate the range of motion in your hip. Increased pain and limitation during some movements may be a sign of inflammatory arthritis. The doctor will also look for a limp or other problems with your gait (the way you walk) due to stiffness of the hip.
X-rays are imaging tests that create detailed pictures of dense structures, like bone. X-rays of an arthritic hip will show whether there is any thinning or erosion in the bones, any loss of joint space, or any excess fluid in the joint.
Blood tests like sedimentation rate (ESR) and C-reactive protein (CRP) are indicators of inflammatory arthritis. Antibodies like rheumatoid factor, antinuclear antibody, and anti-citrullinated peptied can be useful in the diagnosis of inflammatory arthritis.
Although there is no cure for inflammatory arthritis, there are a number of treatment options that can help prevent joint destruction. Inflammatory arthritis is often treated by a team of healthcare professionals, including rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and orthopaedic surgeons.
The treatment plan for managing your symptoms will depend upon your inflammatory disease. Advances in the treatment of inflammatory arthritis have made a dramatic difference in the lives of people with these diseases. Inflammatory arthritis can often be well controlled using medications, and it can go into remission when treated early in the course of the disease.
- Non-steroidal anti-inflammatory drugs (NSAIDs). Drugs like naproxen and ibuprofen may relieve pain and help reduce inflammation. NSAIDs are available in both over-the-counter and prescription forms.
- Corticosteroids. Medications like prednisone are potent anti-inflammatories and can suppress the immune system. They can be taken by mouth or by injection. Injections in the hip, such as corticosteroid, hyaluronic acid, or platelet-rich plasma (PRP), can also help control pain.
- Disease-modifying antirheumatic drugs (DMARDs). These drugs act on the immune system to help slow the progression of disease. Methotrexate is a commonly prescribed DMARD.
There are several newer medications on the market known as biologics, genetically engineered proteins which target specific parts of the immune system that trigger inflammation. These drugs can be very effective for patients with rheumatoid arthritis, psoriatic arthritis, and other forms of autoimmune inflammatory arthritis.
- Physical therapy. Specific exercises may help increase the range of motion in your hip and strengthen the muscles that support the joint. In addition, regular, moderate exercise may decrease stiffness and improve endurance. Swimming is a preferred exercise for people with ankylosing spondylitis because spinal motion may be limited.
- Assistive devices. Using a cane, walker, long-handled shoehorn, or reacher may make it easier for you to perform the tasks of daily living.
If nonsurgical treatments do not sufficiently relieve your pain, your doctor may recommend surgery. The type of surgery performed depends on several factors, including:
- Your age
- Condition of the hip joint
- Which disease is causing your inflammatory arthritis
- Progression of the disease
The most common surgical procedures performed for inflammatory arthritis of the hip include total hip replacement and synovectomy.
Total hip replacement. Your doctor will remove the damaged cartilage and bone, then position new metal or plastic joint surfaces to restore the function of your hip. Total hip replacement is often recommended for patients with rheumatoid arthritis or ankylosing spondylitis to relieve pain and improve range of motion.
Synovectomy is done to remove part or all of the joint lining (synovium). It may be effective if the disease is limited to the joint lining and has not affected the articular cartilage that covers the bones. Generally, the procedure is used to treat only the early stages of inflammatory arthritis.
Your doctor will discuss the various surgical options with you. Do not hesitate to ask why a specific procedure is being recommended and what outcome you can expect.
Complications. Although complications are possible in any surgery, your doctor will take steps to minimize the risks. The most common complications of surgery include:
- Excessive bleeding
- Blood clots
- Damage to blood vessels or arteries
- Dislocation (in total hip replacement)
- Limb length inequality (in total hip replacement)
Your doctor will discuss all the possible complications with you before your surgery.
Recovery. How long it takes to recover and resume your daily activities will depend on several factors, including your general health and the type of surgical procedure you have. Initially, you may need a cane, walker, or crutches to walk. Your doctor may recommend physical therapy to help you regain strength in your hip and to restore range of motion.
Inflammatory arthritis of the hip can cause a wide range of disabling symptoms. Today, new medications may prevent progression of disease and joint destruction, and early treatment can help preserve the hip joint.
In cases that progress to severe joint damage, surgery can relieve your pain, increase motion, and help you get back to enjoying everyday activities. Total hip replacement is one of the most successful operations in all of medicine.