Arthritis

The most prominent symptom of hip arthritis is pain. Most patients think that their hip is in the region of the buttocks and are surprised to learn that true hip pain is most commonly experienced in the groin. The pain can radiate down the front of the thigh for a few inches as well. Occasionally it goes all the way down the thigh to the knee - this is because the hip and knee have an overlapping nerve supply.  
Most patients with significant hip disease have a limp and one leg may feel shorter than the other. Bone-on-bone contact means that you may occasionally feel or hear the hip creaking during walking. As the disease progresses, the hip becomes stiff and less movement is possible - eventually you may have to take a break after walking only a short distance. Night pain also signifies advanced arthritis.

Common forms of arthritis: 

• Osteoarthritis
• Rheumatoid arthritis
• Post-traumatic arthritis 

The term arthritis literally means inflammation of a joint, but is generally used to describe any condition in which there is damage to the cartilage. Inflammation is the body's natural response to injury. The signs and symptoms of joint inflammation are stiffness, swelling, heat and pain.

The articular cartilage is the padding over the ends of the bone that absorbs stress. The proportion of cartilage damage and synovial inflammation varies with the type and stage of arthritis. Usually the pain early on is due to inflammation. In the later stages, when the cartilage is worn away, most of the pain comes from the mechanical friction of raw bones rubbing on each other.

There are over 100 different types of rheumatic diseases. The most common are:

Osteoarthritis: Osteoarthritis is also called as degenerative joint disease; this is the most common type of arthritis, which occurs often in older people. 

Osteoarthritis is the wearing-out or erosion of a joint arising from the wearing away of the articular cartilage. Without this protection, the bones rub together causing severe pain and stiffness. Patients who have early-stage osteoarthritis often notice pain at the beginning of a movement or during the first few minutes of exercise before the joints are given a chance to warm up. Once activity gets underway, the pain usually diminishes, although it is likely to increase again after resting for several minutes. As the condition worsens, pain may be present even at rest and at night. Symptoms are generally aggravated even further in cold or wet weather conditions. Approximately 50 percent of people over the age of 35 display early signs of the disease. 

Rheumatoid Arthritis: This is an auto-immune disease in which the body's immune system (the body's way of fighting infection) attacks healthy joints, tissues, and organs. Occurring most often in women of childbearing age (15-44), this disease inflames the lining (or synovium) of joints. It can cause pain, stiffness, swelling, and loss of function in joints. When severe, rheumatoid arthritis can deform, or change, a joint. For example, the joints in a person's finger can become deformed, causing the finger to bend or curve.

Rheumatoid Arthritis affects mostly joints of the hands and feet and tends to be symmetrical. This means the disease affects the same joints on both sides of the body (both the hands or both feet) at the same time and with the same symptoms. No other form of arthritis is symmetrical. About two to three times as many women as men have this disease.

Post-traumatic arthritis: Arthritis developing following an injury to a joint is called as post-traumatic arthritis. The condition may develop years after the trauma.

Causes of arthritis

Osteoarthritis is caused by the wearing out of the cartilage covering the bone ends in a joint. This may be due to excessive strain over prolonged periods of time, or due to other joint diseases, injury or deformity. Primary osteoarthritis is commonly associated with ageing.

Secondary osteoarthritis is generally the consequence of another disease or condition, such as repeated trauma or injury to the effected joint, or abnormal joint anatomy from birth.

Rheumatoid arthritis is often caused when the genes responsible for the disease are triggered by infection or environmental factors. The "trigger" stimulates the body to produce antibodies against the joint tissues and thereby causing rheumatoid arthritis.

Fractures involving the joint surfaces and joint dislocations may result in post-traumatic arthritis. 

Uric acid crystal build-up is the cause of gout and long-term crystal build-up in joints may cause arthritis.

Symptoms of arthritis

There are more than 100 different forms of arthritis. Symptoms vary according to the type of Arthritis. Each form effects the body differently. Arthritic symptoms generally include swelling and pain or tenderness in one or more joints for more than two weeks, redness or heat in a joint, limitation of motion of joint, early morning stiffness, and skin changes including rashes.

Diagnosis

Doctors diagnose arthritis with a medical history, physical examination and X-rays of the effected part. Computed tomography (CT) scans and magnetic resonance imaging (MRI) scans are also performed to diagnose arthritis. Blood tests are sometimes needed to help make the diagnosis.

Treatment Options

There is no cure for arthritis. Your doctor may prescribe anti-inflammatory medicine. Other conservative measures include occupational therapy or physiotherapy. In severe cases, surgery may be suggested. The type of surgery will depend on your age and severity of the disease. In moderate to severe arthritis, joint replacement is usually the best option.

The initial treatment for arthritis involves conservative measures, consisting of rest, avoidance of high impact weight bearing activities, and the use of non-narcotic analgesic and/or anti-inflammatory medications. With worsening symptoms, a walking stick or braces may be helpful. For more severe symptoms, an injection of cortisone into the joint is frequently advised and can be quite helpful, although cannot be repeated too often. Lubrication injections can give good temporary results for the early to moderate stages of knee arthritis. When conservative measures have been exhausted, offer no relief, and symptoms have become disabling, then surgery may be recommended. There are different surgical procedures that can be used and may include:

Synovectomy: This surgery is indicated for inflammatory arthritis where there is significant swelling (synovitis) that is not controlled by medications. Synovectomy is the surgical removal of the inflamed synovium (tissue lining the joint). The procedure may be performed using arthroscopy.

Arthroplasty: In this procedure, your surgeon removes the affected joint and replaces it with an artificial implant. It is usually performed when the joint is severely damaged by osteoarthritis, rheumatoid arthritis, post-traumatic arthritis or avascular necrosis.  The goal of the surgery is to relieve pain and restore the normal functioning of the joint.

Arthrodesis: A fusion, also called an arthrodesis involves removal of the joints and fusing the bones of the joint together. This surgery is usually indicated when the joints are severely damaged, when there is limited mobility, when there is severe damage to the surrounding ligaments and tendons, after failed previous arthroplasty, and when heavy manual use is expected. The type of surgery is rarely performed for hip and knee arthritis now.

Your surgeon will discuss the options and help you decide which type of surgery is the most appropriate for you.