Understanding Hip Pain

Osteoarthritis :: Rheumatoid Arthritis :: Post-Traumatic Arthritis


The thigh bone (femur) joins the pelvis (acetabulum) to form a ball and socket joint called the hip. Ligaments, which are strong bands of tissue that connect bone to bone, are the main providers of joint stability. Tendons, which are bands of tissue that connect muscle to bone, are secondary stabilizers of the joint. Muscles, ligaments, and tendons work together to complete the kinetic chain.

A smooth substance called articular cartilage covers the surface of the bones where they come into contact within the joint. This articular cartilage acts as a cushion between the bones. The remainder of the inside of the hip joint is covered by a thin, smooth tissue liner called synovium. The synovium makes a small amount of fluid that acts as a lubricant so that the joint glides smoothly.

One of the most common causes of hip pain and loss of mobility is the wearing away of the joint’s cartilage. When this happens, the bones rub against each other, causing significant pain and swelling. The most common cause is a condition known as osteoarthritis. Trauma or direct injury to the knee can also cause osteoarthritis. Without cartilage there is no shock absorption between the bones in the joint, which allows inflammation to build and contribute to pain.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s natural immune response attacks the lining of the joints (called the synovium), causing chronic inflammation and pain. The inflammation may eventually damage the joint’s cartilage and bone, weaken the soft tissue around the joint (cartilage, ligaments and tendons) and prevent the joint from working properly.

Left untreated, RA can greatly reduce your quality of life. You may have already decreased your activity level to avoid the pain caused by a joint affected by RA. It’s not uncommon for the joint damage caused by RA to lead to a loss of movement, an inability to work, and even the need for surgery to repair the damage.

What are the Symptoms of RA?

RA is a chronic, persistent disease that can take a variable course over an affected person’s lifetime. It may progress slowly, sometimes produce “flare ups”, and then at times go into “remission” during which the symptoms may greatly diminish or disappear. There are 3 stages of RA identified by specific symptoms. In the first stage, RA causes pain, warmth, redness and swelling in affected joints. In the second stage, it causes thickening of the synovium. In the third stage, permanent joint damage begins to occur as bone and cartilage are attacked by the enzymes released by the inflamed cells in the once-healthy synovial fluid.

In addition to joint pain, swelling and stiffness, the symptoms of RA commonly include fatigue, weakness, flu-like symptoms accompanied by a low-grade fever, loss of appetite, depression, chronic dry eye or dry mouth and, in people with more advanced RA, bumps (called rheumatoid nodules) under the skin.

How is RA Treated?

Your primary doctor will refer you to a rheumatologist, a doctor who specializes in inflammatory diseases like RA. Your rheumatologist may recommend different treatment options depending on the severity of your RA and its impact on your joint(s) and your body as a whole. And while there is no cure, RA can be controlled through the use of new drugs, exercise, and self-management techniques.

If your RA is so severe that conservative treatment options are no longer managing your symptoms to meet your activity goals, joint replacement may be an option. Some treatment options, such as partial hip replacement, are not indicated for patients with RA because the underlying disorder will inevitably affect the other native parts of the hip. Dr. Fischer will work with you and your other physicians to develop an individual treatment plan

Post-Traumatic Arthritis

Post-traumatic arthritis is caused by the wearing out of a joint that has had any kind of physical injury. The injury could be from sports, a vehicle accident, a fall, a military injury, or any other source of physical trauma. Such injuries can damage the cartilage and/or the bone, changing the mechanics of the joint and making it wear out more quickly. The wearing-out process is accelerated by continued injury and excess body weight.

What Are The Symptoms of Post-Traumatic Arthritis?

The symptoms of post-traumatic arthritis include joint pain, swelling, fluid accumulation in the joint, and decreased tolerance for walking, sports, stairs and other activities which stress the joint.

How is Post-Traumatic Arthritis Treated?

Post-traumatic arthritis is treated similarly to osteoarthritis. Treatment starts with weight loss, low impact exercise and strengthening of the muscles surrounding the joint, non-steroidal anti-inflammatory medicines (NSAIDs such as Advil, Aleve, Celebrex or one of many others) are often recommended if you can take them. Arthritic joints can also be injected with cortisone or substances called Hylamers which act like artificial joint fluid. All of these measures are aimed at making the joint more comfortable and functional. They do not cure the arthritis.When the arthritis progresses to the point that these measures are not effective in treating pain and maintaining function, then surgical treatment will be discussed.

Surgical treatment may include debriding ("cleaning out"), reconstructing or replacing the worn out joint surfaces. Post-traumatic arthritis progresses as time goes on, the joint surface wearing out further with more use over the years. Fortunately, when the nonsurgical treatments are no longer effective, surgical treatment can offer lasting relief. Deformity through or around the joint may necessitate the use of computer assisted navigation to restore the joints normal alignment.