Hip arthritis in India affects young and middle aged persons unlike the west where Primary hip osteoarthritis pre dominantly affects the elderly. Surgery in this group of relatively younger patients requires newer techniques and implants. This article will shed light on the disease and the current modalities of treatment available.
Types of Hip arthritis Hip arthritis is classified as Primary and secondary Osteoarthritis. Primary osteoarthritis is age related wear and tear arthritis. It is rare in India. Secondary osteoarthritis occurs at a younger age and is more common. Rheumatoid arthritis, avascular necrosis, traumatic arthritis and other connective tissue disorders like SLE, Psoriasis etc. all lead to secondary osteoarthritis.
Rheumatoid arthritis is an auto immune disorder, affects all joints particularly the small joints but also does not spare the hip and knees. Avascular necrosis is a condition that reduces the blood supply to the end of the bone. It affects patients with excess alcohol intake, consuming steroids, connective tissue disorders like SLE. Systemic lupus erythematosus (SLE) is a connective tissue disorder affecting mainly young women A photo sensitive rash on the cheeks, renal involvement and arthritis are some notable features. Avascular necrosis affects a proportion of the patients with SLE. Gaucher’s disease is a genetic storage disorder. Post traumatic arthritis occurs after a severe injury to the hip. Fractures of the ball (top of the femur) or socket (acetabulum) can lead to arthritis after inadequate treatment.
Hip arthritis is very disabling as it is a small ball and socket joint unlike the Knee joint which is a large one. In advanced disease a total hip replacement was recommended by Orthopaedic surgeons until recently. Advances in orthopaedic surgery now cater to the specific requirements of these younger patients.
Surgical solutions These are the mainstay of treatment as conservative measures fail to relieve pain. Total Hip replacement (THR) is a time tested operation and has a success rate of 93 % survivorship at 10 years. The hip joint may need to be replaced with an artificial joint when it is irreversibly damaged and cannot be salvaged by alternate surgery. The patient complains of pain and restriction of movement. The pain may often be referred to the knee or felt in the knee and no hip symptoms. Occasionally the pain may be felt more in the buttock area rather than in front of the groin.
Who needs a hip replacement? In India, many young patients with ankylosing spondylitis, avascular necrosis, post septic arthritis, post injury suffer from hip arthritis and are advised a hip replacement for disabling pain. Thus many hip replacement operations are performed in younger patients. The surgery should cater to the enhanced demands on an artificial joint by younger and more active patients. Naturally an operation designed for Western elderly patients is not suitable for younger patients.
What is a total hip replacement?
Fig1. Shows the differences between a normal THR on the left and a Proxima hip on the right
In this operation the ball shaped upper end of the thigh bone (femur) and the socket (acetabulum) are replaced. The ball is replaced with a long metal stem that is fixed into the upper end if the thigh bone. Its upper spherical end articulates with a cup shaped polyethylene socket that is cemented into the pelvis. Conventional hip replacements sacrifice a great deal of normal bone as the head, neck, and upper part of the thigh bone is removed for implantation of the prosthesis. Moreover wear debris from the poly-etheylene liner lead to osteolysis and bone loss. When this first hip is to be changed or revised after its lifespan more bone loss occurs. Conventional hips have a small ball to reduce friction and wear, but the ill effect of this is an increased risk of dislocation. An average dislocation rate of 3- 4 % has been reported. These implants do not last very longer than 20 years and revision rates of 50% at 20 years have been reported. Survival rates are less satisfactory for the relatively younger active patients. Thus a total hip replacement is not an ideal implant for younger patients less than fifty years old who need a new hip. Problems with conventional total hip replacement: •Excessive bone sacrifice and loss •Increased risk of dislocation •Patients cannot squat or sit cross legged on the floor with out the risk of dislocation. •Range of movement is less •Patients cannot involve in sports •Poor survival in young and active patients they require earlier revision. •Revision surgery is difficult •The hip feels less like a normal hip •The cup wears with time and plastic from it harms bone •Change in length of the leg after surgery leading to leg length discrepancy.
Why remove normal bone when only the surface of the ball is bad? This is the logic behind hip resurfacings. This bone preserving hip resurfacing involves replacing only the diseased bony surfaces of the head of femur and acetabulum. This involves sculpting the head of the femur and covering it with a metal cap and fixing an uncemented socket into the acetabulum to receive the head.
Hip Resurfacing- A bone preserving hip replacement! Preservation of bone and less stress shielding makes it easy to revise this hip if needed. The large head size provides a very stable joint and recreates the sensation of a normal hip joint. Patients have gone back to playing Judo and Squash after this operation. Advances metallurgy makes the metal on metal articulation likely to survive longer in the young and active patient. With less metal inside the bone and less invasion of the medullary cavity of the femur, the risk of infection is reduced. Rehabilitation is faster and better. Advantages of hip resurfacing: •Allows the patient to squat and sit cross legged on the floor safely •Allows a normal range of movement •Sacrifices only the surface diseased bone and preserves normal bone •Imparts a more normal sensation •The joint is likely to last longer even in younger and active patients. •Earlier and faster rehabilitation •Less risk of dislocation •Easier to revise if needed. •No leg length discrepancy.
Proxima hip replacement – A perfect bone preserving hip replacement? This is the latest addition to the armamentarium of the hip surgeon in India. It is a bone preserving hip replacement. In this operation, the entire diseased head of the femur is removed. The lining of the hip socket is resurfaced with a metal cup. A tiny uncemented hip with a short stem called the Proxima hip is impacted into the upper end of the femur or thigh bone.
The size of the implant matches the natural one and hence the risk of dislocation is almost eliminated. It is recommended when the bony destruction is advanced and hence unsuitable for resurfacing and a total hip replacement would be overkill. The advantages of the Proxima are •suited for minimally invasive surgery •No thigh pain •Metal on metal – confers longevity •Conformity to normal size eliminates risk of dislocation •Ability to correct biomechanical abnormalities makes this superior to resurfacing. •Imparts a more normal sensation •Allows a normal range of movement and normal activities
Dr. Rianne M. Rozendaal and colleagues at the Erasmus Medical Center in Rotterdam, the Netherlands randomly assigned 222 patients in the early stages of hip arthritis to either glucosamine or a placebo. The research team took careful precautions to ensure the integrity of their results, including requiring that the supplier of the glucosamine double check that the tablets were of the correct dose. In spite of the carefully controlled conditions, the treatment had no significant effect on pain scores, stiffness, or physical function.
Many consumers have turned to glucosamine as a way to treat hip arthritis pain as an alternative to pain medications. However, despite various studies, definitive proof of glucosamine being effective as a treatment for pain associated with arthritis of the hip is lacking. So that leaves consumers wishing to avoid frequent use of pain medication with a big question: ?If glucosamine does not help, then what does??
If you wish to avoid unnecessary strain on your hip, and in doing so relieve hip pain, a variety of independent living products are available that allow you to continue enjoying your usual lifestyle. Many who suffer from hip arthritis are unaware that by making small adjustments to their everyday routine, they can enjoy a relatively pain free lifestyle without the use of narcotics.
Sitting and Standing in the Living Room and Kitchen
Arthritis of the hip can make sitting down and standing up a painful experience, and make standing for a long period of time virtually impossible. With the correct products around the home, however, you can go about your normal routine with very little change to the lifestyle you have grown accustomed to.
Standing up from a chair or couch can be especially difficult, especially if soft foam causes you to sink low into the seat. Not every couch is ?hip arthritis friendly?: couches rarely sit high off the ground and often the armrests are not positioned in a way that makes them ideal for support when you stand up. The CouchCane is an easy to install solution that provides you with a sturdy, comfortably positioned handle that you can lift yourself up with. The weight of your couch holds it in place while the rubber feet on its base prevent slipping and protect your floor. The CouchCane features an adjustable height hand grip, quality steel components, and an adjustable base that fits either end of a variety of couch sizes and styles.
If you lack hand and arm strength, or if you have arthritis in your hand as well, a handle to lift yourself up will not be of much help. Pride Lift Chairs make an attractive addition to any room's d'cor and smoothly lift the user to an almost standing position. Available in a variety of styles, such as Casual Line, Gentle Line, and Luxury Line, Pride Lift Chairs feature an assortment of high quality fabrics in a wide range of colors. The soft upholstery and comfortable arm position make them comfortable enough to sleep in while the durable scissor-style mechanism and powerful motor ensure years of operation. The Luxury Line lift chairs allow the user to adjust the angle of the backrest and ottoman separately for a custom fit, which allows those with hip arthritis to find the leg position that best works them.
Cooking, working at a counter, or washing dishes can require you to stand for long periods of time, which can be extremely painful for your arthritic hip. Barstools can provide the necessary height for your work, but typically have very uncomfortable seats and have a tendency to leave your legs in uncomfortable positions. The Drive Adjustable Arms All Purpose Stool is a cost effective alternative that gives you adjustable height, a soft padded seat, and a seating angle that allows your feet to rest on the ground. By keeping your feet on the ground as opposed to dangling, the all purpose stool takes the pressure off of your hips and knees. It makes an attractive addition to your kitchen and is easily cleaned with a damp sponge.
Bathroom Safety and Convenience
Because hip arthritis limits the use of your legs and makes standing or stepping very painful, the bathroom can be the most difficult room in your home to navigate. Getting in and out the bathtub, standing up in the shower, and getting on and off the toilet are activities that put extra strain on your hip joints.
The Pride Lift Chair is great for getting you on your feet in the living room, but don't you wish you had something like that for the bathroom? The Ergonomic AirLift Bedside Commode is exactly what you are looking for. Functioning as either a stand-alone commode or a toilet-mounted seat, the AirLift features air powered struts that give the user an extra boost when standing up. The struts are adjustable based upon the individual's weight. The Ergonomic AirLift is also constructed with ergonomic armrests, a comfortable seating surface, and a specially designed ?Guest Seat? stand toilet seat that can be easily mounted in place of the AirLift when company is expected. The AirLift is priced much lower than similar toilet lifting systems and is easy to assemble and install.
When arthritis of the hip begins to cause pain, enjoying a warm bath, or at least getting in and out of it, can be virtually impossible. Depending on the setup of your bathroom and the severity of your arthritis, there are two options available. The first would be a bath lift, such as the Sterling 303. The Sterling 303 is more affordable than most bath lifts that are advertised on television and in magazines, yet it has more features. In addition to the side flaps that make transferring in and out of the tub much easier, the Sterling 303 Bath Lift includes a sealed rechargeable battery, a reclining backrest, and thick covers over the seat and back for added comfort. The Sterling Bath Lift can be folded for travel or storage and features suction cups on the bottom for stability and security without the need for a permanent installation.
For a more permanent solution to hip pain while bathing, the Safety Bath Walk-In Bathtub can be installed in place of your current bathtub. The only walk-in bathtub that features a ?swing out? door which will not leak, the Safety Bath comes with all of the necessary plumbing fixtures. It uses your home's hot water as opposed to a separate water heater to save energy costs, uses less water than a standard bathtub, and eliminates the need to step over the edge of a tub. Those with arthritis of the hip will benefit the most from the optional heated seat and 12 jet massager. The Safety Bath can be installed with very little trouble by any qualified plumber.
Getting In and Out of Your Car
Whether you drive a compact car or a large SUV, arthritis of the hip can make getting out of your vehicle a painful experience. For starters, twisting in your seat to find the proper position to stand up or situate yourself in your car can be excruciating. However, a simple and inexpensive device such as the Portable Swivel Seat Cushion eliminates the need to twist by allowing you to rotate easily. It features an attractive grey or camel-colored velour cover which can be easily removed for washing and a comfortable polyfoam padded seat.
Once you are in a position to stand up, the Handybar 3 in 1 Car Aid provides a sturdy, conveniently-placed handle for you to lift yourself up with. Simply insert the smaller end into the striker on your car's door pillar; the specially designed tip holds the Handybar firmly in place while you stand up. The ergonomically designed grip is easy on your hand and wrist.
Pain Relief Through Far Infrared Heat Therapy
Heating pads are the oldest form of pain relief and the most effective. Everyone from arthritis sufferers to athletes relies on heating pads to soothe muscle and/or joint pain. While traditional electric heating pads and microwave heating pads are still quite popular, the most effective way to get deep, penetrating heat to your muscles and joints is by using far infrared heat therapy.
Infrared is a band of light that we perceive as heat. Divided into three segments (near, middle, and far), infrared heat makes up the majority of the sun's energy output. Through a process called ?conversion?, far infrared has the ability to heat objects such as human tissue without heating the air in between. This effect can be felt on a partly cloudy day; when a cloud obscures the sun, you immediately feel cooler even though the air temperature has not had enough time to change. The cloud blocked the far infrared rays from penetrating your body.
Far infrared heat therapy has taken the traditional heating pad and made it even more effective as a way to combat pain through heat. The Thermotex Infrared Heating Pad combines far infrared heating elements with a soft, machine washable, nylon and cotton cover that features convenient velcro straps to help hold it in place. Unlike standard heating pads that are limited in their heating ability without causing discomfort, the Thermotex Infrared Heating Pad can penetrate your body up to three inches while keeping the pad's surface temperature at less than 130 degrees Fahrenheit. Besides being great for arthritis and hip pain, the Thermotex Infrared Heating Pad is ideal for fibromyalgia, back pain, and tendonitis.
The most effective and most relaxing form of far infrared heat therapy is a far infrared sauna. Unlike conventional saunas that can reach temperatures in excess of 220 degrees Fahrenheit, far infrared saunas stay below 150 degrees and stay ventilated with fresh air as opposed to stale, humid air. This allows for longer, more effective treatments and additional amenities such as a CD player and reading light (both included). Far infrared saunas use a fraction of the electricity that a standard sauna. They are also much easier to assemble and heat up faster. The penetrating far infrared heat of this sauna not only eases hip pain, but it also increases circulation and removes toxins from your skin.
Relief of Hip Pain Does Not Have to Come From Pills
The recent study conducted at the Erasmus Medical Center further proves that taking pain relievers and supplements is not the only way to deal with arthritis of the hip. By making simple adjustments to your lifestyle, which can benefit you in other ways, you can reduce the strain on your hip joints and enjoy a pleasant, independent, and less painful lifestyle.
Both Alamapallam Venkatachalam & Richard Chandler are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.