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Brisbane Hip Clinic
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Surgery of the HipJoint

Non-Surgical Treatments

Many people with hip joint arthritis obtain benefit from non-surgical treatment. Non-surgical therapies may reduce pain and improve function, delaying or removing the need for surgery. For this reason, I strongly recommend patients with hip arthritis trial non-surgical treatments before considering an operation.

 

Brisbane Hip Clinic is able to provide a range of services, monitoring and advice for the management of a variety of hip disorders by non surgical methods.

 

It should be noted however that most types of arthritis are permanent and progressive. While non-surgical treatments may assist in improving your symptoms, if your condition remains persistent and problematic then surgery should be considered.

 

RECOMMENDED NON-OPERATIVE TREATMENTS FOR HIP ARTHRITIS

Weight loss

Even relatively small amounts of weight loss will substantially decrease the load force being placed through the hip joint cartilage. Weight loss will often result in an improvement in arthritis pain and significantly decreases your risk of complications if surgery is required. Professional advice will often help - speak with your General Practitioner or weight loss centre. Some people may consider bariatric surgery for weight loss.

Activity modification

Regular exercise is important to improve muscle condition and also for general health. Exercises which are often well tolerated by patients with hip arthritis include swimming, cycling, aqua-aerobics and walking. Core strengthening exercises for supportive musculature about the hip may assist in joint function and symptom control. A walking stick (used in the opposite hand to your arthritic hip) often makes walking more comfortable. Typically, higher grade impact pursuits (for example running) and deep bending of the hip joint (for example some yoga positions or deep squats) may exacerbate symptoms in people with arthritic hips. Some people obtain benefit from advice and exercise prescription under the guidance of an Exercise Physiologist or Personal Trainer.

Medications

Which medications are most effective in the management of hip arthritis differs between individuals. Often a combination of medications taken together is the most effective strategy. Some people experience worsening of pain at certain times during the day or at night - adjusting when you take medications throughout the day is often helpful. Some medications (paracetamol, glucosamine) are best taken on a semi-regular basis while others (anti-inflammatory medications, pain killers) should be used for only a short duration of time to treat 'flare-ups' for a few days or weeks at a time. People with inflammatory types of arthritis (for example rheumatoid arthritis) are often best assessed by a rheumatologist for specialist advice on the specific medications used to treat these conditions.

 

Paracetamol

 

Paracetamol usually needs to be taken a number of times during the day for best effect. Longer acting preparations for use in arthritic conditions (for example Panadol Osteo) are available from your pharmacy without prescription.

 

 Glucosamine 

 

Only limited evidence supports the use of glucosamine sulphate in the treatment of osteoarthritis. Glucosamine is probably most useful in the early stages of arthritic degeneration as a cartilage protecting agent. The effect on pain reduction is uncertain. Depending on the preparation, a typical dose will be 1500-2000mg per day on a regular basis. Many different preparations of glucosamine are available. At present greater evidence supports the use of glucosamine sulphate than glucosamine hydrochloride. Glucosamine sulphate should not be taken by patients with a seafood or sulphur allergy or mothers who are pregnant or breast feeding. Chondroitin is sometimes added to glucosamine preparations, however at present only very limited evidence supports the additional use of chondroitin.

 

Fish Oil/ Krill Oil

 

Omega 3 preparations exert a mild anti-inflammatory activity by mechanisms alternative to prescription anti-inflammatory agents. Fish oil is generally safe and may have other health benefits related to prevention of cardiovascular disease. The dose required differs according to preparation - use according to the manufacturers recommendations. Fish oil needs to be ceased 3 weeks prior to undertaking major surgical procedures.


Anti-inflammatory medications (for example Ibuprofen, Naprosyn, Celebrex, Mobic)


Anti-inflammatory medications are effective in reducing the symptoms of osteoarthritis, but may cause side effects such as stomach irritation, particularly when taken for extended durations. Other side effects may also include worsening of asthma or kidney troubles. For this reason, I would generally recommend anti-inflammatory medications are used for shorter durations of time, intermittently for the management of 'flare-ups'. If you have tried one type of anti-inflammatory medication but it was not helpful, trying a different preparation may still be worthwhile. Some types of anti-inflammatory medications are available as once a day (one tablet) preparations. Some anti-inflammatory medications require prescription however a variety of different types are also available over the counter.


Pain Killers/ Strong Analgesics (for example Panadiene Forte, Codeine, Tramadol, Morphine)


Recommended for limited periods of use only. If your pain is severe enough to require strong analgesics on a regular basis, then surgery should be considered.

Therapeutic steroid injections

Anti-inflammatory steroid injections into the hip joint may provide temporary improvement in symptoms. Injections into the hip joint need to be conducted with either X-Ray or ultrasound guidance. Usually a combination of anti-inflammatory steroid and local anaesthetic is used and may provide partial symptom relief for 3-4 months. Steroid injections are safe, however frequently repeated injections into the joint should be avoided.

Visco-supplementation injections

Viscosupplementation is an injectable medication that assists in improving the quality of the natural joint lubricant (synovial fluid) produced by the hip joint lining. Injections into the hip joint need to be conducted with either X-Ray or ultrasound guidance. A single hip injection provides on average a 30% reduction in pain for 6 - 12 months. At present viscosupplementation medications (Synvisc/ Durolane/ Euflexxa) are not listed on the Australian PBS (Pharmaceutical Benefits Scheme), which means that patient is responsible the full cost of the medication without government assistance. Some health care funds may provide a rebate depending on your extras pharmaceutical coverage.

Physiotherapy/ Exercise physiology/ Pilates

Advice on physical therapy and exercise prescription are often of significant value in managing a variety of hip disorders. For people with hip arthritis, physical therapies may assist in conditioning and obtaining endurance of the surrounding muscles that support the joint. A long term and whollistic approach to the management of a hip with osteoarthritis should include some form of regular physical therapy or conditioning program. Brisbane Hip Clinic is able to offer these services or make recommendations for a suitable therapist local to your region.

 

 


This information has been written by A/Prof Patrick Weinrauch for the purposes of patient education. The details provided are of general nature only and do not substitute for professional recommendations based an individual clinical assessment. © A/Prof Patrick Weinrauch. Brisbane Hip Clinic.