Non-Surgical Care Program

Many people with a variety of hip joint and orthopaedic conditions of the pelvic musculature obtain benefit from non-surgical treatment programs. Non-surgical therapies may reduce pain and improve function, delaying or eliminating the need for surgery. In many instances we often recommend patients with hip arthritis trial a structured non-surgical treatment program before considering an operation. 

Non-surgical treatment is often delivered using a number of strategies in combination to achieve best results. Treatment is individualised and takes into account the degree of symptoms, desired outcomes and patient preference relating to different options.

Brisbane Hip Clinic offers a comprehensive Non-Surgical Care Program for the assessment, coordination and supervision of patients with hip joint conditions.

It should be noted that most types of arthritis are permanent and progressive. While non-surgical therapy may assist in improving your condition, if your symptoms remains persistent and problematic then ultimately surgery may be considered as a more definitive strategy.

RECOMMENDED NON-SURGICAL OPTIONS FOR HIP ARTHRITIS AND MUSCULOSKELETAL CONDITIONS

Weight loss

Even modest amounts of weight loss will substantially decrease the force being placed through the hip joint cartilage. Weight loss will often result in an improvement in arthritis pain and improvement in function. Furthermore, if surgery is recommended, weight loss may significantly decrease the risk of complications in obese patients. Professional advice on weight loss methods will often help - consult 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 strength, general health and weight loss. Exercises that are often well tolerated by patients with hip arthritis include low impact activities and those that do not require deep bending of the hip joint. Swimming, cycling, weight training, aqua-aerobics, walking and Pilates are alternatives that many people with hip arthritis find suitable. 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 exercise prescription under the guidance of an Exercise Physiologist, Physiotherapist or Personal Trainer.

Medications

Most oral medications for the management osteoarthritis are used intermittently. Which medications are recommended differs between individuals. Often a combination of medications taken together or alternated according to symptoms 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 are best taken on a semi-regular basis while others 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

The evidence suppporting this therapy alternative is weak. 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 generall quite effective in reducing the symptoms of osteoarthritis. Side effects such as stomach irritation may be experiences when taken for extended durations, particularly for some types of preparation. Other side effects may also include worsening of asthma or kidney troubles. I would generally recommend anti-inflammatory medications are used intermittently for limited durations in the management of 'flare-ups'. If you have tried one type of anti-inflammatory medication but it was not helpful ir experienced side effects, 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 are typically conducted with ultrasound guidance. Usually a combination of anti-inflammatory steroid and local anaesthetic is used and may provide reasonably good symptom relief for 3-4 months. Steroid injections are safe, however frequently repeated injections into the joint should be avoided.

Viscosupplementation 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 are typically conducted with either X-Ray or ultrasound guidance. A single hip injection provides on average a 30% reduction in pain for 6 - 18 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. Link to further information.

Platelet Rich Plasma injections

Platelet Rich Plasma (PRP) is an injectatble therapy that has proven useful in the management of tendonitis. Only limited data support the use of PRP in joint conditions such as osteoarthritis - viscosupplementation is generally considered a better alternative in most people. Link to further information.

Radiofrequency Neurotomy

Radiofrequency neurotomy (RF) is a non surgical procedure used to assist in the management of moderate to established significant osteoarthritis. A fine needle probe is placed into specific locations about the hip, where sensory nerve fibres arise from the joint. An electric current is passed through the RF probe, disrupting signal transmission of the sensory nerve branches from the joint. In this way, reduction of pain from the joint can be achieved for 12 months or greater. Link to further information.

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 assist with these services or make recommendations for a suitable therapist local to your region.

Recovery Medical

Within our facility at Brisbane Hip Clinic we are able to offer a range of non surgical therapy options and pre-surgical preparation programs though our partner Recovery Medical.

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.