By Dr. Sahil Gaba
World Mental Health Day 2023: The prevalence of hip arthritis, and its impact on the population, increases with age. The most common form of hip arthritis is Osteoarthritis, generally attributed to ageing and wear and tear. Another common cause of hip arthritis, especially in the post-COVID era is Avascular Necrosis (AVN) of the hips. Hip arthritis causes pain, stiffness, difficulty in walking, change in posture and leg lengths, and functional disability in performing routine day-to-day activities. The mental health implications of arthritis are often not diagnosed and treated properly, and can include anxiety, stress, and depression. This combination of physical and mental symptoms causes significant impairment in quality of life.
It is important to understand how hip arthritis can affect a patient’s life. Pain and difficulty in walking lead to difficulty in mobilisation, and hence daily tasks like going to the washroom, going to the market, going for a walk, etc become problematic and sometimes impossible. Pain and stiffness cause difficulty in sitting down and getting up from a chair, using a toilet seat, getting in and out of a car, etc. Another consequence of difficult mobilising is reduced social interaction with friends and family. Secondary muscle weakness and difficulty in maintaining balance occur, which also increases the risk of falls and subsequent fractures. Slow walking and limping can be perceived by patients as a social stigma. All these problems are compounded if immediate family members are not available at home for help and support.
The treating doctor must recognise these facets of the disease and manage them appropriately. A multidisciplinary team comprising an orthopaedic surgeon, dietician, internal medicine specialist, physiotherapist, psychiatrist and psychologist is indispensable to achieving the best possible outcomes.
Treatment of hip arthritis includes both non-operative and operative options. Non-operative therapies include weight loss, occasional pain-killer medications, precautions (eg. avoiding cross-legged sitting and stairs, etc), lifestyle modifications (eg.western toilet seat instead of Indian toilet seat), walking aids, and physiotherapy (muscle strengthening, balance exercises). Another important treatment modality is a joint injection, options available include steroids, hyaluronic acid or gel, platelet-rich plasma (PRP), and bone marrow concentrate. These options are appropriate for mild to moderate stages of the disease.
For severe disease or end-stage disease, we generally resort to surgery. Total Hip Replacement (THR) has been termed the “Operation of the Century” because of excellent short-term and long-term results. According to a recent estimate, around 4 lakh hip replacements are performed worldwide every year. Many studies have shown that the quality of life improves significantly after a patient with disabling hip arthritis undergoes hip replacement surgery. Mobility of the patients increases and they can carry out their activities of daily living comfortably without any external help. Some precautions are generally advised such as avoiding some positions of the leg and avoiding running and high-impact activities. But many patients are able to go back to lighter forms of sports like golf, swimming, cycling, etc.
Recent research in this area has focussed on using robotics and muscle-sparing approaches to improve outcomes and shorten the recovery period after surgery. If you are suffering from hip pain or hip arthritis, you must consult an orthopaedic surgeon before the pain causes severe disability.
The author is Consultant and Assistant Professor, Department of Orthopaedics, Amrita Hospital, Faridabad.
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