… Without surgery
Time isn’t kind to aging hips. Every year, nearly 400,000 Americans, mostly seniors, undergo hip replacement surgery to relieve pain and improve mobility. Millions more have to curtail their normal activities because of hip pain and stiffness.
What happens: Most people with chronic hip pain suffer from osteoarthritis, a “wear and tear” disorder caused by decades of pressure and friction. The cartilage that cushions the ends of bones roughens and breaks down. The bones of the joint begin to “grab” sooner or later instead of sliding smoothly. Result: Persistent inflammation and pain — and, often, disability.
Hip replacement procedures are effective, but they are major surgeries and carry risks, including infection, blood clots or dislocation/loosening of the prosthetic hip. Many people with hip pain — including those who think they need surgery — can often reduce discomfort with medications and lifestyle measures without the risks of surgery. To reduce discomfort and protect the hips…
MANAGE PAIN AGGRESSIVELY
Osteoarthritis sufferers typically experience flare-ups of heightened pain. This is usually due to joint inflammation. Take it seriously. Untreated inflammation accelerates joint damage and makes pain more difficult to manage.
Best approach: Ordinary, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), naproxen (Aleve) or even plain aspirin. These drugs block prostaglandins, inflammatory chemicals that cause pain as well as joint damage. Pain can persist for days when inflammation is allowed to “fester.” Patients get the best results when they take an NSAID at the first hint of pain.
Helpful: Combine an NSAID with acetaminophen (such as Tylenol). The combination works at multiple pain sites and gives additional relief. Also important…
- Start with a low dosing frequency. Take the drugs twice daily — for example, in the morning and evening, when stiffness tends to be worse. If pain persists, increase the frequency to up to four times daily.
- Take NSAIDs with food to reduce stomach upset. Combining NSAIDs with an antacid can reduce this side effect. Follow the dosing instructions on the label and consult with your doctor about regular blood tests to assess kidney and liver functions.
- Try different drugs as needed. Most NSAIDs are chemically similar, but everyone responds to them differently. Try a drug for a week. If it doesn’t seem to be helping, switch to something else — say, naproxen instead of ibuprofen, or aspirin instead of naproxen.
Caution: Many of the NSAIDs can prolong bleeding time (before blood starts to clot) in some patients. They may be dangerous for those with clotting disorders or who take blood-thinning medications, such as warfarin (Coumadin). Talk to your doctor before using NSAIDs on a regular basis.
Oral pain relievers/anti-inflammatory drugs are often sufficient for mild to moderate hip pain, but they don’t work for everyone — particularly for patients with more severe joint damage. Two options…
- Hyaluronic acid, a component of connective tissue, reduces inflammation, increases joint lubrication, inhibits cartilage breakdown and may stimulate cartilage growth.
How it’s used: A doctor injects it into the joint once a week for three to five weeks. Many patients notice some improvement over a 10 to 12 week period after the last injection.
Some patients don’t respond to hyaluronic acid. Those who do may be free of pain — or have reduced pain — for a few weeks to more than a year. The injections can be repeated every six to 12 months. It works best for patients with mild to moderate pain.
- Corticosteroids. Steroids decrease inflammation and reduce immune system response. Cortisone or other steroids can be injected into the joint for very rapid relief, within three to 14 days — important for patients with severe pain. In some cases, a single injection can relieve pain for many months.
Caution: The injections can increase cartilage degradation with repeated use. Most patients are advised to have no more than one or two steroid injections a year.
Glucosamine (a supplement derived from the exoskeletons of crustaceans) is thought to promote cartilage growth, and chondroitin (taken from cow and/or pig tissues) appears to inhibit cartilage breakdown. A number of studies have looked at the effects of these supplements — used alone or in combination — and the findings are mixed.
My experience: Many patients report that glucosamine/chondroitin supplements provide lasting pain relief.
Recommended: A daily supplement that combines 1,500 mg glucosamine with 1,200 mg chondroitin. The supplements don’t work quickly. Take them for two to three months to see how much they help.
Some patients experience stomach upset when taking these supplements, but that is rare. Most people who take them don’t experience side effects.
Obesity substantially increases the risk of hip osteoarthritis and makes existing pain worse. The hips absorb three times our body weight when we walk. Someone who is 10 pounds overweight adds 30 pounds of force to the hip joints. And people who are overweight tend to be more sedentary, which decreases joint strength and flexibility.
Good news: People who lose as little as five to 10 pounds — with diet, exercise, etc. — often report a significant reduction in hip pain and stiffness.
Exercise is among the best treatments for osteoarthritis. Increasing muscle strength and flexibility reduces joint stress… increases levels of pain-relieving body chemicals called endorphins… and increases the flow of synovial fluid, which lubricates the joints.
Recommended: Low-impact cardiovascular exercises, such as riding a stationary bike (set on low resistance) or using an elliptical machine (a treadmill-like device that also exercises the arms). Water exercises — swimming, water aerobics, etc. — are ideal because the water helps support the joints. Walking is also good for those with hip osteoarthritis, as long as you walk on a soft surface and avoid steep hills.
Most people with hip pain experience an increase in discomfort when they first start exercising. Stick with it — those who continue to exercise (working up to a minimum of 30 minutes, four or five days a week) report a long-term decrease in pain and an increase in flexibility and mobility.
Surgical hip replacement is a good choice for patients who can no longer do things they enjoy… have difficulty standing or sitting… get little relief from painkillers… or have trouble sleeping because of persistent pain. More than 90% of patients who have surgery experience significant improvement.
Important: Doctors often base their recommendations for surgery on imaging studies (such as X-ray evidence of joint damage) or on physical findings during an examination. But joint replacement is rarely an emergency procedure, so you can make your own decision. If hip pain is impairing your ability to enjoy life, and the “lifestyle” measures described in this article haven’t worked, surgery might be a good choice.