What non-operative treatments can you try to control your hip symptoms?

Weight reduction

Weight reduction will reduce the stresses on your hip joint and may allow you to bear weight through the joint more easily. To find out whether weight loss is a good idea go to the NHS Body Mass Index (BMI) calculator at NHS BMI Calculator. This will enable you to calculate your BMI according to your height, weight, age, gender, ethnicity and activity level. The calculator will also tell you whether you should try to lose some weight. The calculator only sets you a target that is likely to be achievable and if you really want to help your health, getting into the green zone should be your long-term goal. Many people find it difficult to lose weight when they have a painful hip or knee that makes it difficult to exercise. There is no absolute weight limit for hip or knee replacement surgery but as your BMI increases, so do a number of the risks associated with major joint replacement.

Physiotherapy

Useful advice on the role of physiotherapy can be seen at the Versus Arthritis website

Medications for arthritis

Useful guidance on analgesics (pain killers), anti-inflammatories and other medications can be found at the  NHS Information website.

Joint Injections

There are a number of options when considering injections into painful joints to alleviate or relieve symptoms.  On a positive note, these injections can usually be undertaken by a radiologist (x-ray and imaging doctor), under ultrasound guidance, as an out-patient procedure and do not require any hospital admission.  While injections in joints are normally quick and less painful than surgery, they do carry a very small risk of a bug getting into the joint and, if this occurs, further joint deterioration will be accelerated.  Injection options include:

1) Steroids – Helpful guidance on steroid injections can be found on the NHS Information website.

2) Hyaluronic Acid – Healthy joints contain a small amount of lubricating fluid (synovial fluid) that is manufactured by the membrane that lines the walls of the joint (the synovium). The synovial fluid lubricates the cartilage surfaces of the joint, provide the cartilage cells with their nutrients and remove the waste products of their metabolism. The synovial fluid is a good lubricant because it is more viscous than blood and other body fluids. The viscosity is due to the presence of long chain molecules of hyaluronic acid. In arthritic joints the hyaluronic acid molecules are damaged and hyaluronic acid injections help restore the synovial fluids lubricating properties. There is some evidence that hyaluronic acid injections reduce the inflammatory changes in a deteriorating joint and that the benefits can last for up to six months. However, hyaluronic acid is more expensive than steroid and there is no robust evidence that a hyaluronic acid injection works any better than a steroid injection. On this basis the National Institute for Health and Care Excellence (NICE) recommends thattis treatment should not be available as an NHS treatment. NICE guidance on Hyaluronic acid injections

3) Platelet rich plasma (PRP) – The platelets in our blood contain numerous cargo granules that contain hundreds of proteins and hormones needed to stimulate and control would repair. To obtain PRP, approximately 40cc of a patient’s blood is taken. The sample is placed in a centrifuge and spun to separate the different blood components. The platelets are then extracted from the sample and injected into the patient’s painful joint. Current evidence suggests that the PRP dampens down the inflammatory processes that occur as a joint is becoming arthritic and that this may make the joint more comfortable for a period of time. However, there is no convincing evidence that PRP can stop or reverse the arthritic process.

4) Stem cells, gene expression therapies – In the future, stem cell and gene expression therapies may enable us to slow, halt or reverse the damage that causes arthritic joint degeneration. In both fields, extensive laboratory research is ongoing and clinical trials will follow. There are already more than sixty UK clinics offering stem cell treatments for a variety of conditions. The stem cells are extracted either from fat or bone marrow and can be re-injected into painful joints or cultured in a lab (expanded) to increase their numbers before being re-injected. To date, no one has yet published any robust data showing benefit for patients with degenerative hip disease. Indeed no one yet knows how many viable stem cells are obtained when they are taken from different sources or how the extraction and processing techniques affect the cells. The research team at the South West London Elective Orthopaedic Centre recently won a grant to study these questions and we anticipate that it will be many years before reliable and effective stem cell treatments are developed.