What causes hip pain?

Hip pain is sometimes caused by deformity or injury, but one of the most common causes is osteoarthritis (OA), also known as degenerative joint disease (DJD). Although affected by things like age, weight, joint function and general activity levels, arthritis in the hip is basically the result of your hip’s cartilage lining wearing away slowly over time, and the bones beginning to rub against each other. This causes friction, swelling, pain, stiffness, and instability.

How does arthritis affect the hip?

Arthritis is one of the most common causes of joint disorders, and is the major cause of disability and chronic pain in Australia, affecting 3.85 million Australians1.  And as the average age rises, the number of people with arthritis is also growing. In fact, leading researcher Access Economics suggests 7 million Australians will suffer some form of arthritis by 2050, based on current trends2.

See how arthritis affects the hip in this video:

What can you do about hip pain?

There are many ways to help relieve your pain

The causes of hip pain include:

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Osteoarthritis

Osteoarthritis

What is osteoarthritis?

There are more than 100 forms of arthritis, but the three most significant – osteoarthritis (OA), rheumatoid arthritis (RA) and gout – account for more than 95 per cent of cases in Australia3. OA is sometimes called degenerative joint disease (DJD), because it is caused by deterioration of cartilage in the joints.

In a normal joint, a protective layer of cartilage covers the ends of the bones. With OA, this cartilage breaks down, and bones in an affected joint begin to rub directly against each other, so the joint can’t move as smoothly.

OA mostly affects people over 45, but it can develop in younger people. Of around 3.85 million OA sufferers in Australia, 2.4 million are of working age4.

There is currently no cure for OA, but there are many effective treatments to control symptoms.

What are primary and secondary osteoarthritis? 

Doctors often talk about two kinds of OA. Primary OA is caused by everyday wear and tear, while Secondary OA is caused by a misaligned joint, injury, overuse, or strain on the joint from being overweight. 

What are the symptoms of osteoarthritis? 

If you have OA you may feel discomfort, pain or joint stiffness (which may vary at different times of the day or night) and show signs of swelling and tenderness in one or more joints. You may even hear a crunching sound in your joints as the bones rub directly against each other. 

What causes osteoarthritis in different joints? 

In many cases, it’s hard to identify a clear cause of OA. But research suggests some things may put certain joints at more risk. For example:

  • Knees –a previous knee injury, being overweight or jobs involving kneeling, climbing or squatting.
  • Hips –a previous hip injury, being overweight, or jobs involving heavy lifting, such as farming.
  • Hands – a family history of OA in the family5

How is osteoarthritis treated? 

To diagnose you properly and offer the right treatment, your doctor will consider your symptoms and medical history, examine your joints, and arrange one or more diagnostic tests. For example, he or she may suggest blood tests, X-rays, a CT scan, or an MRI scan to get a clear view of your joint’s alignment and general condition.

Based on the results of these tests, your doctor will then discuss the best treatment options with you. Depending on the severity of your OA and the pain you’re experiencing, treatments may include:

  • Pain relief – using medicines such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs)
  • Exercise and weight loss – an exercise program designed specifically for you, and a weight loss program if you’re overweight.
  • A surgical procedure or joint replacement surgery – if your OA symptoms and pain levels are no longer controlled with other therapies.

Always discuss your treatment options with your doctor.

 

References
1, 2 Painful realities: The economic impact of arthritis in Australia 2007 (REPORT BY ACCESS ECONOMICS PTY LIMITED FOR ARTHRITIS AUSTRALIA 31 JULY 2007)
3  “What is arthritis”, Arthritis Australia website (http://www.arthritisaustralia.com.au/index.php/arthritis-information/what-is-arthritis.html) accessed April 2013.
4, 5 “Arthritis Information Sheet: Osteoarthritis”Arthritis Australia website(http://www.arthritisaustralia.com.au/images/stories/documents/info_sheets/2012/Osteoarthritis.pdf) accessed April 2013.

 

Rheumatoid Arthritis

Rheumatoid Arthritis

What is rheumatoid arthritis? 

Rheumatoid arthritis (RA) is an autoimmune disease, in which the body's natural immune system attacks the lining of joints (known as the synovial membrane). This can become very painful, and causes constant swelling that may eventually damage the joint's cartilage and bone, and weaken the soft tissue around the joint, which prevents the joint from working properly.

There is currently no cure for RA. However, treatment has improved dramatically over the past 20 years, and new medicines are very effective for people with the early stages of RA1.

What are the symptoms of rheumatoid arthritis? 

The symptoms of RA vary from person to person, but the most common are:

  • Joint pain, swelling, and tenderness to touch
  • Stiffness in the joints, especially in the morning
  • Stiffness and pain in the same joints on both sides of the body2.

RA may progress slowly, and sometimes produce ‘flare-ups’ of these symptoms – or at times go into remission, where symptoms are far less noticeable or disappear altogether for a while. Unfortunately, RA never seems to go away completely.

The exact causes of causes of RA remain unclear, but the condition is more common among smokers and people with a family history of RA3.

How is rheumatoid arthritis treated?

To diagnose you accurately and offer the right treatment, your doctor will consider your symptoms and medical history, examine your joints, and arrange one or more diagnostic tests. For example, he or she may suggest blood tests, X-rays, a CT scan, or an MRI scan, to get a clear view of your joint alignment and general condition.

If rheumatoid arthritis is a possibility, your GP may refer you to a rheumatologist – a doctor that specialises in inflammatory diseases like RA. They will recommend treatment options based on the severity of your RA, and its impact on your joints and your body as a whole. Although there is no cure yet for RA, it is possible to control it with new drugs, exercise, and techniques for joint protection.

  • Pain relief – your doctor may need to try several different treatments to find the one that’s right for you. Pain relief medication can include:

o   non-steroidal anti-inflammatory drugs (NSAIDs)

o   corticosteroid medicines or injections

o   disease-modifying anti-rheumatic drugs (DMARDs)

o    biological DMARDs, such as tumour necrosis factor (TNF) medicines4.

  •  Exercise – this can help keep joints flexible and muscles strong. Your doctor may consult or recommend a physiotherapist to help you find the best exercise regime for your condition.
  • A surgical procedure or joint replacement surgery, if your RA symptoms and pain levels are no longer controlled with other therapies.

Talk with your doctor about the best treatment option for you.

References
1, 2, 3, 4   “Arthritis Information Sheet: Rheumatoid arthritis”, Arthritis Australia website http://www.arthritisaustralia.com.au/images/stories/documents/info_sheets/2012/Rheumatoid_arthritis.pdf , accessed November 2012

Post-Traumatic Arthritis

Post-Traumatic Arthritis

What is post-traumatic arthritis?

Post-traumatic arthritis can develop if, after an injury to the joint, the bone and cartilage don’t heal properly. When this happens, the joint is no longer smooth, which can lead to extra wear on the joint. Post-traumatic arthritis often follows serious injury to the hip, or repeated high impact or force to the joint.

What are the symptoms of post-traumatic arthritis?

Injury to a joint, such as a bad sprain or fracture, can cause damage to the articular cartilage. Once this cartilage is damaged, it doesn’t normally grow back. Instead, scar tissue replaces it, which doesn’t protect or cushion the bones in the joint as effectively.

How is post-traumatic arthritis treated?

Post-traumatic arthritis is treated in a similar way to similarly to osteoarthritis.

To diagnose you properly and offer the right treatment, your doctor will consider your symptoms and medical history, examine your joints, and arrange one or more diagnostic tests. For example, he or she may suggest blood tests, X-rays, a CT scan, or an MRI scan, to get a clear view of the joint’s alignment and general condition.

Based on the results of these tests, your doctor will then discuss the best treatment options with you. Depending on the severity of your arthritis, how much it restricts your movement and the pain you’re experiencing, treatments may include:

  • Pain relief – using medicines such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs)
  • Exercise and weight loss – an exercise programme designed specifically for you, and a weight loss programme if you are overweight.
  • A surgical procedure or joint replacement surgery – if your OA symptoms and pain levels are no longer controlled with other therapies.

Always discuss your treatment options with your doctor.

Paget’s Disease of the Hip

Paget’s Disease of the Hip

What is Paget’s Disease?

Paget’s disease is a bone disease that often affects the hip. It speeds up bone formation, which changes the bone’s density and shape, making it larger than normal, but also weak. It is also found in the spine, legs and skull. Paget’s disease is the most common metabolic bone disease after osteoporosis, and affects up to 4% of adults older than 551

What are the symptoms of Paget’s Disease?

For many people who have Paget’s disease, there are no noticeable symptoms, and they may only discover they have it when being tested for unrelated ailments. However, some may have symptoms related directly to the affected bones, or symptoms that relate to the bone’s malformation. These include unusual bone shape, and pain caused by tiny fractures in the weakened bone. 

How is Paget’s Disease treated?

Your doctor may prescribe medication to reduce the risk of fractures in the affected bone. Regular exercise and making sure you have enough Vitamin D can also help you maintain your bone strength.

If this doesn’t work, and you are still experiencing arthritic pain and joint damage that affects your quality of life, your doctor may suggest surgery. Based on the severity of your condition, he or she will determine the most appropriate surgical treatment.

Always discuss your treatment options with your doctor.

Reference
1. “Paget disease of the bone”, Royal Australian College of General Practitioners, http://www.racgp.org.au/afp/2012/march/paget-disease-of-bone/, accessed November 2012

Avascular Necrosis

Avascular Necrosis

What is avascular necrosis, or osteonecrosis?

Avascular necrosis (AVN) is a bone disease also known as osteonecrosis (ON). It can happen when a bone is deprived of its normal blood supply, for example after an organ transplant, or long-term cortisone treatment. Without proper blood flow, sections of bone weaken, die and eventually collapse. This is especially true of the hip joint, as ON appears most commonly at the top end of the femur (the long bone that extends from the knee to the hip joint). ON causes the bone to degrade in the joint, which can cause arthritis1.

In recent years we have learned a lot more about ON and its potential causes, and research into the genetic links is ongoing. You are at higher risk of developing ON if you have dislocated or fractured a hip, suffer from alcoholism, use corticosteroids, or have a glandular disease like rheumatoid arthritis, Gaucher's disease, chronic pancreatitis, Crohn's disease or lupus2.

What are the symptoms of osteonecrosis?

Patients with early-stage ON may not experience or even notice any symptoms, but as the condition progresses, symptoms can include pain, reduced mobility and range of motion in the affected joint, and osteoarthritis. ON develops differently in each person it affects, and it can take from a few months to over a year from feeling the first pain symptoms pain to losing joint function3

How is osteonecrosis treated?

Avascular necrosis/osteonecrosis is treated in a similar way to osteoarthritis.

To diagnose you properly and offer the right treatment, your doctor will consider your symptoms and medical history, examine your joints, and arrange one or more diagnostic tests. For example, they may suggest blood tests, X-rays, a CT scan, or an MRI scan, to get a clear view of your joint alignment and general condition. They may focus on the condition of your femur and whether the head of the bone, which attaches to the hip, is still intact.

Based on the results of these tests, your doctor will then discuss the best treatment options with you. Depending on the severity of your ON, how much it affects your mobility and the pain you’re experiencing, treatments may include:

  • Pain relief – medication can help alleviate your pain, improve your joint mobility and function, and prevent any further damage.
  • Support and exercise – your doctor may recommend you try to reduce weight bearing on the affected joint. This might mean using a crutch, or limiting your activity so your joint can heal faster and more effectively while you're having treatment. He or she may also recommend some simple exercises, or even prescribe a course of physiotherapy,
  • A surgical procedure or joint replacement surgery, if your ON symptoms or pain levels are no longer controlled with other therapies.

Always discuss your treatment options with your doctor.

References
1. Arthritis Foundation website, http://www.arthritis.org/disease-center.php?disease_id=17, accessed November 2012
2. Arthritis Foundation website, http://www.arthritis.org/disease-center.php?disease_id=17&df=causes, accessed November 2012
3. Arthritis Foundation website, http://www.arthritis.org/disease-center.php?disease_id=17&df=effects, accessed November 2012

Sarcoma

Sarcoma

What is a sarcoma?

Sarcomas are malignant tumours that arise from the musculoskeletal system – in bone, fat, cartilage and fibrous tissue. Although a sarcoma can develop at any age, sarcomas most commonly appear in children and young adults.

Bone cancers form in the cells that make hard bone tissue. Cancers such as leukaemia, multiple myeloma, and lymphoma, which arise in cells produced in bone marrow, are not considered bone cancers, but they do affect the bone and may require orthopaedic management1.

The different types of bone cancer include2:

  • Osteosarcoma – the most common type of primary bone cancer, which mostly affects people aged between 10 and 25. Osteosarcoma often starts in the ends of bones, where new tissue forms as we grow. In many cases, it develops in the knee.
  • Chondrosarcoma – more common in those aged 50 or over, chondrosarcomas form in cartilage, usually around the pelvis, knee, shoulders, or upper thighs.
  • Ewing’s Sarcoma – this type usually occurs in a bone’s middle part, often in the hip, ribs, upper arm and thighbones. Like osteosarcoma, it most commonly affects children and young adults.
  • There are also some rare bone cancers that occur primarily in adults, including fibrosarcomas, giant cell tumours, adamantinomas and chordomas. 

How is sarcoma treated?

The kind of treatment depends on many factors, including the stage, type, size and location of the cancer, and a patient’s age and general health. Treating cancers of the musculoskeletal system often involves surgery to remove affected bone, muscle and tissue, and there are sometimes non-surgical treatments following surgery.   Your doctor will recommend the most appropriate treatments for you, and discuss with you what they entail.

When operating to remove bone tumours, surgeons often also take away some of the surrounding bone and muscle to ensure they remove as much cancerous tissue as possible. If operating on an arm or leg, the surgeon will try to preserve the limb and maintain its functionality. Sometimes, surgeons replace removed bone with bone from another part of the body, or use orthopaedic implants to reconstruct bones and joints.

Other forms of treatment may include3:

  • Cryosurgery – once a malignant bone tumour is removed, liquid nitrogen is used to freeze the tumour cavity, killing cancer cells and reducing the chance they will recur. The frozen bone is then stabilised by filling the tumour cavity with a bone graft, surgical cement, or rods and screws, to prevent fractures.

  • Radiotherapy – sometimes used to complement surgery, this destroys or reduces tumours.

  • Chemotherapy – often used to treat primary bone cancers in conjunction with surgery. Chemotherapy is also common after surgery, to kill any remaining cancer cells after surgical removal of the main tumour.

As with any illness, you should learn to be your own advocate, and work with the healthcare professionals to make the decisions that are right for you. Experts will make recommendations based on their knowledge and experience, but the decision is ultimately yours. 

References
1, 2,3. Australian Cancer Research Foundation website ( http://www.acrf.com.au/on-cancer/bone-cancer/) accessed November 2012

Next Steps

Contact your GP or health professional to discuss your options