Hip osteoarthritis (coxarthrosis) is wear of the cartilage in the hip joint. It is the most common cause of hip pain after the age of 50. The cartilage becomes thinner, the joint gets stiffer, and bony growths form around it. It develops slowly, over years, and in the early stages exercises help you walk with less pain.
Symptoms
- Pain in the groin that sometimes runs down the front of the thigh to the knee.
- Stiffness in the morning and after sitting, which eases after a few steps.
- Difficulty putting on socks and shoes, and getting into a car.
- A limp after walking for longer.
- Pain when you get up from a low chair.
- Difficulty moving your legs apart, for example when getting on a bike.
- Sometimes the pain is felt only in the knee.
Pain on the side of the hip, over the bone, more often comes from the tendons and the bursa than from the joint itself. That is why the location of the pain matters, and Kaloyan checks it carefully. The pain is usually worse after effort and in the evening, and in a more advanced stage it also appears at rest.
Why it happens
- Age and wear over the years.
- Being overweight, which loads the joint.
- A hip joint that formed differently from birth (dysplasia).
- Old injuries or fractures around the hip.
- Heavy physical work or years of demanding sport.
- A parent with hip osteoarthritis.
- Too little movement: cartilage gets its nutrients when the joint moves.
The X-ray and the pain don’t always match. Some people with marked changes walk without pain, while others with mild changes have severe symptoms.
How we treat it
Bring your latest X-ray and your discharge summaries from the hospital. Kaloyan checks how far the joint moves, the strength of the muscles around the pelvis, and the way you walk. In early and moderate hip osteoarthritis, the core of treatment is exercises: for the mobility of the joint and for the strength of the buttock and thigh muscles that take the load off it. TECAR therapy warms the joint and the muscles around it deeply and reduces pain, so Kaloyan often combines it with the exercises. If the pain is severe, he starts with gentler exercises, lying or sitting, and gradually makes them harder. A course is usually 4–8 sessions, and then you carry on at home. The effect of exercise fades when you stop, so they stay part of your week after the course ends.
When the osteoarthritis is advanced and your orthopaedic doctor decides on a hip replacement (an artificial joint), post-operative rehabilitation follows: from the first steps on crutches to walking normally and climbing stairs. The aim is for you to be able to do the things that matter to you: a walk, stairs, shopping. Cartilage doesn’t grow back, but with stronger muscles many people walk for longer and with less pain. If surgery is coming up, exercises beforehand make the first weeks afterwards easier.
What you can do yourself
- Move every day. Walking on level ground, cycling and swimming are gentle on the joint.
- On days with severe pain, use a walking stick in the hand on your good side.
- If you are overweight, every kilogram you lose takes load off the joint.
- Choose a higher chair and a raised toilet seat if getting up is difficult.
- Shoes with a soft sole reduce the impact when you walk.
- Don’t sit for long in very low, soft armchairs.
When to see a doctor first
See a doctor first if:
- you have sudden severe pain in the groin after a fall, especially if you are older;
- you can’t put weight on your leg;
- the joint is warm and swollen, or you have a fever;
- the pain is there at rest and at night, and is getting worse.
