Hip osteoarthritis: Local and surgical treatments

Injections may be prescribed for osteoarthritis when the anti-inflammatory drugs and analgesics have failed to relieve a flare-up.

This technique involves injecting an anti-inflammatory cortisone-based product directly into the joint. Cortisone has the advantage of acting on both pain and inflammation. In no case does it damage the cartilage; but some patients on seeing their painful symptoms regress or even disappear push their joint too hard at a time when it is still fragile.  

The injection generally gets good results because the majority of the injected product remains in the joint. It acts on the pain and swelling within hours or days.

Its effect is prolonged, lasting from a few days to two months, depending on the case.

Injections are often feared but, in actual fact, they are not really worse than a blood test if your doctor is experienced. However, it is always possible and sometimes useful to use a local anaesthetic beforehand.

Go easy on your joints for a few hours after the injection. Sometimes the pain increases for several hours following the injection. These problems disappear spontaneously within a few hours and are not a contraindication for further injections.

However, for pain that occurs 48 hours after the injection, you should go and see your doctor immediately to rule out the possibility of an infection. Although this risk is very low (1 in 50,000 injections) you need to be particularly vigilant.

There is no need for a special diet: the passage in the blood of cortisone administered locally is far too low to lead to weight gain. However, if you have diabetes, this may cause a temporary imbalance.

It is recommended not to perform more than three injections per year per joint for the simple reason that if the first three did not have a sufficient effect, it is unlikely that the fourth will be more effective.

Keep track in a notebook or your health record of the date, the product used and the effectiveness of the injection.

By corrective surgery we mean, an operation intended to correct certain defects of the bones that are responsible for the abnormal morphology of a joint. Thus one can occasionally be required to correct the axis of a knee or a malformation of the hip.

The morphological defects result in abnormal pressure on certain parts of the cartilage of the joint in question, and therefore increased wear and tear. By correcting the existing defect, the pressure will be spread better over the entire surface of the cartilage which will thus wear less.

It is therefore understandable that when such defects exist, there is interest in carrying out these procedures as early as possible. That is to say, during the early symptoms of osteoarthritis. Indeed, if the cartilage is too damaged, the procedures will not be effective.

Osteoarthritis of the knees and hips can sometimes benefit from this type of surgery.

This is major surgery: it requires hospitalisation for about ten days and prohibits putting weight on the operated leg for 6 weeks.

The risks are those of any surgical procedure (phlebitis, pulmonary embolism, risk of anaesthesia) and also the risk of infection.

This is to replace a joint badly damaged by osteoarthritis by a joint in synthetic material. The indication is never urgent because it is primarily to improve comfort. The surgical decision is the result of discussions between yourself, your doctor and the surgeon.

The results are generally good with a reduction of pain associated with osteoarthritis and a satisfactory restoration of mobility. However, you should keep in mind that a prosthetic joint rarely functions as well as a normal joint. The techniques with the safest and best results are currently those used for hips and knees.

These are mainly knee joints and hip joints. The prostheses are made of different materials and attached to the bone with a special cement or "biological glues".

The procedure is done under general or local-regional anaesthesia. It also includes a self-transfusion (sample of your own blood before surgery for you if a transfusion is required during surgery). This technique removes all the risks of a transfusion.

Hospitalisation lasts about a week, but a stay of 4 to 6 weeks straight afterwards in a rehabilitation centre is desirable.

In all cases these procedures are necessary only when all other medical treatments have failed. The materials used have the disadvantage of wearing out after 15 to 20 years and even faster in young and active people. This is why a prosthesis is not generally proposed to people under the age of 55 to 60 years (except in special cases).

Preparation is necessary:

• strength training for the muscles that will surround the future prosthesis,
• osteoarthritis in cases of obesity,
• eliminating any source of infection (teeth, sinuses, etc.).

Some surgeons recommend a period of one to several months after the last injection of corticosteroids and the operation in order to be safe from any potential infection with the corticosteroids. the prosthesis may become detached from the bone to which it had been fixed:

• it sometimes loosens due to infection (1-2%),
• poor positioning of the prosthesis and lastly much less serious,
• painful muscle or tendon problems that disappear with proper rehabilitation.