If you have arthritis in your hip, you know how debilitating the disease can be. But how did you get to this point, and what can you do about it? The pain and destruction of arthritis of the hip does not happen overnight, but occurs through a sequence of events that has at its core, a loss of cartilage in the hip. The degenerative changes that occur through this process affect other hip joint structures, and will eventually lead to the narrowing of joint space and the growth of bone spurs. The cycle progresses until movement of the hip joint becomes noticeably restricted. The ongoing hip pain, restriction in mobility, and disability caused by hip arthritis frequently leads sufferers to seek out relief, and their physician and/or surgeon will eventually recommend surgical replacement of the hip. Is a surgical hip replacement the only choice a hip arthritis sufferer has?

<strong>Let’s Take a Deeper Look at the Arthritis Cycle</strong>

What actually transpires before reaching the point of cartilage loss in the hip? Arthritis of the hip almost always begins with ligament weakness or injury. The hip joint is a ball-and-socket joint with massive ligaments. Healthy ligaments hold the bones together, and along with the cartilage enable the bones to glide evenly over one another when the joints go through their various motions. The ligaments are the structures primarily responsible for maintaining smooth joint motion, and making sure the joint doesn’t go out of place or move too much! But when the ligaments and other soft tissue structures of the hip face forces beyond what they can withstand, injury and failure occur, resulting in hip instability. These forces may be sudden, such as through a fall or accident, or over a period of time, when the ligaments are subjected over and over to abnormal forces during situations like when a person continually limps due to an ankle or knee injury. When the ligaments become injured, the entire hip joint will be unstable and will move abnormally. You can understand how the abnormal movement of the joint will then put undue stress on all of the other joint structures which will continue to weaken the ligaments more and more. Even the overgrowth of bone, as seen by the development of bone spurs, is part of the body’s attempts at stabilizing the abnormal joint motion occurring in the joint. The cycle of injury goes on, progressively degenerating the hip in the development of arthritis. At this point, the sufferer is faced with the question of how to relieve the pain and improve function, since mobility is often impaired. Surgical repair and hip replacement are needed at times, but more conservative treatments should be sought first.

<strong>What Are the Treatment Options for Hip Arthritis? </strong>

NSAIDs (non-steroidal anti-inflammatory drugs) and corticosteroid injections are commonly used to treat arthritis pain. Are these good options?  These pain relief options have been shown to be effective in decreasing inflammation and pain in the short-term.  However, these medications have some negative side effects. Unfortunately, they weaken soft tissue and inhibit the ability of the tissue, such as ligaments and tendons, to heal. For this reason, their use is cautioned in those who have ligament and soft tissue injuries. How do they weaken soft tissue? Cortisone actually weakens collagen and as such weakens the soft tissue. Can you see how taking something that weakens soft tissue will actually make injuries occur more easily and cause the joint to be more susceptible to injury and more unstable overall? It’s true! Cortisone contributes to the development of conditions such as arthritis, and pushes the sufferer more rapidly down the road to the eventual joint replacement. For acute ligament injuries, these modalities should be used for the shortest period of time, if used at all. Instead, regenerative medicine techniques, such as Regenerative Orthopedics, which have been shown to resolve ligament injuries, repair tendon injuries, and rebuild cartilage in the hip, should be sought.

<strong><em>Do Hyaluronic Acid Injections Work?</em></strong>

Hyaluronic acid injections, such as Synvisc or Hyalgen, are very popular conservative treatments for hip pain. Hyaluronic acid provides cushion and lubrication to the joints. It can be used as an oral supplement and as an injection that is given directly into the hip joint.

But does hyaluronic acid work and are there drawbacks to its use? Sometimes sufferers experience relief with hyaluronic acid injections, but the reprieve from pain is generally only for a short period of time. When you take a look at studies, the research has shown hyaluronic acid treatment to actually lack clinical effectiveness, with thousands of patients finding only minimal relief or no relief at all.<a href="#_edn1" name="_ednref1">[i]</a> The treatment frequently becomes only a delay of the inevitable hip replacement, because <strong><em>it only lubricates a dysfunctional joint, without fixing anything.</em></strong>

<strong>What about Arthroscopic Surgery? Is it beneficial?</strong>

Elimination of the painful area by arthroscopic shaving and cutting, or by the removal of tissue just delays the pain for a few years until the remaining tissue becomes degenerated. Arthroscopy is a direct assault to joint tissue, and increases the arthritic process. Arthroscopy, like the aforementioned treatments, may relieve symptoms temporarily, but long-term will destabilize the joint and boost degeneration. The hip pain patient must realize that with each procedure and each shaving or cutting of tissue, NSAID prescription, or cortisone injection, the risk of developing long-term arthritis and the eventual hip replacement is greatly increased. The key to keeping the hip strong is to stimulate the area to heal.

<strong>How Can You Stop the Cycle of Instability in the Hip Joint?</strong>

The goal of many therapeutic, non-surgical modalities such as weight loss, exercise, physical therapy, bracing, and orthoses, is to decrease pain and improve function, but they are unable to repair the source of the pain, or the cycle of joint instability that started the problem to begin with. The increased mechanical stress caused by injury to the ligaments, tendons, labrum, etc. that altered the function of the hip joint and made the joint unstable and more susceptible to further soft tissue injury, needs to be stopped. If you don’t repair what caused the arthritis in the first place, it will only continue, since the long-lasting effect of continual joint instability is arthritis. Unfortunately, these treatments may fail because they are unable to repair this instability. The road to arthritis, and the ensuing joint replacement, can only be remedied when the problem of joint instability is addressed.

Fortunately, Regenerative Orthopedics stops the cycle, because the treatments repair the soft tissue injuries, like ligament, tendon, and labrum injuries. Regenerative Orthopedics do not interfere with the normal healing process of the body, like cortisone and NSAIDS do, but rather stimulate the normal inflammatory-reparative mechanisms of the body, laying down new collagen, strengthening the tendons and ligaments, and boosting cartilage growth. The treatments reduce the chance of long-term arthritis. Regenerative Orthopedics offers hope to those suffering from hip arthritis and to those trying to avoid hip replacement. While surgery is necessary in a small percentage of patients, non-surgical regenerative therapies should be a first-line, conservative treatment tried prior to surgery.  If surgery has already been done and pain continues to be an issue, these treatments can be effective at reducing the pain from the arthritis that was accelerated due to surgery. For more advanced conditions, the Gold Standard in Stem Cell Therapy can be utilized, which offers a promising alternative to joint replacement and the opportunity for healing and return to function for those suffering from arthritic hip pain.

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<a href="#_ednref1" name="_edn1">[i]</a> Diehl P, Gerdesmeyer L, Schauwecker J, Kreuz PC, Gollwitzer H, Tischer T. Conservative therapy of osteoarthritis. Orthopade. 2013