ByEvery year around 73,000 Britons undergo a hip replacement. In most cases, this is because the cartilage — which cushions the hip joint — has worn away through wear and tear.
More than half those aged over 50 will have some degree of this damage. Many will resort to non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, but taken long term, these carry a risk of gastric bleeding and ulcers — they may also increase the risk of heart disease.
‘Our aim is to help people maintain joint function and keep them away from surgery for as long as possible,’ says Dr Rod Hughes, a rheumatologist at the Ashford and St Peter’s Trust in Surrey. ‘But we also want to encourage patients not to take strong conventional painkillers for long periods.’
King of the swingers: Follow our tips and you could be moving your hips like Elvis
So are there any alternatives? One hope is that the patient’s own stem cells — which have the capacity to turn into different cells in the body — could soon be used to regenerate cartilage in the joints.
Human trials are already under way at the new £6 million Arthritis Research UK Tissue Engineering Centre at Newcastle University.
In the meantime, what else can you do to tackle hip pain — and try to postpone the need for an op? We asked the experts . . .
One of the most popular remedies for joint health is glucosamine, a dietary supplement usually derived from mussel shells.
Glucosamine is often combined with chondroitin, a substance found naturally in cartilage, but manufactured from animal sources such as bovine cartilage.
Laboratory studies have shown that it nourishes cells — the theory is this helps preserve cartilage in the body. Glucosamine is also thought to act as an anti-inflammatory. Vegetarian varieties are available for those allergic to shellfish.
DOES IT WORK? In a study reported in the New England Journal in 2002, glucosamine was shown to reduce the speed at which damage to knee joints develops.
The six-month trial involved patients taking 1,500 mg daily, and this was found to be more successful in reducing arthritic pain in knee joints than a placebo or paracetamol.
Another more recent U.S. trial found that it helped reduce pain in some patients with severe arthritis, but made no difference to those with mild to moderate arthritis. Then in 2010 a review of studies on hip and knee arthritis found glucosamine made no difference.
EXPERT COMMENT: ‘Anecdotal support for its benefits is strong,’ says Dr Hughes. ‘The trouble is that glucosamine supplements are less predictable than conventional medicines, but they could play a role in a balanced programme of treatment that also includes weight-loss and exercise.’
New lease of life: Glucosamine could have you back on your feet if supplements are combined with exercise
Collagen is the most common protein found in our bodies and it is the loss of this with age that leads to wrinkles. However evidence is emerging to show it helps keep our connective tissue flexible, enabling our bones and cartilage to bear weight.
DOES IT WORK? Taking collagen hydrolysate (a form of collagen supplement) appears to slow collagen loss, according to some studies. A German review of 16 studies involving 2,000 people with osteoarthritis of the hip and knee found that taking collagen hydrolysate a day for at least three months reduces pain and improves mobility.
EXPERT COMMENT: ‘There’s evidence from a small number of studies that taking collagen hydrolysate orally can slow down the progression of osteoarthritis,’ says Professor Greg Whyte, a physiologist from the School of Sports Sciences at Liverpool John Moores University and also an adviser to the British Olympic team. He recommends collagen hydrolysate capsules to athletes in his care.
Shock absorber: Hyaluronic acid, which is found naturally in joint fluid, can be injected to treat joint pain
Hyaluronic acid, which is found naturally in joint fluid, is increasingly used to treat joint pain. A synthetic form is injected into the joint to lubricate and act as a shock absorber. Doctors believe in osteoarthritis, the molecules of hyaluronic acid become smaller and their concentration is reduced.
Injecting it into the joint replaces what has been lost and helps slow the progression of the disease. The jabs need repeating every six to 12 months.
DOES IT WORK? After examining 76 trials of varied size and quality, the respected Cochrane Collaboration, based in Oxford, supported its use in the treatment of knee osteoarthritis. Pain relief comes on slowly but can, in some cases, last up to six months.
Although the Government’s health watchdog the National Institute for Health and Clinical Excellence (NICE) has found the injections have a small beneficial effect in treating osteoarthritis, from a cost-effectiveness point of view the efficacy of the injections would have to be three to five times greater before it would recommend their use on the NHS. For this reason the injections are only available in the UK privately, costing around £200.
EXPERT COMMENT: ‘These injections may have a beneficial effect in early arthritis, but it isn’t clear yet whether they postpone the need for joint replacement,’ says Sudheer Karlakki, an orthopaedic surgeon at the Robert Jones and Agnes Hunt Orthopaedic Hospital.
He points out that injecting a hip joint ‘is more complex than injecting a knee because the joint is much deeper’. ‘You have to use X-ray or ultrasound to ensure the hyaluronic acid gets right into the joint.’
Dr Hughes adds: ‘These injections are in widespread use in private medicine and anecdotally they work well for some patients, but others are disappointed and, occasionally, the injections can cause flare-ups.’
Encouraging results: Rosehips have been shown to reduce joint pain in studies
The active compound found in some rosehips is thought to have an anti-inflammatory effect, helping to reduce joint pain.
DOES IT WORK? More than 80 per cent of participants in one study, reported in the Scandinavian Journal of Rheumatology in 2005, experienced pain relief in three weeks, and 40 per cent were able to cut the number of painkillers they were taking.
A more recent review, published in the journal Osteoarthritis and Cartilage, looked at three rosehip studies and concluded that the traditional remedy had a ‘small-to-moderate short-term effect’ in reducing pain in people suffering with osteoarthritis compared with a placebo.
EXPERT COMMENT: ‘The data, especially where knee pain is concerned, is very encouraging,’ says Dr Hughes. ‘As yet, there are no specific studies on hip pain but there’s no reason to suppose this extract will work any differently on that.’
Hip arthroscopy is a form of keyhole surgery used to ‘smooth out’ the hip joint by trimming or removing loose cartilage or bone to reduce pain and delay the need for full joint replacement.
Knee arthroscopy has been used since the Seventies and is now one of the most commonly performed orthopaedic operations. Hip arthroscopy is a newer technique and fewer orthopaedic surgeons are performing it.
The technique is particularly helpful for those who suffer persistent groin pain as a result of hip impingement — also known as Femoro Acetabular Impingement.
This is caused by bony projections from the leg bone pinching the soft tissue in the joint and can go on to cause osteoarthritis.
The condition affects around one in ten adults and usually first strikes between the ages of 20 and 40.
Hip arthroscopy means patients can have minor repairs done before they go on to develop arthritis.
During a one-hour-long keyhole operation, done under general anaesthetic, the bony projections are cut away and the area around the socket is smoothed out.
DOES IT WORK? A study last year in the British Journal of Sports Medicine found that using hip arthroscopy to treat athletes with Femoro Acetabular Impingement helped protect the hip joint’s surfaces and reduced the risk of early osteoarthritis.
EXPERT COMMENT: ‘There’s evidence that this minimally invasive procedure may delay the need for patients to undergo hip replacement,’ says Mr Karlakki.
COD LIVER OIL
Daily dose: Osteoarthritis sufferers may benefit from taking cod liver oil
Fish oil has long been used as a natural treatment for arthritis. It’s now thought the omega-3 fats it contains could reduce the inflammation that causes pain and swelling.
DOES IT WORK? A study by Dundee University three years ago compared the effects of cod liver oil in 97 patients with rheumatoid arthritis who were already taking NSAIDs.
Forty-nine were also asked to take two teaspoons of cod liver oil daily. The remainder took a placebo. After nine months nearly 40 per cent of those taking cod liver oil were able to reduce their dosage of anti-inflammatory drugs by over 30 per cent.
Only ten per cent of those in the placebo group were able to do this.
EXPERT COMMENT: ‘Good-quality evidence to support the use of fish oils is scarce, and most studies have been on people with rheumatoid arthritis,’ says Dr Hughes. ‘But we believe osteoarthritis sufferers may also benefit from taking cod liver oil.’