Treatment of Hip osteoarthritis (coxarthrosis)

Symptoms of osteoarthritis 

The main symptom of the disease is groin pain. It irradiates down the leg to the knee. Some patients with osteoarthritis of the hip complain of knee pain, which causes misdiagnosis. Others have pain that radiates to the buttock.

The following symptoms of osteoarthritis appear later:

• Limited joint mobility.
• Stiffness after a period of rest.
• Difficulty moving the leg to the side and pulling it up to the chest.
• Crunch in the joint when moving.

The femoral head gradually moves upward, so one limb becomes shorter than the other, and lameness appears. With bilateral osteoarthritis of the hip, a "myopathic gait" develops. The muscles of the thigh and buttocks atrophy. The Trendelenburg sign appears: the pelvis lowers when trying to lean on the affected limb.

Diagnostics of osteoarthritis

The main diagnostic method is X-ray. Its popularity is associated with economic affordability and fairly high information content.

The most accurate method is a CT scan. It allows the doctors to accurately assess the configuration of the joint and plan surgical treatment.

Conservative therapy

Stage 1-2 hip osteoarthritis can be treated with conservative methods. Drugs and non-drug measures are used. The drugs are not able to restore the joint and do not even slow down the disease progression, and therefore they play only an auxiliary role in the therapy regimens. They help the patient relieve pain and inflammation.

The main methods for slowing down the development of hip osteoarthritis include:

• Therapeutic exercises to strengthen the muscles of the lower limbs.
• Weight loss to reduce load on the joint.
• Limiting heavy physical exertion.
• Orthoses that relieve load on the hip joint.

Drug therapy for hip osteoarthritis involves the use of nonsteroidal anti-inflammatory drugs, but they have side effects. About 1% of patients will be hospitalized with severe gastrointestinal bleeding caused by constant intake of these drugs. Therefore, it is advisable to use them in minimal doses, only on demand – in case of exacerbation of pain. With continuous use, the maximum complication rate is observed in the first 3 weeks of treatment.

Opiates can be used for severe unbearable pain. However, narcotic analgesics may be required for the patient only at 3-4 stages of the disease. In such cases, surgical treatment usually becomes an option of choice. The continuous intake of opiates is indicated only when hip replacement surgery is contraindicated.

Physiotherapy, massage, chondroprotectors (glucosamine, chondroitin) are of secondary importance in osteoarthritis. The long-term effectiveness of these methods is not proven.

Surgical treatment

The only surgical treatment method in Europe for hip osteoarthritis is total hip replacement. Organ-preserving surgeries are not performed as there is no evidence that they have a positive long-term effect.

Hip replacement is the most common orthopedic surgery in the world. It significantly improves the quality of life of patients. Doctors have learned to replace almost any joints in the human body, but among all operations, hip replacement has the highest efficiency. Good results are achieved in 90% of cases. Moreover, the indicators are even better in the best hospitals in the world – up to 98% of successful operations.

As a result of surgery, the disease is cured once and for all. The patient no longer suffers from pain and does not need analgesics. The length of the limbs is aligned, gait is normalized, the support ability of the limb and the range of motion are fully restored. A person can lead an active lifestyle, do any job and even do sports.

Modern artificial joints are reliable and functional. They can serve for decades. In 85% of cases, the patient will never need a second operation. The remaining 15% will need revision surgery at different times for complications or wear out of the endoprosthesis. In developed countries, primary arthroplasty is more reliable, so the number of revision surgical procedures is even lower – about 10%.

How is the surgery performed?

The surgery is performed under general anesthesia or spinal anesthesia. In the second case, the person is conscious, but does not feel any pain, since the sensitivity of the lower half of the body at the level of the spinal cord is "turned off".

When performing the operation, the doctor makes a 10-12 cm incision in the thigh. He removes the patient's own joint and replaces it with an endoprosthesis. An artificial joint consists of several components: a stem with a neck and a head – a femoral prosthesis, a cup is implanted in the acetabulum area, and a polyethylene liner is placed between them.

The doctors can use either cement or cementless fixation. In the first case, the components of the endoprosthesis are "glued" using a special solution. This method is usually resorted to in osteoporosis, as well as in elderly patients, for whom early activation is very important. A cementless method is the most common – the components of the endoprosthesis are pressed into the bone or fixed with screws. The artificial joint is gradually fused with a person's own tissues.

Upon completion of the operation, the wound is sutured. Sometimes surgeons leave drainage in it – thin tubes through which liquid flows. The drains are removed after 1-2 days.

Rehabilitation

Recovery after surgery takes 3-4 months. On average, the maximum function of the limb is achieved after 6 months. The terms of rehabilitation depend on the patient's age, the presence of concomitant diseases, as well as the requirements for functional outcomes: for some patients, it is enough to restore the ability to walk and self-care, while others need to achieve maximum leg functionality in order to be able to engage in physical labor.

Early rehabilitation

In the early rehabilitation period, patients receive drug therapy, namely, drugs to relieve pain, inflammation, antibiotics to prevent infections, anticoagulants to prevent thromboembolic complications.

They try to activate the patient as early as possible. If the operation is carried out under general anesthesia, the patient usually gets out of bed for the first time the next day. The first time, a person gets up with the help of medical staff, but then he learns to walk on his own. Crutches and walkers are used as support.

The person lies on his back, the leg is laid out to the side. A roller is placed between the legs. The patient can roll over in bed, but only needs to sleep on his back. It is necessary to do some physical activity while lying in bed, and also standing near the bed. Exercises help the patient to eliminate edema, improve blood circulation, and normalize tissue healing. At first, exercises are accompanied by pain, but gradually it gets weaker and weaker.

In the first few days, the patient is given drugs to relieve pain. The need for them gradually becomes less and less.

The first bandaging is done the next day. Then it is done again every 2-3 days.

Drains, if inserted, are usually removed during the first bandaging.

The stitches are removed after 2 weeks. However, you do not always have to take them off. Sometimes doctors use dissolvable sutures. They dissolve on their own after a few weeks.

Accelerated rehabilitation

Some foreign centers use accelerated rehabilitation programs after hip replacement for osteoarthritis. The patient stays in the hospital for only 4-10 days. In addition, the risk of complications is reduced.

Accelerated rehabilitation involves early activation of the patient after the operation – already in the first 2-4 hours. This is only possible if the hip replacement is performed under spinal anesthesia. It is important that the pain does not interfere with the person's ability to walk and exercise. To eliminate pain immediately after the operation, infiltration anesthesia is performed: local anesthetics are injected into the thigh. After that, a compression bandage is applied, which enhances the effect of anesthesia. At the same time, systemic pain therapy is used.

The patient is able to walk with support already on the day of the operation. He does exercises and receives physical therapy. A person is taught to walk on a flat surface, on steps, sit down and stand up correctly. When the patient can take care of himself and can walk at least 70 meters, he will be discharged from the hospital.

Late rehabilitation

Late rehabilitation starts 2-3 weeks after hip replacement. By this time, pain and inflammation disappear, soft tissues heal. A person can already load the thigh, gradually bringing the load to maximum.

The main means of rehabilitation during this period is therapeutic exercises. It is important to restore the condition of the muscles, to work out the gait, household and professional skills. The late rehabilitation can be completed at a specialized Rehabilitation Center.

You can undergo full recovery after osteoarthritis abroad. The Rehabilitation Centers use state-of-the-art equipment: simulators, robotic systems, exoskeletons. The load is selected individually and constantly adjusted taking into account the results achieved.

Why is it worth undergoing treatment of hip osteoarthritis abroad?

If the diagnostics revealed hip osteoarthritis, you can undergo treatment in one of the best hospitals in the world. People usually go abroad with a severe form of the disease, when the joint is destroyed, and its replacement is required. The cost of treatment is higher here, but the results are better, and complications are less common.

Hip replacement abroad has the following benefits:

• Experienced doctors with thousands of successful hip replacement surgeries.
• It is possible to replace the hip even in complex cases: in dysplastic or post-traumatic osteoarthritis, severe deformation of the acetabulum or the femoral canal, in bilateral coxarthrosis.
• Individual selection, and sometimes – individual manufacture of components of endoprostheses using 3D printing.
• Accelerated rehabilitation programs after hip replacement will minimize the risk of complications and reduce the period of hospitalization.
• High-quality accompanying, symptomatic, pain therapy in the postoperative period, comprehensive care and comfortable conditions.

After hip replacement, you can undergo rehabilitation abroad. It will allow you to permanently get rid of pain and completely restore limb function. Its condition will be the same as before the development of osteoarthritis.

Treatment in European hospitals with Booking Health

To undergo treatment in European hospital, please use the services of Booking Health. On our website, you can see the cost of treatment in different hospitals, compare prices and book a medical program at an affordable price.

Please contact the Booking Health specialists to undergo treatment in European hospital. Here are our benefits for you:

• We will choose the best European hospital whose doctors specialize in hip replacement surgery.
• We will help you overcome the language barrier, establish communication with your attending physician.
• We will reduce the waiting time for the medical program and book a doctor's appointment on the most suitable dates.
• We will reduce the price. The cost of treatment in European hospitals will be decreased due to the lack of additional coefficients for foreign patients.
• We will take care of all organizational issues: documents for entering the country, transfer from the airport, hotel, interpreter, etc.
• We will prepare a program and translate medical records. You do not have to undergo previously performed diagnostic procedures.
• We will provide communication with the European hospital upon the completion of your medical program.
• We will organize additional medical examinations and treatment in European hospitals, if necessary.
• We will buy medicines abroad and forward them to your native country.
• We will help you keep in touch with the European hospital after the completion of the medical care program.

Booking Health makes treatment in European hospitals easier, faster and cheaper. We will fully organize your trip, and you will only have to focus on restoring your health.

Authors: Dr. Vadim Zhiliuk, Dr. Sergey Pashchenko