Non-operative Treatment

Total hip replacement is not a conservative operation. In the procedure your bone and joint is removed and it is replaced with plastic and metal components. You become dependent on the function of these components and any failure of the components can result in pain and loss of function. You should exhaust all reasonable nonoperative measures to control pain and maintain function prior to considering total hip replacement.

Arthritis of the hip is, by definition, a wearing away of cartilage. The cartilage that lines the hip is an exceptional material. It is smoother than any man-made bearing. The cartilage has no nerve endings in it and therefore, any motion between nartilaainous surfaces does not cause pain. As the cartilage wears away however, debris is generated which causes an inflammatory response which produces pain and also accelerates the destruction of the joints. The underlying bone does have nerve endings in it, and is not a good bearing material and any motion between bones without cartilaginous surfaces causes significant pain. The mainstay of non-operative treatment is to control this process by decreasing the force applied across the joint as well as decreasing the number of times that force is applied. In order to decrease the force several things can be done; the first is weight loss. Any excess weight causes significant extra force across the joint which increases the Joint destruction as well as the pain. Because of the muscles acting across the hip joint, normal walking causes a force across the hip approximately three to five times body weight. Therefore, if you are 20 pounds overweight the force across the hip is increased by almost 100 pounds. Any effort at weight loss will decrease the force about the hip, slow down the destruction of the hip joint and decrease pain. Another way to decrease the force is to use a cane or crutch in the opposite hand. This decreases the required muscle function about the hip during walking and reduces the force by several hundred pounds.

Avoidance of unnecessary activities such as tennis, racketball, jumping, jogging, or heavy lifting (greater than 20 pounds) also will be helpful in decreasing the force about the hip. Walking exceptionally long distances (greater than a mile) increases the number of times that the joint load is applied and this will also add to the deterioration of the joint.

Exercises also play a role in the non-operative treatment of arthritis but they are a "double edged sword". Too much exercise can increase the joint force about the hip and cause increased pain and more rapid deterioration of the joint. Therefore the exercises should be designed to maintain muscle tone and maintain range of motion. Isometric exercises as well as gentle range of motion exercises should be sufficient. Vigorous exercises and the use of weights are not encouraged for patients with arthritis.

The use of anti-inflammatory medications is also an important mainstay of non-operative treatment. Aspirin is the most commonly used anti-inflammatory medication but many people cannot take it because of either allergy or gastrointestinal difficulties. There are many aspirin substitutes currently available which may have fewer side effects and more convenient dosage frequencies, but they are considerably more expensive. Some of these include Motrin, Naprosyn, Tolectin, Feldene, Voltaren, Lodine, etc. For these drugs to achieve maximum effectiveness they must be taken regularly to maintain an effective level in the blood.

An appropriate trial of one of these medications should be two weeks of continuous dosage. Side effects should be monitored, and the drug discontinued if they occur. Chronic long term use requires monitoring of blood and urine tests by your doctor.

Heat is also helpful to decrease stiffness and relieve pain. Superficial heat such as provided by liniments and ointments, etc. do not deliver the heat deep enough to be beneficial. The best is a hot water bottle or hot packs because the temperature can be controlled and they deliver a significant amount of heat deep into the joint. Use of a heated whirlpool or spa is also sometimes helpful. Use of a heating pad can be helpful but care must be taken to avoid burning the skin.

In summary, the non-operative treatment of arthritis of the hip involves weight loss (if overweight), the use of a cane in the opposite hand, use of an anti-inflammatory medication, avoidance of activities that cause increased force across the hip, gentle exercises to maintain muscle tone and range of motion and the use of heat.