A reader asks: My husband, 81, began to experience pain in his right hip a couple of years ago. He visited the GP, who sent him for an X-ray, and was advised he had osteoarthritis in his hip. A consultant said he needed a hip replacement. We were surprised as friends who have had this operation seemed a lot worse. He was told alternative treatments could not help as his hip was “too far gone”.
A year later, he was invited for the operation, but his hip has not got any worse, and in fact with some increase in exercise has improved a little. He decided to postpone the operation and ask the GP again about other treatments. We were told steroid injections and physiotherapy wouldn’t help. It seems that my husband has to accept an operation or receive no treatment at all.
He has difficulty walking, and pain, but no pain when resting or in bed at night. He does have some arthritis in the knees which could be made worse by a period of immobility. Your comments would be appreciated.
Dr Rosemary says: In osteoarthritis (OA) the cartilage that protects and cushions the ends of bones inside a joint becomes damaged and worn. Eventually, in places, it may disappear entirely, so the ends of the bones rub on each other when the joint is moved. This can be incredibly painful.
Bony growths can also develop around the joint edges, making the joint appear deformed and knobbly. Unfortunately, once the cartilage is worn there is no way of replacing it, so there is no cure for OA.
Steroid injections can be helpful if the joint is very inflamed, but often have no effect, or the effect is very short-lived, lasting just a few weeks, so they are not often done.
Physiotherapy does not affect the worn cartilage, but it can help to strengthen the muscles that support joints and can be useful for those with knee osteoarthritis, though unfortunately it is often not so beneficial for those with OA of the hips.
Once the cartilage is very worn, the best option is usually to replace the joint and in 2019, over 100,000 hip replacements were done in the UK. It is usually done in those who have severe pain, swelling or stiffness, who have problems performing everyday tasks and have a reduced quality of life because of pain and disability.
Like all operations, there can be risks, such as infection, injuries to blood vessels or nerves, or a deep vein thrombosis, but these are small. Most people come home three to five days after the operation, and it is important to be as active as possible afterwards, doing gentle exercises and starting walking as soon as possible as a prolonged period of inactivity would make knee arthritis worse.
In the end, it is up to each individual to decide if their pain and disability warrants surgery. If your husband feels the pain is not too bad, is not getting worse and can be controlled with painkillers, then it would be reasonable to postpone surgery for now. If he is having problems walking, then surgery would probably be a good option for him.
● If you have a health question for Dr Leonard, email her in confidence at yourhealth@express.co.uk. She regrets she cannot enter into personal correspondence or reply to everyone
This story originally appeared on Express.co.uk
