Hip & Knee Pain

Arthritis is a term which describes pain and inflammation of the joints.

Inflammatory conditions, including rheumatoid arthritis, cause erosion and destruction of the joint and can affect all the joints in the body. This can now often be very successfully treated with modern drugs, but can sometimes lead to the need for joint replacement.

Osteoarthritis involves wearing down of the shock absorbing cartilage which lines the joint and very commonly involves the hip and knee. The weight-bearing joints are the most susceptible to developing osteoarthritis, with the knee joint affected in 18% and the hip in 11%.

Osteoarthritis becomes more and more common as we get older, affecting 42% of men and almost half of women aged over 75. It is estimated that nearly 9 million people in the UK have sought treatment for osteoarthritis.

Interestingly, our active lifestyle has led to osteoarthritis becoming more common in younger age groups, leading to pain and disability at a time in life when we want to remain active. Thirty-three per cent of people over 45 are now affected by osteoarthritis, leading to them seeking treatment to maintain their activities.

The ends of our bones, where they form the joints, is covered in a substance called articular cartilage. This is a spongy material, which acts as a shock absorber. It is very smooth and lubricated by joint fluid, which means our bones slide smoothly against each other. Over time it degenerates and dries out, becoming less effective, eventually becoming worn down.

Osteoarthritis is a condition where cartilage thins, bone becomes exposed and bone spurs called osteophytes form around the joint. This combination causes pain, stiffness and swelling of the joint. When weight-bearing joints are involved this is often very painful with walking and activity and becomes very disabling.

Nobody really knows the answer to this question! The articular cartilage which lines the joint has a unique structure means that has an extremely low friction rate, ideal for its purpose. It has no blood supply and relies on nutrients from the joint. Once it is damaged it does not repair and at the moment we have no way of repairing cartilage once it is damaged.

Osteoarthritis can occur due to a number of reasons. There can be a family predisposition. In younger patients, there are a number of factors which can cause the joint has been damaged, deformed or mal-aligned. This can occur as a result of problems in childhood, the shape of the joint, infection or injury. Most often there is no obvious cause, but results from primary osteoarthritis, which is essentially wear and tear over time.

Maintaining mobility and exercise is important in the early stages of osteoarthritis, as it has a number of benefits, including nourishing the joint, keeping weight down and strengthening the supporting muscles.

We will often recommend physiotherapy when you begin to experience discomfort and stiffness in the joint. Low impact exercise such as cycling, swimming and Pilates is very important in remaining active and managing the pain before patients are ready for joint replacement. Pain-relieving medications, anti-inflammatories and injections can all help control pain to keep you fit and active.

As osteoarthritis progresses patients find their ability to perform even normal activities becomes more and more impaired. As well as pain limiting activity, the joint becomes stiff and pain starts to be felt at night or at rest, which can greatly impact on sleeping patterns.

At this point, surgery may need to be considered. Our surgeons will order the necessary investigative scans and tests to assess the degree of deterioration. He will then help you decide whether you are ready for joint replacement surgery and explain the options available. The likely benefits and potential risks and complications will also be dealt with to guide your decision.