What is Arthritis?

Hip & Knee Arthritis

What causes arthritis?

The term arthritis means inflammation of a joint.  In general, it affects people as they get older. Other causes include injury, genetic predisposition, and some high level sports that can lead to joint injury. Arthritis is more common in women than in men.

What are symptoms of arthritis?

Symptoms vary according to the form of Arthritis. Arthritic symptoms generally include swelling and pain or tenderness in one or more joints, redness or heat in a joint, limitation of motion of joint, early morning stiffness, and skin changes including rashes.

How does a doctor diagnose arthritis?

Doctors diagnose arthritis with a medical history, physical exam and x-rays of the affected part. Computed tomography (CT) scans and magnetic resonance imaging (MRI) scans are also performed to diagnose arthritis.

How do you treat arthritis?

Various treatment options are available for the management of arthritis. Your physician may recommend one or more treatments for better outcomes.

  • Medications – Disease modifying anti-rheumatic drugs, pain medications, biologic agents
  • Physiotherapy – strengthening and stability exercises, electrotherapy
  • Occupational therapy
  • Surgical treatment

What you can do to prevent the progression of arthritis?

  • Consult a doctor who specializes in the diagnosis and treatment of arthritis
  • If you are overweight, try to reduce weight to lighten the load on weight-bearing joints
  • Participate in regular exercise

What are other symptoms of hip arthritis? Do patients complain of hip pain?

The most typical symptom that the patient presents with is pain in the groin. If the patient is pointing towards his or her back, that pain is most probably coming from the back. But hip arthritis pain manifests itself as groin pain. One examination is very important to identify where the pain is coming from, which is why a clinical examination is extremely important. Back pain can give rise to symptoms which are similar to hip arthritis.

It’s the same nerve also that supplies the hip and the knee. Sometimes knee problems can manifest as pain in the hip and vice versa. Clinical examination is extremely important to identify where the pain is coming from. Very rarely it happens that it’s a very confusing picture, patients have pain in the hip as well as in the knee joint. If the picture is confusing, we use a cortisone injection with local anesthetic and inject it into one joint.

The pain that remains is coming from the other joint. We have many tricks to identify where the pain is coming from. But it’s extremely important to identify the location of the pain. That’s a critical part of clinical examination. Patients with hip arthritis typically complain of pain in the groin. That pain is aggravated when the hip is flexed, especially when patients are trying to get in and out of a low car. They have to lift up their thigh and put it inside. That’s a very common symptom. It’s almost diagnostic of hip arthritis.

Is there a genetic component to arthritis of the hips and knees?

There is certainly a very strong genetic component if you develop arthritis of the hips and knees.  It is likely that you got it from your parents who in turn got the genetics from their parents.  Patients who get joint replacements surgery usually give a history of joint replacement surgery in their parents.  Now you know whom to blame!

What are the symptoms of hip arthritis?

Hip arthritis manifests itself as pain in the joint. It also is accompanied with joint stiffness. The patient may also feel some burning and rubbing against the hip bone. The pain is typically in the groin. It is a common misunderstanding that if you’re pointing towards your back that’s where the hip arthritis pain is located. Hip arthritis pain manifests itself as pain in the groin. If you have pain on the outside of your thigh it is probably coming from bursitis of the hip. If you’re pointing to your back the pain is coming from your back and not from the hip joint.

How is hip arthritis diagnosed?

Hip arthritis is diagnosed based on history and examination. Patients will complain of pain in the groin. They will complain of having pain getting in and out of a car, in and out of a sitting position, in and out of a bed. The pain may sometimes radiate down the thigh to the knee. Very rarely patients may complain of pain in the knee joint because it’s the same nerve that supplies the hip and the knee.

On examination the patient may have shortening, there is external rotation, the range of the hip joint is moderately to significantly restricted. On examination, it is critically important to distinguish which joint is the culprit and is causing the symptoms. Occasionally, there may be a confusion between the hip and the knee because both are supplied by the same nerve. If there is confusion, injection of a local anesthetic into the joint resolves the mystery. If the joint is injected with a local anesthetic the pain from that joint goes away.

Additional tests include x-ray of the hip that shows the cartilage being completely worn out accompanied with osteophytes and bone cysts. MRI may show the arthritis but is usually not required because arthritis is cleared seen on an x-ray. MRI is used for diagnosing soft tissue injuries and degenerative tears of the labrum. A CT scan shows the bone better than the MRI and is useful for diagnosing fractures of the hip joint which are subtle and which are not seen on the x-ray.

What can be done for arthritis in the hips?

Arthritis is a progressively deteriorating condition and does not get better with time. It only gets worse. Over-the-counter pain medication is okay once in a while. In the long term, over-the-counter pain medication can cause other problems. I definitely recommend against narcotic medication for any type of arthritis.

What sort of exercise is good for arthritis of the hips and knees?

Swimming is an excellent exercise for arthritis because it offloads the weight of the body and maintains muscle bulk and maintains flexibility. Using the treadmill or any type of impact activity usually aggravates the arthritic pain. Jumping ropes, high-impact aerobics can aggravate the pain from the arthritis.

Why is narcotic medication not recommended for arthritis?

Arthritis is a progressively deteriorating condition and only gets worse with time. With narcotic medication the patient can get hooked onto the medication, arthritis progresses, and they need even a larger dose of medication. Eventually, an arthritic joint needs surgery and when these patients on narcotic medication have surgery they need even a higher dose of medication.

Because this higher dose of medication they become groggy, they develop adverse events to these medications, they don’t cooperate with physical therapy and that increases the risk of complications after the surgery if they are not able to do physical therapy the way we want them to. For these reasons I do not recommend narcotic medication for the hip or for the knee arthritis. Physical therapy is excellent option for keeping the pain at bay.

Physical therapy does not mean exercises necessarily, but we write for pain modalities. Physical therapists use different modalities like TENS, lasers, ultrasonics, friction massage, and other things to decrease the pain. Additionally, walking with a cane is an excellent option because it offloads the joint and helps in decreasing the pain.

What symptoms need a hip replacement?

The symptoms that lead to a hip replacement are due to arthritis in the hip joint, which is characterized by pain in the groin, difficulty in weight bearing, and ranging the hip joint. After hip replacement, you get significant relief of pain and the symptoms of arthritis are gone. Hip replacement surgery is one of the most satisfying surgeries in orthopedics.

Is walking good for arthritis of the hips?

I encourage my patients to be active. I also would want them to be pain-free. Patients with arthritis of the hip have difficulty walking and especially exercises that involve impact to the lower extremity. I advise swimming, which is an excellent activity because it offloads the weight of the body and maintains muscle bulk and flexibility.

What exercise should you do if you have hip pain?

I encourage patients to be active, to maintain their muscle bulk, and to maintain range of motion exercises. Lower extremity exercises that include impact activities are difficult. I encourage patients to do upper body and core exercises. And for the lower extremity, I encourage them to do swimming, which is a non-weight bearing exercise.

How long does it take to get back to work after hip replacement surgery?

For a sedentary job, patients can go back the same week. For patients who do heavy jobs, they go back from six weeks to three months’ time.

What is the best medication for hip pain?

Patients can take over-the-counter medication; however, I do not advise prescription pain medication for hip pain. There are far better treatments available to treat hip pain, better than prescription pain medication. The problem with prescription pain medication is that you can get addicted to it if the pain is been something that has been going on for a very long time. Especially pain from arthritis because it’s going to be aggravated.

The other reason is when the patient do have surgery, they need even a higher dose of pain medication, and they do not cooperate with physical therapy. In addition, prescription pain medications have their own side effects, like damage to the internal organs. And for a variety of reasons, I do not advise prescription pain medication for any type of musculoskeletal pain, especially because we have better methods of treating pain, which include cortisone injections, other types of injections, as well as surgery.

What is the cause of hip pain after chiropractic adjustment?

Chiropractic adjustment should typically not cause aggravation of pain. If it does, the hip is probably ranged through a range of motion, which is not physiological for that particular patient. This could be because the range of motion is limited after the patient gets arthritis.

Is it normal to get groin pain and hip pain from squatting?

Typically, any type of physiological range of motion should not cause pain. And if there is pain, it needs to be evaluated and treated.

What are the causes of hip pain at night?

Hip pain at night could be due to arthritis. The muscles relax, the bone rubs on bone, and that gives rise to pain. It is also particularly important to rule out spinal cause of the hip pain. And examination including investigations like x-ray and MRI should be able to separate out the pain, which is coming from the hip and the back.

Is it dangerous to have hip pain while sleeping?

Hip pain while sleeping can be due to arthritis. It could be due to spinal pathologies. Unless there is an active infection, which includes fever, redness, significantly decreased range of motion or unless the hip pain is associated with the hip dislocation it is unlikely to be dangerous and typically doesn’t require emergent treatment.

Can sciatica be felt as hip pain?

If patients have pain in the front of the groin, it is typically coming from the hip joint. If they are pointing toward their behind, then the pain is most likely coming from the back.

Can sciatica cause hip pain?

By itself sciatica will cause pain on the behind of the hip and it is not originating from the hip joint. Sciatic pain will radiate towards the back of the leg, unlike hip pain, which is typically only in the groin.

How is scoliosis and hip pain treated?

It is extremely important to differentiate pain that comes from the back versus that coming from the hip. The treatment is individualized towards the origin of the pain. Scoliosis pain will come from the back and needs separate treatment. Patients can have both hip pain and pain coming from the back, in which case if there’s confusion, an injection of cortisone usually takes away the pain in the hip joint. The pain that is remaining comes from the back.

Can lower back pain be caused by hip problems?

Lower back pain will not be caused by hip problems. Hip problems will be a separate issue. Lower back pain is typically caused by pain from the back.

Is it possible that the hip pain is the cause of back pain and vice-versa?

Yes, it is possible. If the hip is off track this patient will have a weird gait, an antalgic gait, which can definitely affect the back. On the other hand, treatment of the hip itself will not relieve the pain in the back, unless the back pain is secondary to the hip pain.

Can hip pain be a cause of constipation?

Hip pain can never cause constipation. What can cause constipation is if the patient is taking narcotic pain medication for the hip pain. I strongly advise against prescription pain medication for any sort of hip pain.

How is appendicitis related to hip pain?

Appendicitis is in the abdomen, and hip pain is in the groin. Clinical examination and the symptoms should clearly distinguish between the two. Patients who have appendicitis will have gastrointestinal symptoms and patients with hip pain will not have gastrointestinal symptoms unless they are taking something for the hip pain that affects the gastrointestinal tract.

Is there any relationship between gynecologic procedures and hip pain?

During any gynecological or obstetric procedure the hip may be placed in a certain position. If there is prior labral tear or arthritis, that pain may be aggravated. But gynecologic procedure by itself does not lead to hip pain.

Why is hip pain considered as a symptom of early pregnancy?

Hip pain is not a symptom of pregnancy. During pregnancy, there are hormones, which relax affect the muscles, which can affect the pelvic girdle and that pain should be gone after the pregnancy.

Why do pregnant women complain of back and hip pain?

This pain is due to the hormones and the positioning and the pain should be relieved after the pregnancy is over.

How can hip pain after cesarean section be treated?

Cesarean section and hip pain are unrelated unless the hip is placed in an abnormal position after obstetrical/gynecological procedures. We have to realize that the hip has a limited range of motion and if ranged through unphysiological range of motion there will be increased pain.

Is having arthritis a disability?

Arthritis is a reason for significant disability; however, there are numerous methods and treatments available to make the patient pain free and to prevent disability.

Is hip replacement surgery the best option for hip pain?

The treatment of the pain from the hip depends on its cause. Hip replacement surgery is an option for arthritis or bursitis of the hip. Some options include rest, anti-inflammatory medications, and cortisone injections if it is a labral tear. It includes arthroscopic surgery or non-operative care.

Can I get a short-term disability sticker after surgery?

Most patients get a handicap sticker after surgery. I always give temporary handicap permits, and never a permanent handicap, because the expectation is that the patient will ultimately be significantly better and not need handicap access.

How long is the handicap access needed after surgery?

This depends upon whether the right or the left lower extremities are operated on. If the right lower extremity is involved, it interferes with driving for a longer period and the patient needs handicap parking for a longer time. Patients who have surgery on the left lower extremity can usually resume driving immediately after they are off prescription pain medications. If the patients have had hip replacement surgery they should be careful of hip dislocation precautions, especially using a low car seat while driving.

How does it feel when your hip is out of place?

In the post-surgical period after total hip replacement surgery, if the hip is out of place, the hip has dislocated and the pain is sharp, a very sharp pain of the lower extremity and the patient can not put any weight on the lower extremity. The patient has to be taken to the hospital and the hip has to be placed back in place.

How do you sit after hip replacement surgery?

Patients who have had total hip replacement surgery have to follow hip dislocation precautions. They should not be crossing their legs. They should be keeping their knees apart and it’s absolutely okay to cross their ankles. They should not be bending their hip beyond 90 degrees. The physical therapist, the hospital, and the surgeon talk to the patient prior to the surgery and the immediate post-operative period to prevent the possibility of the ball slipping out of the socket, which is called hip dislocation.

How painful is a hip replacement?

The pain from arthritis resolves immediately after surgery. What patients do have is surgical pain, which only gets better with time. Most patients are significantly happy within days of getting a hip replacement surgery. They are able to put as much weight on that leg as they want after the surgery and they are pain-free within a very short period of time.

What happens to back pain after hip replacement surgery?

I tell my patients that if you have back pain before the surgery from causes other than the hip, then the back pain is going to be aggravated after hip replacement surgery. The reason is because the pain from the hip is gone and the only pain that the patient realizes is pain from the back. Therefore, the patient feels that the pain from the back is aggravated.

By doing hip replacement surgery I am not fixing the back. I am doing anything with the back. I am only treating the pain in the hip joint. However, if the patient is walking a little bit tilted from the hip problem, the back pain may go away after the hip replacement surgery.

Why choose Dr. Karkare?
Dr. Nakul Karkare - NY Orthopedic SurgeonAs a top joint replacement specialist in New York City, Dr. Karkare has a stellar reputation, extensive experience, ensuring patients have the broadest array of safe and effective treatment options to relieve pain and other symptoms.

To schedule your evaluation, call (516) 735-4032 or use our online contact form to learn more.

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