Hip Arthritis

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Applicable stage
  • Normal
  • Start of disease
  • Early Stage
  • Mid Stage
  • Late stage
  • Very Late
Category
  • Diagnosis and Staging
  • Self help
  • Main Line Treatment Options
  • Non-operative
  • Operative
  • Alternatives - Limited evidence,<br>not available on the NHS
  • All
  • Observation/ <br>No Treatment
  • Observation /<br>No <br>Treatment

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Weight Loss info graphic
Weight Loss

Losing weight will slow down the joint wear, decrease pain and improve function.

Applicable stages
  • Start of disease
  • Early Stage
  • Mid Stage
  • Late stage
  • Very Late
  • Works best in following stages
    1. Normal
    2. Start of disease
    What is it?
    • Losing weight through diet and exercise has multiple benefits for knee arthritis patients.

    • Every 1 pound of weight increases the force through the joint by 3 - 6 times.

    • Losing weight will slow down the joint wear, decrease pain and improve function.

    • Obesity increases the risk of osteoarthritis (OA) and, once developed, worsens it.

    • It also increases the surgical and anaesthetic risks when these interventions are considered later on in treatment.

    Benefits
    • Losing even a few pounds can improve arthritis symptoms.

    • Studies say you can experience between a 21% and 33% decrease in arthritis symptoms just with weight loss

    • Weight loss slows down joint wear, the progress of arthritis, improves pain levels, activities of daily living (ADL) and overall mobility.

    • Other health benefits include decreased risk of cardiovascular and respiratory diseases and the development of type 2 diabetes.

    Risks
    • No major risks identified.

    • May crave food and find difficult to stick to the plan

    • Extreme sudden dieting may result in an electrolyte imbalance. It may also affect internal organ function (especially kidneys and liver).

    Cost
    • This is a low-cost option for both the patient and the NHS

    • These changes are unlikely to increase weekly shopping cost. This is especially true if you use available resources, shop intelligently and change habits.

    Limitations
    • Difficult to achieve significant weight loss in a short period of time.

    • Inability to tolerate changes in diet habits.

    • Immediate side effects include lack of energy, headaches and irritability. 

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    Observation or no active treatment info graphic
    Observation or no active treatment

    Applicable stages
  • Normal
  • Start of disease
  • Early Stage
  • Mid Stage
  • Late stage
  • Very Late
  • Works best in following stages
    1. Normal
    2. Start of disease
    3. Early Stage
    4. Mid Stage
    5. Late stage
    6. Very Late

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    Activity Modification info graphic
    Activity Modification

    Impact oriented activities can increase stress going through the joint.

    Applicable stages
  • Start of disease
  • Early Stage
  • Mid Stage
  • Late stage
  • Works best in following stages
    1. Normal
    2. Start of disease
    3. Early Stage
    4. Mid Stage
    What is it?
    • Avoiding impact orientated activities that can increase stress going through the joint.

    • Find alternatives, such as swimming, or take steps to reduce the impact your current activities are likely to have.

    Benefits
    • Many arthritic patients report a decrease in the intensity of pain after modifying their activities.

    • Moderate drop in pain, improvement in activities of daily living (ADL) and mobility in the long term.

    Risks
    • No major risks identified.

    • Pain may increase in the initial stages and some people may notice an increase in swelling.

    • Some may also have problems in adapting to new footwear.

    Cost
    • Low cost option for both the patient and the NHS.

    • May be some personal costs (e.g. footwear, exercise clothing and equipment)

    Limitations
    • Difficult to achieve improvement in a short period of time.

    • Minimal side effects reported.

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    Simple Exercises info graphic
    Simple Exercises

    Low impact exercises have been shown to have significant beneficial effects.

    Applicable stages
  • Start of disease
  • Early Stage
  • Mid Stage
  • Late stage
  • Works best in following stages
    1. Normal
    2. Start of disease
    3. Early Stage
    4. Mid Stage
    What is it?
    • Low impact exercises that can have significant beneficial effects on arthritis symptoms.

    • These exercises can improve the strength of muscles around the joint, while also benefiting the bone and ligaments.

    • They also maintain movement in the affected joint.

    Benefits
    • Many arthritic patients report a decrease in the intensity of pain after modifying their activities.

    • Moderate drop in pain, improvement in activities of daily living (ADL) and mobility in the long term.

    • There’s currently no randomised controlled trial to prove how this is benefiting patients.

    Risks
    • No major risks identified.

    • Pain may increase in the initial stages and some people may notice an increase in swelling.

    • Some may also have problems in adapting to new footwear.

    Cost
    • Low cost option for both the patient and the NHS.

    • May be some personal costs (e.g. footwear, exercise clothing and equipment).

    • There may also be minimal recurring expenses for accessing and maintaining health advice service, website subscriptions, access to physiotherapist and leaflet publications.

    Limitations
    • Difficult to achieve improvement in a short period of time.

    • Minimal side effects reported.

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    Wellbeing info graphic
    Wellbeing

    Applicable stages
  • Normal
  • Start of disease
  • Early Stage
  • Mid Stage
  • Late stage
  • Very Late
  • Works best in following stages
    1. Normal
    2. Start of disease
    3. Early Stage
    4. Mid Stage
    5. Late stage

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    Walking Aid / Simple Pain Killers info graphic
    Walking Aid / Simple Pain Killers

    Simple measures of pain control that is easily available without needing a healthcare professional’s advice.

    Applicable stages
  • Early Stage
  • Mid Stage
  • Late stage
  • Works best in following stages
    1. Normal
    2. Start of disease
    3. Early Stage
    4. Mid Stage
    What is it?
    • These are first line methods to help control local pain and inflammation.

    • These simple measures are easily available and do not need a healthcare professional’s advice.

    • These measures include the local application of heat or cold, ointments, short term use of over-the-counter painkillers, walking aids or heel cushions.

    Benefits
    • Many arthritic patients report a decrease in the intensity of pain after modifying their activities.

    • Moderate drop in pain, improvement in activities of daily living (ADL) and mobility in the long term.

    • Local anti-inflammatory gels have similar benefits as oral anti-inflammatory tablets.

    • A walking stick will help improve walking distance.

    Risks
    • No major risks identified.

    • You may experience skin irritation from local application of medications.

    • Be aware of bleeding ulcers, exacerbation of acidity symptoms or asthma.

    • Excessive use of medications can affect renal or liver functions

    Cost
    • Low cost option for both the patient and the NHS.

    • Patient: cost of over-the-counter medication and/or the purchase of a walking stick.

    Limitations
    • There are minimal side-effects for external physical methods.

    • Oral anti-inflammatory tablets have gastrointestinal side effects.

    • Generally, Paracetamol is less effective with moderate to severe arthritis.

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    Physiotherapy / Structure Exercise Programmes info graphic
    Physiotherapy / Structure Exercise Programmes

    Interaction with a professional therapist will allow for confirmatory diagnosis and planning of tailored physical therapy and exercise plans.

    Applicable stages
  • Early Stage
  • Mid Stage
  • Late stage
  • Very Late
  • Works best in following stages
    1. Normal
    2. Start of disease
    3. Early Stage
    4. Mid Stage
    What is it?
    • Meeting with a professional physiotherapist.

    • This will allow for confirmatory diagnosis and the planning of physical therapy and exercise regimes tailored to you and your condition.

    • The goal of physiotherapy will be to improve your ability to do daily activities and increase strength to support the joint.

    • The physiotherapist will teach you proper posture and recommend devices, aids and appropriate exercises. They may also advise on modifications to your home or workplace.

    Benefits
    • Many arthritic patients report a decrease in the intensity of pain after modifying their activities.

    • Moderate drop in pain, improvement in activities of daily living (ADL) and mobility in the long term.

    • Physiotherapy is low to moderately effective based on the stage of the disease. Studies say that patients can experience up to 70% improvement in pain in the early stages, especially when exercise and mobilisation is combined.

    • This will also improve your general fitness, and help with cardiovascular health and weight loss.

    Risks
    • No major risks identified.

    • Pain may increase in the initial stages and some people may notice an increase in swelling.

    Cost
    • Low cost option for both the patient and the NHS.

    • Patient: Some may wish to enrol in a gym and therefore have a membership fee cost.

    • NHS: £25 to £30 per session, costing approximately £200 per course.

    Limitations
    • Minimal side effects reported.

    • Physiotherapy will only work with adequate motivation and commitment.

    • This treatment requires regular visits to the physiotherapy centre, which may include a time and cost commitment including parking charges.

    • Exercises are based on an ability to perform, rather than a fixed goal.

    • Physiotherapy is not recommended if the patient has significant cardiac problems or exercise-induced cardiac arrhythmias.

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    Prescription analgesics info graphic
    Prescription analgesics

    Prescription analgesics may be appropriate when one is not yet ready to undergo operations and have not exhausted all non-operative methods.

    Applicable stages
  • Early Stage
  • Mid Stage
  • Late stage
  • Works best in following stages
    1. Normal
    2. Start of disease
    3. Early Stage
    4. Mid Stage
    What is it?
    • Stronger analgesics or pain relief techniques may be required when the pain from arthritis is not controlled with simple techniques.

    • These can include the local application of Capsaicin or Transcutaneous Electrical Nerve Stimulation (TENS).

    • These methods may be appropriate when the patient is not yet ready to undergo operations and has not tried all of the non-operative methods.

    Benefits
    • There is fair to good evidence to support the use of a TENS device for pain management.

    • Modest to moderate drop in pain, improvement in activities of daily living (ADL) and mobility in the long term.

    • Local anti-inflammatory gels have similar benefits as oral anti-inflammatory tablets. Capsaicin cream application can also bring down pain levels.

    • A walking stick will help improve walking distances.

    Risks
    • No major risks identified.

    • You may experience skin irritation from local application of medications.

    • Be aware of bleeding ulcers, exacerbation of acidity symptoms or asthma.

    • Excessive use of medications can affect renal or liver functions.

    Cost
    • Low cost option for both the patient and the NHS.

    • Patient: cost of over-the-counter medication and/or the purchase of a walking stick.

    Limitations
    • There are minimal side-effects for external physical methods.

    • Oral anti-inflammatory tablets have gastrointestinal side effects.

    • Generally, Paracetamol is less effective with moderate to severe arthritis.

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    Steroid Injection info graphic
    Steroid Injection

    This involves an injection of corticosteroid medication and local anaesthetic into the joint.

    Applicable stages
  • Mid Stage
  • Late stage
  • Works best in following stages
    1. Mid Stage
    2. Late stage
    What is it?
    • The injection of corticosteroid medication and local anaesthetic into the joint.

    • This should decrease inflammation from the degenerating joint, which is causing pain and swelling.

    • This will be appropriate for selected patients who have tried other methods.

    Benefits
    • There is fair to good evidence for using intra-articular steroid injection. About two-thirds of patients benefit from this injection.

    • However, it is difficult to predict who will benefit most or how long the effects will last.

    • Moderate drop in pain, improvement in activities of daily living (ADL) and mobility in the short term.

    Risks
    • No major risks associated with the use of cortisone injection.

    • There is a minimal (0.5%) risk of introduction of infection.

    • Repeated injections can weaken the ligaments and may worsen the arthritis.

    Cost
    • This is a no cost option for the patient, and has a variable cost for the NHS.

    • NHS: Generally not an expensive option; the cost of treatment of infection, should it occur, could be expensive.

    Limitations
    • In the initial stages, some report exacerbation of pain, though this is usually short-lived.

    • Increase activity gradually a few days after receiving the injection.

    • Minor side effects include a change in local skin colour and fat atrophy.

    • The injection should be used with caution for patients with bipolar disorders, active infection, pregnancy/breastfeeding or recent vaccination.

    • Avoid this intervention if you have an allergy to the medication or to the local anaesthetics.

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    Total Hip Replacement info graphic
    Total Hip Replacement

    The diseased bone is surgically removed and replaced with an artificial joint (typically a mix of plastic and metal).

    Applicable stages
  • Late stage
  • Very Late
  • Works best in following stages
    1. Late stage
    2. Very Late
    What is it?
    • This procedure is performed under anaesthesia - either general or regional.

    • The diseased bone is removed and replaced with an artificial joint. Typically, the socket is replaced with a high-density plastic cup and the top of the thighbone is replaced with a metal ball, supported on a metal stem placed within the middle of the thigh bone.

    Benefits
    • There is very good evidence to support hip replacements.

    • This is one of the best procedures available to improve quality of life.

    • More than 96% of hip replacements will still be functioning 10 years after implantation.

    • There is excellent patient satisfaction after this procedure, with more than 90% of patients happy with this operation.

    • Clinical success, as recorded with patient outcome measures such as Oxford Hip Scores, are generally very good to excellent after hip replacement surgery.

    Risks
    • General risks: Heart related problems (heart attack, irregular heartbeats), lung-related complications (pneumonia, lung collapse), post-operative confusional state, post-operative decline of brain function (cognitive decline), kidney failure, urinary tract problems (infection or retention with the need for using catheter), nerve damage, damage to blood vessels, deep vein thrombosis (DVT), pulmonary embolus (PE), complex pain, pressure sores, diathermy burns, wrong side surgery, severe allergy to medications, damage to structures unrelated to surgery (like lips/teeth/throat, eyelids etc) regret of undergoing surgery and death.

    • Specific Risks: Pain, bleeding, swelling, stiffness, superficial infection, inflammation, sensitive scar, change in appearance of the operated area, puckered scar, thick scar, numbness, failure of tendons or muscles to heal, deep infection needing further surgery, poor alignment of the implant, leg length difference, dislocation, back pain, etc.

    Cost
    • This is a very high-cost option for both patients and the NHS.

    • Patients: You will need to take time off work, have help during the initial recovery stages and visit the hospital and physiotherapy department. This may involve paying for taxis, parking or favours from friends and family.

    • NHS: Generally expensive, costing approximately £8,000 per procedure. However, the cost can be much more should a complication occur and require treatment.

    Limitations
    • You should consider all the limitations and side effects of a major operation.

    • Your scar may be sensitive for a few months after the operation. As a result, you may not be able to lie on the side where your operation took place.

    • Immediately after the operation, pain is likely to get worse before it gets better. Medications will be provided to help you with this.

    • Hip pain may not completely decrease, but is likely to improve significantly.

    • There may be side effects from the medication, especially painkillers, antibiotics or anaesthetic agents. These include skin rash, constipation, liver or kidney damage etc. Please ask your doctor if you wish to know more.

    • While you recover from the operation you will need to use physical aids such as crutches or a frame which may have an impact on your ease of mobility.

    • You will need to take care of the area that was operated on. This may mean being more careful with dressing and wound care - the outreach nurse or practice nurse from your GP will help you manage this.

    • You will need to attend your GP practice or hospital for a wound check and follow-up appointments.

    • You will need to go to the physiotherapy department regularly to get the most out of this surgery.

    • Your work, activities of daily living, walking, sleeping, intimate relationship, family life, leisure activities and driving will all be affected for a few weeks to months after this procedure.

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    Glucosamine & Chondroitin Tablets info graphic
    Glucosamine & Chondroitin Tablets

    Applicable stages
  • Early Stage
  • Mid Stage
  • Works best in following stages
    1. Early Stage
    2. Mid Stage
    What is it?
    • These are protein supplements which are thought to help to rebuild the cartilage in the joint.

    • Not a NICE approved procedure.

    Benefits
    • Some studies show that these tablets may decrease the pain for some patients. Sponsored studies also show that, in some cases, the supplements can reverse the joint wear.

    • Some patients also report a decrease in the swelling.

    Risks
    • Patients with seafood allergies, especially prawn allergies, should not take this medication as it can set off a reaction.

    • This treatment is not recommended by NICE as an effective treatment for an arthritic hips.

    Cost
    • The cost of these tablets is low for the patient and there is no cost for the NHS

    • Patient: Cost may vary depending on where you purchase the tablets; it's usually up to £1 a day for the treatment. It is best practice to purchase the tablets from reputable pharmacy stores.

    • If you're looking to purchase the vegan version, which is derived from seaweed, this is likely to be more expensive.

    • NHS: No cost for the NHS as this is not a prescription medication.

    Limitations
    • The hip pain may not diminish completely

    • The tablets might be too big to swallow, so you may have to break them. Liquid versions are available but are generally more expensive.

    • Some may develop a bloated feeling or loose stools in the initial stages. This tends to settle down over a period of time.

    • This treatment may interfere with the control of diabetes, so requires careful monitoring of blood glucose levels in diabetic patients.

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    Surface Replacement info graphic
    Surface Replacement

    This procedure preserves the bone by reshaping the top of the femur and covering it with a thin metal shell.

    Applicable stages
  • Mid Stage
  • Late stage
  • Works best in following stages
    1. Late stage
    2. Very Late
    What is it?
    • This procedure is performed under anaesthesia - either general or regional.

    • The top of the femur is reshaped and covered with a thin hemispherical metal shell.

    • Unlike a total hip replacement, where all the diseased bone is removed, in a surface replacement very little bone is removed.

    • The socket is shaped and a metal liner is put in place. Therefore, surface replacements have ‘metal-on-metal’ articulation.

    Benefits
    • There is good evidence to support surface hip replacement. It is one of the best procedures available to improve quality of life.

    • This procedure has excellent patient satisfaction; over 90% of patients are happy with their outcome.

    • Clinical success, as recorded with patient outcome measures such as Oxford Hip Score’s, are generally very good to excellent after hip replacement surgery.

    Risks
    • Certain types of metal-on-metal hip replacements do not work very well and may generate unacceptable amount of metal ions from wear. This may result in cyst formation around the bone and soft tissues around the hip, affect liver or kidney function from heavy metal ions (e.g. cobalt or chromium). This is called Metalosis.

    • If Metalosis should occur, then you will have to undergo extensive revision surgery where the surface replacement will be converted to a standard hip replacement.

    • General risks: Heart related problems (heart attack, irregular heartbeats), lung related complications (pneumonia, lung collapse), post-operative confusional state, post-operative decline of brain function (cognitive decline), kidney failure, urinary tract problems (infection or retention with the need for using catheter), nerve damage, damage to blood vessels, deep vein thrombosis (DVT), pulmonary embolus (PE), complex pain, pressure sores, diathermy burns, wrong side surgery, severe allergy to medications, damage to structures unrelated to surgery (like lips/teeth/throat, eyelids etc) regret of undergoing surgery and death.

    • Specific Risks: Pain, bleeding, swelling, stiffness, superficial infection, inflammation, sensitive scar, change in appearance of the operated area, puckered scar, thick scar, numbness, failure of tendons or muscles to heal, deep infection needing further surgery, poor alignment of the implant, leg length difference, dislocation, back pain etc.

    Cost
    • This is a very high-cost option for both patients and the NHS.

    • Patients: You will need to take time off work, have help during the initial recovery stages and visit the hospital and physiotherapy department. This may involve paying for taxis, parking or favours from friends and family.

    • NHS: Generally expensive, costing approximately £8,000 to £10,000 per procedure. However, the cost can be much more should a complication occur and require treatment.

    Limitations
    • You should consider all the limitations and side effects of a major operation.

    • Your scar may be sensitive for a few months after the operation. As a result, you may not be able to lie on the side where your operation took place.

    • Immediately after the operation, pain is likely to get worse before it gets better. Medications will be provided to help you with this.

    • Hip pain may not completely decrease, but is likely to improve significantly.

    • There may be side effects from the medication, especially painkillers, antibiotics or anaesthetic agents. These include skin rash, constipation, liver or kidney damage etc. Please ask your doctor if you wish to know more.

    • You will need to take care of the area that was operated on. This may mean being more careful with dressing and wound care - the outreach nurse or practice nurse from your GP will help you manage this.

    • You will need to attend your GP practice or hospital for a wound check and follow-up appointments.

    • Your work, activities of daily living, walking, sleeping, intimate relationship, family life, leisure activities and driving will all be affected for a few weeks to months after this procedure.

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    Stem Cell Treatment info graphic
    Stem Cell Treatment

    Applicable stages
  • Mid Stage
  • Late stage
  • Works best in following stages
    1. Late stage
    What is it?
    • A bone marrow harvest that’s centrifuged and immediately injected into the joint that has worn out.

    • Alternative sources include fat cells and subchondral bone cells. These may be grown in a lab before injection.

    • Typically, a course of treatment involves between 1 and 3 injections.

    • Evidence is still not clear on which is the best type of stem cell to use.

    • Not NICE approved.

    Benefits
    • Some studies show that stem cell injections may decrease pain for a select group of patients.

    • In some patients, this treatment may slow down joint wear. However, it's difficult to identify who will benefit from this.

    • This may delay the need for more invasive surgery.

    Risks
    • Severe risks include pain, infection, redness and persistent swelling.

    • There are anecdotal serious complications like macular degeneration and blindness, stroke and concerns about potentially stimulating cancer cell overgrowth.

    Cost
    • There is a high cost for both the patient and the NHS.

    • Patient: Cost may vary depending on local arrangements. Some commissioning bodies do not authorise the use of these injections, so the treatment may have to be done under a private setting. This can cost up to £8000 per course, not including the cost of a private consultation. Some insurance companies will not cover this cost.

    • NHS: The exact cost is not known; however, it's likely to be as much as the cost in the private sector.

    Limitations
    • Your knee pain may not diminish completely.

    • The pain may actually get worse after the injection for some patients. It's not possible to predict who will become worse after the injection.

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    FAI (impingement) surgery info graphic
    FAI (impingement) surgery

    This surgery addresses a mismatch between the shape of the ball of the hip joint (femoral head) and the socket (acetabulum), known as a femoroacetabular impingement.

    Applicable stages
  • Start of disease
  • Early Stage
  • Works best in following stages
    1. Start of disease
    2. Early Stage
    What is it?
    • This procedure is performed under general anaesthesia.

    • It is required when there is a mismatch between the shape of the ball of the hip joint (femoral head) and the socket (acetabulum). This is known as a femoroacetabular impingement.

    • This gradual damage can result in the development of arthritis over a period of time.

    • This condition is usually recognised in young active people or high-level athletes. Cam type is common in young men, while the pincer type is more common in women in their mid-30s.

    Benefits
    • There is some evidence to support that FAI surgery may prevent or delay the onset of arthritis.

    • Clinical success as recorded with patient outcome measures, such as Oxford Hip Score’s, are used to monitor your progress.  

    Risks
    • You will need to accept the unpredictable nature of the outcome of this procedure and its ability to prevent the development of arthritis. Your surgeon will advise on your chances of success based on your condition.

    • General risks: Heart related problems (heart attack, irregular heartbeats), lung-related complications (pneumonia, lung collapse), post-operative confusional state, post-operative decline of brain function (cognitive decline), kidney failure, urinary tract problems (infection or retention with the need for using catheter), nerve damage, damage to blood vessels, deep vein thrombosis (DVT), pulmonary embolus (PE), complex pain, pressure sores, diathermy burns, wrong side surgery, severe allergy to medications, damage to structures unrelated to surgery (like lips/teeth/throat, eyelids etc) regret of undergoing surgery and death.

    • Specific risks: Pain, bleeding, swelling, stiffness, superficial infection, inflammation, sensitive scar, change in appearance of the operated area, puckered scar, thick scar, numbness, failure of tendons or muscles to heal, deep infection needing further surgery, nerve injury due to traction, perineal pain, back pain etc.

    Cost
    • This is a very high-cost option for both patients and the NHS.

    • Patients: You will need to take time off work, have help during the initial recovery stages and visit the hospital and physiotherapy department. This may involve paying for taxis, parking or favours from friends and family.

    • NHS: Generally expensive, costing approximately £8,000 to £10,000 per procedure. However, the cost can be much more should a complication occur and require treatment.

    Limitations
    • You should consider all limitations and side effects of a major operation.

    • Your scar may be sensitive for a few months after the operation. As a result, you may not be able to lie on the side where your operation took place.

    • Immediately after the operation, pain is likely to get worse before it gets better. Medications will be provided to help you with this.

    • Hip pain may not completely decrease, but is likely to improve significantly.

    • If the procedure is performed arthroscopically, you may also have soreness around the perineum and swelling that lasts between a few days and a few weeks.

    • There may be side effects from the medication, especially painkillers, antibiotics or anaesthetic agents. These include skin rash, constipation, liver or kidney damage etc. Please ask your doctor if you wish to know more.

    • While you recover from the operation you will need to use physical aids such as crutches or a frame which may have an impact on your ease of mobility.

    • You will need to take care of the area that was operated on. This may mean being more careful with dressing and wound care - the outreach nurse or practice nurse from your GP will help you manage this.

    • You will need to attend your GP practice or hospital for a wound check and follow-up appointments.

    • You will need to go to the physiotherapy department regularly to get the most out of this surgery.

    • Your work, activities of daily living, walking, sleeping, intimate relationship, family life, leisure activities and driving will all be affected for a few weeks to months after this procedure.

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    Labral Repair info graphic
    Labral Repair

    Applicable stages
  • Early Stage
  • Mid Stage
  • Works best in following stages
    1. Early Stage
    2. Mid Stage

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    Osteotomies around the hip joint info graphic
    Osteotomies around the hip joint

    The bone is divided then ‘rotated’ to gain better cover for the ball. The shifted socket is stabilised with two or more screws. 

This shifts the forces that go through the joint to normal or less damaged parts of the hip, potentially prolonging the life of the natural joint.

    Applicable stages
  • Early Stage
  • Mid Stage
  • Works best in following stages
    1. Early Stage
    What is it?
    • This procedure is performed under general anaesthesia.

    • The bone is divided then ‘rotated’ to gain better cover for the ball. The shifted socket is stabilised with two or more screws.

    • By doing this, the forces through the joint are shifted to normal or less damaged parts of the hip, potentially prolonging the life of the natural joint.

    • This is offered to carefully selected patients who have a poorly developed socket (dysplastic acetabulum) or ball part of the hip (femoral head).

    Benefits
    • There is some evidence to support osteotomy surgery may prevent or delay the onset of arthritis.

    • Clinical success as recorded with patient outcome measures, such as Oxford Hip Score’s, are used to monitor your progress.  

    Risks
    • You will need to accept the unpredictable nature of the outcome of this procedure and its ability to prevent the development of arthritis. Your surgeon will advise on your chances of success based on your condition.

    • General risks: Heart related problems (heart attack, irregular heartbeats), lung-related complications (pneumonia, lung collapse), post-operative confusional state, post-operative decline of brain function (cognitive decline), kidney failure, urinary tract problems (infection or retention with the need for using catheter), nerve damage, damage to blood vessels, deep vein thrombosis (DVT), pulmonary embolus (PE), complex pain, pressure sores, diathermy burns, wrong side surgery, severe allergy to medications, damage to structures unrelated to surgery (like lips/teeth/throat, eyelids etc) regret of undergoing surgery and death.

    • Specific risks: Pain, bleeding, swelling, stiffness, superficial infection, inflammation, sensitive scar, change in appearance of the operated area, puckered scar, thick scar, numbness, failure of tendons or muscles to heal, deep infection needing further surgery, nerve injury, avascular necrosis, perineal pain, back pain, ectopic ossification etc.

    Cost
    • This is a very high-cost option for both patients and the NHS.

    • Patients: You will need to take time off work, have help during the initial recovery stages and visit the hospital and physiotherapy department. This may involve paying for taxis, parking or favours from friends and family.

    • NHS: Generally expensive, costing approximately £8,000 to £10,000 per procedure. However, the cost can be much more should a complication occur and require treatment.

    Limitations
    • You should consider all limitations and side effects of a major operation.

    • Your scar may be sensitive for a few months after the operation. As a result, you may not be able to lie on the side where your operation took place.

    • Immediately after the operation, pain is likely to get worse before it gets better. Medications will be provided to help you with this.

    • Hip pain may not completely decrease, but is likely to improve significantly.

    • If the procedure is performed arthroscopically, you may also have soreness around the perineum and swelling that lasts between a few days and a few weeks.

    • There may be side effects from the medication, especially painkillers, antibiotics or anaesthetic agents. These include skin rash, constipation, liver or kidney damage etc. Please ask your doctor if you wish to know more.

    • While you recover from the operation you will need to use physical aids such as crutches or a frame which may have an impact on your ease of mobility.

    • You will need to take care of the area that was operated on. This may mean being more careful with dressing and wound care - the outreach nurse or practice nurse from your GP will help you manage this.

    • You will need to attend your GP practice or hospital for a wound check and follow-up appointments.

    • You will need to go to the physiotherapy department regularly to get the most out of this surgery.

    • Your work, activities of daily living, walking, sleeping, intimate relationship, family life, leisure activities and driving will all be affected for a few weeks to months after this procedure.

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    Alternative Medicine info graphic
    Alternative Medicine

    Applicable stages
  • Normal
  • Start of disease
  • Early Stage
  • Mid Stage
  • Late stage
  • Very Late
  • Works best in following stages
    1. Start of disease
    2. Early Stage
    3. Mid Stage
    4. Late stage
    What is it?
    • A form of treatment that is not usually considered.

    • This can be chiropractic treatment, homoeopathy, Tai Chi and more.

    Benefits
    • There is a lack of solid evidence, especially when treating advanced arthritis.
    Risks
    • Unquantified: but it is likely to be lower than any surgical intervention.
    Cost
    • These treatments are not available on the NHS.

    • Patient: Cost is variable based on the type of treatment chosen and practitioners.

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