hey everyone dr jeff peng here this is a summary table of all the most common
treatment options for hip arthritis there's a lot of information here and my goal is to
simplify everything and go over all the treatment recommendations that
i recommend to my patients who suffer from hip arthritis let's dive right in
now if this is the first time you're watching one of my videos my goal is to help each and every one
of you live an active and healthy lifestyle so if that's something you're interested in please
consider subscribing to my channel osteoarthritis of the hip is a chronic disease that can have a
devastating impact on quality of life and day-to-day function and in treating many
people with arthritis i've found that most people have a limited understanding of what it is and how
to manage it and so by far the most important thing that i want my patients with arthritis
to understand is that arthritis is no longer something you should just suffer with and just
deal with it's something that you want to actively treat and something that you want to
actively manage think of arthritis like aging we can't reverse aging but there are lots of
things that we can do to potentially slow down the effects of aging right daily exercise nutrition
getting good sleep prioritizing mental health all of these will have a major impact on how
we age and much is the same with arthritis once you have it we can't reverse it and we can't get
rid of it but there are lots of things that we can do to treat it and change how arthritis manifests
think of it like another way if you have high blood pressure you may want to take a blood
pressure medication to try to control your blood pressure we don't wait for someone to
have a heart attack before telling them oh now is a good time to treat your high blood pressure and
the same is true for arthritis if arthritis is left untreated it will get worse and you don't
want it to get worse because that leads to worse outcomes and this is why i recommend a multimodal
approach to treating arthritis and everything is summarized in this table now i know there is a
lot of information here but let's break it down together i like to approach treating arthritis
using five big categories the first four are treatment options that provide short-term pain
relief treatment options that provide long-term pain relief and treatment options that improve the
integrity of the joint and decrease the risk of getting a hip replacement now with every
treatment option we also want to take into account the risk of major side effects and so that is the
fifth big category okay so i want to first start down here these are the treatment options that
i recommend using sparingly or ones that i really don't recommend there are a lot of misconceptions
around these treatment options so i really want to try to clarify them the first treatment option is
oral pain medications these include pain relieving medications such as tylenol and opiates as well as
anti-inflammatory medications such as ibuprofen or naproxen so let's first talk about tylenol tylenol
or acetaminophen is perfectly safe to take as long as you don't have any liver disease and
that's because tylenol is cleared from the body by the liver so if you do have liver problems then
you will have decreased clearance of tylenol and it can build up to dangerous levels in your body
and that can cause acute liver failure now if you don't have liver issues and tylenol works
well in controlling your pain then it is actually a great treatment option in providing short-term
pain relief the next class of drugs are nsaids these are non-steroidal anti-inflammatory drugs
and examples include ibuprofen and naproxen these actually work really well in shorting
short-term pain related to arthritis specifically because of their anti-inflammatory effects
but nsaids have a much more dangerous side effect profile especially when compared to tylenol when
taken for a prolonged period of time nsaids cause problems to the heart the kidneys and the stomach
and they also increase your risk for heart attacks and strokes and can cause dangerously high blood
pressure so anyone with any type of cardiovascular disease needs to be extremely cautious when using
nsaids with that said when used sparingly they can be effective in treating short-term pain but they
should never be used long-term without first checking in with your doctor what about opiate
medications such as hydrocodone or oxycodone opiates have significant pain relieving properties
however they come with major side effects and are extremely habit forming i do not recommend the use
of opiates in the treatment of arthritis because their side effect profile is just so dangerous
now the important thing to keep in mind is that oral pain medications only target short-term pain
it does nothing to help long-term pain and does not have any effect on arthritis progression
they do serve an important role during arthritis flares but they should not be viewed as a
long-term treatment option for arthritis now what about steroid injections steroid injections
or cortisone injections are extremely strong anti-inflammatory medications which we can put
into a syringe and then inject into the hip with the hope of decreasing pain and inflammation they
work pretty well in controlling short-term pain but for most patients the effects are short-lived
on average about one to three months they have no long-term pain relieving effects but the
bigger concern with steroid injections are their side effect profiles multiple
studies have shown that steroid injections cause long-term structural damage to the hip steroids
are chondrotoxic meaning they damage the cartilage and increase the risk of developing more arthritis
one recent study reported that even one cortisone injection significantly increased the risk of
developing rapidly destructive hip disease so with steroid injections you are trading short-term pain
relief at the cost of long-term damage now if one steroid injection is what is required to
get you back on your feet and participating in other treatment options such as exercise therapy
and load management then it still serves a role i am just very cautious about putting more than two
cortisone shots in a person's hip unless they have already lost all their cartilage
and are already bone on bone otherwise the risk of cartilage damage is just too high especially when
there are so many other options okay what about hip arthroscopy or more commonly called a hip
scope why can't a surgeon just go in and quote unquote clean everything up well that's what
used to be done and hip arthroscopies have been studied extensively in the orthopedic literature
for degenerative hip disease many studies have come to the same conclusion people who get hip
arthroscopy for arthritis had significantly higher rates of going on to needing a hip replacement
surgery and have overall worse outcomes now this is a slight over generalization as there are still
very specific indications in which hip arthroscopy can still be beneficial and so talk to your doctor
about your specific situation okay so what about treatment options that i actually do recommend
let's first talk about the two most effective treatment options for hip arthritis and that's
exercise therapy and load management and while these may not provide immediate pain relief they
are supported by many studies and they seem to be the best long-term option in controlling symptoms
related to arthritis just remember this phrase motion is lotion when we move we are lubricating
the joints and the day we stop moving we stop lubricating the joints and all that stiffness
and locking and catching related to arthritis returns along with the pain and the swelling
in addition exercise therapy has been shown to decrease the progression of arthritis and has
excellent long-term pain benefits exercise therapy is also incredibly important to restoring function
people who have been pain for a long time tend to be weaker in their affected leg for example if i
am suffering from hip arthritis in my right hip i tend to favor my left and over the course of weeks
to months my right hip gets weaker and weaker and that's because our bodies are trying to protect it
by offloading it this results in muscle atrophy so exercise therapy not only help reduces pain
but it helps restore strength exercise therapy is by far the most important treatment option
for everyone who suffers from arthritis now just to review the cdc and the american heart
association recommends 150 minutes per week of moderate intensity aerobic activities
preferably spread throughout the week this might sound like a lot but all it is is 30 minutes
brisk walk five times a week if you can get more than this that would be even better
great examples of low impact aerobic activity include walking swimming cycling and jogging on
an elliptical in addition specific exercises to help strengthen the hip muscles around the hip
as well as in the legs can be extremely beneficial for those who suffer from hip arthritis now right
up there with exercise therapy is load management load management comes in two varieties the first
is activity modification are you doing anything repetitive that involves constantly overloading
the hip if yes you may need to modify for example we know recreational running is
actually beneficial to those with hip arthritis and actually prevents arthritis from getting worse
but extreme high intensity interval training or elite long distance running
can be detrimental and cause more arthritis so it's all about making adjustments and modifying
i often advise my long distance runners to incorporate more cycling or swimming or even
running on an elliptical so that they can still get a great workout but not overload the hips
now the second aspect of load management is weight and this is a simple physics problem
the more weight you carry around in your body the more weight you're going to load onto your joints
the more weight you're going to load on into your hips and over time this is going to overload the
hips and lead to more arthritis and so exercise therapy and weight management go hand in hand
now diet also plays a critical role in general you're going to want to eat an anti-inflammatory
diet one that is rich in fruits and vegetables and nuts beans and whole grains a great example
of an anti-inflammatory diet is the mediterranean diet these foods are rich in antioxidants and
nutrients that reduce inflammatory signaling cells and decrease cartilage degradation
everyone who wants to actively manage their arthritis really needs to pay attention to diet
weight and exercise people who are successful in making these lifestyle changes have significantly
decreased risk of ending up with a hip replacement surgery okay let's talk about hip injections
there are actually much better options out there besides cortisone the first option is
called visco supplementation other names that it goes by are hyaluronic acid or gel shots
these are synthetically made molecules that help lubricate the joint they have pain relieving and
anti-inflammatory effects when injected into the hip now one important thing to point out
about viscosupplementation is that there is a lot of back and forth in the medical literature
about whether or not they work that is true of their use in knee arthritis and it's even more
true about their use in hip arthritis and because of the back and forth many insurance companies
no longer cover these injections but more recent studies suggest that people who get ultrasound
guided viscosupplementation injections have an excellent benefit because they feel better they
have less need for a joint replacement surgery the only potential downside of viscosupplementation is
the very rare possibility of an allergic reaction again this is relatively uncommon so if covered by
insurance viscosupplementation is an easy choice over cortisone injections it can greatly benefit
multiple categories with only minimal chance of side effects okay so what about prp prp stands
for platelet-rich plasma and is the latest and greatest in terms of what we are using to treat
hip arthritis i made an entire video explaining why prp injections are so effective in treating
hip arthritis so check that out for more details trials comparing prp to cortisone and p repeat of
viscose supplementation show one clear winner prp has better effects in treating short-term pain and
long-term pain more and more studies are also showing that prp injections can improve the
biochemistry of the joint to prevent further structural loss as well as delay the need for
a joint replacement surgery and the beauty of prp is that we're using your own cells
your own platelets and your own growth factors to treat pain into treat inflammation so you
can get as many of these injections as you want without fear of side effects this is why i give
prp injections a moderate to high recommendation for treatment remember the important thing about
hip arthritis treatment is that we want to take a multimodal approach we want to
use multiple treatment options that will target as many of the five big categories as possible
and because of this i routinely encourage all of my patients to work on exercise therapy as well as
weight and load management as well as to consider injection therapy specifically using either prp or
visco supplementation taking this multimodal approach puts you in the best position possible
for success and so that you can continue to live an active and healthy lifestyle
and if you're interested in learning more about prp injections in general or prp injections for
the hip then you're definitely going to want to check out these next videos thanks for watching