The hip is a ball-and-socket joint that connects the thigh bone to the pelvic bone. As a major weight-bearing joint with a wide range of motion, the hip is susceptible to various kinds of injuries. Hip problems may arise with overuse, acute trauma, degenerative diseases such as arthritis, and sports injuries. These conditions require appropriate treatment, which may be non-surgical or surgical. The non-operative orthopedic treatment options are usually the first line of treatment and include non-pharmacological and pharmacological interventions.
Non-pharmacological interventions may range from simple lifestyle modification or physical exercises and rehabilitation programs. Some of the non-pharmacological interventions include:
Weight reduction and physical exercise
The lifestyle changes resulting in weight loss in obese individuals and doing appropriate physical exercises plays an important role in the prevention and management of hip conditions. The optimal weight (BMI) should be 18.5 to 25. BMI of 25-29 is considered overweight and BMI over 30 is considered as obese. Exercises are contraindicated in individuals suffering from cardiovascular diseases. Therefore, rigorous exercises are not ideal for all patients and must be individualized for every patient and done under the supervision of a trained professional.
Transcutaneous electrical nerve stimulation
The transcutaneous electrical nerve stimulation (TENS) method involves the use of low-voltage electric impulses to relieve pain. It is believed to provide pain relief by inhibiting the conduction of pain impulses to the receptors in the brain and spinal cord. The patient wears a device and this device generates the impulses that offer pain relief to the patient. The frequency of the impulses, duration of treatment, and location of the electrical electrodes on the body are decided by your physician based on the severity of the condition as well as the response of the patient. Using the device for at least 4 weeks may provide significant pain relief. It should not be used by patients with a pacemaker or cochlear implants, or those suffering from epileptic conditions. It should also not be used during pregnancy.
Thermotherapy involves the application of hot or cold packs to the affected area on the hip. Although there is some evidence to support the use of cold therapy in providing symptomatic relief, it is contraindicated in individuals with thermoregulatory impairments. Individuals having peripheral vascular disease, diabetes, cardiovascular disease, and hypertension, or who are pregnant should use it with caution.
This method involves the insertion of sterile needles into specific acupuncture points or pressure points on the hip. It is believed that insertion of needles at specific points restores the flow of “qi”, a form of energy and thereby relieves the pain. A modification in acupuncture is electro-acupuncture where the needles are stimulated by an electro-stimulator. Acupuncture performed by trained professionals is considered to be safe and offers pain relief. However, it may have certain risks if treated by untrained professionals.
Massage is one of the oldest methods of treatment and can help to reduce pain through increased circulation of blood and lymph, decreased muscle tension, and therapeutic effects of the touch.
Pharmacological interventions include management of pain using medicinal preparations such as pain-relieving medications or injections.
Non-steroidal anti-inflammatory drugs
These are known as NSAIDs and are found to be effective in reducing pain and inflammation of the hip. Caution must be taken while using NSAIDs for overdosing as they are known to cause liver toxicity. Patients with liver diseases must take extreme care while using them. They can cause a range of side effects that increase with the concomitant use of diuretics, angiotensin-converting enzyme inhibitors, angiotensin 2 receptor blockers, anticoagulants, or oral corticosteroids.
These injections of steroids are given directly into the affected hip joint for severe pain when the use of NSAIDs does not bring appropriate relief. Steroids are very strong anti-inflammatory drugs and if used orally cause various side effects on other body systems. Local analgesics that prevent the sensation of pain are sometimes given along with steroids in the same shot to bring relief quickly. Injections are usually performed by a radiologist under X-ray guidance or by a sports medicine provider with ultrasound guidance.
Weak and strong opioids
Opioids are prescribed when the use of analgesic medications or NSAIDs do not offer symptomatic pain relief, if other treatments have intolerable side effects or when surgery is delayed or contraindicated. Though they offer better pain relief than NSAID’s they are known to cause side effects such as dry mouth, nausea, vomiting, dizziness, and constipation. Overdose may lead to respiratory depression. The dose is reduced slowly otherwise it can cause withdrawal effects. Opioids are also known for addiction and should be used short-term as directed.
Disease-modifying anti-rheumatic drugs and biological agents
Disease-modifying anti-rheumatic drugs (DMARDs) aim at halting the progression of the disease and offer symptomatic relief. Biological agents are antibodies against the disease-causing agents that are manufactured using genetic engineering technology. These agents are recommended in individuals with severe disease conditions.