Treatment options, from conservative care to surgery
Treatment of hip osteoarthritis is stepwise. It starts with weight control, correct loading and physiotherapy, continues with medication and injection therapy, and only then is surgery considered. Conservative treatment reduces pain and can postpone surgery by years, but it cannot restore damaged cartilage.
The steps of treatment
The steps follow one another. The next one is considered when the previous no longer gives enough benefit. None of them rules out the others.
- Weight and how load is distributedEvery kilogram lost reduces the load on the joint several times over, because when you walk the hip joint carries a force much greater than body weight. Using a walking stick correctly, in the hand on the healthy side, takes a significant load off the affected joint. This is not a sign of weakness, it is part of the treatment.
- Physiotherapy and exercisesThe aim is to strengthen the muscles around the joint, especially the gluteal muscles, and to preserve the range of movement. A strong muscle "unloads" the joint. Exercises must be regular; the effect of a single course fades quickly.
- MedicationNon-steroidal anti-inflammatory drugs reduce pain and inflammation. They are prescribed in courses rather than continuously, because long-term use has side effects on the digestive tract, the kidneys and the cardiovascular system. The dose and duration are set by a doctor.
- Injection therapyHyaluronic acid and, in selected cases, corticosteroids. The effect is individual and temporary. It works best in the early and middle stages. In the advanced stage, when the joint space has almost gone, the benefit drops sharply.
- Surgical treatmentTotal hip replacement, that is replacing the damaged joint with an implant. It is considered when conservative treatment is exhausted and the pain significantly lowers quality of life.
What conservative treatment achieves
It reduces pain and inflammation, which directly improves sleep and daily activity.
It preserves the range of movement and muscle mass. This matters even if you do need surgery later, because a better starting state means a better recovery.
It slows progression, especially when weight control and correct loading are actually carried through.
In some patients it postpones surgery by years. In selected cases surgery never becomes necessary.
What conservative treatment cannot achieve
This section exists because unrealistic expectations are the most common reason a patient loses time.
It cannot restore damaged cartilage. There is no medicine, injection or supplement today that brings worn cartilage back.
It cannot correct the altered geometry of the joint, the osteophytes or the deformity.
It cannot stop the disease for good. Slowing it down is possible, stopping it is not.
In the advanced stage, when bone touches bone, no conservative method gives lasting relief.
If you have been taking medication for months and the pain still returns or grows, that is a signal not to increase the dose but to talk to an orthopaedic surgeon.
When surgery becomes a reasonable decision
Surgery is not "the last resort" you wait for in fear. It is a timely choice with specific indications. The decision rests on the X-ray and on your daily life at the same time, never on the image alone.
The pain is constant
You have it at rest as well, not only under load.
Medication no longer works
The drugs no longer give enough relief, or you take them so often that they become a risk in themselves.
Night pain
Pain wakes you and it is hard to find a comfortable position. This is one of the most important signs.
Quality of life has dropped
You give up what you love. The walking distance has shortened, stairs, socks and getting into a car have become difficult.
Advanced changes on the X-ray
The joint space is sharply narrowed or gone, with marked osteophytes and changes in the bone structure.
If the change on the X-ray is large but you walk well and the pain rarely bothers you, surgery is not needed. Treatment is for the patient, not for the image.
Why timing matters
Surgery gives the best result when it is done at the right time, that is neither too early nor too late.
An operation done too early means the patient has not exhausted the conservative options and the service life of the implant starts sooner. This matters especially for a young patient.
An operation done too late has its own price. After long-standing limping the muscles weaken, the tissues around the joint contract, and the other leg and the lower back suffer. The operation itself is then harder and rehabilitation longer.
The window between these two extremes is fairly wide. That is exactly why it is never too late for a consultation, and almost never necessary to rush.
Questions and answers
Can I avoid surgery altogether?
Some patients can. It depends on the stage of the arthritis, the severity of the symptoms, age, and how consistently weight control and exercise are carried through. In the early stage conservative treatment is often enough for years. In the advanced stage, unfortunately, it gives only temporary relief.
How long should I try conservative treatment before surgery?
There is no single timeframe. What matters is not the calendar but the result: if pain and function have not improved after three or six months of properly delivered treatment, it is worth talking to an orthopaedic surgeon again. Waiting a year while nothing works brings no benefit.
Do cartilage supplements work?
Supplements containing glucosamine and chondroitin are widely used, but study results are inconsistent and cartilage regeneration has not been confirmed with them. Some patients report less pain. If you take them, tell your doctor, especially if you take other medication as well.
Will PRP therapy help?
Platelet-rich plasma therapy is less studied in the hip than in the knee, and the evidence is mixed. It does not restore cartilage. The question is considered case by case and the decision should be made with realistic expectations.
My doctor recommended surgery but I am afraid. What should I do?
Fear is natural and talking about it is part of the consultation. Two practical steps help. First, find out exactly what happens on the day of surgery and in the first weeks, because the unknown is always more frightening than the known. Second, get a second opinion. A good doctor never takes that as an insult.
Do both joints have to be operated on at the same time?
No, it is not necessary, and in most cases the joints are replaced in stages. Simultaneous bilateral surgery is considered in selected cases, but that is an individual decision and depends on general condition, age and other illnesses.
Have a question about your own case?
At the consultation we look at your X-ray together and I tell you what stage the joint is at and what the next step is. Seeing a surgeon does not mean surgery.
Updated: · Author: Mikheil Mikeladze, MD