What do Eamonn Holmes, Darcy Bussell and Naomi Campbell all have in common? They are all celebrities that have been in the press over the last couple of months for issues to do with the problems with their hips (alleged problems for Naomi Campbell). The stories are noteworthy for the press because of the relative young age of these celebrities. Certainly not of an age we would usually associate hip problems and hip replacement surgery.

The media are latching on to these stories with increasing frequency, but it is a recognised public health issue that governments around the world are very alive to. Osteoarthritis is one of a number of chronic conditions, like diabetes and heart disease that are set to increase because of ageing populations and the increasing weight of people. The degenerative condition of arthritis has a significant adverse impact on other conditions such as diabetes and heart disease, if people’s ability to move and remain active is limited. This relationship is brought into sharp relief particularly for osteoarthritis of the hip and knee.

Are you young with hip OA?

But why are people with hip arthritis getting younger? We have already mentioned one factor, which is our increasing weight. The other factor is the opposite end of the physical activity spectrum. An article in the MailOnline entitled,

“Why more and more women are needing hip replacements in their 40s:…”,

has people wandering what is going on. We have active people staying active later in life. Being active itself is not the issue and we have to take care that this association does not get translated into cause and effect. The fact is some of us are more predisposed to developing arthritis in the hip based on genetic and social factors that research is now starting to reveal. In years gone by individuals remained active into their late twenty’s and started winding down in their thirty’s. Perhaps later in life in their sixty’s and seventy’s they started developing arthritis in the hip that people would put down to the ageing process. Now based on lifestyle choices the same type of individuals are having the degenerative changes twenty years earlier.

Why not just have a hip replacement?

Now that we are slowly waking up to an emerging problem what are we going to do about it? The gold standard for reducing disabling hip arthritis pain is surgical intervention – usually total hip replacement (THR) or total hip arthroplasty (THA). The first operation was done in 1940 and the modern total hip replacement started in the 1960’s. Technology has moved on since then and the outcomes are generally very good in terms of patient satisfaction. If that is the case what is all the fuss about. Why not just replace all the hips that are in distress? Even though technology has moved on the prospect of revision surgery for people in their 40’s and 50’s is likely and carries increased risks. That aside it is much more complex than you would imagine. Hip replacement is an elective process with approx. 70,000 completed in the UK per annum. The frequency of uptake for surgery peaks in the UK between the ages of 60-69. Many people below 55 elect not to have surgery for a number of reasons. If everyone who potentially could have hip replacement surgery opted to have one our healthcare systems undoubtedly would be under massive pressure and probably not able to cope. If THR is the gold standard what are the reasons people avoid surgery? For most it is unique combination of many factors.

(Feel) Too young – Too young (Doctor says so) – Too risky – Too much weight – Too ill – Too busy – Too vain – Too scared – Too limiting (can’t do what I want to do) – Too depressing – Too drastic – Too stubborn …and the list goes on.

It is very hard to predict an individual’s willingness to undergo hip replacement surgery, but it is likely the most influential factors are the degree of pain they suffer and their expectations of functionality (which varies with age and lifestyle).

What is the alternative?

If you find yourself in this situation and elect not to have surgery whatever the reason(s) the result is the same – what are you going to do instead? For most this means conservative care or self-management and this is usually the first approach healthcare providers will take. When you are in pain with a degenerative condition that will not get better self-management can sound very glib and appear to be a sticking plaster for a gaping wound. With time, and application of methods that work for you, pain can be reduced considerably with self-management.

I will soon be 46 and my chosen path is self-management for some of the reasons already mentioned. I have elected not to have hip replacement surgery at this time and would more than likely not be referred for surgery on the NHS. The fact that I would not be referred for surgery does not diminish the challenges ahead, which I choose to approach armed with as much knowledge and options in the toolkit as possible. There is nothing wrong with hip replacement surgery. It’s just not for me right now.

Just as the technology for hip replacement surgery is evolving and improving so is the knowledge and techniques for self-management. There are resources out there that will describe what is involved in self-management such as NICE Guidance – Osteoarthritis: care and management or Arthritis Ireland – What is Self Management? If you are going to truly engage in self-management then this is just the starting point.

HipTrac is a new device that is part of the self-management evolution for hip arthritis, hip impingement and labral pathology. Here at HipTrac UK we will discuss all aspects of self-management, bringing explanation and ideas of how you can help yourself to manage your condition and live a productive life for as long as you feel able without having surgery. If hip surgery is not for you right now or you want to know more about methods for maintaining good hip health then join HipTrac UK in the discussion for pushing forward techniques in self-management for those who want to remain active.