This article was originally published in Positive Health issue 54 – July 2000

“…Only 34 but she’s had six hip ops”. The heading in a popular newspaper did its job: it caught my eyes. The woman in question had been suffering from her hips since the age of 11. The doctors found, a bit late, that she had been born with congenital hip displacement.

Hip arthritis is most common in people past middle age, so she was surprised by the number of young people who were in ‘her’ hospital for the same reason.

Most hip troubles stem from osteoarthritis. Osteoarthritis is a disease of joint cartilage. Some of our joints are more prone than others to this disease, the more vulnerable being the hip, knee, and thumb joints. Osteoarthritis is said to be caused by trauma or stress (in the sense of strain, pressure) which triggers a process of degenerative wear and tear. The lower limbs, being weight-bearing, are usually affected more often by this joint disease than the upper limbs.

In osteoarthritis, the cartilage becomes progressively damaged. It is a kind of elastic, gristly, smooth and shiny material made of connective tissue, whose purpose is to allow movement without friction, When the cartilage has been ‘eaten away’ by constant and precocious wear and tear, its surface becomes dull and roughened. Its layers become so thin that the bone surfaces are left without protection. The disease also damages the synovium, the joint’s lubricating mechanism. Instead of being well-oiled and kept apart, the joint surfaces become dry and too close for comfort. Soon, the bones are ‘naked’ and articulate with each other, in a grating and rough fashion.

At the beginning of the disease, there is stiffness and limitation of movement. Then comes the pain, in and around the joint. Although patients learn how to adapt to and accommodate a progressively deteriorating and painful joint through various compensations, the result is excruciating and disabling pain. I used to know a man who was suffering a lot because of a ‘bad hip’. He was on a waiting list for an operation; the waiting was protracted and the pain worsening. He told me that driving his car was the best pain-killer he knew and that, sometimes, he would get up in the middle of the night, when he could not bear the pain any longer, and would go for a ride in his car. Let’s not infer from this case that driving is a cure for osteoarthritis of the hip! But, for this man, it was a convenient and harmless pain suppressing technique.

“The disorder comes out of the blue with no easily recognizable cause” says an expert. The same expert remarks, in all seriousness, that: “If you have a worn out hip you can have it replaced in just the same way as if you have a sore throat you can ask your physician for some penicillin tablets.” I am pretty sure you won’t be surprised if I tell you that this expert is a surgeon. After all, cutting into bodies is their trade and skill, their bread and butter – and knife. Let’s not forget that orthopaedic surgery is one of the biggest and most rapidly expanding branches of surgery. Accordingly, it is also a multimillion pound industry. How much of these operations are necessary and legitimate is another story.

Obviously, a hip replacement procedure involves a lot more than getting rid of a sore throat. I agree that there are well advanced cases when the patient is seriously disabled and where no alternative to hip replacement can be found. But, in all other cases, joint-saving procedure should be preferred, and one would be well advised to ask for a second opinion if a hip replacement is offered as the only possible choice.

Hip replacement and hip surgery are serious and complex procedures that are not without risks, some of which can be fatal. As with any other operation there is the risk of complications such as reaction to the anaesthetic, embolus, infection, etc. The operation is not always successful and can be followed by a loosening of the implant, dislocation, or ‘drop foot’ caused by a stretching of the sciatic nerve. Even when the operation is successful, debris from the material used for hip replacement surgery can ‘leak’ and poison the body by travelling to vital organs such as the liver and spleen. Finally, since the surgeon’s knife cannot remove cause but only the effect, the artificial hip doesn’t last for ever and, when the patient is relatively young, has itself to be eventually replaced. Also, at the beginning only one hip is affected by the disease, but the other hip, not being immune, usually suffers the same fate and the patient has to go again into the operating theatre.

Apart from the cases triggered by direct trauma and those from congenital diseases, osteoarthritis is said to be caused by stress. If we don’t like the prospect of becoming scalpel-fodder; if we want to prevent or reverse (before it’s too late) this condition, we must search for the causes of this stress. Why should the hip joint be stressed to the point of undue wear and tear when our modern life does not require much hard labour? Why does the disease ‘attack’ some people and not others? Why can young people suffer from it although they had so little time to subject their joints to this so-called stress?

If undue strain is the cause of most hip arthritis, what is the cause of the undue strain? The orthodox school of thought does not bother itself too much with these questions. They want a cure without having to remove the cause. To this effect they are straining every nerve to get the hip mobilized. This is a mistake because the hip is only the victim. The cause is elsewhere, as we will see next month.