Dear Doctor,

My 56-year-old mother has trouble walking, she complains about pain in her hip from time-to-time but she refuses to get a walker or cane, or see a doctor. I worry about her. What could be the issues and how can I get her medical assistance? Maria

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Dear Maria,

It is possible that your mother is suffering from osteoarthritis of the hip. Usually, it develops at a much later age, around 60 plus years, but it can progress early. This happens particularly in those who walk a lot or have to stand continuously for long hours. These activities place stress on the hips and knees, which are the weight bearing joints of the body.  Degenerative changes with age appear in these joints first. There is also wear and tear in the supporting structures of the joint like the cartilage and muscles around it.  The synovial fluid that lubricates the joint also tends to dry up with advancing age. All these factors add up to make the joint stiff. As natural flexibility of the joint is lost, it hurts on movement.  In early stages, pain may occur when climbing stairs, but it tends to occur later even when walking on a flat road. One hip may be affected early; the other may follow later in life. Some people get severe osteoarthritis affecting both hips and or knees.

Any old trauma to the hip joint makes it more vulnerable to early osteoarthritis. Recent trauma with minor injury to the bone or breakdown of structures around the joint will cause painful movements. As such, rheumatoid arthritis involves small joints of the body, but rarely, large joints like hips can also be involved.

Osteoarthritis is diagnosed by the typical clinical features, physical examination and X-rays of the joint. There is no medical treatment. Pain killers are used to relieve severe pain. Physiotherapy is useful in reducing stiffness and pain as well. After physiotherapy procedures, one can do regular exercise involving the hips to retain flexibility of the joint to some extent. Surgery is done in advanced cases, where the joint is opened up and, "corrected” or is replaced by prosthesis.

Using a stick while walking is a good idea; it shares some of the weight of the body, thus keeping off some strain from the hip joint.

Dr.Rachna Pande is a specialist in internal medicine.