Ozone Hip Therapy

Osteoarthritis of the hip is a degenerative disease of the hip joint and is characterized by progressive cartilage erosion that covers the head of the femur and the acetabulum which receives it.

Causes

There is no specific cause, but there are multiple factors that favor the occurrence of this disease:

• Age: in the young and healthy it is virtually non-existent.

• Characteristics of the joint: greater hip mobility makes it more susceptible to wear and tear and the body load  increases the compression between the bones.

• Heredity: Patients who suffer from osteoarthritis have at least one parent with the same disorder.

• Obesity:  It causes more pressure on the joints. Women between 50 and 60 years with osteoarthritis of the hip are generally obese.

• Activities: Physically intense or heavy manual labor, because they overload the joint and cause premature wear.

• Anatomical malformations, such as knee valgus, may cause an incorrect load distribution and higher pressure in some areas more than others.

• Decrease of estrogen menopausal women are more likely to have coxarthrosis.

• Severe traumas that cause articular fractures ensuing periods of immobility can result in a reduced intake of nutrients to the cartilage and increased stiffness.

Symptoms

The primary symptom is pain at hip level that may spread to the groin and  the inside front of the thigh down to the knee. The pain is more acute at the beginning of movement and subsides as the joint “warms up” the pain disappears when movement stops. The pain is very intense in the morning as soon as the patient gets out of bed, but should disappear after about half an hour.

If  walking or standing for a long time or  over using the hip it is possible that after 20-30 minutes the pain rekindles. In the last stages of coxarthrosis discomfort is felt even when stationary, and especially at night.

The symptoms may be compounded by a difficulty in sitting: the person affected by hip osteoarthritis may find relief  when sitting by leaning on the healthy hip or may attempt to alleviate the symptoms by adopting an incorrect posture, causing overloading on the opposite hip and back.

The symptoms of arthritis tend to lead towards deterioration of the pathology, but the condition does not always advance progressively, over time patients often report pain-free periods alternating with painful flare-ups. Because of these characteristics it is necessary, and important to remember during the diagnosis, to compare the symptoms of hip osteoarthritis in their entirety and not to refer to any particular day.

When to seek medical attention

If you are experiencing any of the above symptoms, go to visit the family doctor, who will check the patient’s history and examine him/her carefully so as to understand the exact area of pain, the movements that cause it and the time of day symptoms occur. The most common instrumental examination to identify the coxarthrosis is a radiograph. The x-ray  will  show any other changes in the bone, such as formation of osteophytes and thickening of bone rarefying.

 Risk Factors

Hip osteoarthritis typically affects patients over 50 years of age and is more common in overweight people. This disorder also has a genetic predisposition. Other factors that may help to develop hip osteoarthritis include trauma injuries and bone fractures.

Treatments and drugs

The treatment of hip osteoarthritis should begin gradually with progressive  measures being taken including  surgery if and when necessary. Not all treatments are suitable for all patients. It is important for the patient to talk to the doctor to assess the most suitable treatments, which may include:

•Losing weight: probably one of the most important treatments but one of  the least realized. The less weight the joint has to carry, the less pain during daily activities.

• Changing  life style: change the way in which we deal with certain activities, for instance making use of walking aids, a cane or a crutch can help to reduce the weight and stress on the arthritic articulation.

• Strengthening the muscles: strengthening  the muscles involved in hip joint movement  can help reduce pain and prevent atrophy of the muscles and is an important factor in maintaining hip function.

• Anti-inflammatory drugs (NSAIDs) and pain relief: although effective in controlling pain, these should always be taken under medical supervision. It is important to remember the potential side effects to the stomach (gastritis, ulcers), the kidney and liver. The intake of other drugs (proton pump inhibitors, gastric protectors) that reduce (but do not cancel!) the effects on the stomach may also cause other side effects.

Glucosamine and Chondroitin. For nearly two decades the effectiveness of glucosamine and chondroitin in osteoarthritis of the hip and knee has been discussed. Glucosamine and chondroitin are two molecules that form the cartilage which is located in our joints. Cartilage is normally subjected to a cycle of formation and consumption. For proper repair it is necessary to have the blocks for cartilage construction. The justification for the use of glucosamine and chondroitin is, that it provides more available blocks  for the repair process. Several studies have initially sought to evaluate the effects of glucosamine and chondroitin at intervals of one or two months and have demonstrated that the reduction of pain in those who had taken glucosamine and chondroitin was comparable to the reduction of pain in those taking anti-inflammatory drugs . A recent study evaluated the effects of intake after a period of three months and again demonstrated its effectiveness. Importantly, one last scientific  experiment followed a group of 200 patients treated with glucosamine and another group using a placebo ( unknown to the patients in this group this is a harmless but ineffectual drug): those taking glucosamine had less pain and a better radiological picture after three years compared to those who had taken the placebo. There are, therefore, no serious reasons for not taking glucosamine and chondroitin when a patient has hip or knee osteoarthritis. However it is  important that the patient talks to the doctor to evaluate any contraindications, particularly when  taking  oral anticoagulants.

Intra-articular hyaluronic acid. Hyaluronic acid is a fundamental component of the synovial fluid, i.e. the liquid present in our joints that protects cartilage from wear and tear. Synovial fluid, in fact, nourishes the cartilage and also works as a shock absorber. The natural process of aging progressively reduces the quantity of synovial fluid in the joints and, lacking the lubricant, increases the friction within the joints. Hyaluronic acid has been shown to be particularly effective in the treatment and prevention of osteoarthritis. Infiltration into the joint can reduce pain and accelerate the healing process, especially in cases of average and modest osteoarthritis. These treatments do not  reconstruct a worn cartilage but in many cases will permit a patient to return to everyday activities which may have been  gradually neglected, and may also delay the need for surgery. The action is not curative, which makes it necessary to repeat the treatment every 6-12 months. The hip joint is, however, difficult to reach without  proper guidance. For this reason, intra-articular hip injections are carried out exclusively using  ultrasound guidance.

Ozone Therapy

• Ozone therapy. The anti-inflammatory action of the mixture of Oxygen-Ozone has determined its use in joints, initially in the knee joint but in recent years also in the hip, within the joint and also its immediate vicinity (infiltration periarticular ).The injection must be carried out using ultrasound guidance.

• Associating Ozone therapy with Hyaluronic Acid, represents a therapy  characterized by the action of two substances combined, the anti-inflammatory action of the ozone  together  with the  lubricating ability of Hyaluronic Acid. The gas injected in the joint with ultrasound guidance also allows better visualization of the hip confirming the correct site for the injection.

Surgery

When the cartilage is completely consumed and the bones rub against each other, the only solution is surgery.

Hip replacement surgery is the second most common procedure for joint replacements, but for many people it can be difficult to know when the  time for surgery is right: surgery is performed when the joint has reached a point where, painful symptoms can no longer be controlled with non-surgical therapies. A total hip replacement is major surgery that, although very frequent and with a high rate of satisfaction among patients, also involves certain risks.

The prostheses currently available have an average effective life of about 10-15 years, but individual variability is large and determined mostly by body weight and levels of physical activity.