The Impact of Ageing on our Hip Cartilage

Ageing is a beautiful and natural part of life, serving as a testament to the experiences we’ve gathered over the years—the cherished memories, the birthdays we’ve celebrated, and the countless stories shared with loved ones. However, alongside the beauty of ageing come inevitable changes, particularly in our bodies, such as the wear and tear on weight-bearing joints like the hips.

Research has shown a 30% decrease in cell density in the cartilage of the human hip joint between the ages of 30 and 70 (E. Vignon et al., 1976). Over time, this gradual deterioration of hip cartilage can lead to discomfort, stiffness, and even conditions like osteoarthritis..

In this blog, we’ll explore the importance of hip cartilage, its common conditions, and why addressing cartilage damage early is beneficial and essential for maintaining joint health. As Mark Twain has said, “The secret of getting ahead is getting started,” when it comes to joint health, taking action as early as needed is key to healthy living. It’s about being proactive and taking control of your health.

Learn more about A/Professor Andrew Quoc Dutton

What is Cartilage

A cartilage is a type of connective tissue in various parts of the body, including the joints between bones, the spine’s vertebrae, the ends of the ribs, the ears, nose, and airways. It is composed of specialised cells called chondrocytes, located in small cavities or lacunae. These chondrocytes produce an extracellular matrix rich in collagen fibres, proteoglycans, and elastic fibres—giving cartilage its unique combination of strength, flexibility, and resilience.

In the hip joints, cartilage plays a crucial role in absorbing the impact of physical activities such as walking, running, and jumping. By cushioning the bones and reducing friction, cartilage helps prevent excessive tearing, maintaining joint integrity and allowing for smooth, comfortable movement. This shock-absorbing function is essential for preserving joint health and ensuring that our daily activities remain pain-free.

As we age, our cartilage naturally deteriorates, which can affect our ability to perform physically demanding activities. The hip joint, a ball-and-socket joint, depends heavily on cartilage to ensure smooth and pain-free movement. The wear and tear of cartilage due to ageing is influenced by several interrelated factors:

Decrease cellular function (chondrocytes become less efficient)
Reduced collagen and proteoglycan production
Loss of water content
Mechanical stress accumulation
Decreased joint lubrication

LIMITED REPAIR CAPABILITIESCartilage tissue has a limited capacity for regeneration due to its low cell density and lack of blood supply (Gaissmaier et al., 2005). This means it must slowly absorb nutrients and oxygen from surrounding tissues, which limits its ability to repair itself.

SLOW HEALING PROCESS The repair process in cartilage is considerably slower than in tissues with a direct blood supply. This reduced healing rate is due to the limited delivery of essential nutrients and oxygen.

LIMITED CELL PROLIFERATION Chondrocytes, the primary cells responsible for maintaining cartilage, have a restricted capacity for regeneration. Their ability to produce new extracellular matrix components declines as we age.

INCOMPLETE REPAIR When cartilage is damaged, the repair process often results in incomplete regeneration. The newly formed cartilage typically lacks the strength and resilience of the original tissue.

Structures & Functions of Cartilage

Cartilage is a versatile connective tissue with various types that serve distinct bodily functions. The main types of cartilage and its functions include:

HYALINE CARTILAGE This type of cartilage is the most abundant in the human body, found in the trachea, epiphyseal growth plates, nose, sternum, and anterior segments of the ribs. It is primarily composed of type II collagen and proteoglycans, which provide it with a smooth, resilient surface. This cartilage reduces friction at joint surfaces, absorbs compressive forces, and facilitates smooth bone articulation.

ELASTIC CARTILAGE Found in the larynx, epiglottis, ear, and eustachian tube, the elastic cartilage provides structural support while allowing these areas to withstand pressure and return to their original shape after deformation, a testament to its impressive flexibility.

FIBROCARTILAGE Fibrocartilage, characterised by its abundance of type I collagen and lower proteoglycan content, is found in tendons, ligaments, intervertebral discs, menisci, and some articular surfaces of bones. This type of cartilage is designed to endure high levels of tension and compression, making it essential for areas of the body subjected to significant mechanical stress.

6 Common Cartilage Conditions & Symptoms

The cartilage is essential for joint function as it supports everyday functionality. Here are common cartilage-related conditions:

Osteoarthritis (OA) Osteoarthritis is the most prevalent form of arthritis among the ageing population in Singapore (Vicky Yang, 2023). It develops when the cartilage that cushions the ends of the hip bones gradually wears away. This condition primarily affects joints in the hips, hands, knees, and spine. Common signs are:

Pain
Tenderness
Stiffness
Bone spurs
Loss of flexibility
Swelling
Grating sensation

Rheumatoid Arthritis (RA) Rheumatoid arthritis, a chronic inflammatory disease, is not limited to affecting your joints. It can also cause damage to your skin, eyes, heart, lungs, and blood vessels. This condition occurs when the immune system mistakenly targets the lining of the joints, leading to painful swelling that can result in bone erosion and joint deformity. Typical symptoms include:

- Tenderness of the joints
- Swollen joints
- Joint stiffness
- Fatigue
- Fever
- Loss of appetite

Femoroacetabular Impingement (FAI) This is a condition in which excess bone develops along one or both of the bones that form the hip joint, resulting in an irregular shape. This irregularity prevents the bones from fitting together properly, causing them to rub against each other. Over time, this friction can wear down the cartilage, leading to pain and restricting physical activity. FAI is usually characterised by:

- - Pain
  - Limping
  - Stiffness

Labral Tear The labrum, a ring of cartilage that encircles the hip joint, provides stability and cushioning. A labral tear, often caused by repetitive motions or trauma, is a common injury among athletes or individuals with hip structural abnormalities. However, with proper treatment, including early detection, a labral tear can be managed, potentially leading to recovery and a return to normal hip function. Signs of labral tears are:

- - Hip pain
  - Hip stiffness
  - Locking sensation in the hip joint

Hip Dysplasia Hip dysplasia is a congenital condition where the hip socket fails to develop properly, allowing the ball of the hip joint to slip partially or completely out of place. The severity of this condition can vary, ranging from a mild abnormality to a complete dislocation of the hip. With this condition you will notice::

- Hip pain or limping
- Knee pain
- A clicking or popping sound in the hip

OsteonecrosisOsteonecrosis, or avascular necrosis, is a condition characterised by the death of bone tissue due to insufficient blood supply. When the blood flow to a bone is disrupted, the affected bone begins to deteriorate and collapse, including the cartilage that covers it. This can lead to significant joint pain and eventual joint dysfunction. Leading symptoms of osteonecrosis are:

- Joint pain
- Groin pain (if the hip joint is affected)
- Limping

Why Dr Dutton for Hip Cartilage Treatment in Singapore

The health of your hip cartilage is crucial for joint function, but it naturally deteriorates with age. The hip cartilage can degrade over time due to several factors, leading to pain, stiffness, swelling, or a grinding sensation. Signs like these often indicate underlying cartilage damage, making it essential to seek timely medical attention.

A/Professor Andrew Quoc Dutton, a Harvard Fellowship-trained orthopaedic surgeon, specialises in diagnosing and treating such conditions. His expertise encompasses a wide range of joint issues, from degenerative diseases like osteoarthritis to sports-related injuries and complex joint reconstructions. This extensive experience positions him as a trusted authority in hip cartilage treatment in Singapore. Don’t wait until it’s too late, there’s no need to suffer in silence when help is at your fingertips. Contact (+65) 6836 8000 to schedule a consultation with Dr. Dutton today.

References:
The cell density of human femoral head cartilage. (1976, December 1). PubMed.
News-Medical. (2023, June 19). What is Cartilage?
Chang, L., Marston, G., & Martin, A. (2022, October 17). Anatomy, cartilage. StatPearls – NCBI Bookshelf.
Osteoarthritis – Symptoms & causes – Mayo Clinic. (2021, June 16). Mayo Clinic.

A/Professor Andrew Quoc Dutton Orthopaedic & Sports Clinic Insurance

The A/Professor Andrew Quoc Dutton Orthopaedic & Sports Clinic offers minimally invasive and surgical treatments for sports-related injuries and orthopaedic conditions.

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About A/Professor Andrew Quoc Dutton

A/Professor Dutton, also known as, has been in clinical practice since 1996 after graduating from Marist College, Canberra and the University of New South Wales, Sydney, Australia. A/Professor Dutton has worked at the Prince of Wales Hospital, Sydney, and the St. George Hospital, Sydney, before completing his orthopaedic surgery training in Singapore. He is currently an associate professor of orthopaedic surgery at the National University of Singapore (NUS).

Conditions

Knee Pain

Knee Osteoarthritis

Meniscus Tear

Cartilage Injury

ACL Ligament

Procedures

Knee Replacement Singapore

Computer Assisted Knee Surgery (CAS)

Cartilage Regeneration

Knee Arthroscopy

Primary Revisions (Redo) Knee Replacement