What Is Hip Osteoarthritis?

Osteoarthritis is a degenerative type of arthritis that affects millions of people in the United States. Osteoarthritis can affect any joint in the body, but more commonly develops in the weight-bearing joints of the body, such as the hip. The hip is one of the largest joints in the body and is known as a ball and socket joint. The acetabulum, which is formed by the large pelvic bone, forms the “socket,” while the femoral head forms the “ball.” The surface of the hip joint is covered by synovium, which serves to lubricate the joint and help with movement.

When a patient has osteoarthritis, the cartilage in the hip joint begins to wear away, and the joint space begins to decrease. When the degeneration is severe, bone can rub against bone, resulting in severe pain within the joint.  Furthermore, the damaged bones may try to compensate for the loss of cartilage by growing outward, which leads to the formation of bone spurs.

Must Watch Video – What is Hip Osteoarthritis?

Osteoarthritis develops slowly, and progressively worsens over time. Patients with hip osteoarthritis most commonly complain about pain and tenderness around the hip joint. They may report that the pain is worse in the morning or after prolonged sitting. The quality of pain differs among patients with some describing the pain as a sharp, stabbing type pain, while others report a dull, aching type pain. Additional symptoms that patients may report include: groin pain that radiates to the buttock or knee, pain the worsens with strenuous activity, hip joint stiffness, inflammation around the hip joint, hip joint locking or grinding, and decreased hip joint range of motion. At times, hip osteoarthritis produces symptoms that make it difficult for a patient to walk and climb stairs, resulting in the inability to perform normal activities of daily living.

Causes Of Hip Osteoarthritis

There are no specific causes of hip osteoarthritis; however, several risk factors have been identified which increase an individual’s risk of developing this condition, including:

  • Increasing age
  • Obesity
  • Previous hip joint injury
  • Congenital deformities (i.e. hip dysplasia)
  • Family history of osteoarthritis
  • Co-morbidities (i.e. diabetes, gout, rheumatoid arthritis)

Treatments For Hip Osteoarthritis

An assessment of patients presenting with symptoms of hip osteoarthritis will usually include a detailed history including past medical history, family history, and a history of the current pain episode. Additionally, a physical exam will look for joint tenderness, gait abnormalities, decreased range of motion, joint crepitus, and signs of muscle, tendon, or ligament damage around the hip joint. Furthermore, an X-ray may be ordered to visualize the hip joint structure, looking for joint space narrowing, bone changes, and bone spur formation. In complicated cases, magnetic resonance imaging (MRI) may be ordered to further visualize bone and soft tissue damage. Once a diagnosis of hip osteoarthritis is confirmed, treatment can be geared toward the problem.

There is no cure for hip osteoarthritis; the goals of treatment are to reduce pain and improve mobility. Early hip joint arthritis is treated non-surgically and involves lifestyle modifications. This may include losing weight, minimizing exposure to activities that increase hip pain, and switching from high-impact exercise (i.e. running) to low-impact exercise (i.e. swimming). The use of assistive devices including canes and walkers may also help to improve mobility.

Alternative treatment options, including physical therapy and chiropractic care, can help to maintain and possibly improve joint range of motion by using mobilization or manipulation of the hip joint and surrounding structures. Further, an exercise program can be developed to help improve range of motion and strength in the affected area.

From a pharmacologic perspective, pain medications and non-steroidal anti-inflammatory drugs (NSAIDs) may be recommended as first line therapy. Acetaminophen can help to relieve mild to moderate osteoarthritis pain. However, taking high doses of acetaminophen has been linked to liver damage. NSAIDs help to relieve inflammation, which may help to relieve associated pain. However, NSAIDs can also cause stomach upset, cardiovascular problems, bleeding issues, as well as liver and kidney damage. Patients taking acetaminophen or NSAIDs for the relief of their osteoarthritis pain should be closely monitored for side effects.

Corticosteroid injections directly into the hip joint may also be recommended to decrease inflammation within the joint, thereby helping to reduce pain. Additionally, injections of hyaluronic acid may also be recommended to help reduce joint pain. Hyaluronic acid is a lubrication medication that is similar to a component that is naturally found in joint fluids.

For patients who have pain that is unresponsive to conservative treatment options, surgery may be recommended. An osteotomy is a procedure that is rarely used; it involves realigning either the femoral head or acetabulum to take pressure off of the hip joint. Hip resurfacing involves removing the damaged bone and cartilage in the acetabulum and replacing it with a metal shell. The femoral head is not removed; it is capped with a smooth metal covering. This procedure allows for a total hip replacement to be performed in the future, if necessary. A total hip replacement involves removing both the damaged acetabulum and femoral head and replacing them with metal, plastic, or ceramic joint surfaces in an attempt to recreate the joint and restore normal joint function.

Complications of hip joint surgery involve infection, bleeding, blood clots, blood vessel damage, hip dislocation, and limb length discrepancy.

Conclusion

Osteoarthritis is a common, degenerative type of arthritis that most commonly affects the weight-bearing joints of the body, including the hip. Patients often complain of joint pain, stiffness, and inflammation. Hip osteoarthritis can become severe and impact an individual’s ability to perform normal activities. There are various effective treatment options available ranging from conservative treatment options such as pain medication and anti-inflammatory medications, to joint injections, and lastly surgery. Patients suffering with hip osteoarthritis should speak with their physicians about the various treatment options that are available to help manage their pain.

References

  1. Atchia I, Kane D, Reed MR, Isaacs JD. Birrell F. Efficacy of a single ultrasound-guided injection for the treatment of hip osteoarthritis. Ann Rheum Dis. 2011;70:110-116.
  2. Ganz R, Parvizi J, Beck M, Leunig M, et al. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clinical Orthopaedics & Related Research. 2003;417:112-120.
  3. Jacobsen A, Sonne-Holm S. Hip dysplasia: a significant risk factor for the development of hip osteoarthritis. A cross-sectional survey. Rheumatology. 2005;44(2):211-218.
  4. Lohmander LS, Gerhardsson de Verdier M, Rollof J, Nilsson PM, Engstrom G. Incidence of severe knee and hip osteoarthritis in relation to different measures of body mass: a population-based prospective cohort study. Ann Rheum Dis. 2009;68:490-496.
  5. Pourbagher MA, Ozalay M, Pourbagher A. Accuracy and outcome of sonographically guided intra-articular sodium hyaluronate injections in patients with osteoarthritis of the hip. JUM. 2005;4(10):1391-1395.
  6. Zhang W, Doherty M, Arden N, Bannwarth B, et al. EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR standing committee for international clinical studies including therapeutics (ESCISIT). Ann Rheum Dis. 2005;64:669-681.