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Osteoarthritis of the hip

Arthritis is a degenerative condition that causes pain and inflammation in the joints. This condition is also referred to as joint “wear-and-tear”. There are mainly 3 types of Arthritis, namely gout, rheumatoid and osteoarthritis (OA), the latter being the kind we will be looking into in this article.

The hip joint is the area where the head of the femur (thigh bone) meets the acetabulum (rounded socket of the pelvic bone). The joint surfaces are covered in cartilage and synovium (or Synovial membrane). Cartilage is what allows for smooth movement of the join and also cushion the bones. Synovium produces a liquid that lubricates the joint and further facilitates movements in the joint. OA of the hip leads to wearing down of the cartilage and synovium, resulting in decreased joint space and change in the surface of the joint.

Types of hip OA

There are two types of OA - primary and secondary. Primary hip OA happens when the onset is insidious (starts on it’s own, without any incident), while secondary hip OA happens when there is trauma, anatomical abnormalities, a previous injury or inflammatory condition that offsets the OA.

Causes

There are many factors that may lead to OA and therefore it is important to view the cause of OA to be a combination of many factors. These factors may include the following:

  • Age: increased age increases the risk of OA

  • History of hip injury/trauma

  • Inflammatory arthritis such as rheumatoid arthritis

  • Joint Shape

  • Genetics

  • Increased weight

  • Occupation and activities that involve high and/or repetitive joint loading

  • Sports: high performance and impact sports , especially with specialization at a young age.

  • Lifestyle factors such as sedentary lifestyle and diet

  • Other conditions: FAI, metabolic diseases and conditions such as menopause, etc.

Symptoms

The most common symptoms are:

  • Pain in the hip or groin area – usually worse in the mornings and in cold weather, and eased with movement and heat.

  • Stiffness – mainly in the mornings and with extended periods of inactivity (i.e. sleeping, sitting for long behind a desk at work).

  • Decreased range of movement – especially internal rotation

  • Crepitations, hip “locking” or “catching” during movement

  • Leg length discrepancy.

Diagnosis

The diagnosis is usually done through a combination of clinical assessment and diagnostic tests. The physical assessment will include screening for risk factors and testing for the symptoms as described above. The behaviour of the symptoms often offers a great inclination as to whether or not it may be OA. Some special tests may be used to put pressure in certain structures or parts of the joint and to clear other symptoms that may present similarly such as hip bursitis, avascular necrosis, etc.

Some of the special tests are:

· Scour test

· FABER test

· Hip quadrant test

X-rays are commonly used to diagnose OA of the hip. The main indicators of OA are decreased joint space and the presence of osteophytes. Other imaging techniques such as CT, MRI or bone scan may also be used to show the condition of the bone and other tissues in the area but generally a simple X-ray will suffice.


Treatment

There is currently no cure for OA, and the treatment entails management of the symptoms and preventing the progression of the symptoms and further deterioration of the joint. The main aim of any treatment will be to ensure the patient will carry on with their daily activities as best as possible.

Patient education will be the most important factor. Patients need to be educated on their condition, their expected progression and the aim of the treatment. It is key for patients to be able to identify aggravating factors, to be able to avoid these and also easing factors in order to diminish their pain.

This is then followed by lifestyle modifications such as:

  • Exercise for mobility and muscle strengthening as guided by your physiotherapist,

  • Change in activities from high impact to lower impact,

  • Wearing appropriate shoes that offer adequate cushioning and support

  • Weight control

  • Diet modifications

A combination of physiotherapy and pharmaceutical interventions to offset or minimise the symptoms as well as slow down progression. Physiotherapy will guide the patient in what exercises to do, when and how to perform certain activities to minimise the load on the joints. Soft tissue release, as well as, anti-inflammatory interventions. Sometimes assistive devices such as walking sticks or walking frames to help to minimise movements and positions that cause pain and modify weight distributions and assist with balance issues that may present.

Medication is used to control symptoms of pain and inflammation that interfere with daily activities. These may be pain killers, nonsteroidal anti-inflammatory drugs (NSAIDs), cortisone and others. Your doctor would be able to better advise you on the appropriate pharmaceutical management if deemed necessary.

Finally, when the conservative methods have not worked or the symptoms have progressed into final stage, surgery is indicated. Surgery may also be indicated in cases aimed towards preserving the joint. The types of surgical intervention are:

  • Hip resurfacing

  • Osteotomy

  • Hip replacement

OA hip is a common condition, especially within the elderly. It is important to recognize the signs of the condition as well as being able to manage the condition appropriately in order to prevent progression. As with all diseases and conditions, prevention is the best cure. Maintaining an active and healthy lifestyle is not only the best option from a health perspective,but it is also the most economical solution with benefits that extend beyond bone health.

Keep it moving, but more importantly, keep it moving correctly!

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