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Hip Arthritis (Osteoarthritis)

(Also known as Hip Osteoarthritis, Osteoarthritis of the Hip, Arthritis of the Hip, Degeneration of the Hip)
Note - The term hip arthritis will be used in this document to describe the condition known as hip osteoarthritis.

What is hip arthritis?
Hip arthritis is a condition characterized by a degenerative process whereby there is gradual eroding of the surfaces of the hip joint with subsequent inflammation. This may occur following a specific injury or due to repetitive forces going through the hip beyond what it can withstand over a period of time.
In a normal hip, joint surfaces are smooth and there is cartilage between the bone ends which allow efficient shock absorption.
When the hip is damaged or overloaded, particularly with excessive weight-bearing or twisting force, degeneration of the cartilage occurs which reduces the hip's shock absorption capacity. As the condition progresses there is eventual wearing down of the bone ends so that the surfaces are no longer smooth and may have small bony processes called osteophytes. This condition is known as hip arthritis.
Hip arthritis usually occurs after the age of 50 years. It is more common in those patients who are overweight or have a past history of injury or trauma to the hip.

Signs and symptoms of hip arthritis
Patients with this condition typically develop symptoms gradually over time. In minor cases of hip arthritis, little or no symptoms may be present. As the condition progresses, there may be increasing hip pain with weight bearing activity and joint stiffness – particularly after rest and first thing in the morning. Severe joint pain, decreased hip flexibility, pain at night and grinding sensations during certain movements may also be experienced. The pain associated with hip arthritis is typically felt in the buttock region and / or front of the hip and groin. Occasionally pain may be referred to the thigh or knee. Symptoms can sometimes fluctuate from month to month with patients reporting an increase in symptoms with colder weather. In severe cases, muscle wasting (especially of the gluteals), and a limp may also be present.

Contributing factors to the development of hip arthritis

There are several factors which may contribute to the development of hip arthritis. Some of these include:
  • age (> 40 years)
  • being overweight
  • genetics
  • history of injury or trauma to the hip joint
  • leg length discrepancy
  • poor biomechanics
  • poor core stability
  • excessive or inappropriate activity

Diagnosis of hip arthritis

A thorough subjective and objective examination from a physician may be sufficient to diagnose hip arthritis, however, an X-ray is usually required to confirm diagnosis. Sometimes an MRI may also be indicated.

Prognosis for hip arthritis
Whilst little can be done to reverse the degenerative changes to the hip associated with this condition, patients can generally remain active by modifying their activities appropriately and undergoing an appropriate rehabilitation program.

Treatment for hip arthritis

The primary goal of treatment in patients with hip arthritis is to remain as active as possible without aggravating symptoms in order to maintain strength and mobility and to avoid deterioration. Treatment should be directed at improving hip range of movement and strength, reducing pain, and restoring normal function.
Most minor to moderate cases of hip arthritis can be managed with appropriate physiotherapy so the patient can remain relatively symptom free and active. The success rate of treatment is largely dictated by patient compliance. One of the key components is that the patient rests from aggravating activities and balances their weight bearing activities with periods of rest (e.g. sitting or lying) to keep symptoms to a minimum or ideally absent. This prevents further damage and deterioration and allows the body to clear any swelling or inflammation associated with the condition. Continuing to participate in painful weight bearing activity is likely to lead to a poor outcome. It is important, however, to keep as active as possible by choosing activities that do not increase symptoms. Better activities include swimming, hydrotherapy or bike riding.
It is very important that patients with this condition perform regular movement and strength exercises to prevent stiffness and weakness from developing and to ensure the hip is functioning correctly. Pain relief and anti-inflammatory medication may also assist in managing the symptoms. Glucosamine and chondroitin supplements may also be beneficial.

Therapy for hip arthritis

Therapy for patients with this condition is vital to ensure an optimal outcome. Treatment may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • mobilization
  • ice or heat treatment
  • exercises to improve strength, flexibility and balance
  • hydrotherapy
  • education
  • crutches or the use of other walking aids
  • walking re-education
  • activity and lifestyle modification advice
  • biomechanical correction
  • anti-inflammatory and supplement advice (e.g. glucosamine and chondroitin)
  • weight loss advice
  • advice on appropriate footwear or orthotics

Other intervention for hip arthritis
In more advanced cases of hip arthritis, where symptoms are severe, patients may require surgical intervention. This may involve a hip arthroscope or hip joint replacement surgery. The treating doctor can advise if this may be required and will refer to an orthopaedic specialist for an assessment and opinion. Occasionally referral to a podiatrist (for orthotics) or to a nutritionist (to assist with body weight reduction) may be appropriate.

Hip joint replacement surgery for hip arthritis
Hip joint replacement surgery for patients with this condition is usually considered where pain is unrelenting, there is significantly reduced function and conservative measures have failed to improve symptoms. Following a total hip joint replacement, patients are normally in hospital for 5 to 10 days and require therapy treatment and rehabilitation from day 1 onwards. Resumption of normal daily activity can usually be achieved 3 – 6 months following surgery.