Osteoarthritis of the Hip
Osteoarthritis is the degeneration of the cartilage within weight-bearing joints – in this case, the hip joint. Many people develop hip osteoarthritis as a result of wear and tear – most commonly age, but also due to excess weight and obesity, repetitive straining from vigorous activities such as sports or even repeated trauma. It is estimated that upwards of 28 million people are living with osteoarthritis in the US. Osteoarthritis is a chronic and irreversible condition; however it can be managed with both conservative and surgical options.
To understand osteoarthritis, we need to know the anatomy of the hip joint. The pelvic bone is connected to the head of the femur or thighbone with a ball and socket joint. In order for the two bones to move past each other smoothly and without pain, the surfaces of both the ball and socket are covered in articular cartilage. The synovium, a thin lining over the joint, produces small amounts of fluid to continually lubricate the cartilage and allow smooth movement.
Causes of Hip Osteoarthritis
Over time, and usually in middle age or later, the constant forces on the hip begin to degrade the cartilage within the hip joint. This degenerative process can be hastened by excess weight that puts extra pressure on the joint or by repeated trauma from contact sports or accidents. As the cartilage begins to wear away, pain, stiffness and swelling can occur within the joint. This can severely limit range of motion and enjoyment of life. As the bone rubs on bone, bone spurs can form, causing worsening pain. Typically, osteoarthritis progresses slowly over many years.
While conventional wisdom has pinned the cause of osteoarthritis on wear and tear, new research shows hormonal changes due to obesity can cause inflammatory reactions that attack the joints and caused additional degradation. Therefore, patients who suffer from obesity and excess weight may have a higher risk of osteoarthritis both on a mechanical and hormonal level.
Hip osteoarthritis can also form as a result of congenital or genetic factors which typically cannot be prevented.
Symptoms of Hip Osteoarthritis
If you are experiencing hip pain, it is important to visit a qualified orthopedic specialist early on. There are many conditions that share the common symptoms of hip osteoarthritis. A proper diagnosis can ensure the right treatment plan going forward. The most common symptoms of hip osteoarthritis include:
- Pain in the hip area that can radiate around the groin, thigh and even down to the knee
- Pain that work worsens with activity
- Stiffness or locking in the joint
- Impeded range of motion
- Pain that may be worsened by cold or rainy weather conditions
Diagnosing Hip Osteoarthritis
The diagnostic process begins with a physical examination as well as a full medical history. During the exam, your orthopedic surgeon will test for tenderness and pain in the hip area as well as evaluate any radiating pain you may have. Range of motion, evaluation of your gait and other basic tests will be performed to understand more about the function of the hip.
X-rays are the first and often definitive diagnostic imaging test we use to diagnose loss of joint space in the hip. X-rays will show changes in bone structure, cartilage health and development of bone spurs in the joint.
Rarely, a CT or MRI will be needed to confirm the condition of the bone, cartilage and soft tissue in the hip.
Treatments for Hip Osteoarthritis
Unfortunately, there is no cure for osteoarthritis as it is a progressive and chronic disorder. However, we have many options for slowing or stopping its progression, especially when caught early. You should visit a qualified orthopedic specialist if you experience prolonged or significant hip pain, especially if you are at risk of osteoarthritis.
Conservative Treatment Options for Hip Osteoarthritis
Lifestyle modification is the first step in slowing or halting the progression of osteoarthritis. Improving exercise and dietary habits allows the patient to lose weight and consequently reduce strain on the hip joint. Further, eliminating visceral fat can reduce the hormone-induced inflammation that attacks joints around the body, including the hip.
Depending on the extent of the damage to the joint, patients may also have to limit the activities that can accelerate degeneration of the hip joint. Running, contact sports and tennis may have to be replaced with swimming, walking and/or cycling to reduce the pressure and strain on the hip joint.
Physical therapy along with rest, elevation, ice and anti-inflammatory medication may all help to reduce the inflammation in the joint and protect it from further damage. Your orthopedic surgeon will create a customized physical therapy and/or lifestyle plan for your particular situation.
Oral and or injected steroids may also be used to reduce inflammation in the joint and improve range of motion. These are known as corticosteroids and while very effective, must be used sparingly.
Surgical Treatment for Hip Osteoarthritis
If nonsurgical treatment fails to offer sufficient relief, we may have to consider surgery. Surgery comes in several forms and largely depends on the degree of degeneration and the patient’s age, desired activity level after surgery, general health and health of the bones and ligaments.
Total hip replacement. This joint replacement option is the definitive corrective option for severe osteoarthritis. During this procedure, the head of the femur and the socket in the pelvis are replaced with metal and plastic parts that work much in the same way as the natural joint. Total hip replacements are very effective; and patients feel immediate relief from their hip pain.
Hip resurfacing. This procedure is employed when less of the hip joint needs to be changed. Instead, the head of the femur and the socket is capped with a metal sheath. However, this procedure is rarely used as the results are still ver variable and candidate selection is still not clear medically.
Osteotomy. While only used in rare cases, an osteotomy involves the cutting and re-alignment of either the thigh bone or the socket of the joint to reduce pressure and pain