Hip Osteoarthritis

21 July 2010

Article Index

1Diagnosis
- 1.1Physical Exam
- 1.2Radiologic Imagery
2Treatment
3References

Osteoarthritis of the hip is a debilitating chronic condition due to the destruction of the joint’s cartilage. Healthy cartilage allows bones to move over one another by absorbing the impact of physical movement, acting as a cushion. The thinning of cartilage causes the bones to eventually contact each other, causing pain, stiffness, and loss of mobility.

As the condition progresses, osteophytes grow on the lateral and medial aspects of the joint. Fragments of the osteophytes can break off and extend into the joint space, which causes significant pain and further damage.

There are many weight bearing joints in the body, however, the hip is the largest and one of the most important. When younger patients develop osteoarthritis it is usually due to a congenital deformity or prior trauma (brigham and womens). However, in older patients, it is the result of wear and tear over time. Although OA and age go simultaneously together, OA is not a natural consequence of aging.

Diagnosis

Physical Exam

Classic symptoms of hip OA include pain with the joint that may or may not extend into the groin and knee. This can affect one or both hip joints. Other common symptoms are stiffness and loss of motion. Morning stiffness of 30 minutes or less is frequent.

The American College of Rheumatology (ACR) published guidelines for the diagnosis of hip Osteoarthritis are:

Hip pain
Two or more of the following:
1. Radiographic femoral or acetabular osteophytes
2. Erythrocyte sedimentation rate (ESR) < 20 mm/h
3. Radiographic joint space narrowing

Radiologic Imagery

Radiology provides assistance when there is question in the type of arthropathy and monitoring treatment as well as disease progression. The classic triad of radiographic findings in the hip includes:

Joint space narrowing (first manifestation of OA due to cartilage thinning)
Sunchondral cyst formation (synovial herniation)
Osteophytosis

Though the x-ray may appear normal, it does not necessarily mean that a patient does not have osteoarthritis. A complete and thorough work-up should always be completed before an official diagnosis is made.

Treatment

Non surgical therapies are often the first form of treatment for hip osteoarthritis. Medications, both prescription pain medications and non-steroidal anti-inflammatory drugs (NSAIDs) can help control pain and inflammation somewhat. It is always recommended for those with osteoarthritis to engage in a consistent exercise program, as keeping the joints flexible and in motion will definitely aid to less pain in the long term. Weight loss may be indicated if the patient is over-weight; should the patient lose even a few pounds, it will take pressure off the painful joint.

Hip replacement surgery may be a final option. Surgery is often only suggested once the patient has reached the point where painful symptoms can no longer be abated with non-surgical therapies.

Increasing physical exercise and physical therapy are essential in treating patients with OA. There are many risks associated with hip replacement surgery as well as pharmacologic therapy, therefore physicaltherapy for direct intervention should be routinely consideredearly in the management of hip osteoarthritis (Lane).