Hip Osteoarthritis
Hip osteoarthritis (OA) is the second most common site for OA after the knee. The prevalence of hip osteoarthritis: a systematic review and meta-analysis—PubMed, with evidence showing it to symptomatically affect 1 in 4 adults before the age of 85 One in four people may develop symptomatic hip osteoarthritis in his or her lifetime—PMC. Risk factors for developing this condition include, but are not limited to, increasing age previous history of fracture around the hip or pelvis, increased BMI, genetics, and underlying metabolic disease due to chronic systemic inflammation. The Role of Metabolic Syndrome in Osteoarthritis Development: Is Obesity the Key Driver? – ScienceDirect.
The condition is characterised by destruction of the articular cartilage on the top of the femoral head and acetabulum (socket of the pelvis) that leads to subsequent reactive bony changes in the subchondral bone and manifests clinically with joint stiffness, pain, and functional loss.
What are the signs and symptoms?
Patients typically complain of groin pain that is worse with activity and eases with rest. The symptoms can also be felt around the trochanter (lateral hip) or sometimes into the buttock or a combination of these. It’s not uncommon for symptoms to refer down the anterior thigh and into the knee, causing the patient to limp and affecting general ambulation distance.
Symptoms are generally slowly progressive over many months, sometimes years, but can also manifest with an acute exacerbation with declining function and progressive symptoms over a much shorter time frame. Night pain is common and stops patients from sleeping; the joint is stiff, and patients often struggle to get their shoes and socks on the affected side. Simple activities like walking and getting into and out of a car become more and more difficult.
How is it diagnosed?
The diagnosis of hip osteoarthritis will usually be made from a combination of your clinical history, examination findings, and a plain film X-ray of your pelvis.
Classically patients describe groin pain that is slowly progressive; clinically the hip is stiff, with a combination of hip flexion and medial rotation being provocative of groin symptoms. This is referred to as the FADIR test (combination of flexion, adduction, and internal rotation of hip), which is highly sensitive for intraarticular hip pathology. Sensitivity and Specificity for Physical Examination Tests in Diagnosing Prearthritic Intra-Articular Hip Pathology Are Highly Variable: A Systematic Review – PubMed. X-rays will confirm the diagnosis with evidence of joint space loss, sclerosis, and osteophytosis (bony spurs) as well as quantify the severity of the changes.
MRI can be helpful if there is concern of an alternative hip pathology or if the plain film X-rays and your clinical symptoms do not correlate with each other. It must be remembered, however, that structural changes are common in the asymptomatic population and that radiographs and MRIs have not shown a good correlation with pain or functional impairment. Meaning hip osteoarthritis is a clinical diagnosis that is only confirmed with appropriate imaging. Osteoarthritis of the hip: is radiography still needed? – PubMed
How are they treated?
Treatment options are divided into conservative and surgical.
Conservative options:
- Oral analgesia in combination with modifications of daily activities may help alleviate some of the symptoms, especially in the early stages of the disease, or allow acute exacerbations to settle down.
- Physiotherapy can be helpful in maintaining hip mobility and strengthening the hip musculature. Effect of exercise therapy in patients with hip osteoarthritis: A systematic review and cumulative meta-analysis – PubMed
- An ultrasound-guided local anaesthetic and steroid injection into the hip joint can be helpful at easing some of the inflammation associated with osteoarthritis. This can act as both a therapeutic and a diagnostic intervention to confirm the hip as causative of your symptoms. Relief is typically temporary, especially in more advanced cases of arthrosis, but can be helpful as a management strategy for patients that are currently not candidates for a hip replacement. Intraarticular Corticosteroids for Hip Osteoarthritis: A Review – PMC. How long the injection will last and how beneficial it will be will depend on the severity of the wear and tear but also the demand of the patient. They can be repeated if they are helpful, but typically a 6-monthly interval is advisable to reduce any potential risks, which will be discussed with the patient prior to proceeding.
- In less severe cases of arthrosis, an ultrasound-guided hyaluronic acid injection into the hip joint can be helpful as a potential alternative to repeated steroid injections. They have a very safe injection profile and can be very helpful in carefully selected patients. Efficacy and Safety of One Shot of Hyaluronic Acid in Hip Osteoarthritis: Postmarketing Clinical Follow-Up for Real-World Evidence – PMC.
Surgical options:
If conservative options do not provide adequate relief or if there is already substantial arthrosis on a plain film X-ray at time of initial presentation, then there are surgical options.
- Arthroplasty (total hip replacement). Is one of the most successful medical operations since its introduction in the 1960s. For suitable patients it provides excellent pain relief, improved function and enhanced quality of life. Even in younger, high-demand patients with severe hip pathology it can provide life-changing results Mid-term outcomes of total hip arthroplasty in patients younger than 30 years – PubMed
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