- Hip Joint Osteoarthritis is an inflammatory process occurs in the synovial joints such as the hip joint, and causes progressive loss of articular cartilage.
- The primary changes in hip joint osteoarthritis are:
- Loss of articular cartilage
- Remodeling of subchondral bone
- Formation of osteophytes
Risk factors for Hip Joint Osteoarthritis
- Joint trauma.
- Muscle weakness;
- These three factors all increase the mechanical forces to which the articular cartilage is subjected.
- Gender: Female > male
- Metabolic disorders.
- Developmental or acquired deformities:
- Hip dysplasia.
- Slipped capital femoral epiphysis SCFE
- Legg-Calvé-Perthes disease.
- Elderly populations are affected by osteoarthritis more frequently and more severely than younger populations.
- Obesity is the strongest modifiable risk factor.
See Also: Risk factors associated with osteoarthritis disease
Compare the cartilage changes in Aging vs Joint Osteoarthritis
|Collagen content||Equal||collagen fibers become un-organized|
|Modulus of elasticity||Increased||Decreased|
Symptoms & Signs:
- Hip pain that increased by activity.
- By disease development, the pain occurs at rest and night, and limits the patient function.
- Stiffness of the hip joint.
- Sensation of instability, locking or catching.
See Also: Anatomic sources of pain in osteoarthritis
- Passive range of motion of the hip joint may causes pain.
- Loss of internal rotation of the hip.
- Limited hip flexion and extension
- Hip flexion contracture or limb length discrepancy may be present.
- Atrophy in muscles crossing the affected joint is often present in chronic disease.
See Also: Hip Examination Special Tests.
- Recommended views:
- Weight-bearing antero-posterior radiographs are the most effective at confirming the diagnosis of Hip Joint Osteoarthritis.
- Antero-posterior view + Lateral view of the hip.
- Narrowing of the cartilage space
- Increased density of the subchondral bone (sclerosis).
- In more severe cases, subchondral cysts (geodes), loose bodies, joint subluxation, deformity, and malalignment may be present.
- Bony ankylosis is rare but may occur.
See Also: Osteonecrosis of the Hip
- First line of treatment for all patients with hip joint osteoarthritis.
- Non-operative treatment includes:
- Activity modification.
- Reduce impact-loading exercises.
- Reduce weight.
- Avoid stairs, inclines, squatting.
- Nonsteroidal anti inflammatory drugs (NSAIDs).
- Cyclooxygenase (COX)-2 inhibitors.
- Glucosamine and chondroitin sulfate.
- Physical therapy.
- Joint injections:
- Corticosteroid: anti inflammatory treatment.
- Can be therapeutic and/or diagnostic of symptomatic hip joint osteoarthritis.
- Assist device (cane or crutch):
- In the opposite hand of affected hip.
- Decreases the joint reaction force on the affected hip.
1. Arthroscopy of the hip joint:
- Traumatic labral tear not associated with dysplasia:
- Labral resection should be avoided because it provides stability in a shallow acetabular socket (labrum usually is hypertrophic).
- In cases of significant dysplasia, arthroscopic débridement is not recommended.
- Hip joint shows mechanical signs of locking, catching, and clicking.
- Loose body removal.
- Débridement of chondral flap tears.
- Synovitis: diagnostic biopsy and therapeutic lavage.
- Diagnostic procedure in undiagnosed mechanical hip pain cases.
- Degenerative arthritis:
- Not helpful in moderate to advanced disease
- Generally, will help only mechanical symptoms, not arthritic ache.
- Indicated in adult / young patients with symptomatic dysplasia with concentrically reduced hip and mild-to-moderate arthritis.
3. Total Hip Arthroplasty:
- Indicated in:
- End-stage and symptomatic or severe hip joint osteoarthritis.
- It’s a preferred treatment for older patients (>50) and those with advanced structural changes.
4. Hip fusion:
- Less frequently used as THA technology advances
- Classical indication:
- Very young male laborer
- Unilateral hip arthritis
- Fusion position:
- 20 to 25 degrees of flexion.
- Neutral abduction.
- Increased back and knee pain when fusion is done in abduction position.
- Neutral or slight external rotation of 10 degrees.
- Indications to convert hip fusion into THA:
- Disabling back pain—most common.
- Disabling ipsilateral knee pain with instability.
- Disabling contralateral hip pain.
5. Femoral Head Resection:
- Indicated in:
- Pathological hip lesions.
- Painful head subluxation.