Osteoarthritis of the Hip: Causes & Management

How Common is Osteoarthritis of the Hip?

Osteoarthritis is the most common cause of hip pain in older adults (above 60 years of age). According to estimates, osteoarthritis affects approximately 10% to 25% of adults aged 60 and older worldwide. While it is more common in older adults it may also affect younger individuals particularly those with a history of hip injuries or other structural abnormalities. Overall it may be considered a public health concern as it can significantly affect one’s quality of life. Effective management strategies such as an early diagnosis, lifestyle modifications, and appropriate treatment will help address the symptoms and manage the cause.

Stages of Osteoarthritis

There are four stages of the osteoarthritis of the hip. They should be understood along with their associated symptoms:

1. Early Stage: Here you may notice mild discomfort or stiffness of the hip joint. It becomes more evident after periods of rest or overuse. The symptoms may be intermittent and might not interfere with your daily activities.

2. Moderate Stage: As the conditions progress, symptoms such as pain, stiffness, and decreased range of motion become more pronounced. Daily activities such as walking, climbing stairs, or getting up from a seated position become more challenging. 

3. Advanced Stage: Here the symptoms are more severe, persistent, and significantly impacting your daily life. There will be a noticeable functional impairment with difficulties in walking, standing, or getting up from a chair. The pain may radiate to the groin, buttocks, and thighs as well.

4. End Stage: Here the hip joint exhibits severe degeneration with significant deformity. Severe pain and disability may necessitate a surgical intervention to alleviate the symptoms and restore function.

Symptoms and Causes of Hip Osteoarthritis

Here are the symptoms and causes of hip osteoarthritis:

Symptoms

Pain: Pain is the most common symptom of hip osteoarthritis that starts gradually but worsens over time. It may also start suddenly. Painful symptoms become more frequent, including at night and during rest.

Stiffness: Stiffness in the joint is usually worse in the morning and may occur after sitting or resting for some time.

Decreased range of motion: You may find it difficult to walk and may experience a limp due to a decreased range of motion.

Joint Instability: You may find your joint unstable as you try to walk or bend.

Pain and Inflammation: Your joint pain may start from the groin or thigh and radiate to the buttocks or knee. Pain may increase with vigorous activity and in rainy weather.

Joint Crepitus: A grinding noise can be heard due to the ‘locking’ or ‘sticking’ of the joint during movement. This happens due to loose fragments of cartilage and tissue that interfere with the motion of the hip.

Difficulty with Daily Activities: Carrying out daily activities like tying a shoelace or walking and bending becomes difficult due to pain and stiffness.
Causes

Age: Increasing age is one of the most common causes of osteoarthritis of the hip. The condition is most common in adults over 60 years of age.

Genetics: Individuals with a family history of osteoarthritis are at a greater risk of developing the condition themselves.

History of Hip Injuries: If you had a previous injury to the hip joint, you may be at a greater risk of hip osteoarthritis. 

Obesity: Increasing weight puts pressure on the hip, which can gradually lead to osteoarthritis.

Overuse: Individuals involved in manual labor or certain sports activities are also more prone to hip arthritis as they have to repetitively use the joint.

Joint Malformation: Improper formation of the joint at birth, known as developmental dysplasia, can also be one of the causes.

Other Medical Conditions: One can still develop hip osteoarthritis without any of the above risk factors, especially when suffering from certain other medical conditions such as diabetes, high cholesterol, vitamin D deficiency, and hemochromatosis (high levels of iron in the blood). 

How is Osteoarthritis of the Hip Diagnosed?

Diagnosing osteoarthritis of the hip involves physical examination and other diagnostic tests such as imaging.

Physical Examination

This involves looking for:

• Tenderness around your hip
• Pain when pressure is applied in the hip region
• Your range of motion, both assisted and self-directed
• A grating sensation in the joint (crepitus) during movement 
• Problems with walking
• Signs of injury to the tendons, ligaments, and muscles surrounding the hip

Imaging Tests

X-rays may be used to get detailed pictures of dense structures like bones. If there is arthritis, the images show the narrowing of the joint space, formation of bone spurs (known as osteophytes), and several other changes in the bone. An MRI (magnetic resonance imaging) or a CT (computerized tomography) may be done to detect any abnormal conditions of the hip bone and soft tissues.

Treatment For Osteoarthritis of the Hip

Non-surgical Treatment

Following are the nonsurgical treatment methods for osteoarthritis of the hip:

Lifestyle medications: Certain lifestyle changes can slow the progression of osteoarthritis. These include minimizing high-impact activities such as running or climbing stairs and maintaining a healthy weight to lower the pressure on your joints.

Physical therapy: Along with the help of your doctor, you can start certain physiotherapy exercises to increase your range of motion and flexibility. This will also help give strength to your muscles in the hip and leg. The exercises will be guided by a physiotherapist and will be tailored to meet your specific needs.

Assistive devices: Using a cane, crutches or a walker can help improve mobility. Assistive aids such as a long-handled reacher can help avoid movements that cause pain. 

Medications: Over-the-counter pain relievers such as acetaminophen (paracetamol) or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help alleviate pain and inflammation.

Surgical Treatment:

When non-surgical methods have proven to be ineffective, your surgeon might recommend surgery.

Total hip replacement (THR): THR is a surgical procedure in which the damaged parts of the hip joint are replaced with artificial implants (prostheses) made of metal, plastic, or ceramic. 

Hip resurfacing: Here the damaged surfaces of the hip joint are removed and replaced with metal in order to restore joint function. 

Osteotomy: Here the bones of the hip joint are realigned to redistribute weight and reduce stress.

The type of treatment chosen depends upon the severity of your symptoms, age, functional limitations, and other medical conditions if any.

Hip Replacement Surgery - Procedure

The standard procedure for hip replacement is as follows:

• General anesthesia is administered which helps you remain asleep during the procedure. In some cases, regional anesthesia may be administered which helps numb the lower half of your body.
• A long incision is made along the side of the hip. The muscles and soft tissues are carefully separated to expose the damaged hip joint.
• The damaged and diseased parts of the hip joint including the femoral head (thigh bone) and the acetabulum (hip socket) are removed with the help of surgical instruments.
• The joint is further prepared to receive the implant by trimming away damaged cartilage and bone spurs.
• An artificial implant with metal, plastic, or ceramic components is anchored to the remaining healthy bone.
• The femoral component, which replaces the femoral head, is inserted into the hollowed-out femur, while the acetabular component, which replaces the hip socket, is placed into the acetabulum.
• Finally the incisions are closed with the help of sutures or staples and the surgical site is covered with a sterile dressing.

These are the general steps of the surgery and it can change depending upon the type of procedure chosen and any specifics of your case.

Recovery and Outlook

Recovery after a hip replacement surgery can vary depending on your overall health, the extent of the joint damage, the type of hip surgery performed, and adherence to post-operative rehabilitation protocols.

• Physical therapy will begin soon after the surgery focusing on regaining mobility and strength.
• You will require assistance with your daily activities for the initial weeks after the surgery.
• Pain and discomfort will gradually decrease and you will be able to increase your activity levels slowly.
• Make sure that you avoid strenuous activities that may place excessive strain on the hip joint.
• Make sure that you attend all the scheduled follow-up appointments in order to keep track of your progress. Also, lead a healthy lifestyle to ensure the longevity of the implants.

Overall, hip replacement surgery can significantly improve mobility, reduce pain, and enhance quality of life for individuals with severe hip joint degeneration. 

Risks/Benefits of Surgery for Hip Osteoarthritis

Possible risks, as with any surgery, are:

• Infection
• Blood clots
• Excessive bleeding
• Limb length inequality
• Hip dislocation
• Damage to arteries or blood vessels

However, there are the following benefits of the surgery:

• Ability to again walk normally
• Better quality of sleep due to freedom from pain at night
• Better quality of life
• Improved mobility function
• Osteoarthritis hip pain relief (the biggest and most important advantage)