Osteoarthritis of the Hip
Osteoarthritis, also called degenerative joint disease is the most common form of arthritis. It occurs most often in older people. This disease affects the tissue covering the ends of bones in a joint (cartilage). In a person with osteoarthritis, the cartilage becomes damaged and worn out causing pain, swelling, stiffness and restricted movement in the affected joint. Although osteoarthritis may affect various joints including hips, knees, hands, and spine, hip joint is most commonly affected. Rarely, the disease may affect the shoulders, wrists and feet.
Osteoarthritis is characterized by damaged articular cartilage, cartilage lining the hip joint. Advanced age is one of the most common reasons for osteoarthritis of hip. You may also develop osteoarthritis if you had hip injury or fracture in the past, if you have family history of osteoarthritis, suffering from hip diseases such as avascular necrosis and other congenital or developmental hip diseases.
How do you know that you have osteoarthritis of hip? The characteristic symptoms and diagnostic test helps in diagnosing the condition. You will experience severe pain confined to hip and thighs, morning stiffness and limited range of motion. Based on the symptoms your orthopaedic surgeon will perform physical examination, X-rays and other scans, and some blood tests to rule out the other conditions that may cause similar symptoms.
Management of Osteoarthritis
There are several treatments and lifestyle modifications that can help you ease your pain and symptoms.
- Medications: Pain-relieving medications such as NSAIDs, COX-2 inhibitors and opioids may be prescribed. Topical medications such as ointments can be applied over the skin where there is pain. If the pain is very severe, corticosteroid injection can be given directly into the affected joint to ease the pain.
- Other Treatments: Your physiotherapist will teach you exercises to keep joints flexible and improve muscle strength. Heat/cold therapy which involves applying heat or cold packs to the joints provides temporary pain relief. Lifestyle modifications can be done to control weight and avoid extra stress on the weight-bearing joints.
- Surgery: Hip joint replacement surgery is considered as an option when the pain is so severe that it affects your ability to carry out normal activities.
Inflammatory Arthritis of the Hip
Inflammation of the joints is referred to as arthritis. The inflammation arises when the smooth covering (cartilage) at the end surfaces of the bones wears away. In some cases, the inflammation is caused when the lining of the joint becomes inflamed as part of an underlying systemic disease. These conditions are referred to as inflammatory arthritis.
The most common types of inflammatory arthritic conditions of the hip include:
- Rheumatoid Arthritis: systemic disease of the immune system commonly affects multiple joints on both sides of the body at the same time
- Ankylosing Spondylitis: chronic inflammatory disease of the spine and the sacroiliac joints (junction where the spine meets the pelvic bone)
- Systemic Lupus Erythematosus (SLE): an autoimmune disease in which the body’s immune system attacks its own healthy cells and tissues
The typical symptom of arthritis is joint pain. Inflammatory hip arthritis is mainly characterized by an aching pain in the groin region, outer thighs or buttocks. The pain is commonly most severe in the morning which sometimes lessens with activity during the day. Vigorous activities may result in increased pain and stiffness and limit your movement making walking difficult.
Inflammatory hip arthritis can be diagnosed by physical examination. Your doctor will ask you to move your hip in different directions to find out which motions are restricted or painful. X-rays and laboratory tests may be ordered to diagnose or rule out other conditions. X-rays may show thinning or erosion in the bones or loss in joint space. Laboratory studies will show the presence of a rheumatoid factor or other antibodies.
The treatment options vary depending on the diagnosis.
Non-surgical treatment: Any infection in the hip joint is treated by non-surgical treatments which may provide relief with relatively few side effects.
- Anti-inflammatory medications or corticosteroids may help reduce the inflammation.
- Physical therapy may be recommended to help you increase the range of motion and strengthening exercises to maintain muscle tone.
- Assistive devices such as canes or walkers can make your daily living activities easier.
Surgical treatment: Surgery is considered the last treatment resort when the above non-surgical treatment options fail to reduce the symptoms. The type of surgery to be performed depends on your age, condition of the hip joint, and the type and progression of the inflammatory disease. The goal of the surgery is to relieve pain and improve the joint motion. The most common surgical procedures include
- Total hip replacement: Indicated for patients with rheumatoid arthritis and ankylosing spondylitis.
- Bone grafts: Recommended for patients with SLE. These grafts aim to build new blood cells to replace the old dead cells.
- Core decompression: Helps to reduce bone marrow pressure and encourages blood flow. Core decompression is another treatment option for patients with SLE.
- Synovectomy is the procedure of removal of a part or whole of the joint lining. This is indicated if the inflammation has not affected the cartilage but is limited to the joint lining or synovium.
Transient Osteoporosis of the Hip
Transient osteoporosis of the hip is a rare condition that causes bone loss temporarily in the upper part of the thighbone (femur). It is mostly found in young or middle aged men between the ages of 30 and 60, and women in their later stages of pregnancy or early postpartum period (following childbirth). It is characterized by abrupt onset of pain that increases with activity.
The hip joint is a ball-and-socket joint. A part of the pelvis bone known as the acetabulum forms the socket and the upper end of the femur, known as the femoral head, forms the ball. In patients with transient osteoporosis of the hip, the femoral head loses its density and strength and becomes more prone to breaking.
An exact cause is unknown. Some of the proposed causes include atypical mechanical stresses acting on the hip joint, hormonal abnormalities, and blockage of some of the small blood vessels surrounding the hip joint.
Symptoms may include:
- Unknown pain in the hip not triggered by any previous accident or injury
- Abrupt onset of pain in the anterior thigh, the side of the hip, groin, or buttocks
- Pain that increases with activities or weight bearing and decreases with rest
- Intense pain with extreme hip range of motion
- Gradually increasing pain that becomes disabling over a few weeks or months
- A prominent limp
Diagnosis of transient osteoporosis of the hip often begins with a history and physical examination. Your doctor may ask you questions related to your general health and any previous accidents or injuries. You will be asked to perform various range-of-motion exercises to replicate your pain. Most patients experience acute pain with weight bearing and active range of motion and minimal pain when the doctor moves the hip for them (passive range of motion). This is one of the indicators in the diagnosis of transient osteoporosis of the hip.
You will also be recommended to undergo imaging studies such as X-rays, CT scans, MRIs, or nuclear scans to further document transient osteoporosis of your hip.
Most patients with transient osteoporosis of the hip are found to have bone marrow edema. Bone marrow edema is a condition where fluid builds up in the bone marrow (spongy material located in the hollow of the long bones) and the bone marrow becomes inflamed. MRI scans have been found to be particularly beneficial in documenting bone marrow edema and are one of the most practicable studies in the diagnosis of transient osteoporosis of the hip.
Transient osteoporosis of the hip resolves on its own and treatment involves preventing any damage to the weakened bones and minimizing the symptoms and discomfort. Treatment includes:
- Medication: Non-steroidal anti-inflammatory medications or NSAIDs may be recommended to alleviate inflammation and pain
- Restricted weight bearing: You may be recommended to restrict or to completely avoid putting weight on your hip joint. You may need to use walking aids such as crutches, cane, or a walker to limit the stress on your hip bone.
- Physical Therapy: Your doctor may instruct you on special exercises to help strengthen the muscles supporting your hip. Water exercises have been found to be helpful as they ease movement and relieve weight bearing.
- Nutrition: Vitamin D and calcium have been found to be effective in healing and rebuilding of bones. Your doctor will recommend foods or supplements that can help you recover faster.