Hip Joint Osteoarthritis

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

1. Obesity.
2. Joint trauma.
3. Muscle weakness,
4. Gender: Female > male
5. Hormones.
6. Metabolic disorders.
7. Genetics.
8. Developmental or acquired deformities: Hip dysplasia, slipped capital femoral epiphysis SCFE and 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

Pathophysiology

	Aging	Joint Osteoarthritis
Water content	Decreased	Increased
Collagen content	Equal	collagen fibers become un-organized
Proteoglycan Content	Decreased	Decreased
Proteoglycan synthesis	Equal	Increased
Chondrocyte Size	Increased	Equal
Chondrocyte Number	Decreased	Equal
Modulus of elasticity	Increased	Decreased

Clinical Evaluation

Symptoms & Signs in Hip Joint Osteoarthritis include:

• 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.

Physical Examination:

• Gait: Analgesic gait, Trendelenburg gait and Leg length discrepancy.
• Passive range of motion of the hip joint may causes pain: Loss of internal rotation of the hip with 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.

Imaging Evaluation

Radiographic:

Recommended views include weight-bearing antero-posterior radiographs are the most effective at confirming the diagnosis of osteoarthritis hip and antero-posterior view + Lateral view of the hip.

Findings include:

• Narrowing of the cartilage space
• Increased density of the subchondral bone (sclerosis).
• Osteophytes
• 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

Hip Joint Osteoarthritis Treatment

Non-Operative Treatment is the first line of treatment for all patients with hip osteoarthritis.

These include:

1. Activity modification.
2. Reduce impact-loading exercises.
3. Reduce weight.
4. Avoid stairs, inclines, squatting.
5. Drugs: Acetaminophen, Nonsteroidal anti inflammatory drugs (NSAIDs), Cyclooxygenase (COX)-2 inhibitors, Glucosamine and chondroitin sulfate and Prednisone.
6. Physical therapy.
7. Joint injections: Corticosteroid injection (Can be therapeutic and/or diagnostic of symptomatic hip joint osteoarthritis) or Hyaluronate injection.
8. Acupuncture.
9. Assist device (cane or crutch) in the opposite hand of affected hip decreases the joint reaction force on the affected hip.

Operative Treatment:

1. Arthroscopy of the hip joint:

Indications of the Arthroscopy of the hip joint include:

• 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.

2. Osteotomy:

Indicated in adult / young patients with symptomatic dysplasia with concentrically reduced hip and mild-to-moderate arthritis.

3. Total Hip Arthroplasty:

Total Hip Arthroplasty is 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:

Hip fusion is less frequently used as THA technology advances. It’s indicated in very young male laborer or unilateral hip arthritis.

Fusion position: 20 to 25 degrees of flexion and Neutral abduction (Increased back and knee pain when fusion is done in abduction position).

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.

References & More

• Campbel’s Operative Orthopaedics 12th edition Book.
• Millers Review of Orthopaedics -7th Edition Book.
• Lespasio MJ, Sultan AA, Piuzzi NS, Khlopas A, Husni ME, Muschler GF, Mont MA. Hip Osteoarthritis: A Primer. Perm J. 2018;22:17-084. doi: 10.7812/TPP/17-084. PMID: 29309269; PMCID: PMC5760056.
• Murphy NJ, Eyles JP, Hunter DJ. Hip Osteoarthritis: Etiopathogenesis and Implications for Management. Adv Ther. 2016 Nov;33(11):1921-1946. doi: 10.1007/s12325-016-0409-3. Epub 2016 Sep 26. PMID: 27671326; PMCID: PMC5083776.