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  • Writer's pictureDaniel Selin

Hip osteoarthritis

Hip osteoarthritis, hip arthrosis, hip wear, joint disease, joint wear, degeneration, age-related changes, hip degeneration, hip pain, hip discomfort, load sensitivity, morning stiffness, stiffness, aging

Osteoarthritis, also known as wear or arthrosis, is the most common joint disease in the world, and its prevalence increases with age. The underlying cause of osteoarthritis is not fully understood, but at the cellular and molecular levels, there are more degradative than constructive events in the joint cartilage's connective tissue and matrix. This leads to changes throughout the joint and surrounding tissues, resulting in a broad impact on a person's mobility and functional tasks over time.


Osteoarthritis is most commonly found in the knees, hips, finger and toe joints, and the facet joints between the vertebrae in the spine.


Osteoarthritis can be broadly categorized into two groups: primary and secondary osteoarthritis:

  1. Primary Osteoarthritis: Joint degeneration without a visible underlying cause.

  2. Secondary Osteoarthritis: Results from either abnormal force distribution in the joint, such as trauma-related reasons, or abnormal joint cartilage, such as rheumatoid arthritis.


In this text, we will take a closer look at hip osteoarthritis, exploring its background factors and treatment principles.

 

Overview of joint cartilage physiology

Cartilage is located at the ends of articulating bones and its main function is to cushion the impact on bones and facilitate movement between them. Cartilage is primarily composed of collagen and proteoglycans that bind water. This tissue lacks blood vessels and nerve endings, so the metabolism and nutrition of cartilage largely depend on pressure variations within the joint.


Pressure on cartilage forces fluid out of the tissue into the joint space. When the pressure subsides, osmotic pressure created by the negative charge of proteoglycans returns the fluid back to the cartilage. Thus, the physiological effects of joint loading play a crucial role in maintaining and improving the properties of cartilage.

 

Symptoms

Symptoms indicative of hip wear often begin with morning stiffness and possible pain in the hip or groin area. As wear progresses, pain and stiffness become more generalized and may bother individuals throughout the day. Movement becomes more challenging, and pain worsens if the hip is overstrained. Advanced wear often alters the shape of the hip joint, further limiting its mobility.


The hip typically exhibits symptoms after prolonged periods of inactivity, making it difficult to initiate movement. There may be cracking or popping sounds in the joint when squatting or standing up. While these joint sounds may initially seem alarming, they are generally harmless and result from diminished gliding properties of the worn cartilage. The intensity of joint sounds and pain does not appear to be correlated, although they can be concerning for individuals with hip osteoarthritis. Furthermore, joint sounds do not predict future pain or loss of functionality.


Typical symptoms of hip osteoarthritis include:

  • Pain in the groin area during movement and when initiating movement

  • Hip stiffness, especially in the morning

  • Reduced range of motion

  • Joint sounds

  • Pain after prolonged sitting or lying down

  • Hip or groin pain disrupting sleep

  • Dull, continuous ache

  • Difficulty supporting body weight on the affected leg

 

Epidemiology

Osteoarthritis is globally considered to be the most common joint disease. Knee osteoarthritis is slightly more common than hip osteoarthritis, but both are prevalent.


The disease primarily affects individuals over the age of 45, with both men and women being susceptible, although women are slightly more affected than men. Osteoarthritis can lead to increased pain sensitivity and reduced functionality, but it's important to note that not all osteoarthritic findings are necessarily painful. Radiographic studies indicate that the majority of detectable wear-related changes are in fact asymptomatic.


Hip osteoarthritis is classified as either primary or secondary based on its cause:


  1. Primary Hip Osteoarthritis:

  • Results from the degeneration of joint cartilage without a known cause

  • Typically associated with age-related wear and tear, where there is more degradation than regeneration of joint cartilage

  1. Secondary Hip Osteoarthritis:

  • Results from the degeneration of joint cartilage due to a known cause

  • Possible causes for secondary hip osteoarthritis include:

  • Obesity

  • Joint restriction or instability, such as following an injury

  • Joint misalignment, either congenital or post-traumatic

  • Previous joint injury, such as a fracture on the joint surface

  • Congenital defects

  • Immobilization and loss of mobility

  • Family history and genetic factors

  • Metabolic reasons

  • Abnormal anatomy


Normal joint cartilage maintains a balance in chemical reactions. However, as osteoarthritis develops, these reactions are disrupted, leading to changes in the collagen structure of the cartilage. This results in disorganized collagen and a reduction in the elasticity of the joint cartilage, leading to cracking and, eventually, erosion. The healing process of damaged cartilage is disturbed, and the cartilage continues to wear away. Once the cartilage is worn away, bony surfaces start to damage, leading to the development of edge formations that further expand and stiffen the joint. Often, this is accompanied by ligament laxity and muscle atrophy.

 

Treatment

Primary treatment for hip osteoarthritis is conservative, involving a combination of pharmacological and non-pharmacological pain management methods, as well as a progressive exercise program designed by a physiotherapist. The goal of treatment is to alleviate pain and improve functional and work capacity.


In hip osteoarthritis, strengthening the muscles surrounding the joint and improving mobility are crucial. This is achieved through a precise, progressive, and individualized exercise program, often including mobility-enhancing exercises and manual therapy. Exercising should start moderately to avoid exacerbating symptoms.


While there is no medication that cures osteoarthritis, pharmacological treatment aims to alleviate symptoms. Pain and anti-inflammatory medications are the primary options, but if these are not effective, opioids or intra-articular injections of corticosteroids or hyaluronic acid may be considered. Consultation with a specialist in osteoarthritis and pain management is advisable in such cases.


Joint replacement surgery becomes an option when conservative treatment, such as physical therapy, fails to achieve the desired results and the patient experiences severe pain and functional impairment. Joint replacement surgeries often yield excellent results, relieving many symptoms. Combining surgery with postoperative physiotherapy ensures that the muscles surrounding the joint function properly and that mobility and function are optimized for long-term effectiveness.

 

Physiotherapy

Conservative treatment for hip osteoarthritis aims to reduce joint pain, increase mobility and stability, and improve the function and strength of the muscles surrounding the hip joint.


Physical therapy often involves a combination of the following:

  • Patient education and guidance

  • Exercise therapy

  • Modification of activities to reduce joint load

  • Weight loss counseling

  • Support for the hip joint

  • Passive and active pain management methods

  • Manual therapy to maintain joint mobility

  • Promotion of an active and healthy lifestyle

  • Strengthening the lower kinetic chain

  • Improvement of proprioception, agility, and balance

  • Enhancement of physical function


A combination of guided exercises and a home exercise program has been shown to produce positive results. Weight loss is beneficial at all stages of osteoarthritis, especially for individuals with symptomatic hip osteoarthritis and a body mass index (BMI) over 25. Weight loss strategies include balancing energy intake and expenditure and incorporating aerobic or daily-life activities. Strength training can also increase energy expenditure, helping to manage weight, provided that this increased energy use is not compensated by an increase in energy intake.


Below are some physiotherapy interventions and their main goals in the treatment of hip osteoarthritis.


With progressive training and load modification, the objectives are to:

  • Manage overall joint load

  • Reduce load on irritated tissues

  • Enhance the load-bearing capacity of muscle and tendon structures

  • Improve hip joint stability by strengthening surrounding muscles

  • Alleviate pain

  • Enhance functional capacity


Manual therapy aims to:

  • Alleviate pain and activate descending pain pathways

  • Reduce static muscle tension

  • Improve muscle and joint performance

  • Decrease cortisol secretion in tissues

  • Increase or improve blood circulation in treated tissues

  • Improve mobility

  • Decrease the perceived intensity of pain


Education and guidance seek to:

  • Provide sufficient information about the nature of the condition, its background, and rehabilitation to ease patient concerns and enhance self-efficacy

  • Offer information about the healing process and prognosis to motivate self-directed rehabilitation

  • Address factors that positively or negatively affect prognosis and timelines

  • Reduce patient uncertainty and concerns, making it easier to live with pain


For an individualized rehabilitation program and advice, individuals with hip osteoarthritis are encouraged to consult a physiotherapist specializing in lower limbs.

 

Self care

  1. Maintain a healthy weight: Hip osteoarthritis places extra strain on joint structures, so a healthy weight helps reduce this burden.

  2. Exercise regularly: Physical activity can help alleviate symptoms and improve joint mobility in hip osteoarthritis. Recommended exercises include walking, cycling, swimming, and water aerobics. Strengthening exercises reduce joint load and fortify the joints. However, it's essential to start these exercises gently and gradually increase the intensity over time. Excessive or strenuous training can aggravate an already sensitive hip joint.

  3. Avoid prolonged standing or sitting: Extended periods of standing or sitting can increase hip strain and impair the sliding properties of joint cartilage.

  4. Wear appropriate footwear: Shoes should be comfortable and provide necessary support for the soles of your feet and joints.

  5. Use cold therapy: Cold treatments, such as ice packs or cold gel, can help alleviate pain and inflammation caused by hip osteoarthritis.

  6. Try heat therapy: Heat therapy can relax muscles and relieve pain associated with hip osteoarthritis. Heat packs or warm gel can be used for this purpose.

  7. Avoid walking on hard surfaces: Hard surfaces increase joint load and osteoarthritis symptoms, so it's better to avoid walking on such surfaces and opt for softer ones during walks.

  8. Engage in strength training: Strength training exercises can help strengthen muscles and improve symptoms of hip osteoarthritis. A physiotherapist can assist in finding suitable exercises.

  9. Ensure adequate rest: Sufficient sleep and rest aid in the body's recovery and may help alleviate symptoms of hip osteoarthritis.

It's important to note that hip osteoarthritis is a complex condition that often requires medical treatment and ongoing monitoring. Therefore, it's always best to discuss treatment options with a doctor or physiotherapist before starting an exercise regimen.

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