Hip Osteoarthritis

What is it?

Osteoarthritis is a degenerative condition which affects many different joints of the body. The word ‘osteo’ means bone and ‘arth’ pertains to the joint whilst ‘itis’ means inflammation. The hip joint is a major weight bearing joint and has a great deal of stability due to its deep ball and socket arrangement. The joint  is comprised of the acetabulum (socket) and the femoral head (ball). Hip osteoarthritis is the most common cause of hip pain.

Osteoarthritis involves the gradual wearing away of the cartilage at the bone ends over years until a cascade of events occurs which can start to lead to typical osteoarthritic symptoms becoming apparent. Over time the joint space narrows and the pressure between the bone ends becomes greater. As the cartilage thins further, the bone margins grow and produce osteophytes in a bid to increase the surface area of the joint and reduce the pressure. The once tight supportive ligaments which span the joint become slack and eventually tighten to adjust to the narrowed joint space. The tissues which surround the joint can become inflamed leading to an overproduction of synovial fluid within the joint. The muscles which cross the joint weaken through disuse and inhibition resulting in a gradual loss of joint stability over time. The combination of these changes inevitably leads to joint stiffness, swelling, pain, intermittent inflammation and a reduction in the individuals’ function.  In individuals with early onset or advanced arthritis of the hip joint it may be appropriate for an Orthopaedic surgeon to make an assessment and establish whether there is any requirement for surgical intervention. Commonly, younger patients with early onset hip osteoarthritis may benefit from a hip joint resurfacing operation, whilst those with more degenerative and debilitating symptoms may benefit from a total hip replacement (THR).
 

Causes

Osteoarthritis in the hip can be classified into either primary or secondary. Primary osteoarthritis results from a wearing of the cartilage which covers the surfaces of the joints and secondary osteoarthritis relates to degeneration of the joint because of other mechanisms of damage or disease i.e. Perthes disease, Congenital dislocation of the hip or conditions whereby the socket part of the joint fails to form in the correct shape, Acetabular dysplasia. 

Treatment

Following a thorough examination and assessment of the presenting problem, advice and treatment may include the following:

• Advice regarding activity modification and symptom easing solutions

• Electrotherapy i.e. Interferential, TENS to reduce pain and inflammation

• Acupuncture for pain relief and control of inflammation

• Provision of  walking aids if appropriate

• Adjustment of relevant biomechanical factors i.e. tight and overactive muscles

• Soft tissue and joint manipulation to address stiffness or restriction of normal movement

• Progression of a tailored rehabilitation programme including appropriate strengthening and stretching exercises with a functional emphasis