What is hip osteoarthritis and how does it occur?

In general, osteoarthritis refers to progressive wear of the cartilage that coats the ends of the bones that make up the hip joint.  Because cartilage does not have any nerve endings, but bone does, loss of this cartilage exposing the bone eventually causes pain.

 

Osteoarthritis is usually a progressive disease that worsens with age.  Osteoarthritis can also be secondary to trauma, untreated hip dysplasia (i.e. hip socket that does not completely cover the ball of the hip joint) or femoroacetabular impingement, prior joint infection, and poor blood supply to the hip bone resulting in the death of bone cells (osteonecrosis).

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Other risk factors associated with hip osteoarthritis include increased weight, high impact sports (football, basketball, etc.), occupational habits (squatting, kneeling, climbing), and genetic predisposition.

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Symptoms:

Pain in the groin and front of the thigh is the most common symptom and tends to gradually worsen over time.  Pain, however, can suddenly appear and be severe.  The joint may also become stiff, especially after activities and with weather changes (rain, cold, etc…).  Everyday activities such as walking and using stairs can become painful as the arthritis worsens.  Patients may furthermore develop mechanical symptoms (locking/buckling/catching) upon range of motion secondary to large osteophytes (abnormal pieces of bone) and loose pieces of bone and cartilage within the joint.

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Diagnostic Testing:

X-rays are usually ordered to evaluate the joint space and look for any osteophytes and loose bodies within the joint.  MRI may be ordered to further evaluate for loose pieces of bone or cartilage within the joint.  It is important to note that the appearance of the joint does not necessarily correlate with symptom severity.  Patients with an x-ray showing severe osteoarthritis may have minimal pain and vice versa.

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Treatment Options:

Nonoperative treatment is first-line treatment for hip osteoarthritis.  Activity modification, physical therapy, and lifestyle modifications are treatment staples.  Weight loss is one of the most important lifestyle modifications and can be accomplished through a healthy diet and regular exercise.  Heat (heating pad/warm towel) in the morning to help with stiffness and ice towards the end of the day or after significant activity can help.  The occasional use of pain medicines such as Tylenol or NSAIDs (such as Aleve and Ibuprofen), if not contraindicated for other health reasons, can also alleviate pain.  Different anti-inflammatory gels may temporarily help as well.  Use of assistive devices such as a cane may help decrease the load put upon the joint and reduce pain.

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Injections such as cortisone, viscosupplements, and platelet rich plasma (PRP) are commonly used.  Follow the links to learn more about viscosupplementation and PRP.  Cortisone is usually only recommended as a last resort given there is evidence that cortisone can soften and degenerate the articular cartilage, thereby paradoxically accelerate progression of the arthritis, especially if given multiple times.  Dr. Steven Lee will discuss all of these options with you during your visit.

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Surgical Treatment:

 

Surgery is usually recommended once all nonoperative treatment options have been exhausted and the pain and functional limitations can no longer be tolerated.  The type of surgery performed depends on the patient’s age, activity level, and arthritis severity. Some surgical options are minimally invasive: hip arthroscopy, synovectomy, chondroplasty, and loose body removal. These procedures involve introducing a small camera and other instruments into the hip joint to either remove degenerative tissue (synovectomy), remove degenerative cartilage and smooth the joint surface (chondroplasty), or remove loose pieces of bone.

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A hip replacement may be recommended for patients with significant arthritis and involves removing the diseased ends of bone and resurfacing those bones with special implants designed to recreate normal hip anatomy.  This creates a new prosthetic joint surface and facilitates smooth joint motion.  The decision to have a total hip replacement is a big decision and a personal decision.  Whether to have it done or not solely rests on the patient's pain, functional deficits, and tolerance of surgery, not what an x-ray may show or what the doctor’s opinion may be.

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Recovery Expectations:

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The postoperative protocol and recovery depends on which surgical treatment is utilized. Physical therapy is usually indicated after surgery to regain strength and restore range of motion.  Depending on the type of procedure done, patients may have to keep weight off the hip with crutches or a cane.

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For total hip replacements, patients are encouraged to weight bear and walk on their new hip right away, even the same day of the surgery.  Depending on the patient’s medical status, many hip replacements can now be done in an ambulatory surgery center, meaning they can go home the same day.  Patients tend to be very stable and mobile even 4-6 weeks after a hip replacement.

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*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice.  Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.

 

*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.