Hip Osteoarthritis

Written by Bethany Elliott-Hutton

A tendon is a strong connective tissue that blends with a muscle at one end and then inserts deep into a bone on the other end, connecting a muscle to a bone. Tendon problems can be acute or chronic and can have different presentations thus different terminology is used. Tendinitis refers to the inflammation of a tendon within the tendon sheath that happens in the acute state. Tendinosis on the other hand refers to the chronically damaged tendon with signs of scar tissue and fiber damage due to degeneration and improper healing.

Gluteal tendinopathy can refer to both tendinitis and tendinosis of all the gluteal muscles (gluteus maximus, gluteus medius and gluteus minimus) together or in isolation. It is the most common cause for lateral hip pain and greater trochanteric pain syndrome ( the greater trochanter can be felt on the outside of the hip and is the location of the attachments of all the gluteal muscles).

Gluteal tendinopathy is most commonly seen in the inactive population, runners and hikers, and affects people predominantly over the age of 40 and females more than males (Grimaldi and Fearon, 2015).

Below are the common symptoms of Hip Osteoarthritis:

Pain around the hip joint. Commonly felt in the groin and thigh area which can refer to the buttocks or knee area. Pain may also be experienced around the low back. Pain usually develops gradually over time however it can come on suddenly if there has been trauma.

Stiffness. This is usually felt first thing in the morning.

Locking of the hip. This is caused by loose fragments of cartilage tissue interfering with the movement of the hip.

Reduced range of motion in the hip. This can be a consequence of the pain and inflammation as well as the narrowing of the joint space and bony spur formation. Reduced range of motion can also be followed by changes in a person’s gait (ability to walk). Pain may be felt when walking, going from a seated position to standing and bending down.

Muscle weakness. Muscles around the hip and buttock area may get weaker due to not using them as frequently due to the pain.

Crepitus. This is a clicking sound coming from the hip.

Leg length discrepancy. This is caused by a reduction in the joint space and can consequently cause changes to a person’s gait.

There are two different subtypes of osteoarthritis primary and secondary arthritis. Primary arthritis is a disease of unknown origin. It usually affects multiple joints and is more common in the elderly population. Secondary osteoarthritis occurs when joints have been damaged from another condition and as a consequence cause osteoarthritis. For example, joint trauma or congenital joint abnormalities.

The common risk factors for developing hip osteoarthritis and osteoarthritis in general include:

• Age – osteoarthritis is more common in people over the age of 50.
• Previous hip trauma
• Congenital and developmental abnormalities of the hip
• Obesity – increased weight can put extra strain and stress onto the weight bearing joints.
• Occupation – repetitive jobs that put excessive strain on the hip joints
• Gender- osteoarthritis is more common in females than males. The reason for this is still not well understood.
• Metabolic disease – such as Diabetes
• Diet – Low vitamin D,C and K levels
• Sedentary lifestyle
• Femoroacetabular impingement
• High impact sport
• Genetics – individuals with family members with osteoarthritis are more likely to suffer from osteoarthritis as there is a genetic component involved in the development of osteoarthritis.

Hip osteoarthritis is commonly diagnosed through a physical examination and imaging.
Your healthcare professional will ask you questions about your hip pain including the onset of pain. They will also ask you your past medical history and if you have had any previous trauma to the hip. After the consultation the physical examination will begin. During you physical examination your healthcare practitioner will look for:

• Tenderness around the hip including the buttock, thigh, knee and low back area.
• Reduced active and passive range of motion of the hip (ability to move your hip aided and unaided).
• Pain when pressure is applied to the hip joint.
• Changes to the way you walk.
• Leg length discrepancy.
• Signs of injury to the soft tissues around the joint including the ligaments, muscles and tendons.

If hip osteoarthritis is suspected by your practitioner it is more than likely that you will be referred to your doctor for further imaging to confirm the diagnosis. Tests may include:

X Ray. This is the gold standard imaging tool used in diagnosing osteoarthritis. X Ray imaging allows us to see the skeletal system and the joint spaces. If osteoarthritis is present the x-ray will show joint space narrowing due to cartilage loss, swelling around the joint and bony spur formation.

MRI. This form of imaging is not usually used to diagnose osteoarthritis. However it may be used in more complicated cases or to rule out other conditions. It is also effective at detecting early changes to the bone structure.

Blood Tests. Blood tests cannot be used to determine osteoarthritis. However your doctor may refer you for blood tests to rule out other causes of hip pain.

There is currently no cure for osteoarthritis. However, there are many treatment options available both conservative and surgical to help you with managing your symptoms and progression of the condition. Overall, the main aims of treatment for hip osteoarthritis are to reduce pain and increase the function of the hip joint.

Conservative treatment includes:

Osteopathy and Physiotherapy. The aims of osteopathic and physiotherapy treatment are to improve strength and mobility, increase joint range of motion, reduce pain and restore normal function and movement of the joints of the lower extremity including the hip, knee, ankle and foot. Treatment will also include the use of a patient specific exercise programme to help improve function and reduce pain.

Medication. Your doctor may advise or prescribe you certain medication to help with relieving the pain and inflammation caused by osteoarthritis. Common medications prescribed include:

Nonsteroidal antiinflammatory drugs – known also as NSAIDS. This group of drugs are used to help with reducing inflammation and pain. Ibuprofen can be bought over the counter. Stronger NSAIDS can be prescribed by your doctor. Due to the fact NSAIDS can upset your stomach lining, they are not recommended for taking for long periods of time. Therefore, your doctor may also prescribe another medication alongside the NSAID to help protect your stomach.

Analgesics – these types of medication are also known as painkillers and do as the name suggests, reduce pain. Over the counter painkillers such as paracetamol can be used without prescription. Stronger painkillers and opioids are always prescribed by your doctor. It is always recommended to seek advice from your doctor before starting a new medication.

Cortisone Injections- If your hip joint is particularly aggravating and swollen and NSAIDS are not helping with reducing the swelling a cortisone injection may be advised. Corticosteroid injection is a strong antiinflammatory drug which is injected directly into the painful joint.

Surgical Treatment includes:
Surgical treatment is usually recommended when conservative treatment has not been effective in reducing pain and stiffness. Below are a few examples of the common types of surgery used to treat hip osteoarthritis. If surgery has been recommended to you, your orthopedic surgeon will discuss with you the surgical options available to you and the risk and benefits of each procedure.

Total hip replacement – this is when the acetabulum and the head of the femur is removed and replaced with new parts made out of ceramic, metal or plastic. This type of surgery will be followed by physiotherapy treatment and exercise rehabilitation to help you get used to your new hip.

Hip Resurfacing – during this procedure the damaged cartilage on the acetabulum is removed and replaced with a metal shell. The head of the femur is then also capped with a metal covering to help with the smooth and flowing movement of the hip joint.

Osteotomy- This type of surgery is less common in the treatment of hip osteoarthritis. During this procedure either the head of the femur or the acetabulum is cut and realigned to reduce the pressure on the hip joint.

Not all causes of hip osteoarthritis can be prevented. Changes made to your lifestyle can help protect your hip joint and can also slow down the progression of osteoarthritis. Below are a few examples of modifications you can start to make today to your lifestyle:

Weight loss – excess weight can increase the load on your joints especially your weight bearing joints such as the knees and hips. Losing weight will help reduce the amount of weight going through the joint resulting in reduced pain and increased function.

Change the type of exercise you are doing – switch from high impact exercises such as jogging and playing tennis to lower impact exercises such as cycling or swimming. This will help reduce the amount of stress and strain on your hip joints.

Correct sitting positions. When sitting make sure the chair is firm and high enough so that your hip is higher than your knee joint. This reduces the stress on the hip joint and makes going from sitting to standing a lot easier. Avoiding crossing your legs is also helpful in reducing the amount of stress put through the hip joint.

Footwear. Avoid wearing high heels as this puts extra strain on your hip and knee joints. Wearing shoes that have a thick sole and are wide enough to make room for your toes helps with reducing the shock going through your hips and knees as you walk.

An individualised and progressive exercise programme is essential in the treatment of hip osteoarthritis. Below are a few examples of exercises that you may find useful in aiding with hip mobility and strength. It is always recommended to get advice from your osteopath or physiotherapist as they can design a tailor made and specific exercise program to help you with your hip osteoarthritis.

Water based exercises are particularly useful in the treatment of hip osteoarthritis. Water based activities reduce weight off the joint but also allow you to take the hip through larger ranges of motion.

Shoulder bridge. Lie on your back with your knees bent and feet flat on the floor. Begin by contracting your buttock muscle and lift your bottom a few inches off the floor or bed. Hold for 15 seconds and then relax back down. Repeat 10 times.

½ wall squat. Stand straight against a wall with your feet a few inches in front of you and just wider than hip distance apart. Begin slowly sliding down the wall by bending your knees. Stop when your knee joint is at a 120 degree angle. Clench your buttocks and push back up to your starting position. Repeat 10 times.

Balance exercises. Stand and hold onto a sturdy surface such as a counter surface or table. Begin by looking straight ahead of you. Clench your buttock muscles and lift one leg off the ground slightly. Trying to stand as still as possible. Hold for as long as possible and repeat 5 times. If this is too easy you can progress the exercises by 1) letting go of the stable surface and 2) closing your eyes.

*It is recommended to get the go ahead from your GP, osteopath or physiotherapist before carrying out any of these exercises.