Arthritis is a degenerative condition that causes pain and inflammation in the joints. This condition is also referred to as joint “wear-and-tear”. There are mainly 3 types of Arthritis, namely gout, rheumatoid and osteoarthritis (OA), the latter being the kind we will be looking into in this article.
Osteoarthritis (OA) is characterised by the degeneration of bone and cartilage. It is believed this occurs due to overload in mechanical forces on weight bearing joints. OA of the hip occurs when the hip joint is subjected to higher loads over an extended period of time resulting in wear-and-tear of the cartilage and bone in the joint. Due to the inflammation caused by in the area other structures such as ligaments, joint capsule and synovium may be affected too. In some instances, small bone projections called osteophytes develop which further contribute to the degeneration of the joint.
The hip joint is the area where the head of the femur (thigh bone) meets the acetabulum (rounded socket of the pelvic bone). The joint surfaces are covered in cartilage and synovium (or Synovial membrane). Cartilage that allows for smooth movement of the join and also cushion the bones. Synovium produces a liquid that lubricates the joint and further facilitates movements in the joint. OA of the hip leads to wearing down of the cartilage, synovium, decreased joint space and even change in the surface of the joint.
Types of hip OA
There are two types of OA primary and secondary. Primary hip OA happens when the onset is insidious (starts on it’s own, without any incident), while secondary hip OA happens when there is trauma, anatomical abnormalities, a previous injury or inflammatory condition that offsets the OA.
There are many factors that may lead to OA and therefore it is important to view the cause of OA to be a combination of many factors. These factors may be:
- Age: increased age increases the risk of OA
- History of hip injury/trauma
- Inflammatory arthritis such as rheumatoid arthritis
- Joint Shape
- Increased weight
- Occupation and activities that involve high and/or repetitive joint loading
- Sports: high performance and impact sports , especially with specialisation at a young age.
- Lifestyle factors such as sedentary lifestyle, diet
- Other conditions: FAI, metabolic diseases and conditions such as menopause, etc.
The most common symptoms are:
- Pain in the hip or groin area – usually worse in the mornings and in cold weather, and eased with movement and heat.
- Stiffness – mainly in the mornings and with extended periods of inactivity (i.e. sleeping, sitting for long behind a desk at work).
- Decreased range of movement – especially internal rotation
- Crepitations, hip “locking” or “catching” during movement
- Leg length discrepancy.
The diagnosis is usually done through a combination of clinical assessment and diagnostic tests. The physical assessment will include screening for risk factors and testing for the symptoms as described above. The behaviour of the symptoms often is offers a great hint as to whether or not it may be OA. Some special tests may be used to put pressure in certain structures or parts of the joint and to clear other symptoms that may present similarly such as hip bursitis, avascular necrosis, etc.
Some of the special tests are:
- Scour test
- FABER test
- Hip quadrant test
X-rays are commonly used to diagnose OA of the hip. The main indicators of OA are decreased joint space and the presence of osteophytes. Other imaging techniques such as CT, MRI or bone scan may also be used to show the condition of the bone and other tissues in the area but generally a simple X-ray will suffice.
Another diagnostic used to aid in the diagnosis is ESR, Erythrocyte Sedimentation Rate. This is a lab test that measures how the speed at which the blood cells(erythrocytes) in the sample settle in the test tube. The test to detects inflammation as a higher the speed of sedimentation (settling) is a sign of inflammation.
There is currently no cure for OA, and the treatment entails management of the symptoms and preventing the progression of the symptoms. The main aim of any treatment will be to ensure the patient will carry on with their daily activities as best as possible.
Patient education will be the most important factor. Patients need to be educated on their condition, the progression and the aim of the treatment. It is key for patients to be able to identify aggravating factors, to be able to avoid these and also easing factors in order to diminish their pain.
This is then followed by lifestyle modifications such as:
- Exercise for mobility and muscle strengthening,
- Change in activities from high impact to low impact,
- Wearing appropriate shoes that offer adequate cushioning and support
- Weight control
- Diet modifications
A combination of physiotherapy and pharmaceutical interventions to offset or minimise the symptoms as well as slow down progression. Physiotherapy will guide the patient in what exercises to do, when and how to perform certain activities to minimise the load on the joints. Soft tissue release, as well as, anti-inflammatory interventions. Sometimes assistive devices such as walking sticks, walking frames or long-handlers to help to reach and pick up things to minimise movements and positions that cause pain.
Medication is used to control symptoms of pain and inflammation that interfere with daily activities. These may be pain killers, nonsteroidal anti-inflammatory drugs (NSAIDs), cortisone and others. Your doctor would be able to better advise you on the appropriate pharmaceutical management.
Finally, when the conservative methods have not worked or the symptoms have progressed into final stage, surgery is indicated. Surgery may also be indicated in cases where to preserve the joint. The types of surgical intervention are:
- Hip resurfacing
- Hip replacement
OA hip is a common condition, especially within the elderly. It is important to recognise the signs of the condition as well as being able to manage the condition appropriately in order to prevent progression. As with all diseases and conditions, prevention is the best cure. Maintaining an active and healthy lifestyle is not only the best but the most economical solution with benefits that extend beyond simply bone health.
Keep it moving!