Hip Osteoarthritis

What is hip osteoarthritis?
Osteoarthritis of the hip is a form of arthritis that denotes the breakdown and eventual loss of the cartilage of the joint. Cartilage is a protein substance that serves as a " cushion" between the bones of the joints.

How frequent is osteoarthritis?
Among the different types of arthritis conditions, osteoarthritis is the most common, affecting over 25 million people in the United States. Before age 45, osteoarthritis occurs more frequently in males. After 55 years of age, it occurs more frequently in females. Osteoarthritis commonly affects the hands, feet, spine, and large weight-bearing joints, such as the hips and knees. 

What’s the cause of osteoarthritis?
OA usually has no known cause and is referred to as primary osteoarthritis. When the osteoarthritis is referred to another disease is called as secondary osteoarthritis. Primary osteoarthritis, osteoarthritis which does not result from injury or disease, is mostly a result of natural aging of the joint. With aging, the water content of the cartilage increases, and the protein makeup of cartilage degenerates. Eventually, cartilage begins to degenerate by flaking or forming tiny crevasses. In advanced osteoarthritis, there is a big area of total loss of the cartilage cushion between the bones of the joints. Repetitive use of the worn joints over the years can irritate and inflame the cartilage, that causes pain and edema. Loss of the cartilage cushion causes friction between the bones, leading to pain and limitation of joint mobility. Inflammation of the cartilage can also stimulate new bone outgrowths (spurs) to form around the joints. Osteoarthritis occasionally can develop in multiple members of the same family, implying a genetic basis for this condition.

Chondral defects on articular surfaces

How obesity acts in osteoarthritis?
Obesity predisposes to osteoarthritis by increasing the loadl stress on the joint and therefore on the cartilage. In fact, next to aging, obesity is the most significant risk factor for osteoarthritis of the hips.

How trauma acts in osteoarthritis?
Repeated trauma to joint tissues (ligaments, bones, and cartilage) is believed to lead to early osteoarthritis of the hips. It is believed also that overuse in sports activity leads to early osteoarthritis. Interestingly, studies have not found an increased risk of osteoarthritis in long-distance runners. Probably, because of their low body weight.

Are there any metabolic types of osteoarthritis?
Crystal deposits in the cartilage can cause cartilage degeneration and osteoarthritis. Uric acid crystals cause arthritis in gout, while calcium pyrophosphate crystals cause arthritis in pseudo-gout. Hormone disturbances, such as diabetes & growth hormone disorders, are also associated with early cartilage wear and secondary osteoarthritis.

How do congenital anomalies act?
Some people are born with abnormally formed joints (congenital abnormalities) that are vulnerable to mechanical wear, causing early degeneration and loss of joint cartilage. Osteoarthritis of the hip joints is commonly related to structural abnormalities of these joints that had been present since birth.

What are the symptoms ?
Osteoarthritis as a mechanical type, does not affect other organs of the body, that usually happens in metabolic arthritis as reumatoid. The most common symptom of osteoarthritis is pain in the affected joint. There can be swelling, warmth, and crepitus of the affected joints. Pain and stiffness of the joints can also occur after long periods of inactivity. In severe osteoarthritis, complete loss of the cartilage cushion causes friction between bones, causing pain even at rest or pain with limited motion.

Symptoms of osteoarthritis vary greatly from patient to patient. Some patients can be debilitated by their symptoms. On the other hand, others may have remarkably few symptoms in spite of dramatic degeneration of the joints apparent on X-rays.

How diagnosis is made?
Blood tests are performed to exclude diseases that can cause secondary osteoarthritis, as well as to exclude other arthritis conditions that can mimic osteoarthritis.X-rays of the affected joints can be used to diagnose osteoarthritis. The common X-ray findings of osteoarthritis include loss of joint cartilage, narrowing of the joint space between adjacent bones, and bone spur formation. Simple X-ray testing can also be very helpful to exclude other causes of pain in a particular joint as well as assisting the decision-making as to when surgical intervention might be considered.

Is there any treatment for hip osteoarthritis?
Starting from weight reduction and avoiding activities that exert excessive stress on the joint cartilage, there is no specific treatment to stop cartilage degeneration or to repair damaged cartilage in osteoarthritis. The goal of treatment in osteoarthritis is to reduce joint pain and inflammation while improving and maintaining joint function. Some patients with osteoarthritis have minimal or no pain and may not need treatment. Others may benefit from conservative measures such as rest, diet control with weight reduction, physical therapy and occupational therapy. Medications are used to complement the physical measures described above. Medication may be used topically, taken orally, or injected into the joints to decrease joint inflammation and pain. When conservative measures fail to control pain and improve joint function, surgery can be considered.

Joint space narrowing in hip osteoarthritis

Physical therapists can provide support devices, such as splints, canes, walkers, and braces.
These devices can be helpful in reducing stress on the joints. In many patients with osteoarthritis, mild pain relievers may be sufficient treatment. Medicine to relax muscles in spasm might also be given temporarily. Pain-relieving creams applied to the skin over the joints can provide relief of minor arthritis pain. Non-steroidal anti-inflammatory drugs (NSAIDs) are medications that are used to reduce pain and inflammation in the joints. The most common side effects of NSAIDs involve gastrointestinal distress. The risk of these and other side effects increases in the elderly. Newer NSAIDs called COX-2 inhibitors have been designed that have less toxicity to the stomach and bowels. Because osteoarthritis symptoms vary and can be intermittent, these medicines might be given only when joint pains occur or prior to activities that have traditionally brought on symptoms.

Glucosamine and chondroitin are newer drugs promising that can relieve symptoms of pain and stiffness for some people with osteoarthritis. Fish-oil supplements have been shown to have some anti-inflammatory properties, and increasing the dietary fish intake and/or taking fish-oil capsules (omega-3 capsules) can sometimes reduce the inflammation of arthritis.

For persisting pain of severe osteoarthritis of the knee that does not respond to weight reduction, exercise, or medications, a series of injections of hyaluronic acid into the joint can sometimes be helpful, especially if surgery is not being considered. These products seem to work by temporarily restoring the thickness of the joint fluid, allowing better joint lubrication and impact capability, and perhaps by directly affecting pain receptors in synovium.

Surgery is generally reserved for those patients with osteoarthritis that is particularly severe and unresponsive to the conservative treatments.

Arthroscopy,  can be helpful when cartilage tears are suspected.

Osteotomy is a bone-removal procedure that can help realign some of the deformity in selected patients, usually those with certain forms of knee disease.

In some cases, severely degenerated joints are best treated by fusion (arthrodesis) or replacement with an artificial joint (arthroplasty). 

Total hip replacements are now commonly performed. These can bring dramatic pain relief and improved function.