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by Adam Brown
Registered Physiotherapist  BScPT, MClScPT
updated Oct 24, 2023


Osteoarthritis of the hip is one of the most common problems that we see in the clinic. It is characterized by the breakdown of cartilage in the hip joint, leading to pain, stiffness, and reduced mobility. Osteoarthritis develops over a long period of time and therefore predominantly affects older people. The exact cause of hip osteoarthritis is multifactorial, involving a complex interplay of genetic, mechanical, and environmental factors. Obesity, joint injury, and certain occupational factors have been identified as potential risk factors. According to epidemiological studies, hip osteoarthritis prevalence varies globally, with higher rates observed in developed countries. A study by Cross et al. (2014) highlighted the burden of hip osteoarthritis, estimating that it affects over 242 million people worldwide.

 

How Is Hip Arthritis Diagnosed?

Diagnosing hip arthritis involves a combination of medical history, physical examination, imaging studies, and sometimes laboratory tests.

Medical History and Physical Examination

Your healthcare provider will start by asking you about your symptoms, including pain, stiffness, and any limitations in movement. They will inquire about your medical history, including any past injuries or conditions that might be relevant. This is followed by a physical examination of your hip joint’s range of motion, stability, and any signs of tenderness or swelling.

Imaging Studies

  • X-rays: X-rays are commonly used to visualize the bones and can show joint damage, narrowing of joint space, bone spurs, and other signs of arthritis. In most cases an x-ray is the only imaging study required to make a diagnosis.
  • MRI (Magnetic Resonance Imaging): MRI provides detailed images of soft tissues and can help in assessing the extent of damage to cartilage and other structures around the hip joint.
  • CT (Computed Tomography) Scan: CT scans offer detailed cross-sectional images of bones and can be used to get a more precise view of the hip joint’s bony structures.
  • Lab Tests: While there is no blood test that definitively diagnoses hip arthritis, certain blood tests might be conducted to rule out other forms of arthritis, such as rheumatoid arthritis. These tests may include erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) tests.

Joint Aspiration (Arthrocentesis)

In rare cases, if the diagnosis is still unclear after imaging and blood tests, a joint aspiration might be performed. This involves using a needle to draw a small sample of fluid from the hip joint. The fluid can be analyzed for signs of inflammation and to rule out other possible causes of joint pain.

 

Is Hip Arthritis Hereditary?

Both genetic and environmental factors contribute to the development of hip osteoarthritis.. While there isn’t a direct single gene responsible for hip arthritis, numerous studies have suggested a genetic component to the risk of developing osteoarthritis. Here is an outline of the evidence supporting the hereditary aspect of hip arthritis:

  • Family Studies: Several family and twin studies have indicated a higher risk of osteoarthritis in individuals with a family history of the condition. If your parents or siblings have hip arthritis, your likelihood of developing it might be higher than someone without a family history.
  • Twin Studies: Twin studies, which compare the rates of osteoarthritis in identical twins (who share 100% of their genes) and fraternal twins (who share about 50% of their genes), have shown a higher concordance rate for osteoarthritis in identical twins compared to fraternal twins. This suggests a significant genetic influence.
  • Genetic Studies: Research has focused on identifying specific genetic variations associated with osteoarthritis. While no single gene has been identified as the primary cause, certain gene variants related to joint structure, cartilage metabolism, and inflammation have been linked to an increased risk of developing osteoarthritis, including in the hips.
  • Heritability Estimates: Heritability studies estimate the proportion of the total variation in a trait (in this case, susceptibility to hip arthritis) that is due to genetic factors. These studies have suggested that genetic factors contribute to approximately 40-65% of the variation in osteoarthritis susceptibility.

While the evidence supports a hereditary component in hip arthritis, it’s crucial to note that environmental factors, such as obesity, joint injuries, and occupational hazards, also play a  role in the development and progression of the condition. Genetic predisposition, in combination with these environmental factors, contributes to an individual’s overall risk.

 

Is Hip Arthritis a Disability?

Whether hip arthritis is considered a disability depends on the severity of the condition and its impact on an individual’s ability to perform essential tasks related to work and daily life, and the availability of reasonable accommodations.

 

What Does Hip Arthritis Feel Like?

Each patient’s case is slightly different. However, there are common signs and sensations associated with hip arthritis:

1. Pain

Hip arthritis typically causes pain in the hip joint and sometimes in the groin area. This is often confusing to patients since they do not associate thier groin with their hip joint. However, the joint line of the hip is in the groin region whereas the lateral thigh contains mostly muscles attaching to the femur. The pain is often a dull, aching pain that may worsen with activity and improve with rest. Initially, the pain might be mild and intermittent, but it can progress to constant discomfort as the condition worsens.

2. Stiffness

People with hip arthritis often experience stiffness, especially in the morning or after periods of inactivity. This stiffness usually improves with movement and gentle stretching.

3. Limited Range of Motion

Hip arthritis can restrict the hip joint’s range of motion, making it difficult to perform activities that involve bending, twisting, or rotating the hip. Patients commonly report noticing this limitation when putting on socks or shoes.

4. Grating Sensation

As the cartilage in the hip joint wears away, the bones may rub against each other, causing a grating or grinding sensation known as crepitus.

5. Limping

Due to pain and limited mobility, individuals with hip arthritis often develop a limp or altered gait as they try to avoid putting weight on the affected hip or limit the amount of time that they are standing on the affected leg. Weakness of hip joint stabilizing musculature may also contribute to altered gait.

6. Pain Radiating to the Thigh or Knee

Often, hip arthritis pain can radiate to the thigh or knee. It is not always obvious to the patient that this pain is being generated by the hip. Any persistent leg pain should be assessed by a qualified clinician.

 

Can Hip Arthritis Cause Back Pain?

While the hip joint itself does not typically refer pain to the back, osteoarthritis of the hip may be a risk factor for developing low back problems. With limited range of motion in a degenerating hip, it can place more stress on the low back causing an increased probability of spinal pain. 

 

What Causes Hip Arthritis to Flare Up?

Hip arthritis can flare up due to various triggers. Some common causes of flare-ups include:

  • Overuse or Excessive Activity: Engaging in activities that put strain on the hip joint, especially high-impact exercises or repetitive movements, can cause inflammation and trigger a flare-up.
  • Weather Changes: Some individuals with arthritis report increased pain and stiffness during changes in weather, especially in cold and damp conditions. While the scientific evidence on this is mixed, many people claim to experience weather-related flare-ups.
  • Weight Gain: Being overweight places extra stress on weight-bearing joints like the hips, exacerbating arthritis symptoms. 
  • Inflammatory Foods: Certain foods, especially those high in processed sugars and saturated fats, can promote inflammation in the body, potentially worsening arthritis symptoms.
  • Psychological Stress: Stress and anxiety can lower pain tolerance and make arthritis symptoms feel more intense.

It’s important for individuals with hip arthritis to identify their specific triggers through self-awareness and, if necessary, with the help of an experienced physiotherapist.

 

How Do I Know If I Need A Hip Replacement?

The decision to undergo hip replacement surgery, also known as total hip arthroplasty, is based on several factors and is typically determined by the patient and their healthcare team including their primary care physician, orthopaedic surgeon and physiotherapist. The following factors will be considered when deciding if a joint replacement is necessary.

1. Pain

Do you have persistent and severe pain in your hip that limits your everyday activities, even with the use of pain medications or walking aids? 

2. Functional Limitations

Does your hip make it difficult to perform simple tasks like walking, bending, or climbing stairs. 

3. Failure of Conservative Treatments

Have you tried managing the condition with physical therapy, pain medications, and the use of assistive devices?

4. X-ray and Imaging Findings

X-rays and other imaging studies can reveal the extent of joint damage and therefore can help establish whether a hip replacement is likely to relieve the symptoms you are experiencing.

5. Impact on Quality of Life

If hip arthritis affects your ability to enjoy life, participate in social activities, work, or maintain personal relationships, your healthcare provider will consider these factors in recommending surgery.

6. Age and Health Status

While age alone is not a determining factor, your overall health and medical condition will be considered. Hip replacement surgeries are performed successfully on patients of various ages. However, the risks and benefits will be evaluated in the context of your overall health status. Patients in poor health may not respond well to a major surgery, and patients that are very young may want to consider conservative management to avoid the need to revise (redo) the hip replacement in the future.

7. Patient Preference

Ultimately, the decision to undergo hip replacement surgery is a personal one. Your preferences, expectations, and goals for surgery are important factors in the decision-making process.

 

How Do You Relieve The Pain of Hip Arthritis?

Managing pain associated with hip arthritis often involves a combination of lifestyle modifications, medications, physical therapy, and, in some cases, surgical interventions. Here are several methods commonly used to relieve hip arthritis pain, supported by research:

Physical Therapy and Exercise

Strengthening Exercises: Strengthening the muscles around the hip joint can provide support and alleviate stress on the joint. Physical therapy programs tailored to individual needs can be highly effective (2). 

Low-Impact Aerobic Exercise: Activities like swimming and cycling are easier on the joints and can improve cardiovascular health and overall joint function.

Weight Management

Maintaining a healthy weight or losing excess weight can significantly reduce the stress on hip joints, leading to decreased pain and improved mobility (3). It is important to lose the “right” kind of weight. A shift in body composition that preserves muscle and reduces fat is ideal. A registered dietician can be a helpful resource. 

Pain Medications

Over-the-Counter (OTC) Pain Relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help reduce pain and inflammation (4). 

Heat and Cold Therapy

Applying heat or cold to the affected hip can help alleviate pain and reduce inflammation. Heat can improve blood circulation, while cold therapy can numb the area and reduce swelling. To decide whether heat or cold are best for you, see THIS ARTICLE (hyperlink to joon heat or ice) 

Assistive Devices

Using assistive devices like canes or crutches can help reduce the load on the affected hip joint, providing pain relief during movement.

Intra-Articular Injections

Corticosteroid injections into the hip joint can provide temporary pain relief by reducing inflammation(5). 

Alternative Therapies

Some people find relief through acupuncture or supplements like glucosamine and chondroitin. While the evidence is mixed, some individuals report benefits (6).

 


Osteoarthritis of the hip can be very disabling and it is natural for patients to have many questions and concerns. A qualified physiotherapist can help to answer those questions and provide guidance on how to manage the condition. 

 

REFERENCES

  1. Cross M, Smith E, Hoy D, et al. The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(7):1323-1330. doi:10.1136/annrheumdis-2013-204763
  2. Fransen M, McConnell S, Harmer AR, et al. Exercise for osteoarthritis of the hip. Cochrane Database Syst Rev. 2014;2014(4):CD007912. doi:10.1002/14651858.CD007912.pub2
  3. Christensen R, Astrup A, Bliddal H. Weight loss: the treatment of choice for knee osteoarthritis? A randomized trial. Osteoarthritis Cartilage. 2005;13(1):20-27. doi:10.1016/j.joca.2004.10.008
  4. Derry S, Moore RA, Rabbie R. Topical NSAIDs for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev. 2012;9:CD007400. doi:10.1002/14651858.CD007400.pub2
  5. Jüni P, Hari R, Rutjes AW, et al. Intra-articular corticosteroid for knee osteoarthritis. Cochrane Database Syst Rev. 2015;2015(10):CD005328. doi:10.1002/14651858.CD005328.pub3
  6.  Lee YH, Woo JH, Choi SJ, Ji JD, Song GG. Effect of glucosamine or chondroitin sulfate on the osteoarthritis progression: a meta-analysis. Rheumatol Int. 2010;30(3):357-363. doi:10.1007/s00296-009-0969-3
About the author

Adam Brown

Co-founder, Physiotherapist Learn More about Adam Brown

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