Hip Osteoarthritis
Description
Hip osteoarthritis is a degenerative joint disease that initially affects the articular cartilage and subsequently involves other structures of the hip joint. The causes are classified as primary and secondary.
Primary causes include:
a) age-related changes (joint wear, endocrine disorders, metabolic changes);
b) circulatory disorders (acute ischemia leading to avascular necrosis of the femoral head, and chronic ischemia contributing to osteoarthritis);
c) neurological disorders, including spondyloarthropathy, spinal canal stenosis, and radiculopathy.
Secondary causes include:
a) developmental dysplasia of the hip;
b) Legg-Calvé-Perthes disease;
c) septic arthritis;
d) slipped capital femoral epiphysis.
The principal mechanism underlying disease development is incongruity of the articular surfaces.
Symptoms
Pain gradually increases as inflammation develops and intra-articular pressure rises. The pain is usually moderate in intensity and is localized to the groin, lateral hip, and knee. It may radiate down the leg. Pain commonly occurs at night or as start-up pain after rising from a sitting or lying position and improves with rest.
Other clinical features include limping, morning stiffness, limb shortening, abnormal limb positioning, and restricted joint movement due to both pain and contractures. Joint deformity may become apparent, and crepitus may be detected during movement.
Diagnosis
The physician evaluates posture, gait, range of motion, and imaging findings. Gait assessment includes evaluation for a Trendelenburg gait and limping caused by pain or limb shortening. Plain radiographs of the hip typically demonstrate joint space narrowing, osteophytes, subchondral sclerosis, and subchondral cysts. Magnetic resonance imaging (MRI) may reveal joint effusion. Radionuclide bone scanning may demonstrate increased radiotracer uptake. Hip arthroscopy may also be performed.
Treatment
Treatment may be conservative or surgical. Conservative treatment is recommended in the early stages of the disease and includes nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, medications that improve microcirculation, sedatives, and neurotrophic agents. Physiotherapy is also recommended.
Surgical treatment is indicated in advanced disease or when conservative management is ineffective. Surgical options include hip arthrodesis, which may be appropriate for younger patients with unilateral disease and otherwise healthy joints, or total hip arthroplasty, which is generally preferred for older patients or those with degenerative changes involving the spine or other lower-limb joints.
Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology