Hip osteoarthritis, or Hip OA, is a chronic disease that causes degeneration of articular cartilage in the hip joint. Often referred to as degenerative arthritis or degenerative joint disease, OA can occur in any joint in the body, though it primarily occurs in weight bearing joints such as the hips or knee, as well as in the hands. The articular cartilage degenerates, and without the normal cushion that healthy cartilage provides, the underlying bone may thicken and deform. While the cause of OA is unknown, increased risk of hip OA is associated with a previous fracture or injury to the hip joint, excessive weight, and occupations that place increased stress on the hips such as construction work or dancing.
A variety of symptoms can occur with OA, though it most frequently begins during middle age. It is equally common in men and women up to age 55, but is more common in women later in life. A gradual onset of pain is characteristic of the early stages of the disease. In the hip, symptoms may begin as pain in the groin, buttock, or thigh. It is typically worse with activity and better with rest. As the disease progresses, stiffness, range of motion loss, pain after exercise, enlarged joints, and crepitus (grinding noise) may occur. Resting will no longer provide the same symptom relief. In severe cases, bone spurs may develop and movement becomes very painful. As movement becomes painful, surrounding muscles weaken and an individual may not be able to walk without a limp.
Hip OA is diagnosed through a clinical examination and subjective history. Diagnosis may be confirmed by changes seen on an x-ray, though it is important to note that x-rays may not correlate with examination findings or with the degree of pain an individual has. There are individuals with severe pain symptoms who have only mild degeneration seen on x-ray and individuals with little to no pain whose x-rays show severe degeneration. Thus, it is important to remember that while diagnostic imaging can be an important tool, the clinical examination remains our best tool in differential diagnosis.
The differential diagnosis process is very important when evaluating for possible hip OA, since numerous pathologies can cause pain in the area of the hip. As discussed in a previous blog, the low back (lumbar spine) may refer pain to the hip joint, and there are numerous structures within, and surrounding, the hip that may be involved. Additionally, depending on the severity of the disease, there may be secondary conditions such as muscle tendinopathies, weaknesses, and significant movement and walking dysfunctions.
While the treatment of hip OA may often include medications such as NSAIDs and corticosteroids, injections, and in severe cases, total joint replacements, physical therapy (PT) may help to reduce pain, promote function, and protect the joint from further damage. Physical therapy should be the first line of treatment, in the majority of cases, for patients with hip pain complaints, and further diagnostic work-up decided on depending on the patient’s response to the therapy. Numerous patients with hip OA diagnoses fair significantly well with physical therapy, with the majority of patients able to postpone hip joint replacements for years or even for a lifetime. One of the first parts of PT is reducing joint pain, swelling and promoting positions of comfort. This may include education on icing and rest, gentle range of motion, and modifications to everyday activities to reduce discomfort. The therapist looks at how a person moves, the compensations they are adopting, and how these movement patterns affect pain symptoms and dysfunctions. Strengthening exercises are prescribed not only for the hip joint, but also to surrounding regions that may help support and take stress off of the painful joint. Joint mobilizations and progressive stretching exercises are effective at improving hip joint mobility. All throughout physical therapy, individuals are educated on a wide variety of topics, from body mechanics, energy conservation techniques, long-term joint health, and long-term home programs to continue the success after therapy ends.
Osteoarthritis can be a frightening diagnosis to hear, but is important to remember that every person is different in how they will progress with the disease. With the right treatment plan, everyone can make positive changes through taking control of their situation and looking to improve function through an individualized treatment plan designed by your physical therapist. At Life’s Work Physical therapy, our goal is to empower our patients with the tools they need to help decrease pain, increase function in everyday life, and continue to do the activities they love to do.