Osteoarthritis of the hip


X-ray evidence of osteoarthritis of the hip is present in about 5% of the population over the age of 65 years.

There is an inconsistent relationship between evidence of osteoarthritis on x-rays and symptoms.

Categorized as primary or secondary types.

The prevalence of symptomatic hip OA among people age 60 years and older is 6.2%.

Primary disease risk factors include advancing age, high bone mass, genetics, increased body mass, participation in weight bearing sports, occupations associated with prolonged standing and lifting.

Twice as common in women as in men.

There is evidence of a strong inherited component.

Often occurs bilaterally.

Obesity, injury, malalignment, and anatomy disorders are associated with onset and progression of hip osteoarthritis, possibly due to increased or altered load across from joint surfaces.

Secondary forms include systemic disease including: hyperparathyroidism, hemochromatosis, hypothyroidism, Paget’s disease of the bone, acromegaly, gout, hyperlaxity syndromes and chondrocalcinosis.

Local secondary risk factors include: joint injuries, joint developmental abnormalities, Legg-Perthes disease, acetabular dysplasia, rheumatoid arthritis, septic arthritis, and osteonecrosis.

Its main symptom is pain.

Typical features include posterior hip pain with squatting, reduced range of movement of an affected hip, groin pain on abduction or adduction.

Patients with severe pain lasting more than three months, extended morning stiffness, weight loss or extreme pain with range of motion may require further investigation.

Patients for whom surgery is considered should also have radiographic confirmation.

Clinical findings include age greater than 60 years, ligament tenderness, decreased external rotation, decreased internal rotation, bony restriction on passive hip movement, and hip abductor weakness or may provide the most useful clinical means of predicting severe radiographic hip osteoarthritis.

The periosteum, subchondral bone, synovium and surrounding soft tissues are greatly innervated by sensory nerve fibers.

Chronic hip joint pain is associated with central sensitization at the spinal and cortical levels which can result in ref2242ed pain and tenderness remote from the affected joint.

Long-standing hip osteoarthritis may affect the gait and lead to pain in the knees and lumbar spine.

Differential diagnosis of hip pain includes: greater trochanteric pain syndrome, piriformis syndrome, stress fracture, inflammatory arthropathy, lumbar radiculopathy, pelvic bone tumors, osteonecrosis, pelvic insufficiency fractures, and meralgia paresthetica.

Groin hernia, intrapelvic pathology, and a leaking abdominal aortic aneurysm may also present with hip pain.

Diagnosis can generally be made without imaging in persons older than 45 years of age with recently related joint pain and without prolonged morning stiffness.

Prolonged morning stiffness points to an inflammatory process, such as rheumatoid arthritis.

X-ray evidence of hip osteoarthritis is common in the general population and is often asymptomatic.

The presence of x-ray findings suggesting hip OA does not always correlate with symptoms: About 21% of patients with radiographic evidence of hip osteoarthritis experience pain.

Conservative nonpharmacological physiotherapeutic treatments recommended for symptomatic disease irrespective of disease severity, pain level or functional status.

Physical therapy involves exercise, manual therapy, and prescription of gait aids.

Among adults with painful osteoarthritis of the hip physical therapy does not result in greater improvement in pain or function compared to sham treatment (Bennell K et al).

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