Anatomy & Background
The hip joint is one of the largest joints in the body. It is composed of one osseous joint. The hip was designed for weight bearing and mobility on several different planes. The stability of the hip comes from the joint design, joint capsule, ligaments, muscle and a cartilaginous tissue called the labrum.
Bone and Joint
The hip is a ball-and-socket joint. It is formed by the head of the femur and the acetabulum, a part of pelvic girdle, meeting. The head of the femur is a large ball and the acetabulum is a shallow socket. This design allows for greater mobility.
The bony joint surfaces of the head of the femur and acetabulum are covered with articular cartilage that has a smooth and shiny surface that allows the ends of the bones to slide freely over each other. This is what enables the joint to move smoothly.
Arthritis is the wearing, degeneration or loss of articular cartilage in a joint. The three most common types of joint arthritis are osteoarthritis, rheumatoid arthritis, and traumatic arthritis. The most common cause of hip pain is arthritis.
The most common form of hip arthritis is Osteoarthritis. Osteoarthritis is a gradual wearing down and degeneration of the joint surfaces or articular cartilage. Osteoarthritis is most common in people over the age of 50, and people who are overweight. Women are more likely to develop osteoarthritis.
Common causes of hip osteoarthritis include:
- Genetics and family history
- Traumatic injury or fracture of the hip can result in the development of osteoarthritis.
- Significant trauma that effects the circulation of the head of the femur. This condition is called “aseptic necrosis” which can result in a deteriorating of the femur head.
- Excessive use of steroids or steroid medication can result in degeneration of the joint and cartilage.
- Diseases of the joint cartilage
Symptoms of Osteoarthritis
- Pain and achy-ness in the hip joint during activities.
- Difficulty with walking and bearing weight on the effected leg.
- Loss of motion of the hip in several directions including abduction (moving out) flexion (moves toward chest) and internal rotation (turning the hip in).
- Noticeable inflammation around the joint.
- Weakness that makes it difficult to get out of a chair, squat, kneel or climb stairs.
- Cracking, grinding, crunching or joint noises called “crepitus” that occurs when moving the hip.
Symptoms of Osteoarthritis
Treatment of hip arthritis will depend on the severity of the condition. Some important guidelines should be followed at the beginning of such a condition:
- Rest: avoid the activities that produce the pain. Avoid jumping, running, going up and down stairs, kneeling, squatting and walking for extended periods of time.
- Ice or moist heat: apply ice to the joint or area experiencing pain or inflammation. It is one of the fastest ways to reduce swelling, pain and inflammation. Individuals with Rheumatoid arthritis may not tolerate ice well. The application of moist heat (like a warm or hot wash cloth) may be helpful with stiff joints. The application of ice or heat should be done at intervals for about twenty minutes at a time. Do not apply directly to the skin.
- Compression: when using ice, apply light compression. This is especially helpful if swelling is present.
- Elevation: elevate the area to help reduce swelling.
- Movement: keep your joints moving whenever possible. When pain occurs, patients tend not to move, but this will only result in further loss of motion and lead to increased pain and loss of function.
Managing Your Pain with Medicine
Avoiding the activities that produce the pain or stress the involved joint is the first line of treatment.
- RICE: Rest, Ice, Compression, Elevation should be used to reduce the stress on the joint.
- NSAIDS (Non-steroidal anti-inflammatory drugs) to reduce pain.
- Use of an assisting device, such as a cane or walker, may reduce stress on the hip while reducing a limp or gait deviation.
- Injection of steroids may be indicated to reduce inflammation of the involved joint.
- In severe recurrent conditions, surgery may be needed. In cases of severe arthritis or joint degeneration a hip joint resurfacing or total hip replacement procedure may be recommended.
Outcomes and prognosis for individuals with hip arthritis will depend on the severity of the joint degeneration, motion loss, weakness and age of the individual.
Patients with mild degeneration respond well to conservative treatment, which includes medication for pain and inflammation, and a program of exercises for stretching and strengthening of the knee joint and surrounding muscles. Most patients show improvement in pain and function in 4-6 weeks.
Patients with moderate degenerative changes usually experience greater loss of motion, pain, weakness and loss of function. In some cases a joint resurfacing of the hip may be indicated. Recovery may take from 8-12 weeks following surgery with emphasis on reduction of swelling and restoration of range of motion, strength and function.
Patients with severe joint degeneration have significant pain, stiffness, loss of motion and function. The cartilage on the joint surfaces has been eroded and X-rays may reveal a loss of joint space and “bone-on-bone” contact. Joint replacement is normally the only treatment option available at this point. Following a joint replacement, the artificial hip will be different from the natural joint and there will be some limitations of motion and function. However, a patient’s quality of life is usually significantly improved following a total joint replacement. Recovery following hip replacement can take 3-4 months of intensive physical therapy and rehabilitation. Improvements and functional gains can continue to develop for up to a year following the procedure.