Hip Arthritis (Osteoarthritis)

Hip Arthritis (Osteoarthritis)

Article by J. MillerS.Armfield

What is Hip Arthritis?

Hip arthritis commonly describes what is known medically as hip osteoarthritis.

Hip osteoarthritis is a joint disease that primarily affects your hip joint cartilage. Articular cartilage is the hard slippery surface covering the sections of bones that move against each other in your hip joint.

Healthy articular cartilage allows your hip joint bones to smoothly and painlessly glide over each other and also helps to absorb any shock forces not dispersed by your hip muscles.

What Causes Hip Arthritis?

In hip osteoarthritis, your top layer of articular cartilage breaks down and wears away. Eventually, your cortical bone that lies under the cartilage rubs together to cause pain, swelling, grating and loss of hip joint motion.

Muscle weakness and the resultant hip joint instability associated are thought to contribute to your hip joint cartilage deterioration. Weaker hip muscles also provide less shock absorption capabilities than their strong counterparts, which increases your hip joint compression forces. Hip osteoarthritis usually happens gradually over time.

Some risk factors that might increase your likelihood of deterioration include:

  • Being overweight.
  • Age.
  • Previous joint injury.
  • Muscle weakness.
  • Stresses on the joints from specific jobs and playing sports.
  • Poor biomechanics.
  • Malformed joints or a genetic defect in your joint cartilage.

Hip osteoarthritis is the most common form of arthritis affecting your hip. Unlike some other forms of arthritis, osteoarthritis affects only joints and not internal organs. It is becoming more familiar with an ageing population. However, it can also occur in younger people, especially with a history of hip injury or heavy work.

Some research suggests that early intervention can delay the onset of hip arthritis and reduce the number of cases of hip osteoarthritis. There is not currently a cure for hip osteoarthritis.

What are the Symptoms of Hip Arthritis?

Hip arthritis results in hip pain, joint weakness, joint instability, and restrictions of movement that interfere with your most basic daily tasks such as walking, climbing stairs or driving.

Your symptoms can develop suddenly or slowly and may include:

  • Hip joint pain or tenderness that comes and goes. Typically there will be sharper pains in the groin and sometimes an ache in the front of the thigh. Many people present with hip arthritis thinking that it is a knee problem.
  • Hip stiffness, particularly early morning stiffness.
  • Hip joint movement is difficult, especially inward rotation, leg movement across the body and hip extension.
  • Weak hip muscles, especially during sit to stand, squatting and stair climbing.
  • Hip joint swelling or deformity can be hard to detect because of the location of the hip joint.

How is Hip Arthritis Diagnosed?

Your initial diagnosis of hip osteoarthritis is usually clinically formed by taking a detailed history of your symptoms and a physical examination looking at the range of movement of your hip joint and any associated pain.

If hip osteoarthritis is suspected, a hip X-ray will assess your hip joint wear and tear, and sometimes a blood test to check for other factors.

In a small number of cases, a CT scan or MRI may be performed.

Hip Physiotherapy Effectiveness

Does Physiotherapy Help Hip Arthritis?

The short answer is Yes!

Short-Term Benefits

Poulsen et al. 2013 compared patient education only, patient education plus manual therapy, and minimal (control) intervention (continue medication usage, minimal education on stretching) groups. At six weeks, significant differences were found, favouring patient education plus manual therapy versus the minimal (control) intervention group. At six weeks, 76.5% of patients in the education-plus-manual therapy group improved, versus 22.2% in the patient-education group and 12.5% in the control group. 1

Medium-Term Benefits

Fernandes et al. 2010 enrolled 109 patients with mild to moderate hip OA and compared patient education versus patient education plus exercise at 16 months. The WOMAC physical function scores had improved significantly for the education-plus-exercise group. Their findings in this study show that participating in a 12-week exercise therapy programme in addition to patient education can reduce the need for THR or postpone surgery in patients with hip OA. This supports the recommendations stating that exercise therapy should be offered to patients with hip OA as first-line treatment. 2

Long-Term Benefits

Svege et al. 2015 conducted a 6-year follow-up study of a previous study of 109 patients. Participants were randomised to 2 groups: exercise plus patient education and patient education only (control group).

Results showed that people who had exercise therapy were less likely to have a hip replacement. People who had exercise therapy were also able to wait longer before a hip replacement. Before having a hip replacement for people in the exercise group, the average time was five and a half years, compared with three and a half years for people who had not had exercise therapy. After six years, 22 of the 55 people who’d had exercise therapy had a hip replacement (40%) versus 31 of the 54 people not in the exercise group (57%).

The people who had exercise therapy also rated their hip function as better.

This means that there is outstanding scientific support for the use of patient education, manual therapy and exercises prescribed by your physiotherapist assisting your hip osteoarthritis and delaying the need for hip replacement surgery. Please consult your physiotherapist to determine if you are a candidate for hip physiotherapy.

What’s the Treatment of Hip Arthritis?

PHASE I – Pain Relief & Protection

  • You are managing your hip pain. Hip pain is the main reason that you seek treatment for hip arthritis.
  • Regular application of ice packs is highly recommended to reduce your hip pain.
  • NSAIDs or anti-inflammatory drugs (i.e. ibuprofen). You should discuss the use of these medications with your doctor.
  • Your physiotherapist will use an array of treatment tools to reduce your hip pain and inflammation. These may include ice, electrotherapy, acupuncture, unloading taping techniques, soft tissue massage and temporary use of a mobility aid (e.g. cane or crutch) to off-load the affected side.

PHASE II – Restoring Normal Hip ROM, Strength

As your hip pain and inflammation settle, your physiotherapist will focus their attention on restoring your normal hip joint range of motion, muscle length and resting tension, muscle strength and endurance, proprioception, balance, and gait (walking pattern).

Hip researchers have discovered the importance of your hip muscle recruitment patterns with a standard order of deep, intermediate, and finally superficial muscle firing patterns in normal pain-free hips. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises specific to your needs.

PhysioWorks has developed a “Hip Core Stabilisation Program” to assist their patients in regaining normal hip muscle control.

Please ask your physio for their advice.

PHASE III – Restoring Full Hip Function

The final stage of your hip arthritis rehabilitation aims at returning you to your desired activities. Everyone has different demands for their hips that will determine what specific treatment goals you need to achieve. For some people, it may be simply to walk around the block.

Your physiotherapist will tailor your hip rehabilitation to help you achieve your own functional goals.

PHASE IV – Delaying Hip Surgery

Hip osteoarthritis is a condition that gradually deteriorates even though your pain may come and go in the initial stages.

In addition to your hip muscle control, your physiotherapist will assess your hip biomechanics and start correcting any defects. It may be as simple as providing your will core abdominal exercises or some foot orthotics to address any biomechanical faults in the legs or feet. Your physiotherapist will guide you.

You are fine-tuning your hip stability and function by addressing any deficits in core strength and balance, learning self-management techniques and achieving the ultimate goal of safely returning to your previous daily or leisure activities!

Your aim for any exercise or physiotherapy program is to delay the deterioration of your hip arthritis. Your best chance is to have strong hip muscles and bones performing activities that don’t traumatise your hip joint surfaces.

PHASE V – Hip Surgery

Hip surgery is usually required as your hip joint arthritis deteriorates and your hip joint becomes permanently deformed. The most common surgical procedure for an arthritic hip is a total hip replacement. Your hip surgeon may also recommend arthroscopic surgery or joint resurfacing.

Your prognosis following a total hip replacement is excellent. In most cases, you will have no or considerably less pain plus improved hip function.

You will require a post-operative hip strengthening and rehabilitation program to prolong the life of your new hip and resume your most active lifestyle.

For more information about hip surgery, please your physiotherapist or doctor.

What Else Can You Do For Your Hip?

Lose Weight

Lose weight. You won’t just look better. You’ll feel better, too. Why? Every extra kilogram you carry around translates to added stress to your hip joints. Excess weight can mean more hip pain, no matter which form of arthritis you have.

Ice it!

When your hip joint is hot and inflamed, applying something cold can decrease pain and swelling by constricting blood vessels and preventing fluids from leaking into surrounding tissues.

Medications

Follow your doctor’s advice. Some medications will be designed for pain relief and others to reduce inflammation. Since most hip osteoarthritis sufferers normally have other medications, it is always wise to check with your doctor before changing.

Exercise – Keep Moving

Exercise helps to lessen your hip pain, increase your hip joint range of movement, reduce fatigue and help you feel better overall.

A well-rounded workout routine for people with hip osteoarthritis includes flexibility exercises to increase your hip joint and muscle range of motion, aerobic exercises to improve your endurance and decrease fatigue, and strengthening exercises to improve your muscle endurance and power.

Your physiotherapist is an expert in the assessment and prescription of hip arthritis exercises. Please ask them what is best for you.

General exercises such as swimming, hydrotherapy, Tai Chi, yoga, pilates, balance and walking programs are excellent if pain-free.

The key is to have a regular daily exercise program. The goal is to keep moving.

Strengthen Your Bones

Ask your doctor to check your bone density. If they are concerned, they’ll arrange for a test to check if you have osteoporosis (bone thinning).

Follow their advice or the advice of your dietitian on your Calcium and Vitamin D intake. It would be best to have normal levels plus some form of weight-bearing exercise to strengthen your bones.

Treat Your Muscles with a Massage!

A quality remedial massage may be just the relief your hip muscles need. Treat yourself to a good rub down with someone you trust. The benefits vary from person to person but may include decreased pain and muscle stiffness associated with your arthritis, increased circulation, and an improvement in your sleep and immune functions. Mentally, massage can also reduce stress and depression.

Besides all that, massage feels good!

Hip Pain Treatment

A thorough analysis of WHY you are suffering hip pain from a movement, posture, or a control aspect, is vital to solving your hip pain.

Only an accurate diagnosis of the source of your hip pain can solve the pain, quickly improve your day to day function, prevent a future recurrence,  or improve your athletic performance.

The first choice of short-term therapy has been symptomatic hip treatment. This approach could include local chemical modalities such as cortisone injections or painkillers. Ice or heat could also assist along with some gentle stretching or exercise.

However, persisting hip problems will require additional investigations to assess your joint integrity or range of motion, muscle length, strength, endurance, power, contraction timing and dynamic stability control.

You should consult a healthcare practitioner who has a particular interest in hip pain and injury management to thoroughly assess your hip, groin, pelvis, lower limb and spine. Due to the kinetic chain, they all impact, especially at the high athletic performance end. A quality practitioner will educate you on your condition and combine it with exercise and manual therapy as per the Clinical Practice Guidelines. (Cibulka et al., 2017) Hip pain education should also include teaching you specific activity modification, individualised exercises, weight-loss advice (if required), and methods to unload any arthritic joints.

Recent research evidence-backed approaches have modernised physiotherapy treatment approaches to effectively managing hip pain. Together with a thorough hip assessment, your hip treatment can progress quickly to restore you to a pain-free hip and perform your regular sport or daily activities in the shortest time possible.

For specific rehabilitation advice regarding your hip pain, seek the professional advice of high quality and up-to-date physiotherapists experienced in the assessment, treatment, prevention and optimisation of hip pain and related conditions. After assessing you, they will individually prescribe therapeutic activities based on your specific needs for daily living, values, and functional activities or point you in the direction of the most suitable healthcare practitioner for you and your hip condition.

Hip Pain Treatment Options

Your hip physiotherapist may consider an extensive range of treatment options, including manual joint therapy to improve your joint mobility, muscle stretches or supportive taping. Your physiotherapist is also likely to add strengthening and hip joint control exercises as they deem appropriate for your specific functional and sporting needs. Please consult with them for advice.

Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.

Tenderness

If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  

Swelling

Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.

Weakness

Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.