Hip Osteoarthritis

The hip joint is a ball and socket joint, made up of the femur i.e. thighbone, and pelvis i.e. hip bone. The end of the femur is a ball that fits into the pelvic bone, the socket.

 Cartilage is a soft and shock-absorbing, that acts as a cushion at the ends of the bones where they meet to form joints, covers the femur and socket of the pelvic bone, making the hip movements smooth and painless. Hip osteoarthritis results when inflammation or injury in a joint causes the smooth, rubbery cartilage that lines and cushions the joint surfaces to break down. When the cartilage is damaged, the joint becomes painful and swollen. In more severe cases, painful bone spurs are formed known as osteophytes.

There is no specific cause of hip Osteoarthritis, but factors that are more likely to develop the disease, include:

• Increasing age, over 65,
• Women mostly get osteoarthritis,
• Overweight,
• Family history,
• Inflammatory arthritis,
• Genetic defects in the cartilage or hips,
• Metabolic diseases,
• Repetitive strain on the hips,
• Vitamins D, C, and K deficiency.

The most common symptom of hip osteoarthritis is pain around the hip joint, other symptoms include:

• Sharp, shooting pain in the hip, buttocks, groin, thigh, or knee
• Stiffness in the hip joint,
• Pain aggravated after sleeping or sitting,
• Feeling of locking and decreased hip joint movement.
• Crepitus while moving the hip joint,
• Pain aggravated while getting out of bed, sitting to standing, while climbing stairs, or walking,
• Difficulty during daily activities, like putting on socks and tying shoelaces.

Pathology:

Osteoarthritis is the degradation of the cartilage and the synovium becomes thick, the subchondral bone begins to remodel forming lytic lesion.

Physical examination:

Physical examination is done to evaluate the pain location, tenderness, range of motion, muscle strength, and balance, including medical history.

X-rays:

X-ray creates detailed pictures of bones. X-rays of an arthritic joint may show changes in the bone, narrowing of the joint space, and the formation of osteophytes.

Magnetic resonance imaging (MRI):

Magnetic resonance imaging (MRI) is used to detect any damage to the muscles, ligaments, and tendons.

Bone scan:

A bone scan helps to determine the condition of the bone and soft tissues of the hip.

Medications: Painkillers, Non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids.

Note: Medication should not be taken without the doctor's prescription.

Surgery: Surgery is done in case the conservative treatment does not relieve symptoms.

Osteotomy: The head of the femur or the socket (either of them) is cut first and then realigned to release the pressure from the hip joint.

Hip resurfacing:

Hip resurfacing provides relief, the arthritic hip joint surfaces are removed surgically and replaced with metal

Hip replacement surgery:

In severe cases, the hip joint degenerates causing rubbing of the bone. This condition requires hip joint replacement surgery.

Cryotherapy:

Cryotherapy or Cold therapy causes numbness resulting in the constriction of blood vessels, thus reducing swelling.

Thermotherapy:

Thermotherapy reaches the connective tissue and muscles, improves blood flow, removes toxic substances, and decreases pain. It also improves flexibility leading to improvement in range of motion.

Ultrasound therapy:

Ultrasound therapy helps to decrease spasms and reduce joint stiffness.

Transcutaneous electrical stimulations (TENS):

Transcutaneous electrical stimulations (TENS) sends tiny electric shocks, through pads placed on the skin, to relieve pain.

Interferential current therapy (IFT):

Interferential current therapy (IFT), is another physiotherapy modality that can be used to decrease pain and increase mobility.

Hydrotherapy:

Hydrotherapy helps increase range of motion by immersing the body for 15 to 20 minutes in water and allowing weight-bearing muscles to relax and alternatively do simple flexion-extension exercises.

Manual therapy:

Manual therapy consists of several techniques and stretches to increase the quality and range of movement of the hip.

Range of motion exercises

Range of motion exercises are started with passive movements of the leg and hip joint and progressed to active exercises.

Strengthening exercises:

Strengthening exercises are taught to restore strength and agility. These include the use of cuff weights, weight-lifting equipment, resistance bands, and cardio exercise equipment such as treadmills or stationary bicycles.

Stretching exercises:

Physiotherapists use stretching techniques to gently move the joint and the muscles around it. Regular stretching increases the range of motion and thus increases mobility.

Aerobic exercise:

Aerobic exercises like cardio or endurance exercises, like speed walking, vigorous swimming, stationary bike, etc can also be done without stressing the hip joint.

The patient is advised to do lower impact activities in daily life and minimize activities that put stress on the hip joint, such as walking instead of jogging, using assistive devices such as a cane, raised toilet seat, etc. The patient is advised to exercise regularly and protect the hip joint while daily activities.