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For further information, see CMDT Part 41-05: Musculoskeletal Injuries of the Hip

Key Features

Essentials of Diagnosis

  • Pain deep in the groin on the affected side

  • Swelling

  • Degeneration of joint cartilage

  • Loss of active and passive range of motion in severe osteoarthritis (OA)

General Considerations

  • Cartilage loss and OA symptoms are preceded by damage to the collagen-proteoglycan matrix

  • The etiology of OA is often multifactorial, including

    • Previous trauma

    • Prior high-impact activities

    • Genetic factors

    • Obesity

    • Rheumatologic or metabolic conditions

  • Femoroacetabular impingement, which affects younger active patients, is considered an early development of hip OA


  • In the United States, the prevalence of OA will grow as the number of persons over age 65 years doubles to more than 70 million by 2030

Clinical Findings

  • Pain in the affected joint with loading of the joint or at the extremes of motion

  • Swelling, grinding, catching, and locking

  • Pain can also produce the sensation of "buckling" or "giving way"

  • The most specific findings to identify hip OA

    • Squat causing posterior pain (sensitivity, 24%; specificity, 96%)

    • Groin pain on passive abduction or adduction (sensitivity, 33%; specificity, 94%)

    • Abductor weakness (sensitivity, 44%; specificity, 90%)

    • Decreased passive hip adduction (sensitivity, 80%; specificity, 81%)

    • Less passive internal rotation (sensitivity, 66%; specificity, 79%) compared with the contralateral leg


  • Radiographs

    • Preferred view: anteroposterior weight-bearing of the pelvis with a lateral view of the symptomatic hip

    • Joint space narrowing and sclerosis suggest early OA

    • Findings of femoroacetabular impingement are commonly reported

    • Sensitivity of radiographs is low (sensitivity 36.7%, specificity 90.5%)

  • MRI

    • Labral changes are seen in almost 70% of asymptomatic patients over age 35

    • Factors that suggest progression to total hip replacement

      • Osteophytes near the femoral head or acetabulum and subchondral bone cysts (advanced Kellgren and Lawrence grade)

      • Superior or (supero) lateral femoral head migration

      • Subchondral sclerosis


Conservative measures

  • Activity modification

  • Proper footwear

  • Therapeutic exercises

  • Weight loss

  • Use of assistive devices (such as a cane)

  • Analgesics may be effective in some cases


  • Joint replacement surgeries

    • Effective and cost-effective for patients with significant symptoms and functional limitations

    • Provide improvements in pain, function, and quality of life

  • Hip resurfacing surgery is an alternative for younger patients

Therapeutic Procedures

  • Corticosteroid injections can be considered for short-term relief of pain

  • Hip injections are best performed under fluoroscopic, ultrasound, or CT guidance to ensure accurate injection in the joint


Follow Up

  • Guidelines recommend prophylaxis for venous thromboembolic disease for a minimum of 14 days after arthroplasty of the hip using

    • Warfarin

    • Low-molecular-weight ...

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