Osteoarthritis, 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

Demographics

• 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

Diagnosis

• 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

Treatment

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

Surgery

• 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

Outcome

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 ...