Hip Arthritis - What You Should Know

The hip is a multidimensional joint designed to provide adequate mobility and strength for daily activities. It is a ball-and-socket joint, with the ball being formed by the top of the thighbone and the socket being formed by a notch in the pelvis (called the acetabulum). This intricate joint is protected by cartilage, synovial fluid, and other connective tissue designed to provide the correct balance of stability and flexibility. The surrounding muscles play a role in support too. When any connective tissue starts to wear out, become unbalanced, or inflamed, it can result in the onset of hip arthritis. Keep reading to learn more about hip arthritis, the different types, causes, symptoms, diagnosis and how to get started with treatment.

Definition of Hip Arthritis

Arthritis is defined as wearing out of the protective cartilage within a joint that allows smooth, pain-free movement. This compromises the integrity of the joint surfaces and can affect the quality of life due to the onset of symptoms. Cartilage is most commonly worn out in the hip joint with repetitive everyday moves, also known as wear and tear. However, chronic inflammation or an auto-immune response can also affect cartilage health.

Types of Arthritis that Affect the Hip

There are two more common types of hip arthritis and three more obscure types as well. Regardless of the type, the result is cartilage damage that leads to pain and stiffness. The types of hip arthritis include the following:

Osteoarthritis (OA)

Osteoarthritis of the hip is the most common form of hip arthritis and is related to wear of the joint with daily activity. With aging, particularly over 65 years of age, the joint will gradually wear out. When the wear is excessive or uneven it can lead to symptoms like joint pain. It often only affects one hip at a time. It has been estimated that a person has a 25% risk of developing hip osteoarthritis in their lifetime.

Rheumatoid Arthritis (RA)

This form of arthritis is caused by an overactive immune system that leads to the body attacking its own healthy tissues. Smaller joints in the hands and feet are most commonly affected. However, any joint in the body can be affected including the hips. Most often, both hips are affected at the same time, due to the systemic nature of RA. Protecting the joint is essential with proper treatment and medication use to preserve the joint and minimize tissue damage.

Post Traumatic Arthritis

This latent form of arthritis is common after a previous injury to the hip. Examples include fracture of the femur or pelvis, dislocation, or a sprain of the hip. Initial damage or imbalances within the joint can lead to late onset of arthritis symptoms years, or even decades, later. This type of arthritis is most common in younger adults, particularly athletes that participate in high-impact sports.

Systemic Lupus Erythematosus (SLE)

Like RA, SLE is caused by an overactive immune system. While there are different forms of lupus, SLE is the most common form and can lead to hip damage. The biggest risk is the loss of blood flow to the femoral head (the ball of the joint) that can compromise bone health and lead to fracture and the need for a hip replacement. Psoriatic arthritis is another inflammatory autoimmune disease that can affect the hips and present similarly to SLE too.

Ankylosing Spondylitis

This type of inflammatory arthritis affects the hips and back. The cause is ultimately unknown, with genetics seeming to play the largest role. The inflammation eventually results in severe loss of range of motion within the hip and joint wear due to changes in the joints directly adjacent to the hips, like the low back and sacroiliac joints.

Symptoms

The exact symptoms experienced with hip arthritis will vary with each individual and the type of arthritis they are suffering from. We will focus on OA symptoms since they are by far the most common. One symptom that can differentiate OA from the inflammatory types RA and SLE is the presence of heat and swelling. OA is typically free of heat, swelling, and redness, whereas these are hallmark signs of RA and SLE. Additionally, OA and post-traumatic arthritis are most often present unilaterally (on one side) too.

• The most common first signs of hip arthritis include hip pain and stiffness in the hip joint itself
• Limited hip joint range of motion and general stiffness
• Secondary pain within the groin, buttocks, outer thigh, or even the knee
• Pain that radiates down the inner thigh
• A popping or grinding sensation within the joint, known as crepitus, with movement
• A locking or sensation of “getting stuck” with leg movement
• Increased difficulty with normal daily activities, such as walking, bending over, getting dressed, and sleeping 
• Onset of a limp with walking
• Pain and stiffness that gradually worsens over time

How Does Hip Arthritis Develop?

There are a few primary risk factors that can play a role in the development of hip arthritis. With the onset of hip arthritis, symptoms can progress quickly as hip function becomes compromised and affects a person’s ability to participate normally in their life. Again, this will depend on the type of hip arthritis too.

• Genetic factors and family history (most common with RA and SLE)
• Structural problems of the hip that cause imbalanced cartilage wear- these include issues like hip dysplasia and femoroacetabular impingement
• Advancing age
• Being overweight or obese
• A prior injury to the hip joint
• Poorly managed autoimmune disease- not keeping up with medication recommendations for reducing the effects of inflammation
• Poor lifestyle choices affecting general tissue health such as being sedentary, eating too much processed food, and neglecting sleep 

What Causes Symptoms to Flare-Up?

When it comes to OA, symptoms can lead to changes in movement patterns that can further aggravate the issue. For example, if you start to limp because of pain, this will actually lead to further uneven wear of the hip joint itself, which can lead to issues like bone spurs. This is what makes getting proper treatment from a physical therapist as early as possible essential to prevent unnecessary damage. OA flare-ups are most often attributed to too much (repetitive motion) or too little activity for the hip joint.

With RA and SLE, flare-ups are tied to systemic management of the disease. Improper medication dosage can be one cause. However, triggers for a flare-up are most often associated with overdoing daily activity, poor stress management, trauma, infection, or even weight gain. This is where following your doctor’s recommendations closely and maintaining optimal healthy lifestyle habits is essential.

How is it Diagnosed?

Diagnosing hip arthritis starts with talking to your medical professional. They will start with doing an in-depth physical exam and asking you about your medical history. Your orthopedic doctor will assess hip strength, range of motion, and how you are moving. This will help them determine if your pain is truly coming from your hip joint. It is important to be able to differentiate pain between the back, hips, and knees.

If arthritis is suspected and the symptoms are moderate to severe, an X-ray is most often ordered. This will help your doctor assess joint space and cartilage health within the hip joint. Plus, it can rule out other issues in adjacent areas like the pelvis and lower back. Additionally, an MRI or CT scan may be ordered to get a better look at any affected connective tissue within the joint itself.

What to Do Next

The two primary nonsurgical treatment recommendations for hip arthritis will revolve around medication for symptom management, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids, and making lifestyle changes. With a round of physical therapy, you can learn to optimize hip use and keep it as strong and flexible as possible with exercise and modalities for pain relief. Additionally, you may need a weight loss program or better nutrition. If symptoms are severe, surgery- such as arthroscopy or total hip replacement; may be necessary to restore function to the hip.

Learn More About Managing Hip Arthritis

Outlook on Hip Arthritis

While cartilage cannot be restored, further damage can be prevented with the right treatment. The good news is that with early detection and a thorough program, symptoms can be well managed. This means the quality of life is better preserved and the need for hip replacement surgery is minimized. Always talk to your healthcare professional about your concerns to get the best possible medical advice and treatment.

Resources:

https://creakyjoints.org/symptoms/arthritis-in-hips/

https://www.ortho.wustl.edu/content/Patient-Care/3207/Services/Hip-Knee/Adult-Reconstruction-and-Hip-Preservation-Overview/Arthritis-of-the-Hip.aspx

https://www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/syc-20351925

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