Hip Osteoarthritis

Hello and welcome back to the ThreeSpires Physiotherapy blog where we take a look at all things physiotherapy and health related. In this blog we are going to follow on from our 2 latest blogs: Hip Pain & Gluteus Medius Tendinopathy and look at a common cause of hip pain: osteoarthritis.

Before looking at how physiotherapy might be able to help with hip arthritis we first need to have a look at exactly what it is and some anatomy.

What is Osteoarthritis?

Osteoarthritis or more commonly arthritis is a degenerative joint disease that primarily affects the cartilage, the protective tissue covering the ends of bones in a joint. It is the most common form of arthritis and typically occurs in weight-bearing joints such as the knees, hips, spine, and hands. Osteoarthritis gradually develops over time and is often associated with aging, though it can also be caused by joint injuries, repetitive stress, or underlying joint abnormalities. In a healthy joint, cartilage acts as a cushion, providing a smooth surface for the bones to move against each other. In osteoarthritis, the cartilage gradually breaks down and wears away, leading to joint pain, stiffness, and reduced mobility. As the disease progresses, other structures within the joint, such as ligaments, tendons, and bone, can also be affected.

What is Cartilage?

Cartilage is a tough, flexible, and rubbery connective tissue found in all joints in the body. It serves as a structural component in joints, providing support, cushioning, and smooth surfaces for movement. Cartilage is composed of specialized cells called chondrocytes embedded in a matrix of collagen fibres and proteoglycans. There are in fact a few types of cartilage but for our purooses we simply need to know about: hyaline cartilage: This is the most common type of cartilage and can be found in areas such as the ends of long bones, the nose, the trachea, and the larynx. Hyaline cartilage provides a smooth surface for joint movement, reduces friction between bones, and helps absorb shock. Cartilage is avascular, meaning it does not have its own blood supply. It receives nutrients and oxygen through diffusion from nearby blood vessels in the surrounding connective tissues. This limited blood supply contributes to the slow healing and limited regenerative capacity of cartilage.

What Does Cartilage Do?

In joints, cartilage acts as a cushion between bones, allowing smooth movement and absorbing shock during weight-bearing activities. It helps distribute forces evenly across the joint surface, preventing excessive stress and wear on the bones. Cartilage also provides structure to certain body parts, maintaining their shape and allowing them to perform their functions effectively. While cartilage has some self-repair capabilities, it has a limited capacity for regeneration, especially in cases of significant damage or disease. Injuries or conditions that lead to the loss or deterioration of cartilage, such as osteoarthritis, can result in pain, stiffness, and reduced joint function.

What are the Symptoms of Hip Arthritis?

It can cause a range of symptoms that can vary in severity from person to person. Some common symptoms of hip arthritis include:

1. Joint pain: Persistent or intermittent pain in the hip joint is a hallmark symptom of hip arthritis. The pain is often described as a dull ache or throbbing sensation in the groin, outer thigh, buttocks, or even the knee. It may worsen with weight-bearing activities such as walking or standing for extended periods.
2. Stiffness: Individuals with hip arthritis may experience stiffness in the hip joint, especially after periods of inactivity or upon waking up in the morning. This stiffness may gradually improve with movement throughout the day.
3. Reduced range of motion: As hip arthritis progresses, the range of motion in the affected hip joint may become limited. Activities such as bending, squatting, or rotating the hip may become difficult and painful.
4. Joint instability: Some individuals with hip arthritis may experience a feeling of instability or weakness in the hip joint. This sensation can lead to a sense of the joint "giving way" or increased risk of falls.
5. Swelling and inflammation: Inflammation of the hip joint may occur in response to the breakdown of cartilage. This can lead to localized swelling and tenderness around the hip area.
6. Hip joint deformity: In advanced cases of hip arthritis, bone spurs or osteophytes may develop around the joint, leading to visible enlargement or deformity of the hip joint.

It's important to note that the progression and severity of symptoms can vary among individuals. Some people may experience mild discomfort and minimal functional limitations, while others may have more severe symptoms that significantly impact their daily activities and quality of life.

Who Can Get Hip Arthritis?

Well to be honest, anyone with a hip can get hip arthritis but while it is more commonly associated with older adults, it can also occur in younger individuals due to certain risk factors or underlying conditions. Below are some factors that can increase the likelihood of developing hip arthritis:

1. Older People: Unfortunately the risk of developing hip arthritis increases with age and there seems to be little that we can do to change this fact. As cartilage naturally wears down over time, the chances of developing osteoarthritis, including in the hip joint, tend to increase.
2. Females: as with many other conditions women are more prone to developing hip arthritis than men, particularly after menopause. Hormonal changes and differences in joint structure may contribute to this disparity.
3. Anyone Overweight: Research has shown a clear link between very high BMI (obesity) and joint arthritis, the reasons are most likely complex but it seems fair to say that excess weight places additional stress on weight-bearing joints, including the hips. This can accelerate the degeneration of cartilage and increase the risk of hip arthritis.
4. If you have previous joint injuries: Previous hip injuries, fractures, or structural abnormalities in the hip joint, such as developmental dysplasia or hip impingement, can increase the likelihood of hip arthritis.
5. People who have osteoathritis in the family: There is unfortunately a strong genetic component to hip arthritis. If you have a family history of osteoarthritis, especially in the hip joint and for example your mother and grandmother had hip arthritis then you will be more likely to have it as well.
6. People with other medical conditions: Certain conditions, such as rheumatoid arthritis, gout, or congenital disorders like Ehlers-Danlos syndrome, can increase the risk of hip arthritis.

What Causes Hip Arthritis?

This is very much the subject of research and it is generally thought that a range of factors contribute to the development of osteoarthritis of the hip:

1. Age: As discussed earlier, unfortunately age is a major cause or at least risk factor for developing hip arthritis and the risk of hip arthritis increases with age. As you get older, the cartilage that cushions your joints tends to wear down, leading to inflammation and arthritis developing.
2. Genetics: Modern research has found that there is unfortunately a large genetic component to the development of hip arthritis, certain genetic factors can make individuals more susceptible to joint damage and cartilage deterioration. As such if many of your relatives have hip arthritis, there is a higher risk of you developing hip arthritis.
3. Joint injuries: Previous injuries to the hip joint, such as fractures, dislocations, labral tears or cartilage injuries can increase the likelihood of developing hip arthritis later in life. Injuries can disrupt the normal structure of the joint and accelerate cartilage breakdown.
4. Joint abnormalities: Structural abnormalities of the hip joint, such as hip dysplasia (a condition where the hip socket is shallow), femoroacetabular impingement (FAI), or Perthes disease, can contribute to the development of hip arthritis.
5. Obesity: Excess weight puts added stress on the hip joint, which can lead to the breakdown of cartilage over time. Obesity is a significant risk factor for hip arthritis and can worsen its symptoms.
6. Inflammatory conditions: Some inflammatory conditions, such as systemic lupus erythematosus, can affect the hip joint and lead to arthritis.

It is important to remember that a range of factors can cause hip arthritis and that if you suspect you have a hip arthritis then you should have it investigated and assessed.

How is Hip Osteoarthritis Diagnosed?

In general osteoarthritis of the hip is usually diagnosed through a combination of a thorough physical examination, a review of symptoms, and imaging with x-rays. Below is a short summary of a usual process:

1. Physical Assessment: A physiotherapist or possibly GP (who is likely to refer onwards to a physio), will begin by conducting a physical examination. They will assess your hip movement and possibly look at your gait when walking.
2. Review of Symptoms: The physiotherapist will ask about your symptoms, including the location, intensity, and duration of pain, as well as any factors that aggravate or alleviate the symptoms. They will also inquire about your activity level, any previous hip injuries, and your overall medical history.
3. Imaging: Unlike many other conditions where imaging is a last resort, x-ray imaging is a routine part of diagnosing hip arthritis and your doctor if he thinks it likely that you have osteoarthritis of the hip will order an x-ray.

Treating Hip Arthritis

Unfortunately there is currently no tested method that successfully repairs joint cartilage and as such treatment for osteoarthritis of the hip centres around activity modification, understanding the nature of arthritis and strengthening and physiotherapy. Once you have a diagnosis of hip arthritis the following would be a usual treatment process:

1. Education: it is essential to have a good understanding of what arthritis is and how it is likely to affect you and as such becoming knowledgeable about it is the first part of any successful treatment. In general a physiotherapist should be able to help with this.
2. Activity Modification: In conjunction with your physiotherapist you need to decide if there are any activities that are particularly provocative and decide if you should either avoid or modify these. There is no simple answer to this and total rest is in general not the answer. It is best to have an assessment with a physio for this.
3. Physiotherapy: A structured physiotherapy program will be a key component of treatment for hip arthritis. The focus is on strengthening the hip muscles, improving balance and general core strength.
4. Pain Management: Various pain management techniques may be employed to alleviate discomfort. These can include:
   •  Ice or Heat Therapy: Applying ice packs or heat pads to the affected area can help reduce pain and inflammation. Ice is typically recommended in the acute phase to control swelling, while heat may be used to promote blood flow and relaxation of the muscles during the recovery phase.
   • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter NSAIDs, such as ibuprofen or naproxen, can help reduce pain and inflammation. It's important to follow the recommended dosage and consult with a healthcare professional before taking any medication.
   • Corticosteroid Injections: In some cases, corticosteroid injections may be considered to provide short-term pain relief and reduce inflammation. These injections are typically administered under guidance using ultrasound or fluoroscopy.
5. Joint Replacement: If your hip arthritis has progressed too far and your symproms do not respond to either physiotherapy or analgaesia then replacing the joint will be the final option. This is usually a highly successful operation and most patients will get a very good result.

How Can ThreeSpires Physiotherapy Help with My Hip Arthritis?

Physiotherapy can be extremely useful if you have been diagnosed with hip arthritis or suspect that you may have it and one of our physiotherapists will be able to help with:

1. Assessment & Diagnosis of Hip Arthritis: this is a vital part of dealing with your hip arthritis and the sooner you have an assessment the sooner you will know what you are dealing with. Our physiotherapists will be able to comprehensively assess your hip, make a diagnosis of the underlying cause of your pain and refer on for imaging if needed.
2. Management Plan: once a diagnosis of osteoarthritis of the hip has been made it is vital that you get a clear and comprehensive plan to begin managing your condition.
3. Exercises for Hip Arthritis: your physiotherapist will be able to determine which are the most appropriate exercises for your hip arthritis and will be able to prescribe the optimum number and frequency to promote recovery.
4. Hands on Treatment: In conjunction with load management and exercises your physio will be able to use soft tissue and hands on techniques to treat any areas that have become overloaded and tight such as your back.

Okay, I hope that you have found this article about hip arthritis helpful and it is part of a series of articles that we will be completing over the next few months about each of the specific causes of hip pain. Should you or anyone you know have developed osteoarthritis of the hip please get in touch and one of our physios would be happy to help.