Your hip is a weight-bearing joint that you regularly use, and it's common for your cartilage to break down over time due to hip osteoarthritis. When cartilage weakens, your pain intensifies, making it difficult to enjoy everyday activities. If you're experiencing hip pain, it's essential to take action that improves your quality of life.
What is hip osteoarthritis?
Hip osteoarthritis (OA) is a progressive process where the cartilage breaks down or gets damaged. Without this smooth and slippery cartilage, your bones rub against each other, causing bone spurs. With osteoarthritis, hip pain may start gradually and progressively worsen.
Osteoarthritis occurs in the hands, knees, spine, and hips, affecting more than 32.5 million U.S. adults, according to the Centers for Disease Control and Prevention.
Your hips are ball-and-socket joints made up of:
- Acetabulum: The cup-shaped portion on the side of the pelvis that creates a socket for your thighbone.
- Femoral head: The upper part of your femur or thigh bone that looks like a ball and fits into the acetabular socket.
- Articular cartilage: This smooth lining, called synovium, creates a fluid that essentially greases your joints for easy movement.
- Osteophytes: Also called bone spurs, osteophytes form in joints lacking enough cushion or cartilage.
The stages of hip osteoarthritis
Since hip osteoarthritis is an irreversible degenerative disease, there are four stages people go through. You may not notice problems in the initial stage or quickly brush occasional pain off to something else. But, your condition will get gradually worse and cause you more pain as you enter later phases.
Phase one is considered minor. You may feel occasional stiffness, but it's trivial and doesn't affect daily activities. If you have a history of OA in other joints, you may adjust your exercise routine or diet to slow progression.
Phase two is mild. You start noticing brief periods of discomfort and stiffness, often after periods of no movement, and bone spurs begin forming. You can see bone spurs on an X-ray, and doctors may recommend a brace or physical therapy.
Stage 3: Moderate
Phase three moves you into moderate OA. Inflammation occurs from cartilage erosion resulting in pain occurring more frequently and intensely during routine activities. Physicians may suggest additional therapies to reduce pain.
Stage 4: Severe
Phase four is severe. An increase in bone spurs and inflammation combined with diminished cartilage leads to pain that's excruciating and constant. In many cases, the bones rub against each other, and it’s difficult to manage the pain. At this stage, doctors recommend surgery.
Hip osteoarthritis symptoms
Although hip osteoarthritis symptoms vary by person and stage, many people feel noticeable differences that continually worsen until it's impossible to simply chalk it up to age. Dr. Vladimir Alexander, Founder of Alexander Orthopaedics, says, "It feels like they have either buttock pain, groin pain or pain on the outside of the thigh."
At first, you may notice some stiffness after a period of inactivity. However, you also may have one or more symptoms, including:
- Radiating pain moving from your thigh or groin area to your butt or down your legs
- Increased tenderness when you press down near your hip joint
- Stiffness or a locking sensation where it feels hard to move your hip or leg
- Swelling or hard lumps around your hip joint
- Noises like popping or a grating sensation when you move
- Feeling pain when doing ordinary things, like shifting your legs while sleeping
- Walking with a limp or noticing increases in pain after strenuous activity
What causes hip osteoarthritis?
According to Dr. Alexander, "The primary cause of hip arthritis is mostly related to genetic predisposition, meaning people are predisposed to having it based on their genes. It happens, slowly and attritionally — gradually and over time." Risk factors for hip OA consist of:
- Genetics: Having a family history of osteoarthritis.
- Age: As you get older, you're more likely to develop OA.
- Obesity: Excess weight stresses weight-bearing joints, and fat tissue is prone to inflammation.
- Repetitive motion: Manual labor or activities that use your hip in the same way for long periods increases joint stress.
- Injuries: Previous injuries may heal but increase your risk of OA.
Pre-existing conditions: Abnormal joint or cartilage formation may predispose you to OA
- Sex: OA occurs more frequently in women.
- Lifestyle: A sedentary lifestyle, typical with office work, increases your risk.
- Other diseases: Metabolic conditions, like diabetes and hemochromatosis, affect bone and cartilage health.
How is hip osteoarthritis diagnosed?
Initially, you may start with your family physician, who uses clinical indicators to rule out other causes of pain and looks at factors like your pain level and frequency and hip flexibility range. During a physical examination, your doctor will ask you questions and request that you move in specific ways to review:
- Hip tenderness
- Range of motion
- Pain with pressure
- Changes to your gait
- Presence of a grating sensation
- Signs of muscles, tendons, or ligaments injuries
They may order diagnostic tests, like an X-ray, also called plain radiographs. X-rays show disease features like a narrowing of the space between your joints, suggesting cartilage damage or loss.
In some cases, doctors may request other tests such as a bone scan, magnetic resonance imaging (MRI) scan, or a computed tomography (CT) scan. An MRI shows deteriorated cartilage, bone fragments, fluid build-up, and soft tissue inflammation. With a CT scan, your doctor can see bone spurs in relation to other soft tissues, whereas a bone scan rules out other concerns and further aids in OA diagnosis.
If you have excessive swelling, your physician may drain fluid to rule out other conditions, such as gout. Lastly, your doctor may refer you to a rheumatologist, rehabilitation specialist, or orthopedic surgeon.
What is the treatment for hip osteoarthritis?
During the early stages of hip osteoarthritis, doctors suggest nonsurgical courses of action. While these don't stop the disease progression, it can slow it down and give you a higher quality of life. Dr. Alexander says, "Hip osteoarthritis can be treated with anti-inflammatories or pain medication; sometimes an injection of cortisone into the hip. If those things don't work, we discuss a hip replacement." Other treatment options include:
- Changes to lifestyle: Losing weight or doing low-impact activities, like swimming instead of high-impact exercises such as running, may help protect your hip joint.
- Physical therapy: Working with a therapist enables you to strengthen hip and leg muscles and increase movement flexibility. You'll also get a list of exercises you can do at home.
- Supportive devices: Tools that help you avoid painful movements, like a cane or walker, let you keep up with regular activities. Doctors may also recommend a brace or alternating heating and cooling elements.
According to Dr. Alexander, "The appropriate definitive treatment for hip arthritis is hip replacement, also known as hip arthroplasty." This procedure removes worn portions of your hip joint and replaces it with an artificial one.
An artificial hip uses materials that are flexible and strong, like metal, plastic, or ceramic. The femoral stem replaces your femur and may use a titanium blend, which is a very strong element. You'll work with your doctor to determine the best implant for you, along with a follow-up plan for therapy after your procedure.
What is the hip osteoarthritis recovery process?
As a degenerative disease, full recovery is not possible unless you get a hip replacement. But, you can take several measures to improve your quality of life and slow progression until it's time for hip surgery. Many people start by talking with an orthopedic surgeon specializing in the musculoskeletal system's care, including your bones and joints.
If you have hip problems, you may wonder if walking is good for hip osteoarthritis, and the answer is — it depends. Dr. Alexander says, "Walking is good for everything because walking moves and circulates the natural joint fluid through the joint. Joint fluid maintains healthy cartilage and maintains overall the healthy feeling of the body to stay active. However, when you have an arthritic joint, it's sometimes not easy to walk, so it can be very painful to walk. So it's not for everyone, and in certain scenarios, doing walking, physical therapy, or exercising is actually detrimental depending on the severity of the condition. If the arthritis is very severe, then walking is really not an option — you've got to feel better before you can walk — and those are the people who probably need surgery sooner than later."
Your physician may suggest techniques like using ice and heat, stretching, and passive movement exercises. Often your recovery includes assistance from occupational therapists or even dietitians to support each aspect of wellness.
Early interventions, such as losing weight or adjusting your exercise routine, let you enjoy your life with less pain. Take steps towards recovery and discuss possible solutions by scheduling an appointment with the experts at Alexander Orthopaedics.