Osteoarthritis In The Hip

Spot The Early Signs And Take Action...

The Short Answer – Your hips are one of the hardest area to detect osteoarthritis. Unlike your fingers for example, osteoarthritis in the hip can be confused with a range of internal pains.

Unfortunately, early detection and a deliberate treatment campaign are the only ways to control it’s development. In this article, we consider the first part – how to spot it and how it is diagnosed.

Developments In Our Understanding Around Osteoarthritis In The Hip.

As I’ve covered in a number of published articles, the thinking around osteoarthritis is changing.

Traditionally considered a disease of wear and tear, scientists and clinicians are seeing that it begins from much wider damage to the joint.

The fact that osteoarthritis was more than just damage to the articular cartilage, changes both the potential signs of it’s development and it’s optimal treatment.

When spotting potential osteoarthritis in the hip, we should now be looking out for damage to any part of the joint including the synovium, subchondral bone, capsule, sensory nerve endings and periarticular muscles.

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Osteoarthritis – Prevalence In The Hip.

While osteoarthritis in general has a wide age range of affected sufferers, Hip osteoarthritis has a greater concentration towards the elderly.

According to the ‘Osteoarthritis and Cartilage’ journal, 25% of the those that live to 85 years old, will develop osteoarthritis in the hip. 

Why Does Osteoarthritis Develop In The Hip?

The hip is particularly vulnerable to osteoarthritis due to it’s fundamental construction. As well as being another key weight bearing joint, it relies on a ball-and-socket design.

  • The ‘socket’ is formed by what is known as the ‘acetabulum’ – this being part of the large pelvis bone.
  • The socket is known as the ‘femoral head’. In reality, its just the upper end of your thighbone (femur)

Both parts of the hip are covered with articular cartilage that acts like a cushioning for the bones, aiding mobility and preventing the bones rubbing together.

The surfaces of the ball and the socket are also covered by a thin lining known as a synovium. This produces synovial fluid that lubricates the cartilage to help prevent wear and tear.

The unique design of the hip lends itself particularly to the wear and tear aspect, because of the large amount of cartilage spread out across the joint.

 

Causes Of Osteoarthritis In The Hip

Medical science has yet to pinpoint the exact cause of osteoarthritis in any part of the body. However, in the hip it is thought that the following factors are potential causes –

Improper Formation Of The Hip joint

This is believed to create improper loading of weight on to your hips.

Depending on the exact type of joint deformity, could see you with early onset osteoarthritis of the hip, or see it developing much later in life.

The more subtle deformaties are likely to lead to much later development of OA.

The link between hip deformities and hip osteoarthritis goes back as far as studies published in 1945 (British Medical journal), but was largely ignored for many yeas, before being picked up again in 2003 by Ganz et al in The Journal of Clinical Orthopaedics and Related Research 

Developmental Dysplasia Of The Hip

A shallow and sometimes disjointed hip socket (acetabulum) can cause a decreased contact surface area for the ball. This leads to the full weighted force baring down on a smaller part of the socket, with resulting hip osteoarthritis in later life (The Journal of Bone and Joint Surgery. British Volume

Femoroacetabular Impingement (FAI)

This is considered to by Murphy et al to be

“a more prevalent underlying cause for the development of hip OA”

There are two basic types of Femoroacetabular Impingement – ‘cam’ and ‘pincer’ FAI.

I wont go in to much detail as the technical mode of action is probably not of interest. But for scholars, you can check a study of both types here 

There have been numerous studies showing that FAI is very influential when it comes to the development of Osteoarthritis in the hip.

In very simple terms, cam impingement occurs when a lesion in cam pushes up against the labram, forcing the albram to sperate from the cartilage and eventually delaminating cartilage for your thigh bone.

Pincer impingement is literally caused by acetabular over-coverage. In other words, too much lining around the edges of the socket leaves very little gap between for the ball to move without causing friction. This friction causes damage and ultimately osteoarthritis.

Periarticular Musculature of the Hip Joint

This is a weakness in the muscle that surrounds the hip. This muscle is designed to improve stability of the hip joint.
When it gets damaged or is weakened through lack of use/ a sedentary lifestyle, then both hips ability to prevent poor movement patterns or to absorb shock are compromised.

This leads to jerky pulls on the hip and greater shock/ force being felt by the hip – both of which ultimately lead to the faster development of osteoarthritis in your hip.

Previous Injury To The Hip

In the hip, a common injuy is the acetabular labral tear. This type of tear Is very common – estimated to be present in roughly two thirds of people with mechanical hip pain. (Osteoarthritis Cartilage).

Such a tear could easily occur following an accident (car crash etc), but could just as easily happen while turning in bed – pretty much anything that could lead to a sudden twist.

Exactly how much of a contributor to hip osteoarthritis is uncertain, although such injuries are very often present prior to developing OA.

It is however, openly accepted that any injury to the hip will increase your chances of developing hip osteoarthritis.

Family History Of Osteoarthritis

This is not necessarily in the hip, but anywhere. However, in the case of hip osteoarthritis the link between family genes and development of the disease is particularly strong.

In one study (Arthritis And Rheumatism) they put a figure on it, suggesting that genetics contributed approximately 60% of hip osteoarthritis risk. 

Obesity

Being a weight carrying joint, the more weight you are carrying, the higher the pressure on your hips and the greater the force of rubbing that takes place.

The correlation between the hips and your BMI is not as strong as between your knees and your BMI – but it is still very evident.

This is not just because of the increased loading however – obesity has also been found to promote various other pro-inflammatory factors that promote osteoarthritis.

This is actually proven because studies found that even hand osteoarthritis increased in overweight patients. Thee cant be weight loading issues with fingers and hands, so this must have been down to the inflammatory properties.

Sex

I have included this because for osteoarthritis as a whole it is a cause. However, osteoarthritis in the hip, there is no evidence backing up this link.

In actual fact, one analysis of 14,000 people actually found no difference in hip OA between men and women. (Osteoarthritis and Cartilage

This only backs up the point I make about different areas of the body needing to be considered very differently.

Age

Age is clearly a major in the development of forms of osteoarthritis – but not jut in the way you might imagine.

As well as the obvious fact that more age = more activity = more chance for cartilage to erode, there are a whole range of destabilising factors that kick in as you age.

These include hormonal changes, alterations in the density of your bones and ‘chondrocyte’ density.

All of which affect the strength and stability of your hips and contribute to the onset of osteoarthritis.

Diet

Deficiencies in certain vitamins such as vitamins D, K, and C have often been associated with the faster onset of osteoarthritis.

There is some evidence around the effect of vitamins D and C, but similarly some trials indicate no relationship.

Vitamin K has no direct evidence on any element of osteoarthritis, even though the theory suggests it could have an impact on bone mineralisation.

Early Signs Of Osteoarthritis In The Hip

Many sufferers report a dull pain that spikes after a range of activities. The primary early symptom is pain around the hip of course, but this can be categorised much further –

  1. Pain That Flares Up After Vigorous Activity
  2. Pain The Starts In Your Thigh Or Groin That Seems To Move to Your Knee Or Your Bum
  3. Pain That Occurs When Getting Up From A Seated Position
  4. Pain During Certain Movements Including Bending Down Or Getting In And Out Of The Car
  5. Pain While Jogging Or Playing Sports (Impact Activities)
  6. Pain That Is Reduced/ Relieved Altogether While Resting
  7. Pain That Gets Worse If You Rest Too Long. Inactivity for more than 30minutes aften causes stiffness and more pain.
  8. Early pain will typically be on one side only, as osteoarthritis doesn’t affect parallel joints at the same rate.
  9. Stiffness In Your Hip Joint. Often accompanied by a ‘crunching’ sensation when you start moving again.
  10. Stiffness After You Sit For A While, That Eases Following Movement.
  11. ‘Locking’ Of Your Hip Joint
  12. Increased Pain During Wet Weather
  13. Decreased Range Of Motion

Diagnosis For Osteoarthritis Of The Hip

History Analysis

Your dr will ask about…

  • a family history of osteoarthritis
  • whether you’ve had any particular hip injuries in the past
  • your levels of activity
  • your general health

Physical Examination

In the physical examination your dr will be looking for…

  • Tenderness around your hip
  • Range of motion
  • Pain levels when still/ during movement
  • Any signs of injury
  • Problems with the way you walk (Gait)
  • A grating sensation in your joint (technical term ‘crepitus’)

Blood Tests

While there is no specific blood test for osteoarthritis, tests can rule out other diseases that can present with similar symptoms such as rheumatoid arthritis.

X-Ray

This test looks for a physical narrowing of the joint space between the ball and socket in your hip. It can also spot bones spurs (growths on your hip bone) that form as a result of OA.

MRI

Very occasionally an MRI or even a CT scan can be used to determine the condition of your hip and the tissue around it.

The Final Word –

There is no cure for osteoarthritis.

Successful treatment revolves around strategies that stop your condition from getting worse.

It is also accepted that for late stage osteoarthritis, almost all treatments (except high dose opioids) will not have any effect.

So the key is early diagnosis and trying a variety of treatments to find which works.

Please check out our article on treatment for arthritis in the hip for advice on dedicated hip-related treatments that might be able to help.

It is a fact that many of us will get osteoarthritis at some point in our lives. If you ae ready for it however, it does not necessarily mean an end to the life you love.

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References Used –

1. L.B. Murphy, C.G. Helmick, T.A. Schwartz, J.B. Renner, G. Tudor, G.G. Koch, A.D. Dragomir, W.D. Kalsbeek, G. Luta, J.M. Jordan. (Nov 2010). One in four people may develop symptomatic hip osteoarthritis in his or her lifetime. Osteoarthritis and Cartilage.
2. GC Llody-Roberts. (1945) Osteoarthritis. BMJ Journals.
3. Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock K. Femoroacetabular impingement: a cause for osteoarthritis of the hip. The Journal of Clinical Orthopaedics and Related Research.
4. Klaue K, Durnin CW, Ganz R. The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. J Bone Jt Surg Br. 1991
5. Neumann G, Mendicuti AD, Zou KH, Minas T, Coblyn J, Winalski CS, Lang P (Aug 2007) Prevalence of labral tears and cartilage loss in patients with mechanical symptoms of the hip: evaluation using MR arthrography. Osteoarthritis Cartilage.
6. MacGregor AJ, Antoniades L, Matson M, Andrew T, Spector TD. (Nov 2000). The genetic contribution to radiographic hip osteoarthritis in women: results of a classic twin study. Arthritis Rheumatology
7. Srikanth VK, Fryer JL, Zhai G, Winzenberg TM, Hosmer D, Jones G. (Spet 2005). A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis. Osteoarthritis and Cartilage.

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