Hip osteoarthritis, hip arthrosis, hip wear, joint disease, joint wear, degeneration, age-related changes, hip degeneration, hip pain, hip discomfort, load sensitivity, morning stiffness, stiffness, aging
Osteoarthritis, also known as wear or arthrosis, is the most common joint disease in the world, and its prevalence increases with age. The underlying cause of osteoarthritis is not fully understood, but at the cellular and molecular levels, there are more degradative than constructive events in the joint cartilage's connective tissue and matrix. This leads to changes throughout the joint and surrounding tissues, resulting in a broad impact on a person's mobility and functional tasks over time.
Osteoarthritis is most commonly found in the knees, hips, finger and toe joints, and the facet joints between the vertebrae in the spine.
Osteoarthritis can be broadly categorized into two groups: primary and secondary osteoarthritis:
Primary Osteoarthritis: Joint degeneration without a visible underlying cause.
Secondary Osteoarthritis: Results from either abnormal force distribution in the joint, such as trauma-related reasons, or abnormal joint cartilage, such as rheumatoid arthritis.
In this text, we will take a closer look at hip osteoarthritis, exploring its background factors and treatment principles.
Overview of joint cartilage physiology
Cartilage is located at the ends of articulating bones and its main function is to cushion the impact on bones and facilitate movement between them. Cartilage is primarily composed of collagen and proteoglycans that bind water. This tissue lacks blood vessels and nerve endings, so the metabolism and nutrition of cartilage largely depend on pressure variations within the joint.
Pressure on cartilage forces fluid out of the tissue into the joint space. When the pressure subsides, osmotic pressure created by the negative charge of proteoglycans returns the fluid back to the cartilage. Thus, the physiological effects of joint loading play a crucial role in maintaining and improving the properties of cartilage.
Symptoms
Symptoms indicative of hip wear often begin with morning stiffness and possible pain in the hip or groin area. As wear progresses, pain and stiffness become more generalized and may bother individuals throughout the day. Movement becomes more challenging, and pain worsens if the hip is overstrained. Advanced wear often alters the shape of the hip joint, further limiting its mobility.
The hip typically exhibits symptoms after prolonged periods of inactivity, making it difficult to initiate movement. There may be cracking or popping sounds in the joint when squatting or standing up. While these joint sounds may initially seem alarming, they are generally harmless and result from diminished gliding properties of the worn cartilage. The intensity of joint sounds and pain does not appear to be correlated, although they can be concerning for individuals with hip osteoarthritis. Furthermore, joint sounds do not predict future pain or loss of functionality.
Typical symptoms of hip osteoarthritis include:
Pain in the groin area during movement and when initiating movement
Hip stiffness, especially in the morning
Reduced range of motion
Joint sounds
Pain after prolonged sitting or lying down
Hip or groin pain disrupting sleep
Dull, continuous ache
Difficulty supporting body weight on the affected leg
Epidemiology
Osteoarthritis is globally considered to be the most common joint disease. Knee osteoarthritis is slightly more common than hip osteoarthritis, but both are prevalent.
The disease primarily affects individuals over the age of 45, with both men and women being susceptible, although women are slightly more affected than men. Osteoarthritis can lead to increased pain sensitivity and reduced functionality, but it's important to note that not all osteoarthritic findings are necessarily painful. Radiographic studies indicate that the majority of detectable wear-related changes are in fact asymptomatic.
Hip osteoarthritis is classified as either primary or secondary based on its cause:
Primary Hip Osteoarthritis:
Results from the degeneration of joint cartilage without a known cause
Typically associated with age-related wear and tear, where there is more degradation than regeneration of joint cartilage
Secondary Hip Osteoarthritis:
Results from the degeneration of joint cartilage due to a known cause
Possible causes for secondary hip osteoarthritis include:
Obesity
Joint restriction or instability, such as following an injury
Joint misalignment, either congenital or post-traumatic
Previous joint injury, such as a fracture on the joint surface
Congenital defects
Immobilization and loss of mobility
Family history and genetic factors
Metabolic reasons
Abnormal anatomy
Normal joint cartilage maintains a balance in chemical reactions. However, as osteoarthritis develops, these reactions are disrupted, leading to changes in the collagen structure of the cartilage. This results in disorganized collagen and a reduction in the elasticity of the joint cartilage, leading to cracking and, eventually, erosion. The healing process of damaged cartilage is disturbed, and the cartilage continues to wear away. Once the cartilage is worn away, bony surfaces start to damage, leading to the development of edge formations that further expand and stiffen the joint. Often, this is accompanied by ligament laxity and muscle atrophy.
Treatment
Primary treatment for hip osteoarthritis is conservative, involving a combination of pharmacological and non-pharmacological pain management methods, as well as a progressive exercise program designed by a physiotherapist. The goal of treatment is to alleviate pain and improve functional and work capacity.
In hip osteoarthritis, strengthening the muscles surrounding the joint and improving mobility are crucial. This is achieved through a precise, progressive, and individualized exercise program, often including mobility-enhancing exercises and manual therapy. Exercising should start moderately to avoid exacerbating symptoms.
While there is no medication that cures osteoarthritis, pharmacological treatment aims to alleviate symptoms. Pain and anti-inflammatory medications are the primary options, but if these are not effective, opioids or intra-articular injections of corticosteroids or hyaluronic acid may be considered. Consultation with a specialist in osteoarthritis and pain management is advisable in such cases.
Joint replacement surgery becomes an option when conservative treatment, such as physical therapy, fails to achieve the desired results and the patient experiences severe pain and functional impairment. Joint replacement surgeries often yield excellent results, relieving many symptoms. Combining surgery with postoperative physiotherapy ensures that the muscles surrounding the joint function properly and that mobility and function are optimized for long-term effectiveness.
Physiotherapy
Conservative treatment for hip osteoarthritis aims to reduce joint pain, increase mobility and stability, and improve the function and strength of the muscles surrounding the hip joint.
Physical therapy often involves a combination of the following:
Patient education and guidance
Exercise therapy
Modification of activities to reduce joint load
Weight loss counseling
Support for the hip joint
Passive and active pain management methods
Manual therapy to maintain joint mobility
Promotion of an active and healthy lifestyle
Strengthening the lower kinetic chain
Improvement of proprioception, agility, and balance
Enhancement of physical function
A combination of guided exercises and a home exercise program has been shown to produce positive results. Weight loss is beneficial at all stages of osteoarthritis, especially for individuals with symptomatic hip osteoarthritis and a body mass index (BMI) over 25. Weight loss strategies include balancing energy intake and expenditure and incorporating aerobic or daily-life activities. Strength training can also increase energy expenditure, helping to manage weight, provided that this increased energy use is not compensated by an increase in energy intake.
Below are some physiotherapy interventions and their main goals in the treatment of hip osteoarthritis.
With progressive training and load modification, the objectives are to:
Manage overall joint load
Reduce load on irritated tissues
Enhance the load-bearing capacity of muscle and tendon structures
Improve hip joint stability by strengthening surrounding muscles
Alleviate pain
Enhance functional capacity
Manual therapy aims to:
Alleviate pain and activate descending pain pathways
Reduce static muscle tension
Improve muscle and joint performance
Decrease cortisol secretion in tissues
Increase or improve blood circulation in treated tissues
Improve mobility
Decrease the perceived intensity of pain
Education and guidance seek to:
Provide sufficient information about the nature of the condition, its background, and rehabilitation to ease patient concerns and enhance self-efficacy
Offer information about the healing process and prognosis to motivate self-directed rehabilitation
Address factors that positively or negatively affect prognosis and timelines
Reduce patient uncertainty and concerns, making it easier to live with pain
For an individualized rehabilitation program and advice, individuals with hip osteoarthritis are encouraged to consult a physiotherapist specializing in lower limbs.
Self care
Maintain a healthy weight: Hip osteoarthritis places extra strain on joint structures, so a healthy weight helps reduce this burden.
Exercise regularly: Physical activity can help alleviate symptoms and improve joint mobility in hip osteoarthritis. Recommended exercises include walking, cycling, swimming, and water aerobics. Strengthening exercises reduce joint load and fortify the joints. However, it's essential to start these exercises gently and gradually increase the intensity over time. Excessive or strenuous training can aggravate an already sensitive hip joint.
Avoid prolonged standing or sitting: Extended periods of standing or sitting can increase hip strain and impair the sliding properties of joint cartilage.
Wear appropriate footwear: Shoes should be comfortable and provide necessary support for the soles of your feet and joints.
Use cold therapy: Cold treatments, such as ice packs or cold gel, can help alleviate pain and inflammation caused by hip osteoarthritis.
Try heat therapy: Heat therapy can relax muscles and relieve pain associated with hip osteoarthritis. Heat packs or warm gel can be used for this purpose.
Avoid walking on hard surfaces: Hard surfaces increase joint load and osteoarthritis symptoms, so it's better to avoid walking on such surfaces and opt for softer ones during walks.
Engage in strength training: Strength training exercises can help strengthen muscles and improve symptoms of hip osteoarthritis. A physiotherapist can assist in finding suitable exercises.
Ensure adequate rest: Sufficient sleep and rest aid in the body's recovery and may help alleviate symptoms of hip osteoarthritis.
It's important to note that hip osteoarthritis is a complex condition that often requires medical treatment and ongoing monitoring. Therefore, it's always best to discuss treatment options with a doctor or physiotherapist before starting an exercise regimen.
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