Hip Osteoarthritis

Osteoarthritis (OA) is a disease that affects the bone and cartilage of a joint and is most commonly found in the hip and knee (Lane et al., 2011). Cartilage is known as the elastic material that covers and protects the outer surface of the bones that form the joint. OA of the hip is shown to be the failure of the body’s ability to repair any cartilage that has been damaged in the hip joint (Lane et al., 2011).  OA of the hip joint can result in significant symptoms such as pain and stiffness in the hip that become worse with activity. Normally, these symptoms are relieved by rest and resurface again with activity. These symptoms tend to become gradually more apparent over the course of a few years, as the OA progresses. OA also damages the ligaments and muscles surrounding a joint and some cases lead to inflammation (Arden & Nevitt, 2006). OA is commonly diagnosed by the combination of joint symptoms and structural pathology (e.g. on X-ray). (Pisters et al., 2007).If the degeneration is advanced enough, a surgical process of total hip replacement may be needed, however if addressed early enough OA can often be treated conservatively without the need for surgery.

What causes Osteoarthritis?

As previously mentioned, lining each of our joints is a substance known as articular cartilage. It has special properties that make it an excellent shock absorber and protective covering for the surfaces of bones in our joints. Specifically, in the hip there is cartilage covering the ball-like head of the femur, as well as lining the cup-like pocket of the hip known as the acetabulum. Surrounding this joint is a capsule containing synovial fluid, allowing the two bones to move past one another with very little resistance.

As we put weight through our joints, damage can occur to the cartilage as it absorbs the impact of our movements. This is completely normal, and we regenerate the damaged cartilage keeping our joints moving properly. The process of OA begins when our cartilage becomes unable repair itself and continue covering the underlying bone properly. When this happens the bone beneath the cartilage thickens in response to the increased pressure or force, which is no longer being softened to the same extent by the cartilage (Shahiraz & Wainright, 2018). This bony growth further increases the damage to the cartilage, and aggravates the surrounding joint capsule causing inflammation and pain.

If the disease progresses untreated and unmonitored, the bone can continue to thicken with the cartilage thinning and wearing away until no cartilage remains. This leaves just thickened bone with very little space left in the joint to move, as well as a very irritated synovial joint capsule causing pain with movement.

Am I at Risk of Developing Hip Osteoarthritis?

Hip OA is one of the most disabling conditions primarily affecting those as they age. For example, in those aged 85 there is roughly a 25% risk of developing hip OA. (Murphy, Eyles, & Hunter, 2016). OA most often occurs in joints that are exposed to heavier than normal workloads over a long period of time. It can also be triggered by those with joints formed differently or who have experienced joint injuries in the past (Murphy, Eyles, & Hunter, 2016). Risk factors for OA can be separated into those at the level of the joint and the level of the whole person. At the level of the joint the most significant factor is an abnormal hip joint (i.e. Hip dysplasia or femoroacetabular impingement) which leads to increased stress on the hip joint over time. (Murphy, Eyles, & Hunter, 2016).  Your age, sex, weight, and occupation are some of the risk factors that can also influence your risk of developing hip OA.

How do I know if I have Hip Osteoarthritis?

OA tends to affect individuals differently, but the most common symptoms of OA in the hip are pain and stiffness, which becomes worse with activity and feels better with rest. The hip will often feel stiff and painful first thing in the morning, improving within an hour. This stiffness and pain will seem to gradually become worse and worse, while being difficult to pinpoint a specific day or moment when the hip started feel stiff and painful.

This is a process that can occur over several years, progressing very slowly. Coming in to see a physiotherapist, or your family doctor about medical imaging of the hip can help diagnose if the pain you’re feeling is related to OA or a different condition. The earlier you know, the more can be done to limit further damage and manage the condition.

I have Hip Osteoarthritis, how can Physiotherapy help?

Physiotherapy can help to assess the state of your current hip OA, as well as plan for the future. PT’s can help with giving you proper education on OA and can create an individualized program to help you increase your general mobility, strength, flexibility, and manage your symptoms surrounding the hip joint. The individualized programs consist of exercise prescription to help reduce pain and improve the quality of movement in the hip joint and improve your overall quality of life. The conservative strategies that physio can provide may be enough to help you continue moving and get on with your life without causing further damage (Shahiroz & Wainright, 2018), potentially preventing the need for a hip replacement. If you are a candidate

for hip replacement, physiotherapy prior to treatment can help you to prepare for the upcoming surgery. A large predictor of successful outcomes following surgery is the functional status and preparation before, so early management is a key to ensuring the best recovery possible.

Final Thoughts on Osteoarthritis

OA is a painful and potentially disabling condition for individuals as they age. However, there are ways to prevent the disease from progressing, and ways to manage it even after pain and stiffness are already present. Physiotherapy can help conservatively manage and treat painful and stiff joints, while planning for the future and what treatments you may need. In the instances where surgery is required, physiotherapy can help prepare you before, and get back to moving after surgery. If you’re experiencing pain and stiffness when you’re moving, come see the physiotherapists at Family Physiotherapy, they’re here help you move and feel your best.

References

Arden, N., & Nevitt, M. (2006). Osteoarthritis: Epidemiology. Best Practice & Research Clinical Rheumatology,20(1), 3-25. doi:10.1016/j.berh.2005.09.007

Department of Physical Therapy. (2017). CP-Hip-OA-2017-18. Toronto: University of Toronto.

Lane, N., Brandt, K., Hawker, G., Peeva, E., Schreyer, E., Tsuji, W., & Hochberg, M. (2011).

OARSI-FDA initiative: defining the disease state of osteoarthritis. Osteoarthritis and Cartilage,19(5), 478-482. doi:10.1016/j.joca.2010.09.013

Murphy, N. J., Eyles, J. P., & Hunter, D. J. (2016). Hip Osteoarthritis: Etiopathogenesis and Implications for Management. Advances in Therapy,33(11), 1921-1946. doi:10.1007/s12325-016-0409-3

Pisters, M. F., Veenhof, C., Meeteren, N. L., Ostelo, R. W., Bakker, D. H., Schellevis, F. G., & Dekker, J. (2007). Long-Term effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: A systematic review. Arthritis & Rheumatism,57(7), 1245-1253. doi:10.1002/art.23009

Shahiroz, J., & Wainright, A. (2018, January 23). Osteoarthritis and the Role of the Physiotherapist Across the Continuum of Care. Lecture presented in University of Toronto, Toronto.