Arthritis of the Hip: An Overview

Introduction: Anatomy of the Hip

The hip joint is a “ball and socket joint” made up of the femur (thighbone) and the acetabulum (a part of the pelvis). In a healthy hip, a smooth cushion of cartilage sits between the head of the femur (ball) and the acetabulum (sockt), allowing them to glide together smoothly. The hip joint is supported by muscles that help provide stability and motion.

Arthritis is a disease that affects the cartilage in the joint. Damaged cartilage causes a roughened surface and may lead to a clicking and catching sensation with persistent pain and limited range of motion.

Hip Arthritis

There are three common types of arthritis:

Osteoarthritis (degenerative joint disease) – the most common type – is a progressive disease in which the cartilage is slowly worn down. The normally smooth surface of the joint becomes rough, which may cause pain, stiffness, and limited motion.

Rheumatoid arthritis (inflammatory arthritis) is a systemic process that may involve multiple joints at the same time. Rheumatoid arthritis can affect people at any age and often is treated with very specific medications. The symptoms vary somewhat as pain usually worsens after periods of rest and inactivity as joints stiffen. Some may experience pain, swelling, redness and warmth, especially in the morning.

Post-traumatic arthritis may occur following an injury to the ligaments, cartilage, and bone that causes instability to the joint and leads to increased wearing of the cartilage surfaces.

Cartilage Wear

The hip joint may develop cysts, bone spurs or loss of cartilage. The absence of cartilage will cause friction and narrowing of the normal joint space.

Symptoms may include an aching pain in the groin area, outer thigh and buttocks, and joint stiffness and reduced range of motion (difficulty putting on shoes and socks). The stress placed on the hip cartilage may increase pain symptoms and reduce activity levels. Inactivity can lead to weakened muscles that control the hip joint and further reduce the ability to perform daily activities.

The likelihood of arthritis increases with a family history and advancing age. Patients who are overweight and those who have undergone trauma to the hip joint may also experience increased wearing out of cartilage.

 

Fig. 1: Healthy anatomy of the hip (above left), details of various signs of arthritis (above center), and a total
hip implant and its placement within the hip and upper thigh (above right). Click on any image for a larger view.

Treatment of Hip Arthritis

Nonsurgical

  • Rest and limited activity may reduce an inflamed joint. You may be advised to avoid high impact sports, including running and jumping, or any activity that places repeated impact on the hip joint.
  • Weight loss can also reduce stress on the hip joint.
  • You may be instructed to participate in low impact activities which will maintain function without overstressing the joint.
  • Physical therapy may be recommended to include gentle hip motion exercises such as swimming, water aerobics, walking on a level surface, and using a bicycle to improve range of motion and strengthen the muscles.
  • The use of supportive devices (cane or orthotics) may also be indicated.
  • Nonsteroidal anti-inflammatory medication such as aspirin, naproxen, or ibuprofen may reduce the  pain. Another class of medications called Cox -2 inhibitors can reduce inflammation. Consult your physician prior to taking any medication.
  • Injections directly into the hip joint may be ordered. These provide temporary, symptomatic relief, but are not generally recommended or prescribed for prolonged use.

It is difficult to predict the timing and progression of the arthritic condition. Sometimes pain increases and the ability to participate daily activities decreases despite nonsurgical treatment plans. In those cases, a total hip replacement surgery may be recommended.

Total Hip Replacement Surgery

The artificial joint or prosthesis replaces the damaged bone with a new joint composed of an artificial ball connected to a stem which is inserted into your thigh bone.

An artificial socket or bowl-shaped cup will replace the worn out socket. All of the new parts create a smooth contact surface designed to mimic your healthy joint to provide greater range of motion, improving your function and quality of life.

There are many types of hip replacements that use different materials. Some are metal on metal, metal on plastic, or ceramic. Your surgeon will discuss various options and help determine the best choice and most appropriate one for your individual needs.

Questions

Your surgeon will discuss your condition and treatment plan. For any questions regarding the above information please feel free to contact the HSS Patient Education Programs at 212.606.1263.

 

Back in the Game Patient Stories: