Hip osteoarthritis, often referred to as “wear-and-tear arthritis,” is a prevalent condition that typically arises with advancing age. While it can affect any joint in the body, it is most commonly found in weight-bearing joints like the hip.
This condition leads to discomfort and stiffness, making everyday tasks challenging. Simple actions such as tying your shoes, getting up from a chair, or taking a short walk may become difficult.
Since hip osteoarthritis tends to progress gradually, starting treatment early can significantly reduce its impact on your daily life. While a complete cure is not available, a variety of effective treatments can help manage pain, improve mobility, and maintain an active lifestyle.
Anatomy of the Hip
The hip is one of the largest joints in the human body, functioning as a ball-and-socket joint.
The socket, known as the acetabulum, is a part of the large pelvic bone. The ball is the femoral head, located at the upper end of the femur (thighbone). Both the ball and socket are coated with articular cartilage, a smooth, slippery tissue that protects the bones, cushions impacts, and facilitates seamless movement.
A thin membrane called the synovium lines the joint’s surface. In a healthy hip, the synovium produces a small amount of lubricating fluid, which keeps the cartilage moist and aids in the joint’s mobility.
The normal anatomy of the hip.
Understanding Osteoarthritis
Osteoarthritis is a progressive form of arthritis commonly seen in individuals aged 50 and older, although it can also develop in younger people.
This condition occurs when the cartilage in the hip joint gradually deteriorates. Over time, the cartilage becomes rough and worn, reducing the protective space between the bones. As a result, the bones may start to rub against each other, leading to pain and stiffness. To compensate for the loss of cartilage, the damaged bones may form bony growths called bone spurs (osteophytes).
Osteoarthritis progresses slowly, with symptoms such as joint pain and stiffness worsening as the condition advances.
A hip damaged by osteoarthritis.
Causes of Hip Osteoarthritis
While osteoarthritis does not have a singular, definitive cause, several factors can increase the likelihood of developing the condition. These include:
- Advancing age
- A family history of osteoarthritis
- Previous injuries affecting the hip joint
- Obesity, which adds stress to the joint
- Developmental dysplasia of the hip, a congenital condition where the hip joint is improperly formed
Symptoms of Hip Osteoarthritis
Pain is the most common and defining symptom of hip osteoarthritis. This pain typically develops gradually, worsening over time, although a sudden onset is also possible. Symptoms are often more pronounced in the morning or after prolonged periods of rest or inactivity. Over time, the pain may become persistent, occurring even during periods of rest or at night.
Additional symptoms include:
- Pain originating in the groin or thigh, radiating to the buttocks or knee
- Increased pain after vigorous activities
- Stiffness in the hip joint, making walking or bending difficult
- Sensations of “locking” or “sticking” in the joint, often accompanied by a grinding sound (crepitus) caused by loose cartilage or tissue fragments interfering with smooth joint movement
- A reduced range of motion in the hip, potentially leading to a limp
- Joint pain that worsens during rainy or humid weather
Doctor’s Evaluation
During your consultation, your doctor will review your symptoms and medical history, perform a thorough physical examination, and may recommend diagnostic tests, such as X-rays, to better understand your condition.
Physical Examination
As part of the physical examination, your doctor will assess the following:
- Tenderness in and around the hip joint
- The range of motion, both passive (assisted) and active (self-directed)
- Crepitus, which is a grating sensation within the joint during movement
- Pain levels when pressure is applied to the hip
- Gait abnormalities (any irregularities in the way you walk)
- Signs of potential injury to the muscles, tendons, or ligaments surrounding the hip joint
Imaging Tests
X-rays: X-rays offer detailed images of dense structures like bones. In cases of hip osteoarthritis, X-rays may reveal joint space narrowing, bone changes, or the development of bone spurs (osteophytes).
Additional Imaging: In some instances, your doctor may recommend advanced imaging tests, such as magnetic resonance imaging (MRI) or computerized tomography (CT) scans. These provide more detailed insights into the condition of the bones and soft tissues surrounding the hip
(Left) In this X-ray of a normal hip, the space between the ball and socket indicates healthy cartilage. (Right) This X-ray of an arthritic hip shows severe loss of joint space.
In this X-ray of an arthritic hip, the arrow indicates a large bone spur (osteophyte) at the bottom of the femoral head.
Treatment Options for Hip Osteoarthritis
While there is currently no cure for hip osteoarthritis, various treatments are available to alleviate pain and enhance mobility.
Nonsurgical Treatments
In the early stages of hip osteoarthritis, treatment typically focuses on nonsurgical methods. Your doctor may suggest several strategies to manage symptoms and slow disease progression:
Lifestyle Modifications
Adopting certain lifestyle changes can help protect the hip joint and minimize stress on it:
- Reducing activities that exacerbate symptoms, such as climbing stairs.
- Transitioning from high-impact activities (e.g., jogging, tennis) to low-impact ones like swimming or cycling.
- Losing weight to relieve pressure on the hip joint, which can lead to reduced pain and improved function.
Physical Therapy
Targeted exercises can enhance range of motion, improve flexibility, and strengthen the muscles supporting your hip and leg. A physical therapist can create a customized program tailored to your specific needs and lifestyle.
Assistive Devices
Mobility aids such as canes, crutches, or walkers can increase independence and reduce pain during movement. Additional tools like long-handled reachers can help avoid motions that may trigger discomfort.
Medications
When pain interferes with daily activities or does not improve with lifestyle changes, medication may be introduced:
- Acetaminophen: Over-the-counter options like Tylenol can help relieve mild pain but should be used with caution and under medical advice to avoid side effects.
- Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Medications like ibuprofen and naproxen can alleviate pain and reduce inflammation. Some NSAIDs may require a prescription.
- Corticosteroids: Potent anti-inflammatory drugs, either oral or injectable, can provide relief in cases of severe joint pain.
Surgical Treatments
When nonsurgical options fail to provide relief and arthritis pain leads to significant disability, surgery may be recommended.
Total Hip Replacement
This procedure involves replacing the damaged femoral head and acetabulum with new joint surfaces made of metal, plastic, or ceramic materials to restore hip function.
Hip Resurfacing
In this less invasive procedure, the damaged bone and cartilage in the acetabulum are replaced with a metal shell, while the femoral head is capped with a smooth metal covering instead of being removed.
Osteotomy
Rarely performed for osteoarthritis, this procedure involves cutting and realigning the thighbone or hip socket to redistribute pressure and reduce joint strain.
Potential Complications
Like all surgical procedures, hip surgeries carry risks, though doctors take precautions to minimize them. Common complications include:
- Infection
- Excessive bleeding
- Blood clots
- Hip dislocation
- Limb length discrepancies
- Damage to nearby blood vessels or nerves
