Hip Osteoarthritis

Aka: Hip Osteoarthritis, Degenerative Joint Disease of the Hip, Hip DJD, Hip Arthritis, Femoroacetabular Joint Osteoarthritis

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II. Epidemiology

  1. Most common cause of Anterior Hip Pain in older adults

III. Symptoms

  1. See Hip Pain
  2. Gradual onset of pain with or without history of hip Trauma
  3. Pain with prolonged sitting or prolonged ambulation

IV. Signs

  1. Pain worse with Hip Range of Motion (hip flexion, hip rotation)
  2. Decreased Hip Range of Motion

V. Differential Diagnosis

  1. See Hip Pain Causes

VI. Imaging

  1. See Hip XRay in Osteoarthritis
  2. Standing Anteroposterior Pelvis XRay (first-line study)
    1. Degree of osteophytes and joint space narrowing does not correlate with symptom severity

VII. Management

  1. Non-Surgical Management
    1. See Osteoarthritis
    2. Physical Therapy
      1. Improves pain and function in mild to moderate Osteoarthritis
    3. Hip Intra-articular Injection of Corticosteroid
      1. Pain and function improved in the short-term (3-4 months), but not longterm (>=6 months)
      2. Lei (2024) Bone Joint J 106-B(6):532-9 [PubMed]
    4. See Knee Osteoarthritis Management
      1. Hip Osteoarthritis conservative management includes many of the same therapies as Knee Osteoarthritis
      2. NSAIDs are effective if not contraindicated
  2. Surgical Management
    1. Indications
      1. Refractory pain despite conservative management (e.g. limits walking, sleep, sitting)
      2. Loss of mobility even with joint unloading (e.g. Crutches, cane)
    2. Modifying Factors Complicating Hip Arthroplasty
      1. Peripheral Vascular Disease
      2. Leg Length Discrepancy (e.g. hyperlordotic spine, oblique Pelvis)
      3. Reduced Hip Range of Motion (e.g. flexion contractures, limited hip flexion <90 degrees)
      4. Factors that increase infection risk (Prosthetic Joint Infection)
        1. Uncontrolled Diabetes Mellitus
        2. Smoking (current or previous)
      5. Factors that protect against complications
        1. Higher socioeconomic status
        2. Higher education level
        3. Cohabitation (e.g. married patients)
        4. Urban home (in contrast to rural setting)
    3. Total Hip Arthroplasty (THA)
      1. Substantial pain improvement in 80% of cases
      2. THA lasts 20 years
      3. Acute Complications in 5% (PE, MI, Infection, Pneumonia) and mortality 1%
      4. Perioperative Tranexamic Acid significantly reduces risk of severe Anemia requiring transfusion
      5. Postoperative physical therapy and unsupervised home Exercise both equally improve function
      6. Chronic Complications
        1. Prosthetic Hip Dislocation (1-3%)
        2. Periprosthetic Fracture
        3. Prosthetic loosening
        4. Prosthethic hip Septic Joint
    4. References
      1. Hannon (2024) J Am Acad Orthop Surg 32(20):e1027-e34 +PMID: 38781351 [PubMed]
      2. Varacallo (2022) Total Hip Arthroplasty Techniques, StatPearls, Treasure Island
        1. https://www.ncbi.nlm.nih.gov/books/NBK507864/

VIII. Complications

  1. High morbidity (pain, significant functional limitations in ADLs)
  2. Deconditioning with decreased Physical Activity

IX. References

  1. Chamberlain (2021) Am Fam Physician 103(2):81-9 [PubMed]

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