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

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

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Related Studies

Ontology: Osteoarthritis of hip (C0029410)

Definition (MSH) Noninflammatory degenerative disease of the hip joint which usually appears in late middle or old age. It is characterized by growth or maturational disturbances in the femoral neck and head, as well as acetabular dysplasia. A dominant symptom is pain on weight-bearing or motion.
Concepts Disease or Syndrome (T047)
MSH D015207
ICD10 M16 , M16.9
SnomedCT 239857001, 156492009, 201905004, 201892008, 239872002
English Coxarthroses, Coxarthrosis, Hip Osteoarthritides, Osteoarthritides, Hip, Osteoarthritis, Hip, Coxarthrosis [arthrosis of hip], Coxarthrosis, unspecified, Hip osteoarthritis NOS, Osteoarthritis NOS, of hip, Hip osteoarthritis, osteoarthritis of hip (diagnosis), osteoarthritis of hip, osteoarthrosis of hip (diagnosis), osteoarthrosis of hip, OS5, OSTEOARTHRITIS OF HIP, OSTEOARTHRITIS SUSCEPTIBILITY 5, Osteoarthritis of hip, unspecified, Osteoarthritis, Hip [Disease/Finding], hips osteoarthritis, degenerative hip joint disease, hip osteoarthritis, Osteoarthritis;hip, oa hip, osteoarthritis hips, of hip osteoarthritis, coxarthrosis, degenerative disease hip joint, osteoarthritis hip, hip oa, Osteoarthritis of hip, Osteoarthritis Of Hip, Osteoarthritis Of Hips, Osteoarthritis NOS, of hip (disorder), DJD of hip joint, OA - Osteoarthritis of hip, Degenerative joint disease of hip, Osteoarthritis of hip (disorder), Osteoarthrosis of hip, Hip Osteoarthritis, OA hip, OA hips, Hips osteoarthritis, osteoarthritis of the hip, Hip arthrosis
Dutch osteoartritis heupen, osteoartritis heup, heupartrose, coxartrose, Coxartrose, niet gespecificeerd, Coxartrose [artrose van heup], Artrose van de heup, Artrose, cox-, Coxartrose
French A de la hanche, A des hanches, Ostéoarthrite des hanches, Coxarthrose, Arthrose coxo-fémorale, Arthrose coxofémorale, Arthrose de la hanche
German Osteoarthritis der Hueften, OA Huefte, OA Hueften, Hueftarthrose, Koxarthrose [Arthrose des Hueftgelenkes], Koxarthrose, nicht naeher bezeichnet, Koxarthrose, Arthrose, Hüft-, Osteoarthrose, Hüft-
Italian Osteoartrite delle anche, Artrosi dell'anca, Coxartrosi, Osteoartrite dell'anca
Portuguese Osteartrite da anca, Artrose da anca, Osteartrite das ancas, Coxartrose, Osteoartrite do Quadril
Spanish OA de cadera, OA de caderas, Artrosis de cadera, Artrosis de caderas, artrosis, SAI, de cadera, Osteoarthritis NOS, of hip, artrosis, SAI, de cadera (trastorno), artrosis de la cadera (trastorno), artrosis de la cadera, Coxartrosis, Osteoartritis de la Cadera
Japanese 股関節症, コカンセツショウ, ヘンケイセイコカンセツショウ, 股関節OA, コカンセツOA, 変形性股関節症, 股関節変形性関節症, 変形性関節症-股関節
Swedish Höftartros
Czech osteoartritida kyčelní, coxarthrosis, koxartróza, Osteoartritida kyčlí, Artróza kyčle, Osteoartritida kyčle, Koxartóza
Finnish Lonkan nivelrikko
Russian TAZOBEDRENNOGO SUSTAVA OSTEOARTRIT, OSTEOARTRIT TAZOBEDRENNOGO SUSTAVA, KOKSARTROZ, КОКСАРТРОЗ, ОСТЕОАРТРИТ ТАЗОБЕДРЕННОГО СУСТАВА, ТАЗОБЕДРЕННОГО СУСТАВА ОСТЕОАРТРИТ
Korean 엉덩관절증, 상세불명의 엉덩관절증
Croatian OSTEOARTRITIS KUKA
Polish Zapalenie stawu biodrowego zniekształcające, Koksartroza, Choroba zwyrodnieniowa stawu biodrowego
Hungarian OA csípőkben, Csípőízületi OA, Csípők arthrosisa, Coxarthrosis, Csípőízületi arthrosis
Norwegian Hofteartrose, Hofteleddsartrose, Artrose i hoften, Degenerativ hoftelidelse