Hip Osteoarthritis - Human & Disease

Hip Osteoarthritis


 DEFINITION

• Osteoarthritis is a pathology associated with inflammation in the joints of the  body.In the case of hip osteoarthritis,the arthritis and inflammation most commonly associated with a loss of acetabular and/or femoral head cartilage,leading to hip, groin, and buttock pain.

•Osteoarthritis is a term derived from the Greek word “osteo”, meaning “of  the bone,” “arthro,” meaning “joint,”  and “itis,” meaning inflammation, even  though the amount of inflammation present in the joint can range from excessive to little or no inflammation.

Osteoarthritis is a pathology associated with inflammation in the joints of the body.In the case of hip osteoarthritis,the arthritis and inflammation most commonly associated with a loss of acetabular and/or femoral head cartilage,leading to hip, groin, and buttock pain. •Osteoarthritis is a term derived from the Greek word “osteo”, meaning “of the bone,” “arthro,” meaning “joint,” and “itis,” meaning inflammation, even though the amount of inflammation present in the joint can range from excessive to little or no inflammation.
Hip-Osteoarthritis









SYNONYMS

• Hip arthritis

• Hip degenerative joint disease


ETIOLOGY

• The wearing down of the hyaline cartilage leads to an inflammatory response in which there is thickening and sclerosis of the subchondral bone and development of osteophytes or bone spurs.

This leads to a narrowing of the joint space, loss of shock absorption, and ultimately pain.

• Daily wear and tear in combination with various injuries sustained throughout life is the most common cause of the breakdown of healthy tissue.

• Degeneration of the cartilage and resultant arthritis can also be the result of other factors such as trauma or joint injury.

• At a cellular level, as a person ages, the number of proteoglycans in the articular cartilage decreases.

Proteoglycans are hydrophilic and work within cartilage to bind water. With the reduction of proteoglycans comes a decrease in water content within the cartilage and a corresponding loss of cartilage resilience. With the decreases in cartilage resilience, collagen fibers of the cartilage become susceptible to degradation and injury. The breakdown of collagen and other cartilage tissue are released into the surround joint space. Inflammation results as the body attempts to respond to the influx of byproducts from cartilage injury.

• As the cartilage degrades,the joint space narrows and ligaments become more lax. In response to the laxity, new bone outgrowths, called spurs or osteophytes, can form on the margins of the joints in an attempt to improve the congruence and passive stability of the articular cartilage surfaces.

Osteoarthritis is a term derived from the Greek word “osteo”, meaning “of the bone,” “arthro,” meaning “joint,” and “itis,” meaning inflammation, even though the amount of inflammation present in the joint can range from excessive to little or no inflammation.
Cartilage-Degeneration










• Primary osteoarthritis refers to joint degradation resulting from aging and tissue degeneration.

• Secondary osteoarthritis refers to joint degradation and tissue degeneration that results from factors other than aging such as obesity, trauma, and congenital disorders.


• The stages of hip osteoarthritis are as follows:

• Stage I: 

Slight cartilage wearing,slight joint space narrowing, and small osteophytes.


• Stage II:

 Moderate cartilage wearing, moderate joint space narrowing and cyst formation on the femoral head; increased number and size of osteophytes.


• Stage III: 

Complete cartilage deterioration, very narrow or absent joint space, significant bony sclerosis, and large osteophytes and bony cysts.

Osteoarthritis is a pathology associated with inflammation in the joints of the body.In the case of hip osteoarthritis,the arthritis and inflammation most commonly associated with a loss of acetabular and/or femoral head cartilage,leading to hip, groin, and buttock pain. •Osteoarthritis is a term derived from the Greek word “osteo”, meaning “of the bone,” “arthro,” meaning “joint,” and “itis,” meaning inflammation, even though the amount of inflammation present in the joint can range from excessive to little or no inflammation.
Hip-Joint-Arthritis







EPIDEMIOLOGY AND 

DEMOGRAPHICS

• Symptomatic hip osteoarthritis occurs in 3% of the adults 55 years of age and older.

• Osteoarthritis is the number one cause of disability.

• 70% of all individuals older than 70 years of age have x-ray evidence of hip osteoarthritis. Only one-third to one-half are symptomatic.

• Individuals older than 60 years of age are most prone to hip osteoarthritis.

• There is a higher prevalence of hip arthritis in women than men, and there is a higher prevalence of hip osteoarthritis in white Americans than Chinese and Chinese Americans.

• 150,000 hip replacements are performed each year.

• $54 billion per year is spent annually in medical costs and lost wages related to osteoarthritis.

Osteoarthritis is a term derived from the Greek word “osteo”, meaning “of the bone,” “arthro,” meaning “joint,” and “itis,” meaning inflammation, even though the amount of inflammation present in the joint can range from excessive to little or no inflammation.
Hip-Arthritis







MECHANISM OF INJURY

• Osteoarthritis is a pathology of overuse.The mechanism of injury is therefore the result of repetitive motions that stress the hip joint. The more cycles of an activity that the hip performs, the more likely the result will be anatomical damage.

• Daily use of the hip in weight-bearing positions

• Misalignment of the femur (anteversion abnormalities)

• Excessive use/strain of the hip secondary to work, obesity, or recreational activities

• Injuries, such as fracture and strains/sprains, that cause inflammation and scar tissue in the hip.


COMMON SIGNS AND 

SYMPTOMS

• Pain in the groin, inner thigh, and/or buttock

• Stiffness in the hip

• Cracking or deep crunching in the hip

• Difficulty crossing legs

• Limping (ipsilateral lurch during weight bearing)

• Anterior hip pain with walking or standing

• Anterior hip pain or inability to tie shoes


AGGRAVATING ACTIVITIES

•Weight-bearing activities (walking, running, dancing, jumping, etc)

• Long-term standing,especially on harder surfaces like concrete

• Walking

• Squatting or kneeling

• Tying shoes or putting on socks

• Crossing legs

• Standing after prolonged sitting or lying down; inactivity leads to stiffness

• Inactivity allows the inflammation to“pool” and increase pressure, leading to discomfort and loss of available movement.

Osteoarthritis is a pathology associated with inflammation in the joints of the body.In the case of hip osteoarthritis,the arthritis and inflammation most commonly associated with a loss of acetabular and/or femoral head cartilage,leading to hip, groin, and buttock pain. •Osteoarthritis is a term derived from the Greek word “osteo”, meaning “of the bone,” “arthro,” meaning “joint,” and “itis,” meaning inflammation, even though the amount of inflammation present in the joint can range from excessive to little or no inflammation.
Painful-Hip







EASING ACTIVITIES

• Rest

• Gentle motions of the hip joint

• Gentle stretching and exercise, heat, massage, anti-inflammatory medication, non–weight-bearing activities, and leg elevation.

• Generally speaking,these activities lead to decreased wear and tear, increased joint lubrication, and loss of stiffness and inflammation associated with this condition.


24-HOUR SYMPTOM PATTERN

• Stiffness in the morning (10 to 15 minutes).

• Better after a warm shower and taking medication.

• Can worsen with excessive movement.

• Stiffens again in the evening

• Stiffness after prolonged inactivity


PAST HISTORY FOR THE REGION

• Jobs or recreational activities that require excessive use/strain of the hip (walking, running, jumping, dancing, gymnastics, etc...).

• Abnormal amount of damage because of injuries.

• Obesity

• Past history of injury to the hip or any part of the lower extremity.

• Past history of injury to the contralateral lower extremity can create increased loading onto the now symptomatic hip joint.

• Childhood history of hip joint pathology or lower extremity torsions.


PHYSICAL EXAMINATION

• Loss of hip ROM, especially hip flexion and hip internal rotation.

• Hip adduction, flexion, and internal rotation combined will cause anterior hip pain.

• Crepitus with movement.

• Decreased weight bearing in stance phase of gait.

• Increased hip external rotation with all phases of gait.

• Possible Trendelenburg’s weakness on the affected limb.

• Pain with resisted hip flexion and resisted hip adduction.

Osteoarthritis is a pathology associated with inflammation in the joints of the body.In the case of hip osteoarthritis,the arthritis and inflammation most commonly associated with a loss of acetabular and/or femoral head cartilage,leading to hip, groin, and buttock pain. •Osteoarthritis is a term derived from the Greek word “osteo”, meaning “of the bone,” “arthro,” meaning “joint,” and “itis,” meaning inflammation, even though the amount of inflammation present in the joint can range from excessive to little or no inflammation.
Arthritis-Hip-Joint










IMPORTANT OBJECTIVE TESTS

• Possible leg length discrepancies.

• FABER test.


DIFFERENTIAL 

DIAGNOSIS

• Hernia

• Hip sprain/strain

• Sacroiliac joint dysfunction

• Lumbar spine dysfunction

• Tendonitis (hip flexor,ITB)

• Bursitis (trochanteric)

• Dislocation

• Avascular necrosis of the femoral head.

• Osteochondritis desiccans

• Pelvic dysfunction such as endometriosis,ovarian cysts, or prostate enlargement

• Sigmoid colon pathology

• Appendicitis


CONTRIBUTING FACTORS

• The hip is designed to handle normal daily use. When factors change the body’s ability to respond to normal forces, damage occurs.

• Therefore the clinician should thoroughly interview the patient to determine which factors may contribute to the patient’s symptoms.

• Uncontrolled risk factors that contribute or predispose an individual to hip osteoarthritis pathology:

• Gender (females more than males).

• Age (increase 2% per year after age 40 years).

• Genetics

• Prior history of injury to either lower extremity.

• Prior history of childhood hip pathology.

• Leg length discrepancies

• Modifiable risk factors that contribute or predispose an individual to continue or progress to hip osteoarthritis.

• Weight

• Work or recreational activities

• Repetitive or significant traumatic injuries to the hip.

• Poor health (smoking, longterm use of steroids).


TREATMENT

SURGICAL OPTIONS

• Total hip replacement (arthroplasty) Cemented or biological fixation; anterior or posterior approach.

• Osteotomy

Total hip replacement (arthroplasty) Cemented or biological fixation; anterior or posterior approach.
Arthroplasty






• Factors affecting choice of hip surgery:


• Cemented:

Younger,high level ofactivity,overweight/obese.

•  Uncemented: Older,inactive, frail

• Osteotomy:Very young (<50 years of age);postpones arthroplasty.

• Lifespan of total hip replacements is 15 to 20 years of age.

OPTIMAL NUMBER OF VISITS 3 to 6 visits (12 visits if status post arthroplasty) MAXIMAL NUMBER OF VISITS 20 to 36 visits (60 visits if status post
Hip-Arthroplasty






REHABILITATION

• Rehabilitation should focus on the following:


• Education in correct use of ice/heat at home for pain abatement and edema control.

• Implementation of a home exercise program.

•  Teach proper footwear with or without orthotics Correction of foot alignment and reduction of loading on the joint are important factors related to hip osteoarthritis.

• Manual therapy (STM, joint mobilization) can be used to improve joint mobility and arthrokinematics and to decrease pain.

• Massage can be used to decrease pain by relaxing muscular tension, improving circulation, and increasing endorphin release.

• Pathological changes to cartilage cannot be repaired by the body at this time. Even surgical advances have yet to solve the problems associated with cartilage damage. With this in mind, rehabilitation should focus on decreasing the stress placed on the damaged cartilage and correcting biomechanical and anatomical abnormalities that may predispose an individual to increased stress at the hip joint.

• The clinician should also evaluate the patient for leg length discrepancies that would cause abnormal stresses to placed onto the hip joint. Shoe lifts can be recommended to equalize the length of the legs during function.

• The hip joint is a synovial joint. Therefore the cartilage heals and is affected by joint motion.It is aggravated by activities that excessively load the joint, but motion in a non–weight-bearing to a limited weight-bearing environment can greatly decrease the patient’s symptoms.

Osteoarthritis is a pathology associated with inflammation in the joints of the body.In the case of hip osteoarthritis,the arthritis and inflammation most commonly associated with a loss of acetabular and/or femoral head cartilage,leading to hip, groin, and buttock pain. •Osteoarthritis is a term derived from the Greek word “osteo”, meaning “of the bone,” “arthro,” meaning “joint,” and “itis,” meaning inflammation, even though the amount of inflammation present in the joint can range from excessive to little or no inflammation.
Arthroplasty-Rehabilitation







• Exercises include the following:


• Stretches:Hip flexors,piriformis,quadriceps,ITB,hamstrings to decrease the stresses placed across the joint.

• Strengthening exercises: Quadriceps, hamstrings, hip abductors, hip adductors, hip extensors, hip internal/external rotators.

• Proprioceptive exercises to improve balance and function.

• Cardiovascular exercises, such as bicycle, progressing to treadmill, promote circulation and healing.

• Exercises creates a sense of control over the symptoms and the condition.

• Modalities: Ice/heat, ultrasound, electrical stimulation, and tape/braces can be used as adjuncts to improve the healing environment.

• Factors that contribute to abnormal joint mechanics and loading should be determined and addressed.


PROGNOSIS

• Long-term prognosis for a patient with hip osteoarthritis depends on the extent of wear and tear and ability to reduce the joint strain placed on the joint (posture, activity, etc..).

• For the most part, hip osteoarthritis is a degenerative condition. At earlier stages of the pathology, rehabilitation aimed at reducing the load placed on the joint can potentially slow or halt the progression of degeneration.

• For patients who are further along in the degenerative process, outcomes will be less favorable because cartilage has only a limited ability to repair itself.



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