osteoarthritis of the hip

Genetics

familial predisposition

Clinical manifestations

• pain in the groin (60%)
  • less commonly over the greater trochanter, in the buttocks or referred to medial aspect of knee
• pain on passive rotation of the hip
• pain & stiffness following periods of walking or standing
• pain when first getting out of a chair
• pain with difficulty ascending stairs*
• limited range of motion
  • reduced internal rotation & abduction
  • with advanced disease, the hip is flexed & motion is reduced in all directions
• limp (antalgic gait)

* hip flexion is the most important action when climbing

Radiology

• X-ray of hip
  • see osteoarthritis
  • standing views for weight-bearing joints (hip, knee) appropriate to confirm diagnosis
  • diagnosis of hip osteoarthritis may be missed with reliance on X-ray

Complications

• fatigue is the strongest risk factor for reduced activity

Differential diagnosis

• lumbar spine disease
  • when hip & back pain present together, features that best predicte hip disease are groin pain, limp (antalgic gait), & limited internal rotation of the hip

Management

• see osteoarthritis
  • acetaminophen no better than placebo
  • NSAIDs
    • topical diclofenac not useful for hip osteoarthritis
    • oral NSAIDs
    • avoid oral NSAIDS in patients with coronary artery disease, heart failure, chronic renal failure & peptic ulcer disease
  • use of beta-blockers is associated with less arthragias & less use of opioids & other analgesics for symptomatic large-joint osteoarthritis
  • no significant benefit duloxetine
• use of a cane
• heel wedge to correct discrepancy in leg length
• weight reduction of no benefit
• raised seating alleviates forces across the knee & hip
• glucocorticoid injection under fluoroscopy
  • Kenalog 40 mg + bupivicaine
  • benefit at 2-3 months but not at 6 months
  • high dose hip joint injection 80 mg dexamethasone or repeated injections confer a risk of rapidly destruction hip disease
    • a single hip joint injection of 40 mg triamcinolone confers low risk
• ultrasound-guided, intra-articular injection of lidocaine plus triamcinolone acetonide (40 mg) results in pain relief persisting to 2 months
• intra-articular hyaluronic acid no better than placebo
• intramuscular glucocorticoid injection of some benefit
  • 40 mg of triamcinolone acetate IM into the gluteus muscle
  • may reduce hip pain at rest & walking
• tramadol of minimal benefit with significant adverse effects
• colchicine 0.5 mg QD may reduce need for total hip arthroplasty
• exercise of benefit, no specific exercise program superior
  • physical therapy of benefit; of no benefit
    • neuromuscular exercise (NEMEX; postural & functional stability)
    • progressive resistance training (PRT; muscle strength)
    • similar but modest benefits]
  • Tai-Chi as beneficial as physical therapy
• recommendations to primary care providers through the electronic medical record in combination with telephone- based patient intervention focused on weight management, physical activity, & cognitive behavioral therapy for pain management of benefit
• surgery: hip replacement (hip arthroplasty)
  • reduces cardiovascular risk possibly due to increased exercise capacity & decreased NSAID use

More general terms

• osteoarthritis (OA)

Additional terms

• hip joint

Patient information

osteoarthritis of the hip patient information