Introduction
Osteoarthritis is a degenerative disease of the bone that commonly affects people above the age of 50 years. It is also known as wear and tear arthritis. Osteoarthritis occurs when the cartilage or protective tissues surrounding the ends of bones deteriorate, which causes the bones to rub together and results in pain and stiffness, reducing the flexibility of joints. Osteoarthritis commonly affects the hands, fingers, spine, hips, shoulders, knees, etc. However, hips are the most common site of developing osteoarthritis.
What Is Hip Osteoarthritis?
When the cartilage wears in the weight-bearing joints or hip joints, the space between the joints reduces, and the bones in the joint start rubbing against each other. This results in the outward growth of bones known as osteophytes or bone spurs. The damaged cartilage causes severe pain and inflammation. Following are the four stages of osteoarthritis in the hip:
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Minor: There will be small signs of tension. The wear and tear of hip joints are minimum and small bone spurs may appear. Bone spurs are usually undetectable at this stage. But if detected, they are treatable. The person may experience little or no pain.
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Mild: The developing bone spurs are more visible in the X-ray. The person experiences symptoms like stiffness and joint pain, especially while standing up for a long time. This stage is also known as mild hip osteoarthritis.
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Moderate: More wearing of cartilage occurs resulting in joint inflammation. Large bone spurs are visible in the X-ray. Activities like walking, running, squatting, etc. are affected and a popping noise may also be heard while moving joints.
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Severe: In this stage, cartilage is almost completely worn out which causes severe inflammation of the hip joint. The person will experience pain and stiffness all the time.
Other arthritis that affects hip joints are:
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Rheumatoid Arthritis: It is a type of arthritis that causes inflammation of the joints resulting in thickening and building of fluids lining the synovial membrane.
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Psoriatic Arthritis: It is a type of arthritis which is associated with psoriasis, causing skin and nail disease along with swelling of joints.
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Post-Traumatic Hip Arthritis: The type of arthritis that occurs shortly after hip fracture is known as post-traumatic hip arthritis.
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Hip Arthritis Due to Avascular Necrosis: When the bone loses blood supply, it starts to collapse leading to avascular necrosis. In the hip, the femoral head is prone to avascular necrosis.
What Are the Risk Factors for Osteoarthritis in the Hip?
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Old Age: As age advances, more wearing of hip cartilage can occur. Studies found higher incidence of hip osteoarthritis in people above 50 years and below 70 years.
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Gender: Women during the post-menopausal period are at higher risk for developing osteoarthritis than men. During the post-menopausal period, the estrogen level is reduced in women. Estrogen plays a key role in reducing bone resorption in women.
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Genetics: As part of certain autoimmune conditions, hip osteoarthritis can run in families.
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Obesity: Increased weight or obesity can cause additional stress on hips and knees that can end up in osteoarthritis in both hips and knees.
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Structural or Developmental Abnormalities: Abnormalities like hip dysplasia, slipped capital femoral epiphysis (SCFE), and hip impingement can increase the risk of hip osteoarthritis.
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History of Injury or Trauma: Injury or tear in hip joints due to any accident or fall can lead to osteoarthritis.
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Intense Sports: Athletes who participate in intense sports activities have a high risk of developing hip and knee osteoarthritis.
What Are the Signs and Symptoms of Hip Osteoarthritis?
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Stiffness in the hip makes moving or rotating hips difficult. Activities that involve bending, such as putting a shoe on, sitting for a long time, etc., become difficult.
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Popping sound while moving hip joints.
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Pain in or near the area of the hip. A person with hip osteoarthritis often experiences pain in the groin, thigh, or buttock area, making the diagnosis difficult for the physician.
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Some people may experience locking of the hip for a few moments.
How Is Hip Osteoarthritis Diagnosed?
After taking the detailed medical history that involves signs and symptoms, doctors will conduct the following tests:
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Pain or tenderness in the hip and area surrounding the hip.
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Pain on applying pressure on the hip.
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Popping sounds or grating sounds while moving hips.
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Range of motion.
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Analysis of gait or walking patterns.
This is followed by X-ray analysis which can detect the narrowing of joints and the presence of bone spurs or osteophytes. Other advanced imaging technologies such as computed tomography (CT) and magnetic resonance imaging (MRI) may also be used to get an accurate picture of hip osteoarthritis as well as associated problems in soft tissues like muscles and tendons.
What Is the Treatment for Hip Osteoarthritis in the Elderly?
The treatment for hip osteoarthritis is broadly classified into non-surgical and surgical.
Non-Surgical Treatment: This treatment modality involves medications, physiotherapy, and assisted devices.
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Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen and ibuprofen are prescribed to reduce pain and inflammation. Acetaminophen is the most effective painkiller that reduces severe pain associated with hip osteoarthritis. In some cases, corticosteroids are also given to relieve pain.
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Physiotherapy: Physiotherapy plays a key role in the treatment of hip osteoarthritis. The goal is to improve strength and mobility. In patients with hip osteoarthritis, physiotherapy can reduce pain and restore normal mobility.
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Assisted Devices: Canes, crutches, or walking sticks are the most common assisting aids for people with walking problems.
Surgical Treatment: Following are the surgeries performed for hip osteoarthritis:
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Hip Replacement Surgery: In this surgery, the parts of the hip joints, such as the femoral head and damaged acetabular, are replaced with metal, ceramic, or plastic joint surfaces. This surgery can restore the function of the hip joint.
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Hip Resurfacing: In hip resurfacing, the damaged part of the acetabulum in the hip joint is removed and replaced with a metal shell. However, the femoral head is preserved.
How to Manage Hip Osteoarthritis in the Elderly?
Even though there is no permanent cure for osteoarthritis, certain exercises, and lifestyle modifications can relieve pain and improve mobility in elderly patients.
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Weight Management: Increased weight is a cause of hip osteoarthritis. Hence, being overweight or obese with hip osteoarthritis can add extra strain on the hip joint, which can worsen the condition. A balanced diet with regular exercise can help in weight management. Patients can also consult a nutritionist to help them in a healthy weight loss journey.
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Regular Walking: Walking can improve blood flow to the cartilage and has many additional benefits. Hence, it is considered the best exercise for hip osteoarthritis.
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Exercise: There are specific exercises for hip osteoarthritis in physiotherapy like hip extensions, chair squats, body weight squats, knee-to-chest stretches, etc. However, these exercises have to be performed only under the guidance of a licensed physiotherapist. Strengthening and aerobic exercises are also effective.
Conclusion
Hip osteoarthritis occurs due to cartilage degeneration surrounding the hip joint and most commonly affects older people. Post-menopausal women, obese people, and people with a history of hip injury are more likely to develop osteoarthritis. Severe hip pain and inflammation are the main symptoms of hip osteoarthritis. Hip replacement surgery and hip resurfacing are surgical procedures done to treat hip osteoarthritis. Non-surgical methods include medications and physiotherapy. With proper care, support, and certain lifestyle modifications, hip osteoarthritis in older people is manageable.
