What is Arthritis?
Arthritis is a degenerative
disease that causes destruction of the cartilage in
a joint. Arthritis can strike any joint, but the most
commonly affected sites are the hip, knee, and hand.
In almost every joint in your body, the bone surfaces
that rub together are covered by cartilage, which is
normally very smooth and lubricated with joint fluid
that allows nearly frictionless bending of the joint.
When arthritis affects a small area of joint cartilage,
it loses its smooth glistening surface, and becomes
rough and irregular. The result is further destruction
of the rest of the joint as the imperfect surfaces contact
one another. The joint may attempt to create new bone
(spurs) surrounding the joint as a response to the destruction,
which can be quite painful. Eventually, pieces of bone
and cartilage can break off and float in the joint fluid,
causing further destruction to the once–smooth
surfaces. The end result is partial or complete destruction
of the joint and finally, deformity. The most common
form of arthritis is called osteoarthritis. Although
most cases of osteoarthritis come with age, persistence
in sports into middle age may worsen the condition and
accelerate hip destruction. Osteoarthritis can also
be a hereditary condition. Other types of arthritis
are forms of systemic inflammatory diseases that are
not necessarily related to sports or activities. There
may be genetic causes for the development of this type
of arthritis. The most common of these is rheumatoid
arthritis, which is thought to be a result of the body's
immune system attacking body tissues such as cartilage.
Osteoarthritis may begin after repeated
minor injuries to your hip or a specific traumatic injury,
especially a fracture. Overuse and years of chronic
stress on your hip may also cause arthritic deterioration.
Though physicians are not exactly sure what causes osteoarthritis,
many contributing factors have been identified that
put people at risk:
– The majority of people suffering arthritis are
over the age of 45. By age 60, most people have some
signs of mild osteoarthritis. However, athletes and
active people may be at risk of developing osteoarthritis
at a younger age because of the added stress that activities
place on their joints.
– Some people who suffer osteoarthritis may have
inherited a propensity to develop the disease. This
is especially true of males of Northern European descent.
– Extra pounds put added stress on your hips.
Controlling your weight can help relieve some of the
pain associated with arthritis.
– Overuse and underuse of your joints can contribute
to osteoarthritis. Overuse may contribute to wear-and-tear
and can erode hip cartilage. Underuse may weaken the
leg muscles that help your hip to properly function.
body structure – Joints that are not aligned properly
or not matched in size, length, or strength may cause
slight imbalances that put added stress on your hips
and may cause premature arthritis.
Osteoarthritis generally continues
to progress within your hip unless it is treated. Your
cartilage has no direct blood supply and usually cannot
heal on its own. In addition, cartilage cannot regenerate.
Younger people have a better ability to heal small areas
of damaged cartilage without undergoing surgery. Active
people over 40 are more likely to develop osteoarthritis
as a complication of an injury. However, arthritis can
occur after a significant injury at any age. The initial
symptoms usually can be treated with rest, physical
therapy, and certain medications. As the disease progresses,
surgery, which may be a total hip replacement, may ultimately
be required. Surgery is primarily prescribed for older
patients. Most younger athletes with signs of early
arthritis usually can return to some type of activity
after non–operative treatment. After a total hip
replacement (THR) patients may still be active, but
they can no longer participate in contact sports or
high-impact activities like running.
There are three parts to an orthopedic
evaluation: medical history, a physical exam, and tests
that your physician may order.
Your doctor will likely ask you when
you noticed your hip pain, how it has been feeling since
the pain began, and if your hip has been previously
injured. It is also important for your physician to
know whether your hip was treated by a physician during
your childhood years, as there are some childhood conditions
that can contribute to hip arthritis later in life.
Physicians also typically ask about other conditions,
such as personal habits, other medical conditions like
diabetes and allergies, and medications currently being
taken. You may also be asked about your physical and
athletic habits and goals – information that will
help the doctor decide what treatment might be best
for you in achieving your goals.
usually performs a number of physical tests to check
for instability and any discomfort while examining your
hip in a variety of positions.
– Your posture, stride, hip alignment, muscle
tone, and ability to move from a standing to sitting
position will be observed for abnormalities.
in your back – Your abdomen, lower back, pelvis,
and hip joint will be observed as your hip is put through
a range of motion.
on your side – Your physician may press on your
ITB (iliotibial band) to check for any signs of inflammation.
– Your physician may test your muscle strength,
reflexes, and sensitivity to touch. Your physician may
also check your pulse.
Your physician will also examine you to determine if
you have leg length differences.
X–rays of your hip usually can
reveal arthritic degeneration. Physicians may see narrowing
of the hip joint space, deformity, loose bone fragments,
bone cysts, or other types of bone damage. Most patients
with "typical" osteoarthritis will only require
an X–ray unless the diagnosis is in doubt. Your
physician also may choose to order one or more of the
(magnetic resonance imaging) scans can help your physician
visualize the inside of your joint and bones. This study
can confirm a diagnosis of osteoarthritis, but more
commonly is ordered to look for another condition such
as a tumor or avascular necrosis (the "ball"
of the hip joint dies causing destruction of the joint).
bone scan uses dye injected into the bloodstream. Images
allow physicians to look for uptake of the dye in the
hip. This would be done to rule out a tumor or occult
fracture. Dye injected into the joint is called an arthrogram.
This is not commonly done in adults unless physicians
also perform an aspiration (drawing fluid from the joint
with a needle to look for infection, gout, or certain
rare kinds of arthritis) or an injection of steroids,
which may be done in certain cases to temporarily treat
the pain of arthritis.
tests may be used to rule out other causes of hip pain
such as rheumatoid arthritis or infection.