Hip > Arthritis

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:

   Age – 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.

   Genetics – Some people who suffer osteoarthritis may have inherited a propensity to develop the disease. This is especially true of males of Northern European descent.

   Weight – Extra pounds put added stress on your hips. Controlling your weight can help relieve some of the pain associated with arthritis.

   Activities – 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.

   Abnormal 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.

Your physician usually performs a number of physical tests to check for instability and any discomfort while examining your hip in a variety of positions.

   Standing – Your posture, stride, hip alignment, muscle tone, and ability to move from a standing to sitting position will be observed for abnormalities.

   Lying in your back – Your abdomen, lower back, pelvis, and hip joint will be observed as your hip is put through a range of motion.

   Lying on your side – Your physician may press on your ITB (iliotibial band) to check for any signs of inflammation.

   Sitting – 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 following tests:

   MRI (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).

   A 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.

   Blood tests may be used to rule out other causes of hip pain such as rheumatoid arthritis or infection.

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