Have you experienced a deep pain in and around your hip? There can be many different causes of hip pain, but hip osteoarthritis has some common telltale symptoms. Does it feel as though pain extends right around or through the hip (e.g., it may be deep around the front corner of the hip making you grab your hand around this corner, or deep between the front, back and side of the hip)? You might also find that sitting in deep chairs or long drives is painful, and you might have noticed increasing difficulty with putting on your shoes and socks, or cutting your toenails. Perhaps you've had an X-Ray or MRI of your hip, where the report states “osteoarthritis” but you don't know a lot about this. Well, have no fear! This blog will provide you with a better understanding of Hip Osteoarthritis.
This blog will take you through what osteoarthritis (OA) is, its signs and symptoms, its causes and treatment options. Let’s begin with what it is!
What is osteoarthritis?
Osteoarthritis (OA) is one form of arthritis, which is just a general term for pain and difficulty with functioning of joints. Osteoarthritis should not be confused with Rheumatoid Arthritis, which is a systemic health condition, usually managed by rheumatologists. Osteoarthritis should also not be confused with Osteoporosis, which is a reduction in bone density. Osteoarthritis refers to changes that naturally occur in our joints as we age - its like having wrinkles on the inside! This process involves thinning of our cartilage (you might see the words 'reduced joint space' on XRay reports) and for some people, bone remodelling around the joint. It is important to be aware that for most people these gradual changes are not painful, and that there is a big mismatch between how a joint looks on XRay and how it feels.
For people who develop pain with these joint changes, there is usually some inflammation of the joint involved, which can result in swelling. Stiffness also commonly accompanies osteoarthritis¹.
While joint changes associated with osteoarthritis cannot be reversed, there is much that can be done to change the way the joint feels. Keep reading to find out more!
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So let’s talk about hip osteoarthritis. The hip is a ball and socket joint - between the head of the femur (head of your thigh bone) and the acetabulum (the socket in your pelvis onto which the head of femur inserts). The head of femur and inner acetabulum are covered by smooth cartilage in order to help the joint glide and rotate through movement. For some people, when this cartilage thins, the joint can become painful and lead to restrictions in joint movement. Joint stiffness is related to stiffening in the joint capsule and ligaments, and later in the process the body may lay down some additional bone around the joint in an attempt to protect the joint. This is not necessarily painful, but will often restrict some of the extremes of motion.
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Symptoms of Hip Osteoarthritis?
There are many different symptoms for hip osteoarthritis, including:
- Pain may be felt deep within the joint either at the front and/or side and/or buttock region. People with hip OA will often grasp the side of their hip with their hand in the shape of a “C” as it wraps around their hip (“C sign”) to describe where their pain is felt. Generally, osteoarthritis presents as more of a deep achey feeling and can become worse towards the end of the day or after long periods of activity².
- Pain related to hip osteoarthritis can also extend down the thigh, and can commonly be felt in the knee and shin - this area might ache at night. Sometimes, people with hip OA will present with knee or shin pain with no hip pain at all!
- Joint swelling - Although more obvious in other joints such as knees or wrists, joint swelling can occur at the hip when osteoarthritis is present².
- Joint stiffness - A feeling of stiffness is one of the most common symptoms of hip osteoarthritis and is often felt first thing in the morning or after prolonged periods of rest (e.g. a long car drive, after sitting at a desk or on the couch for a while)⁴. It might take a few steps to stand up straight and get walking after you've been sitting a while.
- Reduced range of motion in the hip often accompanies the feeling of stiffness, in people with hip osteoarthritis. People with hip OA may find that they aren’t as flexible at the hip as they used to be². Tasks such as reaching to the foot to put on socks or shoes or cut the toenails can become difficult.
- Walking can become difficult. Due to stiffness and pain, walking may become difficult for people with hip osteoarthritis. This is particularly when walking on uneven surfaces, or when walking quickly or taking larger strides. This might result in limping, to try to avoid the pain. An increase in sideways trunk sway is another compensation that is often used to try to escape the pain, or due to assocaited muscle weakness.
- Positions or actions that bring the knee towards the chest can be aggravating for people with hip osteoarthritis. For example, sitting in deep lounges or driving where the seat base slopes down to the back, bringing the knees higher than the hips, can become painful either while sitting or on rising from sitting. Squatting, bending over to put on shoes and socks, sitting on your heels and leaning over in the garden can all be aggravating for those with painful hip osteoarthritis.
Causes of Hip Osteoarthritis:
Hip osteoarthritis is common worldwide and often has multiple contributing factors for each individual. The most common possible causes for hip osteoarthritis are discussed below:
Age – the chances of developing OA increase with age, however it is possible for younger people to develop OA following traumatic events or surgeries at a young age⁵.
Genetics – People who have family members with OA are more likely to develop it⁵.
Trauma or Surgery – Those who have had previous significant trauma to the hip, or those who have had symptoms bad enough to require surgery/arthroscopy are more likely to develop arthritic changes⁶.
Shape of the top of the femur - extra bone laid down in adolescence (cam mophology) may result in Femoroacetabular impingement (FAI) which can increase the risk of hip osteoarthritis³.
Developmental disorders such as acetabular dysplasia, congenital hip dislocation, Perthes disease and slipped capital femoral epiphysis can predispose someone to hip OA³.
Obesity – Due to the larger compression and gravitational forces down through the hip joint, obesity is thought to progress arthritic changes. There may also be metabolic reasons for this link.
Treatment Options for Hip Osteoarthritis:
Understanding hip osteoarthritis:
Education and exercise (below) are the first line of treatments for hip osteoarthritis - treatments that should be tried first. Understanding about osteoarthritis, what triggers the pain or how to best manage it is extremely important for controlling symptoms, and can be very empowering.
Exercise for hip osteoarthritis:
Exercise has many benefits and is essential for people with hip osteoarthritis. Targeted exercises will help strengthen muscles around your hip and can in turn relieve some of the stress on your hip joint. Regular movement of your hip joint will also help to reduce joint stiffness and increase your range of movement in your hip.
If you find that land-based activities are painful, hydrotherapy (exercise in water) can be a great alternative as it will reduce the load on your joints while still allowing for a great workout!¹.
Medication for hip osteoarthritis:
Speaking with your GP can be useful as they can discuss with you the many different pain and anti-inflammatory medications available and whether these might be appropriate for you¹. However, research has shown that exercise is equally as effective as medication for controlling the symptoms of hip osteoarthritis⁷, so it's a good policy to try the exercise first and then you can reduce medication use.
Hands on treatment for hip osteoarthritis:
Getting some hands-on treatment (manual therapy) by a physiotherapist has been associated with reducing osteoarthritis symptoms in the short term. Manual therapy can include various stretching and/or mobilising techniques to target the hip joint and tissues around the hip joint and provide some pain relief. Ensure that you seek manual therapy from a qualified health professional.
Injections for hip osteoarthritis
If the above treatment options aren’t sufficing, injections might be offered to help reduce pain temporarily. It's important to be aware though, that the effects of injections are only temporary, so don't stop looking after your hip and doing those ever-so-important exercises!
There are a few injectable options available, though the two most common options are:
- Corticosteroid injection – Cortisone injections are useful for reducing pain and inflammation, however research has found cortisone is most effective when paired with exercise. Cortisone can also reduce health of the cartilage and underlying bone, so it is best left as an 'only if you really need it' option.
- Viscosupplementation – This is a gel-like fluid called hyaluronic acid (a naturally occurring substance within the body) that medical professionals can inject into your hip joint for lubrication and allow smoother gliding between the head of femur and acetabulum while also acting as a shock absorber. There is some evidence for a positive 'medium' term effect, which means that the effects take a little longer to be noticeable, and do not last for the longer term.
Surgery for hip osteoarthritis
There are several surgical options for treating hip osteoarthritis, with the most common being a Total Hip Replacement (THR). A total hip replacement is an option for more advanced cases of hip osteoarthritis when quality-of-life is affected and all the above treatments are no longer adequately controlling symptoms.
A total hip replacement involves replacing the head of femur and relining the acetabulum (hip socket). Total hip replacements are generally very successful surgeries, though like any surgery, they come with risks, which is why surgery is the last line of treatment. Therefore it is important that you speak with a qualified medical professional about whether this option is suitable for your presentation. Indeed, it is important to know that many people with hip osteoarthritis will never require a hip replacement!
Getting Help for your Hip Osteoarthritis
While there is no cure for joint changes associated with hip osteoarthritis, symptoms are not well matched at all with the joint changes, and there are many options for managing your symptoms. Remember it's what your joint feels like, and what you can do with your hip that are the important things.
If you think you might have hip osteoarthritis, book a consultation with one of our physiotherapists at PhysioTec Physiotherapy. The staff at PhysioTec have higher level experience in the treatment and management of hip pain and hip related injuries. Our staff will provide you with the most up-to-date education about your condition, conduct a thorough examination and provide you with an evidence-based treatment program to give you the best chance to get back to do doing what you love.
Do you have Hip Osteoarthritis, or some of the symptoms listed above? Visit us at PhysioTec, and let one of our physios assess you and provide you with a personalised program to help you get on-top of your condition, and back to doing the things you love!
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This blog was written by Molly Connolly, one of our Sports Physiotherapists and Pilates Instructors. Molly's undergraduate degree was in Exercise and Sports science and she completed a PhD of the title: A multidisciplinary approach to understanding low back pain in elite adolescent tennis athletes. She also has a love of triathlon! Molly completed a post-graduate Masters in Physiotherapy at the University of South Australia.
You can read more about Molly here.
Blogs by Molly
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- Allen, K. Thoma, L. & Golightly, Y 2022, Epidemiology of osteoarthritis. Osteoarthritis and cartilage, 30(2), pp.184-195.
- Arthritis Foundation 2023, Available at https://www.arthritis.org/diseases/osteoarthritis (Accessed: 28 August 2023)
- Harris-Hayes, M. & Royer, N 2011, Relationship of Acetabular Dysplasia and Femoroacetabular Impingement to Hip Osteoarthritis: A Focused Review. PM&R, 3(11), pp.1055-1067.e1
- Lespasio, M. Sultan, A. Piuzzi, N. Khlopas, A, Husni, M. Muschler, G. & Mont, M 2018, Hip osteoarthritis: a primer. The Permanente Journal, 22.
- Murphy, N. Eyles, J. & Hunter, D 2016, Hip osteoarthritis: etiopathogenesis and implications for management. Advances in therapy, 33, pp.1921-1946.
- Richmond, S. Fukuchi, R. Ezzat, A. Schneider, K. Schneider, G & Emery, C 2013, Are Joint Injury, Sport Activity, Physical Activity, Obesity, or Occupational Activities Predictors for Osteoarthritis? A Systematic Review. Journal of Orthopaedic & Sports Physical Therapy, 43(8), pp.515-B19.
- Weng Q, Goh SL, Wu J, et al. Comparative efficacy of exercise therapy and oral non-steroidal anti-inflammatory drugs and paracetamol for knee or hip osteoarthritis: a network meta-analysis of randomised controlled trials. Br J Sports Med. 2023 Aug;57(15):990-996.