Hip Osteoarthritis

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Original Editors - Eric Robertson, Kim Presiaux

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== Search Strategy ==

Database: Pubmed

Keywords: Treatment OA, Exercise OA, OA

Database: Website Library VUB

Keywords: Treatment OA, Exercise OA, OA

Definition/Description

Hip osteoarthritis is a common type of osteoarthritis. Since the hip is a weight-bearing joint, osteoarthritis can cause significant problems.
Hip osteoarthritis is caused by deterioration of articular cartilage of the hip joint.
There are several reasons this can develop:
• Previous hip injury
• Previous fracture, which changes hip alignment
• Genetics
• Congenital and developmental hip disease
• subchondral bone that is too soft or too hard 5

Clinically Relevant Anatomy

The hip joint is a synovial ball and socket joint, with the convex femoral head articulating with the concave acetabulum.  Stability of the joint is achieved through a combination of muscle action and several ligaments forming a loose, but strong joint capsule, the iliofemoral ligament, the ischialfemoral ligament and the pubofemoral ligament.  Another ligament, the ligamentum teres, does not provide stability to the hip but offers a portion of blood supply to the femoral head in some individuals. 

The femoral head and acetablum are covered by smooth hyaline cartilage, and the acetabulum contains a labrum, which functions to facilitate movement and support the forces passed through the joint. 

The hip, despite the requirement to support the weight of the body, has the second largest exursion of motion of any joint in the body. 

External Link:  [Hip Anatomy Video]

<== Epidemiology /Etiology ==

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Characteristics/Clinical Presentation

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Differential Diagnosis

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Diagnostic Procedures

Altman et al have established guidelines by which clinical diagnosis of hip osteoarthritis can be made.  The guidelines, established in 1991, present a 3 pronged approach to diagnosis of hip osteoarthritis including clinical, radiological, and laboratory findings.  According to these guidlelines, a patient was considered to have osteoarthritis if they presented with:

1. Hip Pain and...
2. Hip Internal Rotation < 15 degrees and Hip Flexion less than or equal to 115 degrees

or, hip pain in combination with:

1. Hip Rotation < 15 degrees or...
2. Pain with Hip Internal Rotation or...
3. Hip stiffness in the AM less than 60 minutes or...
4. Age > 50 years

More recently, Sutlive et al have proposed a clinical prediction rule to identify individuals with hip osteoarthritis presenting with unilateral hip pain.

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Outcome Measures

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Examination

The beginning of OA is characterized by limited

abduction and  rotation in the hip joint. Later on flexion, extension, adduction,.. will become more difficult.
Physiotherapeutic examination ¹

1) Palpation of M. gluteus medius.
Position: patient lies on his side. Upper leg in adduction and flexion
OA: Zone of greater Trochanter is sensitive and painful.

2)Flexion and forced flexion

Position: patient lies on his back.

OA: Flexion is limited.

3) Extension

Position: Patient in prone. Physiotherapist stabilizes the pelvis and raises the leg.

OA: Amplitude is limited

4) Abduction and adduction

Position: Patient lies on his back. Physiotherapist stabilizes the pelvis and performs abduction and adduction.

OA: abduction is limited, adduction keeps normal amplitude.

Medical Management

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Physical Therapy Management

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Key Research

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Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

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