Edit concept Question Editor Create issue ticket

Hip Arthritis

Arthritis is the medical term for joint inflammation. This is a progressive disease that begins gradually and worsens over a period of time. Hip arthritis is known to be a common cause of pain in the hip joint.


Presentation

The patient is initially examined for gait. Limping with pain is indicative of hip arthritis, resulting from weakened muscle, shortened leg, bent stiffness, or impaired knee. Other indicators are inability to rotate, bend, stretch, or move the leg away from the body. Placing one hand of the observer on the patient's iliac crest will confirm the presence or absence of pelvic movement. Bent stiffness can be ascertained by extending the affected leg and bending the opposite hip as far outward as possible to stabilize the pelvis. Presence of tenderness over the femoral greater trochanter is indicative of bursitis which is an extra-articular disorder. Pain elicited with passive range of motion that is, internal and external rotation with the patient lying down and the hip and knee bent to 90° is intra-articular. Patients may present with both intra-articular and extra-articular disorders.

Hip pain in patients with OA may be due to OA of the hip per se or to referred pain from other affected sites such as the lumbosacral spine [17]. Likewise, osteoarthritis of the hip may result in referred pain to distant structures such as the knee [17].

Onset of RA is insidious, commencing with a febrile episode, malaise, joint pains, and weakness, followed by joint inflammation and swelling.

Ankylosing spondylitis (AS) is manifested by inflammation, back pain, peripheral enthesitis and arthritis, with systemic and localized extra-articular involvements.

SLE is initially manifested by arthralgia or arthritis [18], as reported in 48% of  patients followed for 10 years [19]. Patients complain of arthralgia, (as pain and stiffness) is subjective. Arthritis in SLE is off and on, present before consultation and absent during evaluation.  Arthritis in SLE has less erosions and physical abnormalities than in rheumatoid arthritis.

Difficulty Walking
  • This may include: pain in one or both hips pain in the buttocks, groin, or thigh pain that is worse in the morning and gets better through the day difficulty walking or bending flare-ups of pain during physical activity locking or sticking in the hip[uihc.org]
  • Symptoms of Hip Arthritis Patients with hip arthritis usually experience difficulty walking, since the pain can manifest itself in not only the hip, but also the groin, thigh, buttocks or knee.[websterorthopedics.com]
  • Patients with hip arthritis have difficulty walking, climbing stairs, getting up from a seated position, or standing for prolonged periods of time.[symptoma.com]
  • walking or walking with a limp Pain that worsens with vigorous or extended activity Stiffness in the hip or limited range of motion In patients with rheumatoid arthritis or lupus, fatigue and weakness may also occur.[ortho.wustl.edu]
Aspiration
  • Radiologic studies were reviewed for the following imaging and technical factors: presence of a sinus tract, fluid turbidity, volume of fluid (mL) aspirated, and whether the fluid analyzed was primarily aspirated or reaspirated after lavage.[ncbi.nlm.nih.gov]
  • Regenerative injection therapy with whole bone marrow aspirate for degenerative joint disease: a case series. Clin Med Insights Arthritis Musculoskelet Disord. 2013 Sep 4;6:65-72. doi: 10.4137/CMAMD.S10951. eCollection 2013. 4.[getprolo.com]
Leg Pain
  • Hip osteoarthritis, a breakdown of cartilage in the hip joint, can often cause symptoms of back, hip, and leg pain.[spine-health.com]
  • pain five days ago, and today has trouble bearing weight.[orthobullets.com]
  • This can result in back pain and other-sided leg pain. What you will also see on physical exam is that the patient's leg will be slightly shorter than the other leg. There are several treatment options for arthritis of the hip joint.[lifebridgehealth.org]
Symmetrical Arthritis
  • RA patients present with polyarticular, symmetric arthritis of the wrists, 2nd and 3rd metacarpophalangeal joints.[symptoma.com]
Foot Drop
  • drop)hypotension with cement insertion, main complications death, dislocation, severe HO, infection, nerve palsy, leg length inequality. death In-hospital 0.1-0.8%, 30-day 0.15-1,42%, 90-day 0.2-0.74%: cause commonly cardiac or thrombeembolic Periprosthetic[eorif.com]
Excitement
  • We are working with our basic science research colleagues on exciting research designed to create gold nanoparticles with mild radioactivity to help fight the pain and inflammation of hip arthritis.[hipandknee.com]

Workup

  • The index of suspicion for patients with OA is the gradual onset of symptoms and signs, especially in the elderly. Plain radiographs of the most affected joints will show marginal osteophytes, joint effusions and narrowing of the joint space, markedly dense subchondral bone with cyst formation, and altered bony structure.
  • RA patients present with polyarticular, symmetric arthritis of the wrists, 2nd and 3rd metacarpophalangeal joints. Laboratory tests include rheumatoid factor (RF), anticyclic citrullinated peptide antibody (anti-CCP), and erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP).
  • Laboratory examinations for ESR, CRP and complete blood count (CBC) are indicated for patients with AS. Imaging of the lumbosacral spine and X-ray for sacroiliitis will establish the diagnosis of AS.
  • Patients with psoriatic arthritis will test positive for RF. Clinical diagnosis of psoriatic arthritis can be conclusive. Rule out other disorders with similar manifestations.
Eikenella
  • Our patient presented with persistent and worsening sharp lower back pain and underwent arthrocentesis of the hip joint, yielding purulent fluid positive for Eikenella corrodens.[ncbi.nlm.nih.gov]
Scedosporium
  • A 30-year-old man had endocarditis and hip arthritis associated with the recently recognized fungus, Scedosporium inflatum. Inhibition, and possibly cure, of endocarditis occurred with medical therapy alone.[ncbi.nlm.nih.gov]

Treatment

For mild arthritis, the recommendation is treatment with oral anti-inflammatories, regulating activities to minimize stress on joints, and physical therapy to alleviate symptoms. Injectable anti-inflammatory medication may be prescribed. The treatment of choice for severe hip arthritis is total hip arthroplasty, or hip replacement (THR). Patients with (OA) osteoarthritis experienced improvements after THR [20] [21]. Reduction in pain, better quality of life and satisfaction with THR have been reported in patients with ankylosing spondylitis (AS) [22] [23] although functional improvement has not been clearly attained [24].

Arthritis in SLE occurs in 69-95% of patients examined. Inflammation is less in SLE than in rheumatoid arthritis but with concomitant joint anomalies especially in the hand and knee, for that matter, most joints [25]. Patients with predominant arthralgias or arthritis may adopt the methods used in rheumatoid arthritis. Isometric exercises for joint inflammation of the hip and knee are beneficial for biomechanical stability [26]. Isotonic exercises are prescribed for those with minimal or without joint inflammation in addition to transfers and ambulation activities for mobility.

Reconstructive therapy and joint replacement are appropriate for patients with psoriatic arthritis. Most patients have responded well to hip and knee joint arthroplasties.

Prognosis

Arthritis is the most common disorder imposing limitations on functions and mobility among 20 million affected adults reported in the United States [15]. In general, prognosis in osteoarthritis depends on the structures and extent of damage involved. There is yet no curative treatment available, hence, pharmacologic treatment is only for symptomatic relief. Prognosis is good with surgery for joint replacement. Successful rate is at least 90% in hip and knee arthroplasty. However, a joint prosthesis need to be revised after 10-15 years, more so among younger and active patients than in the elderly or sedentary persons.

Prompt diagnosis and treatment are essential in the treatment of rheumatoid arthritis. Intermittent exacerbations and remissions are the usual course of the disease. Outcomes vary while about 40% of patients are with pronounced disability after 10 years [16]. The status of patients range from relatively self-limited disease to chronic progressive illness.

The prospect in spondyloarthropathies, including AS, is better than with rheumatoid arthritis. Long-term treatment for inflammation may be needed. Morbidity can emanate more from spinal and peripheral joints than from extra-articular foci. Prognosis is poor with involvement of peripheral joints, onset at young age, elevated erythrocyte sedimentation rate (ESR), and non-response to nonsteroidal anti-inflammatory (NSAIDs) therapy.

Etiology

Five principal types of arthritis are known to affect the hip.These are:

The most frequently encountered type of joint disease is osteoarthritis, which altogether involves the weight-bearing structures of the body - i.e., the hips, knees, ankle, and feet as well as cervical and lumbosacral spines. The hip joint is subjected to daily stresses with gradual wear and tear of the cartilage which facilitates smooth or friction-free movement of the ball-and-socket articulation of the femoral head with the acetabulum. Either overloading of a healthy joint or normal loading of an impaired joint, can precipitate catabolic effects of the chondriocytes and further deterioration of the articular cartilage [1] [2] [3] [4].

Rheumatoid arthritis is a chronic, systemic, inflammatory manifestation of the disease which is due to an immune response of the body, including the hip joint. The precise cause of RA remains largely unknown. A common complaint of patients is long-standing synovitis (polyarthritis) of the hands and feet, for that matter, any joint lined by a synovial membrane, on both sides of the body.

Ankylosing spondylitis is the prototype axial spondyloarthritis, likewise chronic, inflammatory, and involving the spine and sacroiliac joints (where the spine articulates with the pelvis). The condition may be accompanied by ocular inflammation, enthesitis, and peripheral arthritis. Up to 25% of patients develop terminal-stage hip damage [5]. AS occurs in patients with severe spine disease, who acquire the disease at a younger age, become functionally impaired [6], and present with recurrent acute inflammation [5] [7].

Systemic lupus erythematosus is a systemic autoimmune disorder of the entire body, including the hip joint. SLE at the hip is characterized by inflammation and damage to the joint. It can occur in persons regardless of age, but especially in women 15-35 years old. 

Psoriatic arthritis is a chronic, inflammatory arthritis that occurs in at least 5% of patients with dermatological condition, such as psoriasis. Patients with psoriasis are seronegative for oligoarthritis.

Epidemiology

The Center for Disease Control and Prevention (CDC) in the United States estimated that 25% of people may acquire symptomatic hip osteoarthritis by age 85, regardless of gender, race, educational attainment, and body weight. More than 20 million persons in the US are affected by the disease.

Sex distribution
Age distribution

Pathophysiology

Early osteoarthritis commences with swelling of the articular cartilage due to increased level of proteoglycans as the chondrocytes attempt to repair the cartilage. This process may take years leading to hypertrophy of the articular cartilage. In the advanced stage of the disease, the level of proteoglycans is so low that the cartilage softens and loses elasticity thereby disrupting the integrity of the joint. When examined under the microscope, the normally intact cartilage on the surface of the affected joint appears flaky and fibrillated. Joint space is diminished and movement along the ball-and-socket hip joint is painful, leading to difficulty in walking or limping.

Damage to the hip joint in osteoarthritis is greatest at the point where the stress from weight-bearing is most severe. Persistent wear and tear of the damaged cartilage over time will expose the underlying bone which continues to articulate with the opposite surface. When the increasing stresses surpass the capacity of the bone to cope, the subchondral bone will become vascularized, increase cellularity, and appear thickened and dense (eburnation) at pressure areas [8].

The pathogenesis of rheumatoid arthritis is not fully understood. Risk factors such as infection, cigarette smoking or trauma are suspected of triggering an autoimmune reaction in genetically susceptible individuals. Synovial hypertrophy and chronic joint inflammation develop with extra-articular involvement.

Ankylosing spondylitis is a chronic, inflammatory disease of the axial skeleton, causing progressive stiffness of the spine and back pain. Other structures are involved e.g. shoulders, peripheral joints, the temporomandibular joints, and extra-articular organs (eyes, heart, and lungs). As in the spondyloarthritis family, the disorder is associated with HLA-27 and is manifested by inflammation around the enthesis.

Systemic lupus erythematosus is an autoimmune, inflammatory disorder characterized by multisystem involvement and the generation of autoantibodies. The specific cause of SLE is unknown but multiple factors contribute to the acquisition of the disease - race, genetic, epigenetic, immunological, hormonal, and environmental [9] [10] [11] [12]. Genome-wide association studies (GWAS) have implicated a strong correlation of several loci with SLE, which are related to the immune and biologic systems [13]. SLE is being linked with genes previously linked with other autoimmune diseases e.g., PTPN22 and diabetes mellitus, STAT4 and rheumatoid arthritis.

The causative relationship between psoriasis and psoriatic arthritis is not clear. However, there are indications that genetics, immunity, and environment are involved [14].

Prevention

Medications should be used with caution. Drugs that exacerbate psoriasis should be avoided. Withdrawal from systemic corticosteroids and lithium have been known to precipitate resurgence of disease.

Since arthritis is generally a chronic disease, there are no universal preventive measures to consider. However, the basic tenet of prevention is promoting wellness through adequate rest and exercise. If needed, protection of affected joints and the use of supports such as splints, braces, walkers, and canes are advised.

In general, a healthy lifestyle may help minimize risk or alleviate symptoms. As usual, a diet that is low in calories and saturated fats and high in fibers and micronutrients can boost the body's natural defense against infections and stress. Exercises that promote bone and muscle tonicity, maintaining proper body weight, and avoiding activities that predispose to joint injury are essential.  

Summary

Hip arthritis occurs when the cartilage of the ball-and-socket hip joint, which is normally normally smooth and facilitates the friction-free articulation of the femoral head with the acetabulum is eroded with prolonged use, and probably with some other factors associated with age. Daily stress is borne by the hip joint with movement while bearing the weight of the body. The articular cartilage loses its integrity leaving the femur to grind against the acetabulum, causing inflammation, pain and immobility. The degradation of the cartilage worsens with time and with repeated grinding motion, hence the prevalence of the disorder among the elderly, as it is in osteoarthritis. Other types of arthritis have varied causes and manifestations.

Diagnosis is through physical examination, medical history, X-rays, and blood tests. Surgical and non-surgical procedures are recommended for treatment, including medications, weight loss and physical therapy. The best approach to prevention is a healthy lifestyle to minimize the risks and to alleviate the symptoms.

Patient Information

Hip arthritis is inflammation of the ball-and-socket hip joint which is the articulation of the femur (large thigh bone) with the pelvis (hip bone) via the acetabulum (socket). The hip joint is protected by a cartilage which allows friction-free movement of these components. Daily wear and tear and bearing the weight of the body with movement cause the articular cartilage to erode and become striated. The joint space is lessened and the underlying bone continues to grind against the opposite surface, followed by changes in the integrity of the bone itself. The onset of pain is gradual and progressive, increasing with age. In the advanced stage, joint deformities and/or immobility may occur. Other factors such as autoimmunity or infections may exacerbate the symptoms of arthritis.  Of five main types of hip arthritis the most common is osteoarthritis. Pain in front of the hip or groin is the hallmark of hip arthritis and other medical problems in the hip itself. Patients with hip arthritis have difficulty walking, climbing stairs, getting up from a seated position, or standing for prolonged periods of time.

Treatment of mild arthritis is with oral anti-inflammatories and modifying one's daily activities to minimize the stress on the affected joints. Joint protection with the use of supports such as splints, braces, walkers can help alleviate pain. Injectable anti-inflammatory medication may be prescribed. Total hip arthroplasty or hip replacement (THR) may be needed for severe hip arthritis.

References

Article

  1. Burkitt HG, Stevens A, Lowe JS. Skeletal system. Basic Histopathology. 3rd ed. New York, NY: Churchill Livingstone; 1996. 260.
  2. Hamerman D. The biology of osteoarthritis. N Engl J Med. 1989 May 18; 320(20):1322-30.
  3. Hartmann C, De Buyser J, Henry Y, Morère-Le Paven MC, Dyer TA, Rode A. Nuclear genes control changes in the organization of the mitochondrial genome in tissue cultures derived from immature embryos of wheat. Curr Genet. 1992 May; 21(6):515-20.
  4. Howell DS. Pathogenesis of osteoarthritis. Am J Med. 1986 Apr 28; 80(4B):24-8.
  5. Vander Cruyssen B, Munoz-Gomariz E, Font P, et al. Hip involvement in ankylosing spondylitis: epidemiology and risk factors associated with hip replacement surgery. Rheumatology (Oxford). 2010;49:73–81.
  6. Hamdi W, Alaya Z, Ghannouchi MM, et al. Associated risk factors with worse functional prognosis and hip replacement surgery in ankylosing spondylitis. Joint Bone Spine. 2012;79:94–96.
  7. Chen HA, Chen CH, Liao HT, et al. Factors associated with radiographic spinal involvement and hip involvement in ankylosing spondylitis. Semin Arthritis Rheum. 2011;40:552–558.
  8. Radin EL, Paul IL. Response of joints to impact loading. I. In vitro wear. Arthritis Rheum. 1971 May-Jun; 14(3):356-62.
  9. Cooper GS, Dooley MA, Treadwell EL, St Clair EW, Parks CG, Gilkeson GS. Hormonal, environmental, and infectious risk factors for developing systemic lupus erythematosus. Arthritis Rheum. 1998 Oct; 41(10):1714-24.
  10. Rahman A, Isenberg DA. Systemic lupus erythematosus. N Engl J Med. 2008 Feb 28; 358(9):929-39.
  11. D'Cruz DP, Khamashta MA, Hughes GR. Systemic lupus erythematosus. Lancet. 2007 Feb 17; 369(9561):587-96.
  12. Lupus Foundation of America. What are the risks for developing lupus. Available athttp://www.lupus.org/webmodules/webarticlesnet/templates/new_learnunderstanding.aspx?articleid=2237&zoneid=523. Accessed: March 22, 2012.
  13. Deng Y, Tsao BP. Genetic susceptibility to systemic lupus erythematosus in the genomic era. Nat Rev Rheumatol. 2010 Dec; 6(12):683-92.
  14. Ritchlin CT. Pathogenesis of psoriatic arthritis. Curr Opin Rheumatol 2005; 17:406.
  15. Brault MW, Hootman JM, Helmick CG, Theis KA, Armour BS. Prevalence and Most Common Causes of Disability Among Adults - United States, 2005. MMWR 2009;58(16):421-426.
  16. Lipsky PE. Harrison's Principles of Internal Medicine. Isselbacher KJ, Braunwald E, Fauci AS, et al.Rheumatoid arthritis. 17th ed. New York, NY: McGraw-Hill; 1994. 1648-55.
  17. Moskowitz RW, Holderbaum D. Clinical and laboratory findings in osteoarthritis. In: Arthritis and Allied Conditions, Koopman WJ (Ed), Williams & Wilkins, Baltimore 2001. p.2216.
  18. Cronin ME. Musculoskeletal manifestations of systemic lupus erythematosus. Rheum Dis Clin North Am. 1988;14(1): 99-116.
  19. Cervera R, Khamashta MA, Font J, et al: Morbidity and mortality in systemic lupus erythematosus during a 10-year period: A comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore). 2003; 82(5): 299-308.
  20. Bruyere O, Ethgen O, Neuprez A, et al. Health-related quality of life after total knee or hip replacement for osteoarthritis: a 7-year prospective study. Arch Orthop Trauma Surg. 2012;132:1583–1587.
  21. Ethgen O, Bruyere O, Richy F, et al. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am. 2004;86-A:963–974.
  22. Osnes-Ringen H, Kvien TK, Henriksen JE, et al. Orthopaedic surgery in 255 patients with inflammatory arthropathies: longitudinal effects on pain, physical function and health-related quality of life. Ann Rheum Dis. 2009;68:1596–1601.
  23. Calin A, Elswood J. The outcome of 138 total hip replacements and 12 revisions in ankylosing spondylitis: high success rate after a mean follow-up of 7.5 years. J Rheumatol. 1989;16:955–958.
  24. Sweeney S, Gupta R, Taylor G, et al. Total hip arthroplasty in ankylosing spondylitis: outcome in 340 patients. J Rheumatol. 2001;28:1862–1866.
  25. Braddom R. Chan L, Harrarast M, Kowalske K, Matthews D, Ragnarsson K, Stolp K. Physical Medicine & Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2011.
  26. Hicks JE, Miller F, Plotz P, Chen TH, Gerber L. Isometric exercise increases strength and does not produce sustained creatinine phosphokinase increases in a patient with polymyositis. J Rheumatol. 1993 Aug; 20(8):1399-401.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-07-11 22:12