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]

  Hip arthritis symptoms generally include: Stiffness in the hip area, including the thighs and groin Pain in the hip area Difficulty moving the hip in different directions Difficulty walking [medstarwashington.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]

  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]

• 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]

• 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]

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.

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.

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

• Osteoarthritis (OA)
• Rheumatoid arthritis (RA)
• Ankylosing spondylitis (AS)
• Systemic lupus erythematosus (SLE)
• Psoriatic arthritis

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.

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.

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].

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.  

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.

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.

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