Osteoarthritis of the Hip
What is it: Osteoarthritis of the hip is a degenerative process of the articular cartilage. Osteoarthritis may be idiopathic or secondary to childhood hip diseases, osteonecrosis, previous joint infection or other conditions.
How does it present: The pain associated with osteoarthritis generally develops gradually and is most commonly reported in the groin or anterior thigh. In some cases patients may present with pain in the buttock or referred to the knee. Usually pain is present with activity but in more severe cases can be present at rest, and may present with stiffness and/or a limp.
Common exam findings: The earliest indicator of osteoarthritis on the exam is a loss of internal rotation on range of motion testing. In progressive osteoarthritis, patients may develop fixed external rotation and a flexion contracture. The Faber (Patrick) Test is usually positive. These can lead to the presence of an antalgic gait.
Tests and treatment: Osteoarthritis is most often evaluated with an AP and lateral radiographs of the hip to evaluate for joint space narrowing, osteophyte formation, and subchondral cyst formation. Treatment includes lifestyle modifications such as weight loss and minimizing aggravating activities such as high impact sports. Low impact or aquatic exercises may improve function by increasing range of motion and flexibility. Some patients may benefit from assistive devices, NSAID or other pain-relief therapy, and/or corticosteroid injection (typically radiographic-assisted). For progressive osteoarthritis, surgical options may also be considered including: realignment osteotomy, hip fusion, or total hip replacement.