HIP JOINT INVOLVEMENT IN OSTEOARTHRITIS
Osteoarthritis (OA) of the hip is a common problem in the United States and worldwide. As many as 1 in 4 Americans may suffer from OA in their lifetime. With the continued growth of the elderly population in the United States, and the desire for these patients to continue an active lifestyle, OA is a growing medical and economic concern. Appropriate management of OA, both medically and surgically, requires the physician to be able to accurately diagnose the condition.
The typical patient with primary OA of the hip presents in middle age or later. Difficulties with gait and walking distances is often a common chief complaint. Pain can vary in location and severity, although groin pain is the classic location. Pain typically worsens with increased activity and is relieved with rest. Often, patients complain of accompanied stiffness in the affected joint, especially after periods of inactivity. Stiff-ness that is alleviated by movement is common in the early stages of OA. As the OA progresses to the more severe stages, pain may be present even at rest or at night. Other common complaints include some limitations in the ability to perform activities of daily living. Loss of flexion and internal rotation of the hip may make putting on shoes and socks difficult, for example. The differential diagnosis of hip OA can be wide. Some such examples include avascular necrosis of the femoral head, which would closely mimic the symptoms of OA. Trochanteric bursitis often presents as localized lateral hip pain reproduced by palpation. Lumbar stenosis may cause radicular pain that radiates to the groin. Lumbar back pain often presents as pain localized to the buttock. Finally tumors of the lumbar spine, pelvis, or upper thigh may cause pain in this general region.
Radiographs usually confirm the diagnosis the diagnosis of OA. Joint space narrowing, sclerosis, and osteophyte formation are the hallmark features of OA. Occasionally, the etiology of hip pain cannot be elucidated, even after history, physical examination, and radiographs. In these cases, MRI of the hip or a diagnostic hip injection under fluoroscopic guidance can assist in the diagnosis.
Treatment of OA of the hip needs to be individualized to the particular patient. Conditions such as gastric ulcers, cardiac disease, renal disease, as well as patient expectations must be taken into account. Nonoperative treatment includes patient education, acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy for muscle strengthening, activity modification, and the use of ambulatory aids. Patients who have severe pain nonresponsive to nonoperative treatment are candidates for total hip arthroplasty. Total hip arthroplasty often dramatically reduces pain and improves function, but the decision to proceed has to be made with the understanding of the risks involved.