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Hip

Hip Arthritis

Osteoarthritis of the hip is a degenerative condition that occurs progressive loss of articular cartilage. Hip arthritis is more common in females than males and may be associated with either general or acquired deformities (hip dysplasia or slipped capital femoral epiphysis, for example).

Anatomy and Pathophysiology

The hip is a ball-and-socket joint. The ball is the femoral head, while the socket is part of the pelvis known as the acetabulum. On the surface of the femoral head and the acetabulum, articular cartilage exists and enables a low friction surface for gliding of the joint. The labrum is fibrocartilage that forms a tight seal around the joint and helping to provide stability.

Signs and Symptoms

The hip is often painful both at rest and with activity. Over time, walking tolerance becomes limited, as does hip range of motion. Some experience a catching sensation within the hip joint.

Physical Examination and Work-up

On examination, the hip joint often has limited range of motion relative to a non-arthritic hip joint. Additional tests of range of motion, strength and neurovascular examination are also conducted.

Imaging

X-rays enable evaluate of the joint for signs of osteoarthritis, such as joint space narrowing, osteophytes, subchondral sclerosis or cysts. An MRI if generally not needed to make the diagnosis of hip arthritis.

Management of Hip Arthritis

Activity modification, rest, physical therapy and injection are often the first line of treatment. Physical therapy focuses on hip and core strengthening, and addresses imbalances of musculature and flexibility. If symptoms do not improve with prescribed non-operative management, surgery may be considered.

End stage, symptomatic or severe hip osteoarthritis is managed with total hip arthroplasty (THA), or “hip replacement” surgery. In this procedure, the damaged sections of the hip joint are resected and replaced with materials consisting of metal and plastic. The goal is to reduce pain and improve lower extremity function. Post-operative rehabilitation is closely guided and important for a successful outcome.


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