Hip Pain

What is Osteoarthritis?

Osteoarthritis is one of the most common orthopedic conditions among physical therapy patients. Osteoarthritis (OA) describes degeneration of cartilage and, eventually, bone in a moving joint. The development of OA can be the result of a previous injury or specific joint condition but is most often idiopathic in nature.¹ Knees, hips, and thumbs are notorious for developing OA as a result of the large, repetitive forces these joints have to absorb over the course of a lifetime.² The term OA refers to a wide spectrum of joint degeneration and can sometimes be used to describe a joint that appears damaged on an X-ray but doesn’t hurt or cause a decline in function (asymptomatic osteoarthritis). Various studies of the general population in the U.S. estimate that 20-28% of adults aged 60+ have evidence of hip OA on an X-ray, yet only 4-10% of this population have pain or poor function due to hip OA.³ ⁴ Although an X-ray may show hip joint degenerative changes, treatment generally does not occur until someone begins to have symptoms. 

What are the early signs of hip osteoarthritis?

Early signs and symptoms of hip OA overlap with many other orthopedic hip conditions but the most typical are pain and stiffness.¹ Pain due to hip OA most often occurs in the groin.  Other common areas to experience pain include the lateral (side) part of the upper thigh or radiating down toward the knee.  Pain is infrequently experienced in the buttock with hip OA. Arthritic pain is commonly caused by prolonged activity or even by prolonged rest. Finding a good balance between activity and rest can be frustrating for patients dealing with hip OA but, in general, avoiding vigorous high-impact activity or sitting for long periods will be the first step to lessen pain. Another early sign of hip OA is joint stiffness. Many people with hip OA will notice difficulty taking full length strides or bending forward to pick something up. Putting on shoes and socks may cause some difficulty as will getting in and out of a car.  Decreased range of motion in the hip joint can greatly affect your whole body and encourage compensations of the lumbar spine or legs which can cause a variety of other problems. In more advanced cases of hip OA, people may notice locking, catching, or popping in the hip joint. It is important to keep in mind that although hip stiffness and pain are signs of OA, not all hip stiffness or pain indicate that someone has OA.

How do I know if my hip stiffness is from arthritis?

So how do you know if your hip stiffness is caused by OA or not? Several risk factors make you much more susceptible to a diagnosis of hip OA. The biggest risk factor for hip OA is age. Anyone over the age of 60 is at a higher risk for having progressed hip joint degeneration due to wear and tear over time.5 Gender also affects your likelihood of OA; women are found to have higher rates of hip OA than men especially as age progresses.¹ Furthermore, genetics have a large effect on whether or not someone will develop OA. In fact, researchers suggest that genetics account for as much as 60% of variation in risk of developing OA.⁵ Unfortunately, we cannot control any of these risk factors, but knowing that you fall into one or more of these groups may lead you to seek evaluation and treatment sooner if you begin to see early warning signs of OA. 

Although we can’t change our genetics or age, there are many ways that people can mitigate hip joint degeneration. One of the most important factors affecting joint health is body weight. The hip joint bears your entire body weight when standing but this force can be multiplied many times during more intense activity such as walking, running, or jumping. Excess bodyweight will compound to put very high loads on the hip joint. This can lead to additional wear and tear and possible increase in damage to the hip joint. In addition to increased mechanical stress, high body mass often coincides with metabolic issues that lead to chronic low-grade inflammation in joints.² ⁶ Middle-aged populations with OA were found to be five times more likely to have underlying metabolic complications associated with obesity when compared to similar aged populations without OA.⁶ Maintaining a healthy body weight is likely one of the best ways to reduce the chance of developing hip OA. Another way to reduce your chances of developing hip OA is to limit repetitive stresses. Many jobs or hobbies involve asymmetrical repetitive motions which over time can lead to overload and joint damage. Working on performing these motions on both sides and increasing hip muscle strength can be very helpful in reducing the chance of developing hip OA. Low impact exercise is often advised for aging persons with hip degeneration to reduce mechanical stresses on that joint.

I have been diagnosed with Hip OA… now what?

Luckily there are numerous treatment options for decreasing hip OA symptoms and improving function. Evaluation by an orthopedic doctor or physical therapist is the first step to improving your hip health and getting back to doing the things you love. Early diagnosis and treatment can prevent further joint damage, decrease pain, and increase the longevity of your hip joints.

• See a Physical Therapist is the first stop

  • They will do a full biomechanical analysis of you, but specifically the hip both passively, actively, and with function

  • Gait Analysis to see how the hip is effecting your walking or conversely what factors are effecting your hip.

    • This could be shoe selection, balance, selective muscle weakness, or even orthotics

Authors:

Nick Jackson, PT, DPT
Dr. Jonah Hulst, MD
Orthopedic Surgeon & Sports Medicine Physician

Contributors:

Dr. Christopher Boone, MD
Orthopedic Surgeon & Sports Medicine Physician
Ben Wobker, PT, MSPT, CSCS, CFSC, SFMA

Related Blogs, Webpages, and Videos

References:

1. Lespasio MJ, Sultan AA, Piuzzi NS, et al. Hip Osteoarthritis: A Primer. Perm J. 2018;22:17-084. doi:10.7812/TPP/17-084

2. Reyes C, Leyland KM, Peat G, Cooper C, Arden NK, Prieto-Alhambra D. Association Between Overweight and Obesity and Risk of Clinically Diagnosed Knee, Hip, and Hand Osteoarthritis: A Population-Based Cohort Study. Arthritis Rheumatol. 2016 Aug;68(8):1869-75. doi: 10.1002/art.39707.

3. Kim C, Linsenmeyer KD, Vlad SC, et al. Prevalence of Radiographic and Symptomatic Hip Osteoarthritis in an Urban United States Community: The Framingham Osteoarthritis Study. Arthritis & Rheumatology. 2014;66(11):3013-3017. doi:10.1002/art.38795

4. Jordan JM, Helmick CG, Renner JB, et al. Prevalence of Hip Symptoms and Radiographic and Symptomatic Hip Osteoarthritis in African Americans and Caucasians: The Johnston County Osteoarthritis Project. The Journal of Rheumatology. 2009;36(4):809-815. doi:10.3899/jrheum.080677

5. Lane NE. Osteoarthritis of the Hip. New England Journal of Medicine. 2007;357(14):1413-1421. doi:10.1056/nejmcp071112 

6. Kluzek S, Newton JL, Arden NK. Is osteoarthritis a metabolic disorder? British Medical Bulletin. 2015;115(1):111-121. doi:10.1093/bmb/ldv028