Osteoarthritis of the Hip

By Jennifer Cuthbertson

The hip is the second largest weight-bearing joint – second only to the knee. It is a ball-and-socket joint. The socket is formed by part of the pelvic bone (acetabulum) and the ball is the upper end of the thigh bone (femur).

Smooth, slippery cartilage covers the surfaces of the ball and socket. It pads and protects the bones, allowing them to move easily. 
With OA, the cartilage wears way over time. The bone ends get rough and the space in the joint gets small. The bones rub against each other and bone spurs grow, causing pain. 
 

There is no single cause of osteoarthritis. Certain factors make you more likely to have OA.

• Age.
• Family history.
• Injury to the hip, even an old one.
• Being overweight or obese.
• Improper growth of the hip joint, known as hip dysplasia.
   

Symptoms usually develop slowly and worsen over time. You may feel worse in the morning or after sitting or resting for a while. 

• Pain in the groin is the most common symptom. You may also feel pain in the thigh, buttocks or down your leg to the knee.
• Crepitus is the grinding noise and “locking” or “sticking” that you feel when you move your hip. 
• Stiffness in the hip joint makes it difficult to walk or bend.
• Decreased range of motion in the hip may affect your ability to walk and cause you to limp.
   

To make a diagnosis your doctor will ask you questions and examine your body. They will check for:

• How far your hip will move in different directions.
• Signs of injury.
• Grinding (crepitus) when you walk.
• Problems with the way you walk.
• Pain when pressure is applied to the hip.

Your doctor will likely order X-rays. They can show a thinning of the joint space, any changes in the bone and bone spurs (bony points on the edges of the joint). Sometimes, magnetic resonance imaging (MRI) might be used to get a picture of the hip that includes both bone and soft tissue.
 

OA cannot be cured. However, you can treat your symptoms and find pain relief. 

Non-Drug Treatments
Try these self-care basics to help ease your pain and stiffness and help you walk better.

• Topical creams that include ingredients like capsaicin, camphor or CBD.
• Exercise – water aerobics and swimming are good choices.
• Physical therapy or occupational therapy. 
• Weight loss.
• Cane or walker.
• Hot or cold packs, acupuncture, massage.

Drug Treatments
When pain keeps you from doing what you need to do, medication may help. 

• Oral medications that include acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs; Advil, Aleve) can help ease pain.
• Gel or creams that include NSAID (Voltaren), lidocaine (Aspercreme) and slicylates that can be rubbed on the knee.
• Steroids (glucocorticoids) can be taken by mouth or injected into the joints. The injections provide short-term relief and can be given three to four times a year.

Surgical Treatments
If pain continues even with self-care and medicine, your doctor may recommend surgery. 

• Hip resurfacing is when the damaged bone and cartilage are removed and replaced with a metal shell. The “ball” part of the joint is not removed. Instead it is capped with a smooth metal covering.
• Total hip replacement (arthroplasty) is when your doctor removes the damaged hip socket and the head of the femur. They are replaced with metal, plastic or ceramic parts.
• Osteotomy is used rarely. The bones are cut or shaved down to realign joint.