Osteoarthritis of the Hip

Common causes of hip osteoarthritis include:

• Genetics and family history can predispose individuals to developing osteoarthritis and joint degeneration
• Traumatic injury or fracture of the hip can result in the development of osteoarthritis.
• Significant trauma that effects the circulation of the head of the femur. This condition is called aseptic necrosis and can result in the degeneration of the ball, or femoral head.
• Excessive use of steroids or steroid medication can result in degeneration of the joint and cartilage.
• Obesity that causes increased weight and pressure on the hip joints, when performing everyday activities. This puts added stress on the hips, which increases force on the joint cartilage.
• Diseases of the joint cartilage

• Pain and achiness in the hip joint during activities. Hip pain may be reported on the outside of the hip, groin and even refer down the leg to the knee.
• Difficulty with walking and weight bearing on the involved leg.
• Loss of motion of the hip in several directions including abduction (moving out) flexion (moves toward chest) and internal rotation (turning the hip in). Stiffness that may improve with movement.
• Noticeable swelling around the joint.
• Weakness that makes it difficult to get out of chair, squat, kneel or climb stairs
• Cracking, grinding, crunching or joint noises called crepitus that occur when moving the hip. This may happen as the cartilage surfaces wear and there is bone-on-bone rubbing, or bony spurs.

Treatment of hip osteoarthritis will depend on the severity of the condition. Some important guidelines should be followed at the onset.

Physical Therapists are professionals, educated and trained to administer interventions. As defined by The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and the patient or client’s goals.

Your physical therapist will perform a thorough evaluation to assess and determine the following:

• Joint: a series of measurements will be performed to determine which joint is involved and the extent to which the inflammation is acute
• Strength: resisted testing is performed to determine if there is associated weakness or strength imbalances
• Flexibility: range of motion measurements will be taken to determine if there is reduced joint movement
• Technique and ADL: the therapist will review what activities you have difficulty with and will help you make modifications in technique to reduce stress on the involved joint.
• Gait, Balance and Alignment: the therapist will assess your gait and balance on even and uneven surfaces. An assistive device such as a cane or walker may be indicated to improve safety, gait and reduce stress on the effected joint.

Physical therapy for hip osteoarthritis must remain conservative at the onset to avoid aggravating the condition. Emphasis will be placed on rest, reducing the inflammation, protecting the joint and increasing the blood circulation for healing. Once the initial inflammation has reduced, a program of stretching and strengthening will be initiated to restore flexibility and improve strength to reduce stress on the hip joint. An assistive device for ambulation, or moving around, may be necessary to decrease weight bearing on the hip and normalize the gait.

Common Physical Therapy interventions in the treatment of Hip Osteoarthritis include:

• Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, stretching and joint mobilization by a physical therapist to improve alignment, mobility and range of motion of the hip. The use of mobilization techniques also helps to modulate pain.
• Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen muscles of the hip and lower extremity to support, stabilize and decrease the stresses place on joint cartilage and the hip joint.
• Neuromuscular Reeducation (NMR) to restore stability, retrain the lower extremity and improve movement techniques and mechanics (for example, walking, bending, or stair climbing) of the involved lower extremity to reduce stress on the joint surfaces in daily activities. Gait and balance training may be indicated in those individuals who have problems with walking.
• Modalities including the use of ultrasound, electrical stimulation, ice, cold, laser and others to decrease pain and inflammation of the involved joint.

Avoiding the activities that produce the pain or stress the involved joint is the first line of treatment.

• RICE: Rest, Ice, Compression, Elevation should be used to reduce the stress on the joint.
• NSAIDS (Non steroidal anti-inflammatory drugs) to reduce pain
• Use of an assistive device such as a cane or walker may reduce stress on the hip while reducing a limp or gait deviation.
• Injection of steroids may be indicated to reduce inflammation of the involved joint.
• In severe recurrent conditions surgery may be indicated. In cases of severe arthritis or joint degeneration a hip joint resurfacing or total hip replacement procedure may be recommended.