Pathophysiology
- Repetitive microtrauma irritates the cartilage |
- Immune response causes swelling and softening |
- Surface damage occurs |
- Subchondral cysts, joint space narrowing, sclerosis , deformity and osteophytes in chronic cases |
Causes
- Age |
- Repetitive trauma (prolonged standing/sitting), heavy physical exertion) |
- FAI |
- Obesity |
- Male gender |
- Congenital defects |
Presentation
- Prolonged stiffness upon arising (<60 mins) and inactivity |
- Inability to put their socks on, shave their legs, climb stairs |
- Groin, anterior thigh and buttock pain |
- C Sign (Index finger over anterior aspect of hip, near ASIS and thumb over posterior trochanteric region when they point to their area of pain |
- Pain below the knee can indicate saphenous nerve involvement |
- Pain gradually progressive from dull to sharp and increases with weight bearing |
- Crepitus can be present |
- TTP over GT |
- ROM Diminished in capsular pattern (PROM >15 degrees in internal rot, >155 in hip flexion) |
- AROM flexion and extension painful |
- Tight ilipsoas, adductors, QL, TFL, piriformis |
- Weak gluts, Quads, external rotators of the hip |
- +ve Trendeleburg, FABRE, Quadrant, FAIR, Thomas |
- WOMAC
-HHS
-HOOS for symptoms and disability
Imaging
- Standard for Hip OA: |
if >65 years old |
Severe pain |
Hx of trauma |
Osteoporosis |
Cancer |
Corticosteroid use |
Alcohol abuse (AVN) |
Asphericity of the femoral head on x-ray = AVN MRI NEEDED |
Any red flags |
Blood tests (ESR, FBC, CRP, RF, ANA, WBCC) for infection/inflammatory arthropathy |
Management
- EMT of the hip |
- SMT/EMT of Lx, SI, LL |
- Swimming, cycling, walking on safe and flat surfaces |
- Stretching of psoas, adductors, quads, TFL and piriformis |
- Strengthening of gluts, quads, ext rots of the hip, hup adductors, hip flexors and core muscles |
- Lifestyle recommendations - avoid aggravating activities (require internal rotation) , overweight patients weight reduction program |
- Temporary cane in opposite hand |
- NSAIDs/1500mg of glucosamine and chondroitin |
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