Osteoarthritis of the Hip
Osteoarthritis (OA) of the hip is one of the most common joint disorders that affects the joint and causes capsular changes within. OA usually occurs in middle age and elderly people and causes cartilage loss, subchondral bone and joint degeneration, decreased joint space, flattening of the formal head, and a shortening of the joint capsule. Over time, osteophyte formation may occur from the excessive tensile forces on the capsule or from the increased pressure on the articular cartilage. This disease causes loss of range of motion (especially internal rotation and flexion), stiffness, and muscle weakness especially of the abductors. These changes associated with the disease are usually slow to progress but in some cases can happen very rapidly but the disease process can be slowed through proper exercise and management. Treatment of OA includes patient education on ways to decrease pain, improve their function, reducing stiffness, and reducing the need for medications, functional gait and balance training, the use of an assistive device, manual therapy, strengthening exercises, and flexibility exercises. However, some individuals may require a total hip arthroplasty if they do not respond to treatment.
Signs & Symptoms
- Moderate pain in the lateral or anterior hip with weight bearing and may progress to the anterior thigh or knee
- Morning stiffness that improves in less than 1 hour
- Limited PROM of hip joint (especially decreased internal rotation and flexion)
Risk Factors
- Over 60 years old
- History of developmental disorders such as Legg-Calve-Perthes disease, congenital dislocation, or slipped capital femoral epiphysis
- Dysplagia of the femur or acetabulum
- Caucasian
- Male
- Family history
- An occupation that required heavy lifting (i.e. farming)
- Participation in certain sports such as running, football, and hockey
- Have a leg length discrepancy
Important Questions
- Is there pain with weight bearing?
- Morning stiffness? How long does it last?
- Aggravating/Easing factors
- Is there a family history of OA?
- Occupation
- Past illnesses
Special Tests
- AROM
- PROM
- Scour Test
- FABER’s
- Fitzgerald Test for labral tears
- Flexion-adduction internal rotation for labral tears
- Sacroiliac joint provocation test
- Femoral nerve stretch test for L-3 radicolopathy