Hip osteoarthritis (coxarthrosis)

Synonym for hip osteoarthritis

• Coxarthrosis

What is hip osteoarthritis?

Hip osteoarthritis affects the entire joint, including the cartilage, bone, and synovial membrane—the thin layer that lines the inside of the joint.^{1, 2} It becomes more common with age, though it is not an inevitable consequence of aging.³

Cartilage covers the surfaces of the bones that meet at a joint. It allows them to glide smoothly and helps distribute pressure during movement.

As osteoarthritis progresses, the cartilage becomes thinner. However, all the structures that make up the hip joint can be affected.¹ Changes can be observed in the cartilage, bone, ligaments, and muscles, as well as in the capsule that surrounds the joint and the synovial membrane that lines the inside of the joint and produces the lubricating fluid.

What are the symptoms of hip osteoarthritis?

Symptoms of hip osteoarthritis include progressive pain in the groin, morning stiffness, and difficulty moving the hip. Many people live with osteoarthritis without experiencing any pain.^{4, 1}

The severity of the changes in the joint alone does not predict your pain or what you can do.

When osteoarthritis does cause symptoms, here's what you might experience:

• Pain in the groin area that develops gradually
• Hip stiffness, often worse in the morning or after a period of inactivity
• Morning stiffness lasting less than an hour is one of the symptoms consistent with hip osteoarthritis, though it is not sufficient on its own to make a diagnosis.⁵
• Decreased hip flexibility
• Creaking or cracking sounds with movement
• The pain can sometimes radiate to the buttock, thigh, or knee

What are the risk factors for hip osteoarthritis?

Factors associated with hip osteoarthritis include age, certain previous injuries, hip shape, obesity, and high physical stress. Their significance varies from person to person.

A study conducted among residents of Johnston County, North Carolina, estimated that about one in four people who live to age 85 would develop symptomatic hip osteoarthritis.⁷ However, osteoarthritis is a chronic condition that generally progresses over several years, though the rate of progression varies greatly from person to person.^{2, 8}

Certain factors are associated with a higher likelihood of developing hip osteoarthritis, but they do not allow us to predict how the condition will progress in an individual:

• A previous hip joint injury, such as a fracture or sprain, is associated with a higher risk of osteoarthritis.⁹
• Certain hip conditions: dysplasia, in which the hip socket does not adequately cover the rounded head of the femur, the thigh bone; or the so-called “cam” deformity, in which a bony bump is present at the junction between the head and the neck—the narrower part just below it¹⁰
• Obesity⁹
• Certain occupational activities that place a heavy physical strain on the hip⁹
• Certain high-level sports are associated with a higher risk of osteoarthritis, especially in the context of joint injuries. The results vary by sport, and moderate recreational activity is not associated with the same risk.^{11, 9}
• An inflammatory condition can also cause hip symptoms, but this is a different problem than osteoarthritis

How is hip osteoarthritis diagnosed?

Hip osteoarthritis is diagnosed primarily by asking about your symptoms and examining your range of motion. An X-ray can confirm signs of osteoarthritis, but is not always necessary.^{4, 12}

Your physical therapist can determine whether your symptoms and range of motion are consistent with hip osteoarthritis, assess your range of motion and strength, and identify situations that also require a medical evaluation.

Hip pain that worsens when the thigh rotates inward—a movement called internal rotation—may be one of the signs of osteoarthritis.^{1, 12, 5}

A hip X-ray can reveal signs of osteoarthritis, such as narrowing of the space between the bones or osteophytes (small bony spurs). However, it is important to note that what is seen on an X-ray does not always correspond to your symptoms^{.1, 13} Some people have significant visible osteoarthritis but little or no pain, and vice versa.

When should you consult a physiotherapist for hip osteoarthritis?

You can see a physical therapist if you have pain, stiffness, or difficulty moving your hip that limits your activities. You can also make an appointment after your doctor has ruled out other causes of pain.

If you have persistent symptoms or symptoms related to a known case of osteoarthritis, you can schedule an appointment directly with a physical therapist. The physical therapist will refer you to a doctor if other causes need to be investigated.

Go to the emergency room if you experience severe pain after a fall or other injury, or if you can no longer walk or put weight on your leg. Tingling or a loss of sensation after an injury also requires urgent care.

Seek urgent medical attention if you experience sudden, severe pain without any injury, a warm and swollen hip, or a change in skin color around the hip. Hip pain accompanied by general malaise and a high fever—or sensations of heat, cold, or chills in addition to general malaise—also requires urgent medical attention. A warm, swollen hip warrants medical attention even without a fever. The UK’s National Health Service describes these warning signs.

Apart from these emergency situations, it is a good idea to see a doctor if:

• Pain limits your daily activities
• If your morning stiffness lasts an hour or longer, another cause should be considered, although this duration alone is not sufficient to establish a diagnosis. A physical therapist may refer you to a doctor based on other symptoms observed.⁵
• You have difficulty walking or climbing stairs
• Pain wakes you up at night

What are the physiotherapy treatments for hip osteoarthritis?

Physical therapy uses movement and tailored exercises to manage the symptoms of hip osteoarthritis. Your physical therapist will create a personalized program based on your needs and goals.

A tailored exercise program may provide a slight improvement in pain and in your ability to perform daily activities. The average effect is modest and varies depending on the individual and the treatment with which the exercise is compared.^{14, 15, 16}

During active mobilization, the physical therapist maintains a gliding motion in the joint while you move your hip. In a trial involving 40 older adults, this technique reduced pain and improved certain movements and activities immediately after the session, compared with sham mobilization. A review published in 2015 did not confirm a long-term benefit of manual therapy.^{17, 18}

Your physical therapist will first conduct a comprehensive evaluation to understand your symptoms and what makes your activities difficult. This evaluation includes:

• Your ability to move your hip
• Signs that might indicate that another problem is contributing to your symptoms
• The quality of your movements
• Your strength—for example, when getting up from a chair—and your balance when you put your weight on your leg

• Guide the movements of your hip with your hands to help reduce pain and make movement easier
• Providing you with specific exercises to improve control over your hip movements
• Prescribing exercises to regain mobility, reduce pain, and restore your muscle strength
• Teaching you how to properly manage your daily activities and hobbies
• Giving you advice on your posture and daily movements

What to do at home for hip osteoarthritis?

Physical activity tailored to your tolerance level can help manage the symptoms of hip osteoarthritis at home. Start slowly and gradually increase the intensity based on your tolerance.

Appropriate, gradual exercise helps reduce pain and makes it easier to live with hip or knee osteoarthritis. Treatment may also include advice on activities, weight management, footwear, and walking aids.

A prosthesis—an artificial hip—may be considered if non-surgical treatments do not provide sufficient relief. The 2023 surgical guidelines apply to people with moderate or severe osteoarthritis who experience pain and functional limitations, have tried non-surgical treatments, and have decided to undergo surgery in consultation with their doctor. The guidelines suggest not delaying surgery solely to repeat these non-surgical treatments. However, medical preparation may justify a delay, particularly to better control diabetes or reduce nicotine use. The timing of the procedure is determined based on your individual situation.^{20, 21, 22}

If you don’t get much exercise, start with short, regular walks and gentle hip movements. A physical therapist can show you how to bend at the hip or practice transitioning from a sitting to a standing position based on your abilities. Gradually increase the duration or intensity. If an activity significantly worsens your symptoms, reduce it and ask how to adapt it. If you’re already active, continue with the activities you can tolerate.

• Temporarily stop movements that cause too much pain and gradually resume them later
• Avoid staying in the same position for long periods of time. Limit the amount of time you spend sitting. Replacing some of that sitting time with light activity is associated with certain benefits for overall health. These studies observed people’s habits; they do not prove that replacing sitting time directly alleviates hip osteoarthritis.^{23, 24}
• Engage in physical activity every day according to your tolerance level
• Heat can help you relax. Stop using it if it makes your symptoms worse.
• After exercise, cold may provide short-term relief for some people, but this does not prove that it reduces inflammation

How to prevent hip osteoarthritis?

Physical activity supports joint health, but it does not guarantee prevention of hip osteoarthritis.^{25, 9}

The Canadian guidelines suggest the following benchmarks for adults. If you have osteoarthritis, a healthcare professional can help you adapt them to your abilities:

• The general Canadian guideline is 150 minutes per week of moderate- to vigorous-intensity physical activity, tailored to each person’s abilities and health
• Get several hours of light physical activity, including time spent standing, as your ability allows
• Do strength training exercises that include major muscle groups twice a week
• For adults, aim for 8 hours or less per day spent sitting or lying down while awake, and break up long periods of sitting as often as possible

• For overweight or obese individuals living with hip osteoarthritis, guidelines generally recommend weight loss, often in combination with exercise. However, direct evidence specific to the hip remains limited.^{26, 27, 5}
• Avoid accumulating multiple joint injuries
• A varied diet can support your overall health, though it does not guarantee that it will prevent hip osteoarthritis

To learn more

Episode 15 of the podcast by Alexis Gougeon, a physical therapist, discusses osteoarthritis and explores the topic in greater depth.

Find the episode on YouTube.

Sources

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