What is Hip Osteoarthritis (Arthrosis)? What Are the Symptoms? How Is It Diagnosed and Treated?

Hip osteoarthritis is a health issue that can seriously reduce your quality of life. Known commonly by this name, hip joint arthrosis occurs as a result of the wear and tear of the cartilage in the hip joint over time. Among the symptoms of hip osteoarthritis, pain felt primarily in the groin area comes first. This pain is mild at the beginning, but can become constant in later stages. Causes of hip osteoarthritis include trauma, aging, and various joint diseases. In this article, we will examine in detail topics such as where hip osteoarthritis pain radiates, what the symptoms of hip bone osteoarthritis are, what is good for hip osteoarthritis, and treatment options for hip osteoarthritis.

What Is Hip Osteoarthritis (Coxarthrosis)?

Hip joint osteoarthritis is called coxarthrosis in medical terms. This condition occurs as a result of the wear and tear of the cartilage structure in the hip joint over time. The name "calcification" (kireçlenme) can be misleading. Because when the hip joint is opened, a layer of lime like that at the bottom of a kettle is not seen.

Hip Joint Structure

The hip joint is one of the largest joints in your body. Located between the head of the femur (thigh bone) and the socket in the pelvic bone, this structure forms a ball-and-socket joint. Thanks to this design, your hip can move in every direction.

The bone surfaces in the joint are covered with cartilage. This cartilage layer protects your bones and allows for smooth movement. A special membrane surrounding the hip joint also produces synovial fluid. Thanks to this fluid, your hip movements occur easily and painlessly.

Your body's center of gravity is carried by the hip joint. Therefore, this joint works under constant load and is susceptible to wear. During walking, three times your body weight is loaded onto the hip joint. During running, this load increases to seven or eight times.

How Does the Osteoarthritis Process Progress?

The osteoarthritis process begins primarily in the cartilage tissue. The cartilage between the two bone surfaces begins to wear out. The structure of the cartilage deteriorates and thins. At this stage, its load-bearing capacity decreases.

As the cartilage thins, the loads on the underlying bones increase. Your bones respond to this increased load by creating new bone. This new bone formation is called an osteophyte, and it is what gives the disease the name "calcification." Over time, the two bones begin to rub against each other. As a result of this long-term friction, hip osteoarthritis occurs.

In the future, the joint structure deteriorates significantly. Not only the inside of the joint, but also the soft tissues outside it are affected over time. Pain and swelling may also occur in muscles, tendons, and ligaments.

Hip osteoarthritis consists of four stages. The first stage is the beginning, the second and third stages are moderate, and the fourth stage is the advanced stage requiring surgery. When intervened early, treatment can be planned without the need for surgery. However, in the advanced stage, surgery becomes inevitable.

Hip osteoarthritis is usually seen with aging. If there is no trauma at a young age, it is encountered after the age of 55-60.

Causes and Risk Factors of Hip Osteoarthritis

The causes of hip osteoarthritis are multifaceted and arise as a result of the interaction of multiple factors. Genetic, environmental, and mechanical factors play a role in the development of the disease.

Wear Due to Aging

Advanced age is the most common cause of hip osteoarthritis. As age progresses, the joint cartilage thins and loses its elasticity. This leads to the friction of joint surfaces against each other. The cartilage tissue begins to wear out over time and loses its protective feature.

Usually, after the age of 50, the wear and tear in the cartilage tissue accelerates. With aging, the frequency of occurrence increases significantly. According to research, the risk of a person developing hip osteoarthritis throughout their life is approximately 25%.

Developmental Hip Problems

Hip problems seen in infancy or childhood pave the way for osteoarthritis in the future. Developmental dysplasia of the hip is a typical example of this. Because the hip socket develops shallowly, the head of the femur is not fully covered.

This incompatibility disrupts the load distribution in the joint. The load concentrates on a narrow area, and early wear begins in that region. In untreated cases, the wear of the joint can progress, and advanced-stage osteoarthritis can develop. Childhood diseases such as Perthes disease or slipped capital femoral epiphysis can also cause early osteoarthritis in a similar way.

Trauma and Fractures

Previous fractures and dislocations in the hip area increase the risk of osteoarthritis. High-energy injuries, especially motor vehicle accidents or extreme sports, damage the joint surfaces. Repetitive mechanical stresses such as occupational accidents and heavy lifting also increase the risk.

Permanent damage can occur in the joint after sports injuries. Structural disorders that develop after trauma lead to irregular wear of the cartilage.

Rheumatic Diseases

Inflammatory rheumatic diseases such as rheumatoid arthritis can affect the hip joint. Inflammation in the joint lining thickens the synovium. This causes the release of chemicals that damage the cartilage and bone. While pain due to inflammation is seen at the beginning, the damage to the joint cartilage progresses over time, and osteoarthritis pain begins.

Femoral Head Necrosis (Avascular Necrosis)

As a result of the disruption of blood flow to the femoral head, the bone tissue dies. This condition is called avascular necrosis. Long-term or high-dose cortisone use is the most common cause. Especially in COVID treatment, steroid use has increased. Regular steroid use in people with diseases such as asthma and COPD interrupts the blood flow to the hip.

Excessive alcohol consumption also increases the risk of avascular necrosis by disrupting blood flow. Medical conditions such as sickle cell anemia, Gaucher disease, and blood clotting disorders also increase the risk.

Other Risk Factors

Obesity accelerates cartilage wear by putting excessive load on the hip joint. Every 5 kg of excess weight increases the risk by 10-15%. Genetic predisposition is also important. The risk is higher in people with a family history of hip osteoarthritis.

In women, especially after menopause, the decrease in estrogen levels can weaken the cartilage structure. Smoking increases the risk by narrowing blood vessels. Those who do intense sports or work in heavy jobs are at higher risk.

What Are the Symptoms of Hip Osteoarthritis?

Pain is the most prominent complaint of hip osteoarthritis. It does not manifest itself clearly at the beginning, but as cartilage loss progresses, the symptoms become more pronounced.

Where Does Hip Osteoarthritis Pain Radiate?

The groin area is the most common place where hip joint osteoarthritis pain is felt. This pain, which starts in the groin, often radiates to the front and middle parts of the thigh. In some cases, while the pain goes down to the knee, this situation can mislead patients.

The characteristics of the pain change over time. In the early periods, it appears after activities such as long walks or climbing stairs. Even during short-distance walks, the pain begins to increase. Especially when turning from right to left, sitting down, and getting up, this discomfort felt in the hip radiates towards the leg.

Morning stiffness is a common condition. After sitting or resting for a long time, pain and stiffness become more pronounced. Weather conditions also affect the pain. Complaints intensify in rainy weather and humid environments.

Movement Limitation

As the cartilage damage in the joint progresses, your hip's range of motion decreases. You do not want to move because of the pain. You begin to have difficulty even in simple daily activities.

It becomes difficult to put on shoes and socks. It becomes difficult to sit by bending over, to cross your legs. Going up and down stairs involves serious difficulty. Significant pain occurs, especially during rotation movements.

As the disease progresses, you may hear clicking or crunching sounds while moving your hip. You experience a feeling of joint locking. This is caused by cartilage fragments preventing the smooth movement of the joint.

Limping and Leg Shortening

Limping is one of the visible symptoms of hip osteoarthritis. Your walking pattern changes due to pain. The decrease in range of motion causes limping.

A feeling of shortening may occur in the affected leg. This can be a real shortening due to the deterioration in the bone structure. Limping becomes more pronounced over time, and that side of the leg feels as if it has shortened.

Advanced Stage Symptoms

As the disease progresses, pain appears even during rest. You feel discomfort in the groin and leg while sleeping at night. Pain can even be seen during turning movements in bed.

These pains felt during rest reduce your sleep quality. You do not want to go out, and you are forced to prefer a sedentary life. The effect duration of painkillers decreases.

In the advanced stage, the limitation of movement in daily life increases significantly. Along with this, the hip undergoes deformation, and cosmetic disorders appear. You may need assistive devices such as a cane.

Hip Osteoarthritis Diagnosis and Diagnostic Methods

Making an accurate diagnosis forms the basis of the treatment plan. The diagnosis of hip osteoarthritis is made by evaluating physical examination findings and imaging methods together. In patients who apply to an orthopedist with complaints of groin or hip pain, the initial evaluation is done in this way.

Physical Examination

The orthopedist first evaluates your hip's range of motion. Especially the occurrence of pain during rotation movements suggests a problem originating from the hip joint. The doctor determines which positions you feel pain in by moving your hip in different directions.

During the examination, sounds coming from the joint are listened to. Abnormal sounds such as crunching or creaking may indicate cartilage damage. Your gait is examined, and whether there is limping is observed.

The condition of the muscles and ligaments around the hip is checked. Leg length difference is measured. The intensity and time of occurrence of pain during movement are recorded.

X-Ray Imaging

The primary diagnostic method for hip osteoarthritis is an X-ray. A simple X-ray is usually sufficient to make a diagnosis. The X-ray provides information about the general condition of the hip and allows for a definitive diagnosis.

Narrowing of the joint space in standing X-rays is the most important finding. Destruction of joint surfaces and deterioration of the structure are seen. New bone formations are observed in areas where wear has begun. These bone spurs are called osteophytes in medical terms.

MRI and Tomography

In some cases, a more detailed examination may be required. MRI evaluates the condition of soft tissues. It shows cartilage damage and surrounding structures. MRI may be requested for early-stage cartilage damage or soft tissue problems.

Computed tomography provides detailed images of the bone structure. Tomography may be requested for pre-operative planning. Blood tests may be performed to rule out an underlying disease. Blood tests check for inflammation markers or the presence of rheumatic diseases.

Stages of Osteoarthritis

Hip osteoarthritis is divided into stages according to X-ray findings. Usually, 3 stages are defined. In Stage 1, there is minimal narrowing in the joint space, and hip movements are relatively normal. In Stage 3, there is advanced narrowing, and hip movements are completely restricted.

In some classifications, 4 stages are used. The first stage is the beginning, the second and third stages are moderate, and the fourth stage is the advanced stage requiring surgery. Hip osteoarthritis caught in the first 3 stages can be improved with non-surgical treatments.

How Is Hip Osteoarthritis Treated?

The treatment approach is determined according to the stage of the disease. When intervened early, treatment can be planned without the need for surgery. Osteoarthritis caught in the first 3 stages can be improved with non-surgical methods.

Early Stage Conservative Treatment Methods

Painkillers are used in initial treatment. If simple painkillers are not enough, non-steroidal anti-inflammatory drugs can be tried. Joint-supporting drugs such as chondroitin sulfate and glucosamine are also included in the treatment.

Physical therapy includes applications aimed at relieving pain. Heat applications and electrical currents reduce pain. Exercise programs strengthen the muscles that support the joint. To see the maximum effect, you need to continue the exercises regularly for 4-6 weeks.

Weight control and activity regulation are important. Rest may be necessary to reduce the load on the hip joint. You can use assistive devices such as a cane or walker.

What Is Good for Hip Osteoarthritis?

Swimming is at the forefront because it does not put direct load on the hip joint. Exercises done in water and cycling are also among the recommended sports. Thermal springs are good options where water, exercise, and heat can be applied together.

Regular exercise strengthens muscles and increases range of motion. However, you should avoid activities that put excessive load on the hip. Short-term movements should be preferred instead of long walks.

Injection Treatments and Stem Cells

Cortisone injections are applied in cases where pain is at the forefront. Hyaluronic acid injections are used in milder cases.

PRP treatment is the injection of platelet suspension prepared from your blood into your joint. It gives ideal results in mild or moderate osteoarthritis. Its effect increases as it is done early.

Stem cell therapy provides benefits in the early period. Supportive treatments such as PRP, stem cells, and collagen are used in the first stages. Injections must be done under imaging guidance. Reaching the correct area with the help of ultrasound is ensured.

Hip Replacement Surgery

The only method resorted to in advanced-stage patients is surgery. Salvage surgeries are applied in problems involving less than 50% of the hip joint. Surface arthroplasty or cartilage transplantation are among these treatments.

In total hip replacement, damaged joint surfaces are removed and replaced with an artificial joint. Prostheses made of metal, ceramic, or plastic materials are used. Ceramic prostheses are more resistant to wear. It is possible to use these prostheses for up to 30 years.

Post-Operative Process and Recovery

After the surgery, you will stay in the hospital for 3 days. You can leave by walking at the end of the third day. Especially, your walking is ensured, and your muscle strength is preserved.

For the first 3 months, you are asked to move as recommended by the doctor. Your sitting and standing methods, including toilet habits, are taught. After three months, restrictions decrease.

After one and a half to 2 months, you can return to your daily life without restrictions. The physical therapy and rehabilitation process is an inseparable part of the surgery.

Prosthesis Life and Things to Consider

The life of the prosthesis depends on the surgical technique, prosthesis quality, and your lifestyle. Perfect placement and correct prosthesis selection provide 15-20 years or perhaps longer use.

Ceramic-on-ceramic surfaces are extremely resistant to wear. However, they are more sensitive to breakage. The classic metal-polyethylene choice can be used for over 20-30 years.

In patient groups with good muscle levels and young patients, the prosthesis gives gratifying results. Patients can continue their lives as if the prosthesis does not exist. Regular doctor check-ups and recommended exercises extend the life of the prosthesis.

Frequently Asked Questions

Which doctor should I go to for hip osteoarthritis?

When you experience hip pain, you should first apply to an orthopedics and traumatology specialist. Orthopedists specialize in the diagnosis and treatment of joint diseases. They can make a definitive diagnosis with the necessary examination and imaging methods.

Does hip osteoarthritis go away without surgery?

When caught in early stages, non-surgical treatment is possible. Your pain can be brought under control with physical therapy, exercises, medications, and injection treatments. However, in the advanced stage, surgical intervention becomes inevitable. Therefore, early diagnosis increases your chances.

Which exercises should be done for hip osteoarthritis?

Swimming and water exercises are the most suitable options. Cycling also increases your muscle strength without putting too much load on the joints. Stretching and strengthening movements done under the supervision of a physical therapist are especially beneficial. You should avoid high-impact activities such as heavy lifting and running.

How many hours does hip replacement surgery take?

The surgery is usually completed in 1-2 hours. You are expected to stay in the hospital for 3 days. You can be discharged by walking on the third day. The full recovery process takes place within approximately 6-12 weeks.

Is cold or heat good for hip osteoarthritis?

Both applications are used for different purposes. Heat application allows muscles to relax and reduces pain. Thermal spring waters are relaxing for this reason. Cold application is beneficial especially if there is swelling and inflammation. You should discuss with your doctor which method is suitable for you.

Can I walk normally after hip replacement?

Yes, most patients regain their normal gait after the prosthesis. You are asked to move carefully for the first 3 months. However, you can easily return to your daily activities after one and a half to 2 months. Regular exercises and doctor check-ups give successful results.

In Summary, Hip Osteoarthritis

Hip osteoarthritis can seriously affect your quality of life. However, when you notice it in the early period, recovery is possible with non-surgical treatment options. If you feel constant pain in the groin area, you should definitely consult an orthopedist.

Regular exercise, weight control, and compliance with doctor recommendations increase the success of your treatment process. In advanced stages, prosthesis surgery becomes inevitable, but with the right prosthesis selection and post-operative care, you can move comfortably for many years. Early diagnosis increases your chances and expands your treatment options.