Degenerative arthritis refers to diffuse loss of normal articular cartilage in the joint and must be considered as the primary cause of hip pain, regardless of age. Osteoarthritis, traumatic arthritis, and rheumatoid arthritis are common causes of degenerative arthritis. Typically the presence and extent of arthritis tends to increase with age. Degenerative arthritis is the most common cause of hip pain in patients over fifty years of age.
Signs and Symptoms
Patients report progressively worsening pain, typically with a gradual onset. As activity increases, pain also tends to increase. A limp may develop, occasional sharp pains may be noted, and stiffness may be progressive. Radiographs reveal joint space narrowing, and possible cysts, spurs (also called osteophytes), and sclerosis (thickening of the bone adjacent to the joint). A decrease in range of motion may also be noted,
Differential Diagnosis
Differential diagnosis includes loose bodies, labral tears, ligamentum teres tears, and arthritis in the lumbar spine with radiating pains to the hip area.
Management
For patients with mild arthritis, nonoperative treatment may suffice. NSAIDS (non-steroidal anti0inflammatory medications), glucosamine and chondroitin sulfate, steroid injections, and hyaluronic acid injections may be effective. Activity modification is an option to minimize symptoms. Tylenol and the use of NSAIDS may be effective and should be discussed along with your primary care physician. There are concerns with the use of NSAIDS, particularly in the long term.
For patients who have failed nonoperative management, three surgical options exist:
1) For diffuse areas of articular cartilage injury, typically noted as joint space narrowing on plain x-rays, a total joint replacement is the best surgical treatment option.
2) For patients who have little to no joint space narrowing and who have localized or focal areas of articular cartilage injury:
2a) An open hip dislocation with treatment of the intra-articular abnormalities as well as any contributing abnormal bone alignment may be considered.
2b) An arthroscopic approach, through small incisions, may also be effective.
My approach to deciding which surgery is best is decided on an individual basis, with a number of factors taken into consideration, including but not limited to age and activity level.
