What is hip osteoarthritis (OA)?

Hip osteoarthritis is a common cause of hip and groin pain, affecting people over 50.

Hip osteoarthritis is a progressive, degenerative condition affecting the joint architecture.

Over time the cartilage within the joint becomes damaged. Normally with repetitive joint loading.

The unprotected joint surfaces come into contact with one other.

This causes the joint to become inflamed and further damage can occur.

What are the symptoms of hip osteoarthritis?

The symptoms of hip osteoarthritis are:

Pain located in the crease of your hip/groin especially when sitting or putting your socks on.

Painful with activities of daily living including dressing, walking, and gardening.

Pain after a period of rest such as getting up from a chair or out of bed in the morning.

Stiffness/lack of mobility with bringing your knee towards your chest.

Hip osteoarthritis vs Greater trochanteric pain syndrome

Hip osteoarthritis is often associated with pain in the groin area, located in the crease of the hip. This is in contrast to greater trochanteric pain syndrome. Which is not a joint condition but refers to pain emanating from a gluteal (buttock) tendon or bursa.

Hip osteoarthritis is common in older patients. It is very painful and accompanied by stiffness. Greater trochanteric pain syndrome can occur at any age. It can be due to many factors including poor muscle control or bad posturing. It is rarely associated with hip joint stiffness.

How do you know if you have hip osteoarthritis?

Hip osteoarthritis is a progressive disease. It gets worse over weeks or months, often creeping up over a prolonged period of time. On occasion, what appears to be an innocuous incident at the time can trigger the pain. For example, tripping up, twisting, or missing a step.

You will start to notice your hip getting stiff and painful when completing tasks. Such as putting your footwear and socks on or getting out of a seat. The pain is normally located in the groin and around the side of the hip. It can also refer down the front and side of the thigh to the knee. Classically, arthritic symptoms are worse in the morning. Or with inactivity and ease up as you start moving and carrying out normal activities.

With arthritic pain, you will experience good days and bad days. Acute flare-ups can last for a few weeks but will often settle down with relative rest and medication.

As hip osteoarthritis progresses. You may notice a more significant loss in range of movement of the joint and more morning stiffness. You may also start to limp and get pain at night.

How is osteoarthritis of the hip diagnosed?

Getting the right diagnosis is essential. Ensuring you embark on the right treatment plan for you.

Hip osteoarthritis is visible on an X-ray. All GP’s will be able to send you for an X-ray. The waiting time for an X-ray is short on the NHS. Your GP may also refer you for blood tests. To rule out any other systemic reasons for your pain such as rheumatoid arthritis.

An X-ray will also assess the stage of arthritis; be it mild, moderate, or severe. It is not unusual that a patient has severe pain but minimal arthritic changes on an X-ray. It is also known that many patients over 40 years old have osteoarthritic changes on X-ray. But do not experience pain.

This is why it is essential that the results of your X-ray are combined with a full clinical assessment. This includes an assessment of your joint range of movement. Muscle length and muscle strength. We will also assess your biomechanics and function.

At Core Physio, many physiotherapists are highly experienced in hip pain. They can carry out an ultrasound of your hip and surrounding soft tissues. This is a very useful investigation of hip pain. It allows visualisation not only the bones and joints. But also the surrounding muscles, tendons, and joints. We can also assess how much inflammation and swelling there is. Within the joint and surrounding structures.

Ultrasound is excellent at differentiating between other reasons for your hip pain. Which an X-ray will not show. such as:

Hip flexor and gluteal tendinopathy

Bursitis

Muscle tear

‘Groin’ strain also known as adductor tendinopathy

How do we treat osteoarthritis in the hip?

It is not possible to reverse the structural changes with hip osteoarthritis. Physiotherapy plays a key role in the management of osteoarthritis. Of all joints and the hip is no exception. Research suggests that maintaining good flexibility and strength around the joint can help. Primarily to slow disease progression (Hunter et al, 2009).

It is not uncommon that you get associated muscle weakness with this condition. Muscles are one of the key shock absorbers around the hip. So it is important to strengthen your gluteal muscles and hip flexors. To reduce compression on the joint.

Hip osteoarthritis can respond well to physiotherapy. This may include soft tissue techniques. Joint mobilisations. Acupuncture and a progressive home exercise program.

Here are a few top tips you may also like to try yourself:

Try to lose weight – this can make a significant impact on your pain and function

Rest or change the activities that aggravate your pain

Begin a gentle strengthening programme

Take simple painkillers such as paracetamol or ibuprofen.

Try using a topical anti-inflammatory such as Voltarol Gel.

Before using any medication always speak to a pharmacist or GP.

What if conservative treatment does not work?

If you are still getting pain and all conservative options have been unsuccessful. There are a few other treatment modalities available to you. Ultrasound-guided injections are one of these options. And should be considered if the pain is:

Waking you up at night

Stopping you from engaging in everyday activities such as walking

Preventing you from engaging in a course of physiotherapy

At Core, all our injections are carried out using real-time ultrasound guidance. This ensures the accuracy of the injection into the joint.

Injections aim to reduce your pain, improve your range of movement and delay surgery. Following injection, we would always advise that you commence a course of physiotherapy. To maximise the pain relief.

At Core Physio, we inject either steroid or hyaluronic acid. On occasion, we will inject both at the same time. On occasion, we may suggest Platelet Rich Plasma (PRP) injections. As an alternative option. This would only be considered for younger patients. With mild to moderate osteoarthritis of the hip.

Steroid Injections A majority of the hip injections we carry out are steroid injections. We always carry out the procedure with ultrasound guidance. Using local anaesthetic to reduce any discomfort from the injection itself. A steroid, is a strong anti-inflammatory and can provide rapid pain relief. The duration of the pain relief from a steroid injection varies. It is not possible to predict how long an injection will last. Broadly speaking the less severe arthritis the longer they last.

Hyaluronic Acid

Hyaluronic Acid is a naturally occurring substance within the body. It has anti-inflammatory properties and also acts to lubricate the joint. There is a growing body of evidence. That hyaluronic acid can provide pain relief. In active patients, who are not overweight. This will be injected under ultrasound guidance. Along with local anaesthetic, as a safe alternative to steroid.

How many injections can you have?

Patients often ask how many injections we recommend. The Arthritis Research Council (ARC) suggests no more than three steroid injections per year. with a minimum of 3 months between each injection. At Core Physio, we try to limit the number of steroid injections to a minimum.

Before any injection is carried out we will always carry out a full assessment. Including an ultrasound scan and discuss all your available options.

What if an injection does not work?

If there is significant arthritis in the hip and the injection does not work. We may refer you to an orthopaedic consultant to discuss potential surgical options.

To discuss your condition please call the team on 01698 540380