OA Hip (Osteoarthritis of Hip)

Hip Joint

• ball and socket joint
• bone surfaces covered with resilient articular cartilage lubricated and nourished by synovial fluid (produced within hip joint)

OA Hip (Osteoarthritis of Hip)

• condition characterized by irregularity or erosion of articular cartilage on weight bearing joint surfaces; with loss of cartilage, joint capsule (normally flexible envelope) shrinks resulting in loss of joint flexibility; bone may erode and/or deform producing bony outcroppings called osteophytes or spurs (form around margin of socket causing pain and, possibly, limiting hip range of motion)
• x-rays may reveal degenerative changes in moderate to severe cases
• familial or genetic link, in absence of trauma, is leading cause of this condition
• pain mostly felt in groin may radiate down front of thigh to knee; occasionally pain also felt deeply into buttock
• stiffness and pain are primary symptom complaints in early stages of condition; first symptom complaint occurs with rising from sitting (e.g., from bed; from toilet as hip joint compressed in low sitting position) or flexing and twisting at hip (e.g., putting socks on); later, walking any distance elicits pain and maladaptive pain-avoidance strategy (e.g., limping)

Physical Therapy Treatment

• application of electrotherapeutic modalities and moist heat
• gradual strengthening (non-weight bearing approach, e.g., cycle and/or swim may be indicated to start), stretching, and cardiovascular exercises demonstrated and assigned (respect pain)
• education re joint protection (body weight, recreational activity and task performance, proper footwear) and use of assistive devices (e.g., walker, crutches, cane, raised seating, etc) as required to avoid compensatory problems due to antalgic (pain-avoiding), aberrant gait (e.g., limping)

Other Treatments

• anti-inflammatory and analgesic medications; optional supplementation using Glucosamine Sulphate (a normal constituent of cartilage matrix and synovial fluid) +/- Chondroiton Sulphate -- positive anecdotal evidence but sparse and inconclusive clinical research substantiating claims lauding benefits of either supplement to cartilage health
• Synvisk^TM (mimics synovial fluid) injections may be considered
• acupuncture may afford pain relief
• surgery (hip replacement or resurfacing) considered in cases of severe pain and/or functional disability

Physical Therapy Treatment

Post Surgical

• education re-precautions (as per surgeon's specific direction, e.g., avoid hip flexion beyond 90 degrees, no hip abduction past neutral, hip rotations restricted to less than end range), safety considerations, and use of assistive aids (e.g., walker, crutches, cane)
• electrotherapeutic modalities and ice for inflammation and symptom control; manual joint mobilization; active range of motion, strengthening (incl core stabilization), stretching; cardiovascular exercises; functional rehabilitation (commencing with posture, balance, and gait retraining)
• hydrotherapy (exercise in shallow pool) offers advantages of low impact and fluid resistance workout along with land-based exercise routine

Prognosis

• Non-surgical: 2 to 4 weeks to discharge with home routine
• Post-surgical: occasional, scheduled follow-up with physical therapist for up to 12 weeks