- Most common cause of Anterior Hip Pain in older adults
- Pain worse with Hip Range of Motion (hip flexion, hip rotation)
- Decreased Hip Range of Motion
- See Hip Pain Causes
- See Hip XRay in Osteoarthritis
- Standing Anteroposterior Pelvis XRay (first-line study)
- Degree of osteophytes and joint space narrowing does not correlate with symptom severity
- Non-Surgical Management
- See Osteoarthritis
- Physical Therapy
- Improves pain and function in mild to moderate Osteoarthritis
- Hip Intra-articular Injection of Corticosteroid
- Pain and function improved in the short-term (3-4 months), but not longterm (>=6 months)
- Lei (2024) Bone Joint J 106-B(6):532-9 [PubMed]
- See Knee Osteoarthritis Management
- Hip Osteoarthritis conservative management includes many of the same therapies as Knee Osteoarthritis
- NSAIDs are effective if not contraindicated
- Surgical Management
- Indications
- Refractory pain despite conservative management (e.g. limits walking, sleep, sitting)
- Loss of mobility even with joint unloading (e.g. Crutches, cane)
- Modifying Factors Complicating Hip Arthroplasty
- Peripheral Vascular Disease
- Leg Length Discrepancy (e.g. hyperlordotic spine, oblique Pelvis)
- Reduced Hip Range of Motion (e.g. flexion contractures, limited hip flexion <90 degrees)
- Factors that increase infection risk (Prosthetic Joint Infection)
- Uncontrolled Diabetes Mellitus
- Smoking (current or previous)
- Factors that protect against complications
- Higher socioeconomic status
- Higher education level
- Cohabitation (e.g. married patients)
- Urban home (in contrast to rural setting)
- Total Hip Arthroplasty (THA)
- Substantial pain improvement in 80% of cases
- THA lasts 20 years
- Acute Complications in 5% (PE, MI, Infection, Pneumonia) and mortality 1%
- Perioperative Tranexamic Acid significantly reduces risk of severe Anemia requiring transfusion
- Postoperative physical therapy and unsupervised home Exercise both equally improve function
- Chronic Complications
- Prosthetic Hip Dislocation (1-3%)
- Periprosthetic Fracture
- Prosthetic loosening
- Prosthethic hip Septic Joint
- References
- Hannon (2024) J Am Acad Orthop Surg 32(20):e1027-e34 +PMID: 38781351 [PubMed]
- Varacallo (2022) Total Hip Arthroplasty Techniques, StatPearls, Treasure Island
- Indications
- High morbidity (pain, significant functional limitations in ADLs)
- Deconditioning with decreased Physical Activity