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osteoarthritis of the hip

Genetics: familial predisposition [2] Clinical manifestations: 1) pain in the groin (60%) - less commonly over the greater trochanter, in the buttocks or referred to medial aspect of knee 2) pain on passive rotation of the hip [1,14] 3) pain & stiffness following periods of walking or standing 4) pain when first getting out of a chair 5) pain with difficulty ascending stairs* 6) limited range of motion [1] a) reduced internal rotation & abduction b) with advanced disease, the hip is flexed & motion is reduced in all directions 7) limp (antalgic gait) * hip flexion is the most important action when climbing Radiology: - X-ray of hip - see osteoarthritis - standing views for weight-bearing joints (hip, knee) appropriate to confirm diagnosis [1] - diagnosis of hip osteoarthritis may be missed with reliance on X-ray [11] Differential diagnosis: - lumbar spine disease - when hip & back pain present together, features that best predicte hip disease are groin pain, limp (antalgic gait), & limited internal rotation of the hip Complications: - fatigue is the strongest risk factor for reduced activity [14] Management: 1) see osteoarthritis - acetaminophen no better than placebo [1,13] - NSAIDs - topical diclofenac not useful for hip osteoarthritis [1] - oral NSAIDs [1] - avoid oral NSAIDS in patients with coronary artery disease, heart failure, chronic renal failure & peptic ulcer disease [1] - use of beta-blockers is associated with less arthragias & less use of opioids & other analgesics for symptomatic large-joint osteoarthritis [16] - no significant benefit duloxetine [20] 2) use of a cane 3) heel wedge to correct discrepancy in leg length 4) weight reduction of no benefit [22] 5) raised seating alleviates forces across the knee & hip 6) glucocorticoid injection under fluoroscopy a) Kenalog 40 mg + bupivicaine b) benefit at 2-3 months but not at 6 months [3] c) high dose hip joint injection 80 mg dexamethasone or repeated injections confer a risk of rapidly destruction hip disease [18] - a single hip joint injection of 40 mg triamcinolone confers low risk [18] 7) ultrasound-guided, intra-articular injection of lidocaine plus triamcinolone acetonide (40 mg) results in pain relief persisting to 2 months [19] 8) intra-articular hyaluronic acid no better than placebo [6] 9) intramuscular glucocorticoid injection of some benefit [17] - 40 mg of triamcinolone acetate IM into the gluteus muscle - may reduce hip pain at rest & walking [17] 10) tramadol of minimal benefit with significant adverse effects [21] 11) colchicine 0.5 mg QD may reduce need for total hip arthroplasty [23] 12) exercise of benefit, no specific exercise program superior [1] - physical therapy of benefit [1]; of no benefit [9] - neuromuscular exercise (NEMEX; postural & functional stability) - progressive resistance training (PRT; muscle strength) - similar but modest benefits [25]] - Tai-Chi as beneficial as physical therapy [1] 13) recommendations to primary care providers through the electronic medical record in combination with telephone- based patient intervention focused on weight management, physical activity, & cognitive behavioral therapy for pain management of benefit [12] 14) surgery: hip replacement (hip arthroplasty) - reduces cardiovascular risk possibly due to increased exercise capacity & decreased NSAID use [6] - total hip arthroplasty for severe hip osteoarthritis superior to resistance training [27]

Related

hip joint

General

osteoarthritis (OA)

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11,14,16,17, 19 American College of Physicians, Philadelphia 1998,2006,2012,2015, 2022 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  2. Journal Watch 21(2):15, 2001 Lanyon P et al, Assessment of a genetic contribution to osteoarthritis of the hip: sibling study. BMJ 321:1179, 2000 PMID: 11073507
  3. Lambert RG, Hutchings EJ, Grace MG, Jhangri GS, Conner-Spady B, Maksymowych WP. Steroid injection for osteoarthritis of the hip: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2007 Jul;56(7):2278-87. PMID: 17599747
  4. Atchia I, Kane D, Reed MR, Isaacs JD, Birrell F. Efficacy of a single ultrasound-guided injection for the treatment of hip osteoarthritis. Ann Rheum Dis. 2011 Jan;70(1):110-6. PMID: 21068096
  5. Prieto-Alhambra D, Javaid MK, Judge A, Maskell J et al Fracture risk before and after total hip replacement in patients with osteoarthritis: potential benefits of bisphosphonate use. Arthritis Rheum. 2011 Apr;63(4):992-1001. PMID: 21452321
  6. Ravi B et al The relation between total joint arthroplasty and risk for serious cardiovascular events in patients with moderate-severe osteoarthritis: propensity score matched landmark analysis. BMJ 2013;347:f6187 PMID: 24174640 http://www.bmj.com/content/347/bmj.f6187
  7. Zhang W, Moskowitz RW, Nuki G et al OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence. Osteoarthritis Cartilage. 2007 Sep;15(9):981-1000. PMID: 17719803 - Zhang W, Moskowitz RW, Nuki G et al OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008 Feb;16(2):137-62. PMID: 18279766 - Zhang W, Nuki G, Moskowitz RW et al OARSI recommendations for the management of hip and knee osteoarthritis: part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage. 2010 Apr;18(4):476-99. PMID: 20170770
  8. Hochberg MC, Altman RD, April KT et al American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012 Apr;64(4):465-74. PMID: 22563589 (corresponding NGC guideline withdrawn Dec 2017)
  9. Bennell KL et al Effect of Physical Therapy on Pain and Function in Patients With Hip Osteoarthritis. A Randomized Clinical Trial. JAMA. 2014;311(19):1987-1997 PMID: 24846036 http://jama.jamanetwork.com/article.aspx?articleid=1872817
  10. Fernandes L, Hagen KB, Bijlsma JW EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis. 2013 Jul;72(7):1125-35 PMID: 23595142
  11. Kim C et al Association of hip pain with radiographic evidence of hip osteoarthritis: diagnostic test study. BMJ 2015;351:h5983 PMID: 2663129 http://www.bmj.com/content/351/bmj.h5983 - Nieuwenhuijse M, Nelissen R Hip pain and radiographic signs of osteoarthritis. BMJ 2015;351:h6262 PMID: 26635241 http://www.bmj.com/content/351/bmj.h6262
  12. Allen KD, Yancy YS. Bosworth HB et al A Combined Patient and Provider Intervention for Management of Osteoarthritis in Veterans: A Randomized Clinical Trial. Ann Intern Med. Published online 22 December 2015 PMID: 26720751 - Allen KD, Oddone EZ, Coffman CJ et al. Patient, provider, and combined interventions for managing osteoarthritis in primary care: A cluster randomized trial. Ann Intern Med 2017 Jan 17 PMID: 28114648 http://annals.org/article.aspx?articleid=2478159
  13. da Costa BR, Reichenbach S, Keller N et al Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis. Lancet. March 17, 2016 PMID: 26997557 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2816%2930002-2/abstract - Moore N, Salvo F, Duong M, Gulmez SE Does paracetamol still have a future in osteoarthritis? Lancet. March 17, 2016 PMID: 26997558 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2901170-8/abstract
  14. Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  15. Brown MD, Gomez-Marin O, Brookfield KF, Li PS. Differential diagnosis of hip disease versus spine disease. Clin Orthop Relat Res. 2004 Feb;(419):280-4. PMID: 15021166
  16. Valdes AM, Abhishek A, Muir K et al Association of Beta-Blocker Use With Less Prevalent Joint Pain and Lower Opioid Requirement in People With Osteoarthritis. Arthritis Care Res (Hoboken). 2017 Jul;69(7):1076-1081. PMID: 27696728
  17. Dorleijn DMJ, Luijsterburg PAJ, Reijman M et al. Intramuscular glucocorticoid injection versus placebo injection in hip osteoarthritis: A 12-week blinded randomised controlled trial. Ann Rheum Dis 2018 Jun; 77:875 PMID: 29514801 http://ard.bmj.com/content/77/6/875
  18. Okike K, King RK, Merchant JC et al. Rapidly destructive hip disease following intra-articular corticosteroid injection of the hip. J Bone Joint Surg Am 2021 Nov 17; 103:2070. PMID: 34550909 https://journals.lww.com/jbjsjournal/Abstract/2021/11170/Rapidly_Destructive_Hip_Disease_Following.2.aspx
  19. Paskins Z et al. Clinical effectiveness of one ultrasound guided intra-articular corticosteroid and local anaesthetic injection in addition to advice and education for hip osteoarthritis (HIT trial): Single blind, parallel group, three arm, randomised controlled trial. BMJ 2022 Apr 6; 377:e068446. PMID: 35387783 Free article https://www.bmj.com/content/377/bmj-2021-068446.long
  20. van den Driest JJ et al. No added value of duloxetine in patients with chronic pain due to hip or knee osteoarthritis: A cluster-randomized trial. Arthritis Rheumatol 2022 May; 74:818 PMID: 34989159 https://onlinelibrary.wiley.com/doi/10.1002/acr.24519 - Lenhard NK et al. Does screening for depressive symptoms help optimize duloxetine use in knee osteoarthritis patients with moderate pain? A cost-effectiveness analysis. Arthritis Rheumatol 2022 May; 74:776 PMID: 33253496 PMCID: PMC8164641 (available on 2023-05-01) https://onlinelibrary.wiley.com/doi/10.1002/acr.24519
  21. Zhang X et al. Efficacy and safety of tramadol for knee or hip osteoarthritis: A systematic review and network meta-analysis of randomized controlled trials. Arthritis Care Res (Hoboken) 2023 Jan; 75:158. PMID: 34251756 https://onlinelibrary.wiley.com/doi/10.1002/acr.24750
  22. Joseph GB et al. Effects of weight change on knee and hip radiographic measurements and pain over four years: Data from the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 2023 Apr; 75:860. PMID: 35245415 PMCID: PMC9440955 (available on 2024-04-01) https://onlinelibrary.wiley.com/doi/10.1002/acr.24875 - Salis Z et al. Investigation of the association of weight loss with radiographic hip osteoarthritis in older community-dwelling female adults. J Am Geriatr Soc 2023 Aug; 71:2451 PMID: 37074126 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18371
  23. Heijman MWJ et al. Association of low-dose colchicine with incidence of knee and hip replacements: Exploratory analyses from a randomized, controlled, double-blind trial. Ann Intern Med 2023 May 30; [e-pub] PMID: 37247416 https://www.acpjournals.org/doi/10.7326/M23-0289
  24. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol. 2020;72:220-233. PMID: 31908163
  25. Kjeldsen T, Skou ST, Dalgas U et al. Progressive resistance training or neuromuscular exercise for hip osteoarthritis: A multicenter cluster randomized controlled trial. Ann Intern Med 2024 Apr 9; [e-pub]. PMID: 38588540 https://www.acpjournals.org/doi/10.7326/M23-3225
  26. American Academy of Orthopaedic Surgeons Management of Osteoarthritis of the Hip Evidence-Based Clinical Practice Guideline. aaos.org/oahcpg2 Published 12/01/2023 https://www.aaos.org/globalassets/quality-and-practice-resources/osteoarthritis-of-the-hip/oah-cpg.pdf
  27. Frydendal T et al. Total hip replacement or resistance training for severe hip osteoarthritis. N Engl J Med 2024 Oct 31; 391:1610-1620. PMID: 39476341 https://www.nejm.org/doi/10.1056/NEJMoa2400141