Top Conditions of Hip Joint - Arthritis, Muscle Strains, Other Diseases
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Conditions of the Hip Joint

Dr.Surya Rao Poodipeddi profile Authored by Dr.Surya Rao Poodipeddi on 30 May 2014 - 16:26.

Of all the diseases affecting the hip joint, Arthritis of the hip joint is the most common condition seen both in men and women.

Arthritis is basically inflammation of a joint. Any condition in which there is damage to the cartilage is known as arthritis. Inflammation of the joint is usually noticed in the synovium. The extent of damage to the cartilage and the synovium varies with the type of arthritis and the stage of involvement. The initial pain is always almost due to inflammation. The pain increases gradually in proportion to the damage of the cartilage. The more the cartilage is worn out, the more the pain. It is caused due to rubbing of the bony surface devoid of the cartilage and leading to friction in the joint, causing pain.

An X-ray of the hip joint in A.P. and lateral positions reveals the joint space lost and the presence of bone spurs, signifying severe arthritic changes in the joint.

There are two broad categories of arthritis namely Osteoarthritis and Rheumatoid Arthritis.

Osteoarthritis often labeled as O.A (Osteo Arthritis) mainly damages the joint cartilage usually accompanied by some inflammation, and its cause is not known. However, in most cases it is thought that wear and tear is the reason. It mostly affects one or two major joints like the hip or the knee or both. It can also affect the shoulder joint. Osteoarthritis never affects internal organs.

There are some conditions which may predispose the hip joint to osteoarthritis. For example, a fracture involving the joint may trigger osteoarthritis. Growth abnormalities of the hip like shallow socket may lead to premature arthritis. Some childhood hip problems like slipped epiphysis also called Legg-pert he's disease, may lead to osteoarthritis at a later age.

In this condition, the cartilage cushion becomes either thinner than normal, or is completely absent. The bare bone on the femoral head rubs against the bone of the pelvic socket leading to a sort of mechanical pain.  Sometimes the joint shows fragments of the cartilage, which leads to inflammation in the joint lining which becomes the second source of pain. X-ray reveals narrowing of the joint space with an irregular outline. Blood tests do not indicate osteroarthritis.

Rheumatoid Arthritis (R.A.): Rheumatoid Arthritis is mainly inflammatory in nature and starts in the synovium. The cause is not known. It destroys the joint cartilage damaging the bone next to the cartilage and makes it very soft. Rheumatoid Arthritis affects multiple joints simultaneously. Unlike in the case of osteoarthritis, rheumatoid arthritis also affects internal organs. Another form of arthritis of the hip joint which is mainly inflammatory in nature is known as Lupus. There are other forms of arthritis affecting the hip joint which are basically of inflammatory type but are very rare. They are basically similar to rheumatoid arthritis.

Though X-ray changes are similar in both osteoarthritis and rheumatoid arthritis, the distinguishing feature in rheumatoid arthritis is loss of bone density. Unlike in osteoarthritis blood tests are available in the diagnosis of rheumatoid arthritis. However, they are not accurate. Rheumatoid factor in 7 percent of people above the age of 70 years, test +ve for rheumatoid factor without the presence of rheumatoid arthritis. The test by itself is therefore, not very reliable. Anti-inflammatory drugs like NSAID (Non Steroidal Anti-Inflammatory Drugs) are commonly used in both types of arthritis of the hip joint.

Osteonecrosis: Though pain is the commonest symptom in both types of arthritis there is one condition known as Osteonecrosis which is not an arthritis type but yet presents with severe pain. Osteonecrosis is a condition that occurs when blood flow to an area of bone is restricted.

If an inadequate amount of blood flow reaches the bone, the cells will die and the bone may collapse. Hips is one of the most common places where osteonecrosis occurs. In this condition a  part of the femoral head dies and the dead bone cannot withstand the stress of walking. The necrosed head collapses and this leads to irregular shape of the bone.

The collapse of the dead bone leads to more severe pain. Though the cause for this rare type of condition is not known, it is believed that excessive use of alcohol and drugs containing cortisone are the common causes for osteonecrosis. In majority of cases the cause is idiopathic, meaning cause is unknown.

There are few more conditions which can affect the hip joint. These include:

  • Lumbar Pain-Referred Symptoms: Many problems in the back and spine can mimic a hip joint problem leading to confusion in diagnosis. Herniated Disc and Sciatica are the two common conditions which can mimic hip joint pain though in effect,the hip joint is free from any problem.
  • Snapping Hip Syndrome: this condition includes three distinct problems namely the 1) IT (intertrochantric) band snaps over the outside of the thigh 2) The deep hip flexor snaps over the front of the hip joint and 3) Tears of the cartilage and the labrum, around the hip socket can cause a snapping sensation.
  • Muscle Strains: Any train in the muscles around the hip and pelvis can cause pain and spasm. The most common strains are a groin pull and strain in the hamstring muscles of the thigh.
  • Hip Fracture: A fracture in the hip is most common in elderly patients especially if associated with osteoporosis, a condition in which the bone becomes brittle due to low density. Treatment of a broken hip requires surgery, to either replace the broken portion or repair it.

Childhood hip problems are yet another category affecting a hip from childhood. Only a brief mention of the possible problems in this category will be made. These include:

1) Developmental Dysplasia a condition characterized by dislocation of the hip joint in infancy which might not present with pain but might lead to early arthritis later, including problems in walking.

2) Leg-Calve-Perthes Disease also known as perthes disease, is almost similar to osteonecrosis affecting adults. If it is severe it can lead to permanent damage to the hip joint and early arthritis.

*Disclaimer: This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.