Anatomy
The hip joint consists of the hip socket (acetabulum) and the head of the femur (caput femoris). The joint surfaces are covered by a layer of cartilage a few millimetres thick, which reduces the stress on the joint surfaces. In some cases, the osteoarthritic changes can lead to an ‘inflammation’ of the synovial membrane (synovitis), which causes fluid formation, swelling, restricted movement and pain in the hip joint.
Cause
Repeated strain can damage first the cartilage and then the bone under the cartilage (osteoarthritis). This can also be caused by a single, severe trauma. In some cases, the osteoarthritic changes can lead to an ‘inflammation’ of the synovial membrane (synovitis), which causes fluid formation, swelling, restricted movement and pain in the hip joint.
Symptoms
There is reduced mobility and pain in the hip joint, primarily with rotation and movement in all extreme positions. Mild degrees of osteoarthritis are often asymptomatic. In severe cases, there is rest pain.
Examination
The diagnosis is made on the basis of an X-ray; in younger patients (< 1–45), this should be an X-ray of the pelvis, as hip pain in this age group often has causes other than osteoarthritis. General clinical examination shows reduced mobility of the hip joint in all directions.
In many cases, there are creases on the joint lip, which are best seen on MRI scans. Fluid accumulation in the hip joint or in the iliopectineal bursae can be seen on ultrasound and MRI scans.
Treatment
Treatment primarily includes relief from pain-inducing activity, stretching and graduated rehabilitation within the pain threshold. Genoptræning har primært til formål at styrke musklerne omkring hofteleddet og bevare ledbevægeligheden.
There is no treatment that can restore the damaged cartilage (and bone). In cases of swelling in the hip joint, synovitis can be treated with anti-inflammatory tablets (NSAID) or by attempting to drain the synovial fluid and administering an ultrasound-guided injection of Corticosteroids, into the hip joint (and possibly into the bursa at the front of the hip joint).
Pain without joint swelling is treated with paracetamol (which has fewer side effects than NSAIDs). For severe osteoarthritic changes with pain at rest (at night), it may be necessary to replace the hip joint. There is no evidence that being active makes the osteoarthritic changes themselves worse.
Complications
Osteoarthritic changes in the weight-bearing parts of the joint often lead to the discontinuation of sports that put a lot of weight on the hip joint. Cycling and swimming are significantly less stressful for the hip joint than running.
You should consider whether this could be the case:
- Inflammatory arthritis (arthritis)
- Tendonitis of the superficial hip flexor attachment
- Rupture of the deep hip flexor
- Outer jump hip
- Inner jump hip
- Fluid build-up in the hip joint
- Fatigue fracture of the femoral neck
- Bursitis on the front of the hip joint
- Inguinal hernia
- Sportsman’s hernia
- Nerve entrapment
- Piriformis syndrom
- Lumbargo