Hip
Hip Osteoarthritis
고관절 골관절염
Degenerative joint disease causing gradual cartilage loss in the hip joint, leading to pain and functional limitation
- How common
- Very common
- Typical age
- Ages 50–80
What is it?
Degenerative disease with progressive cartilage wear accompanied by subchondral bone changes, osteophyte formation, and synovial inflammation
Commonly affected: Femoral head, acetabulum, articular cartilage, synovium
How it develops
- Cartilage WearProgressive loss of articular cartilage due to weight bearing and repetitive motion
- Subchondral SclerosisHardening and cyst formation in exposed bone after cartilage loss
- Osteophyte FormationBone spur formation at joint margins restricting motion
- Joint Space NarrowingMedial and axial joint space reduction, femoral head deformity
Symptoms
- Groin PainTypical deep groin pain, may radiate to medial thigh and knee
- ROM LimitationInternal rotation and abduction restricted first (Capsular pattern)
- Morning StiffnessJoint stiffness lasting less than 30 minutes upon waking
- LimpAntalgic gait and Trendelenburg gait
- CrepitusGrinding or grating sounds during movement
How it is examined
- FABER TestFlexion, ABduction, External Rotation position elicits groin pain → Positive
- IR RestrictionReduced internal rotation is earliest finding. <20° vs normal 40°
- Trendelenburg SignContralateral pelvic drop during single-leg stance → Gluteus medius weakness
- Thomas TestHip flexion contracture confirmed when thigh rises while opposite knee is held to chest
Imaging
Pelvis AP and hip lateral views are standard
- Joint space narrowing (superolateral > medial)
- Subchondral sclerosis
- Osteophyte formation
- Subchondral cysts
- Femoral head deformity
Excellent for evaluating cartilage damage and early changes
- Cartilage loss and damage
- Bone marrow edema
- Synovial thickening
- Joint effusion
Non-surgical care
- Weight Loss1kg weight loss = ~3kg reduction in hip joint load
- Physical TherapyAquatic exercise, gluteus medius strengthening, ROM exercises
- Assistive DevicesCane (use in contralateral hand), walker
- MedicationsNSAIDs, acetaminophen, intra-articular steroid injections
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Failed conservative treatment >6 months, severe pain and functional disability, severe joint damage on X-ray
Procedures that may be discussed
- Total Hip Arthroplasty (THA) — gold standard
- Osteotomy — joint preservation in young patients
- Hip resurfacing arthroplasty
Outlook
90-95% pain relief and functional recovery after THA. Prosthesis lifespan 15-20 years