Hip
Osteoarthritis
Causes
▪ About 11 in every 100 people over the age of 45 in England
have osteoarthritis of the hip. You are more likely to get it if
you are a woman, have close relatives who have it, if you
smoke, or if you are overweight.
▪ Trauma
▪ Repetitive stress and mechanical overload
Symptoms
▪ Hip Pain which can radiate into the groin, lateral aspect & buttocks.
▪ Restricted capsular pattern (internal rotation, flexion, abduction)
▪ Joint Stiffness up to 30min, Locking, Crepitus
▪ Poor Gait – Positive Trendelenburg
▪ Functional disability
Assessment/Diagnosis
▪ Subjective & Objective Assessment
▪ MR <15 degrees
▪ Pain on Hip flexion < 115
▪ +VE Quadrant Test
▪ X-Ray
Treatment Pathway
▪ Weight Management
▪ Education
▪ Physio (Strengthening, ROM, Aerobic)
▪ CSI - Multiple injections increase the risk of infections compared to a single injection
(Chamber et al. 2017). In the year before a total hip arthroplasty showed triple the
periprosthetic joint infection rate compared to those having only one injection.
▪ Hip Replacement
▪ NICE Guidelines: Do not offer acupuncture or electrotherapy.
Research: Exercise and Weight Loss in People Who Have Hip Osteoarthritis – Paans et al. 2013
➢ 35 participants - 25 years or older, had clinical and radiological evidence of hip OA, and were
overweight with a BMI of >25 kg/m2).
➢ They participated in an 8-month program of exercise in combination with weight loss.
➢ Outcome measure: self-reported physical function, pain, and walking tests.
➢ After 3/12 pain scores decreased by 25.4%
➢ After 8/12 walking distance on the 6-minute walk test improved by 11.6%.
➢ After 3 and 8 months, there were significant decreases in body mass—2.8 kg & 5.6kg
Research: Exercise therapy may postpone THR surgery in patients with Hip OA – Svege et al. 2015
➢ Long-term follow-up of a randomised trial of 109 participants with radiographic hip OA
investigating the efficacy of exercise therapy and patient education versus patient education
only.
➢ The response rate at follow-up (16months) was 94%.
, ➢ 22 participants in the group receiving both exercise therapy and patient education and 31
patients in the group receiving patient education only underwent THR during the follow-up
period, giving a 6-year cumulative survival of the native hip of 41% and 25%.
➢ Median time to THR was 5.4 and 3.5 years.
➢ The exercise therapy group had better self-reported hip function prior to THR or end of
study, but no significant differences were found for pain and stiffness.
➢ The study concluded that exercise therapy in addition to patient education can reduce the
need for THR by 44% in patients with hip OA.
Impingement (FAI)
Symptoms involving premature contact between the acetabulum and the femoral head.
Degenerative changes and osteoarthritis may develop in the long-term because of this abnormal
contact.
Pincer: Is a deformity of the socket, if the acetabulum sticks out too far it will jam into the socket
during hip flexion movement. Griffin et al. 2016
Cam: is a deformity of the femoral head, if the femoral head is shaped abnormally it will jam into the
socket during hip movements – common in cyclist Griffin et al. 2016
Metabolic analysis of tissue samples show that articular cartilage may be the main site of
inflammation and degeneration in hips with impingement and that if OA progresses, metabolic
activity spreads to the labarum.
Causes
▪ Multifactorial
▪ Cam more common in men & Pincer more common in women
▪ Repetitive movement (hip rotation and hip flexion)
▪ Malunion following femoral neck fractures.
▪ Surgical over-correction of conditions such as hip dysplasia
Symptoms
▪ Hip/Groin Pain
▪ Joint Stiffness
▪ Reduced ROM – most commonly MR & Flexion
▪ Clicking/Catching/Pinching
▪ Locks or Giveaway
▪ Reduced ROM In Squatting
Griffin et al. 2016
Assessment/Diagnosis
▪ Subjective History
▪ +VE FABERS – Low specificity - therefore can result in false positives and inaccurate
diagnosis.
▪ +VE FADIRS – This position of provocation is associated with impingement at the anterior rim
of the acetabulum. Frangiamore et al. 2017
Osteoarthritis
Causes
▪ About 11 in every 100 people over the age of 45 in England
have osteoarthritis of the hip. You are more likely to get it if
you are a woman, have close relatives who have it, if you
smoke, or if you are overweight.
▪ Trauma
▪ Repetitive stress and mechanical overload
Symptoms
▪ Hip Pain which can radiate into the groin, lateral aspect & buttocks.
▪ Restricted capsular pattern (internal rotation, flexion, abduction)
▪ Joint Stiffness up to 30min, Locking, Crepitus
▪ Poor Gait – Positive Trendelenburg
▪ Functional disability
Assessment/Diagnosis
▪ Subjective & Objective Assessment
▪ MR <15 degrees
▪ Pain on Hip flexion < 115
▪ +VE Quadrant Test
▪ X-Ray
Treatment Pathway
▪ Weight Management
▪ Education
▪ Physio (Strengthening, ROM, Aerobic)
▪ CSI - Multiple injections increase the risk of infections compared to a single injection
(Chamber et al. 2017). In the year before a total hip arthroplasty showed triple the
periprosthetic joint infection rate compared to those having only one injection.
▪ Hip Replacement
▪ NICE Guidelines: Do not offer acupuncture or electrotherapy.
Research: Exercise and Weight Loss in People Who Have Hip Osteoarthritis – Paans et al. 2013
➢ 35 participants - 25 years or older, had clinical and radiological evidence of hip OA, and were
overweight with a BMI of >25 kg/m2).
➢ They participated in an 8-month program of exercise in combination with weight loss.
➢ Outcome measure: self-reported physical function, pain, and walking tests.
➢ After 3/12 pain scores decreased by 25.4%
➢ After 8/12 walking distance on the 6-minute walk test improved by 11.6%.
➢ After 3 and 8 months, there were significant decreases in body mass—2.8 kg & 5.6kg
Research: Exercise therapy may postpone THR surgery in patients with Hip OA – Svege et al. 2015
➢ Long-term follow-up of a randomised trial of 109 participants with radiographic hip OA
investigating the efficacy of exercise therapy and patient education versus patient education
only.
➢ The response rate at follow-up (16months) was 94%.
, ➢ 22 participants in the group receiving both exercise therapy and patient education and 31
patients in the group receiving patient education only underwent THR during the follow-up
period, giving a 6-year cumulative survival of the native hip of 41% and 25%.
➢ Median time to THR was 5.4 and 3.5 years.
➢ The exercise therapy group had better self-reported hip function prior to THR or end of
study, but no significant differences were found for pain and stiffness.
➢ The study concluded that exercise therapy in addition to patient education can reduce the
need for THR by 44% in patients with hip OA.
Impingement (FAI)
Symptoms involving premature contact between the acetabulum and the femoral head.
Degenerative changes and osteoarthritis may develop in the long-term because of this abnormal
contact.
Pincer: Is a deformity of the socket, if the acetabulum sticks out too far it will jam into the socket
during hip flexion movement. Griffin et al. 2016
Cam: is a deformity of the femoral head, if the femoral head is shaped abnormally it will jam into the
socket during hip movements – common in cyclist Griffin et al. 2016
Metabolic analysis of tissue samples show that articular cartilage may be the main site of
inflammation and degeneration in hips with impingement and that if OA progresses, metabolic
activity spreads to the labarum.
Causes
▪ Multifactorial
▪ Cam more common in men & Pincer more common in women
▪ Repetitive movement (hip rotation and hip flexion)
▪ Malunion following femoral neck fractures.
▪ Surgical over-correction of conditions such as hip dysplasia
Symptoms
▪ Hip/Groin Pain
▪ Joint Stiffness
▪ Reduced ROM – most commonly MR & Flexion
▪ Clicking/Catching/Pinching
▪ Locks or Giveaway
▪ Reduced ROM In Squatting
Griffin et al. 2016
Assessment/Diagnosis
▪ Subjective History
▪ +VE FABERS – Low specificity - therefore can result in false positives and inaccurate
diagnosis.
▪ +VE FADIRS – This position of provocation is associated with impingement at the anterior rim
of the acetabulum. Frangiamore et al. 2017
