Hip Osteoarthritis

Osteoarthritis is a joint disease characterised by cartilage thinning and other degenerative changes in the joint. It literally means “cartilage thinning”.

Over time, the cartilage in the joint is slowly broken down. Cartilage is the smooth, elastic tissue that covers the ends of your hip ball and socket. It acts as a gliding surface, allowing your hip joint to move smoothly.

In osteoarthritis, this cartilage becomes thinner and rougher, which can lead to stiffness and reduced range of motion. The less gliding surface there is between the ball and socket, the less smoothly the joint moves. This can lead to inflammation of the joint, causing pain.

It is the inflammation that causes the pain, not the cartilage itself, as cartilage is not innervated.

A comparison can be made to a car tyre (the hip joint). If there is a puncture somewhere in the tyre, the air (cartilage) slowly escapes. The less air in the tyre, the bumpier the ride. Unlike a car tyre, we cannot pump air into the joint. If you are driving on the rim (end-stage osteoarthritis), it may help to fit a completely new tyre (total hip arthroplasty). In younger, active patients with good bone quality, a hip resurfacing prosthesis (RSP) can also be an option, where only the worn surface of the femoral head is replaced.

Symptoms of hip osteoarthritis can vary depending on the severity and specific location of the affected cartilage.

Common symptoms of hip osteoarthritis (coxarthrosis) include:

• Pain that worsens with movement (such as walking or climbing stairs) and improves with rest.
• Pain when putting on and taking off shoes and socks.
• Pain when getting in and out of the car.
• Radiating pain to the groin, upper thigh, or buttocks.
• Morning stiffness or stiffness after rest.
• First steps after prolonged sitting are painful and often involve limping.
• Creaking or clicking sounds during movement.

Hip osteoarthritis typically has a fluctuating course with “ups & downs”: sometimes you may experience flare-ups of pain without a specific trigger, while on other days it seems to be going well.

Additionally, the severity of osteoarthritis does not always determine whether or how much pain you experience. Many people with osteoarthritis have little or no pain at all.

Where does the pain in osteoarthritis come from?

Pain is an alarm signal from your body, caused by a nerve warning you of possible damage or danger. Cartilage itself has no nerve endings and therefore cannot cause pain.

However, over time, changes can occur in and around the joint, which can eventually cause pain in hip osteoarthritis:

• Inflammation: the synovial membrane (synovium) on the inside of your joint can become inflamed and swollen due to overuse. This causes pain and stiffness.
• Overload: of the surrounding joint structures (such as the joint capsule and ligaments) which do contain nerves.
• Muscle problems: the muscles around your hip can weaken or become tense due to changes in movement patterns and joint loading. This can lead to muscle pain and stiffness.
• Bone growth: in more advanced osteoarthritis, bone spurs (osteophytes) may develop. These can put pressure on surrounding tissues and cause pain.
• Bone-on-bone contact: in end-stage osteoarthritis, the bone in your hip joint can come into direct contact with other bone when the cartilage layer has disappeared in certain areas. This friction can cause irritation and pain.
• Small bone damage: damage to the bone directly beneath the cartilage can cause tiny cracks or lesions, which can be painful. This can occur in later stages of osteoarthritis.

It is important to understand that the severity of the pain you experience does not always correlate with the severity of osteoarthritis seen on X-rays. Some people with severe osteoarthritis have little to no pain, while others with mild osteoarthritis can experience a lot of pain. This is because pain is influenced by many factors, including inflammation, muscle strength, mental well-being, previous pain experiences, and the overall health of the joint. Therefore, it is important that you understand how pain arises and why we experience pain.

Through conservative treatments such as temporary load modification, specific exercise therapy aimed at strengthening the hip muscles, and possibly supportive injections into the joint, you can still achieve significant improvements in pain and functionality.

Our primary goal is always to avoid surgery, unless exercise therapy or injections do not yield the desired results. If this is the case, we can discuss together whether a hip replacement is necessary. Depending on your age, activity level and bone quality, two options are available: a total hip replacement (THA) or a resurfacing hip replacement (RSP).

We will discuss with you which treatment option is most suitable based on your specific situation and needs.