7940 South University Blvd Suite 100
Centennial Co 80109
Phone (303) 927-6181 or (720) 515-8002
Email: GenesisSpineCenter@gmail.com
Genesis Chiropractic Spine & Sports Center      













Osteoarthritis Of HIP

General Information

Description:

  • Localized degenerative joint disease (DJD)

Also called:

  • Degenerative arthritis
  • Osteoarthritis
  • Osteoarthrosis

Who is most affected?

  • Elderly persons

Incidence/Prevalence:

  • Very common, 88/100,000 person-years in one health maintenance organization (HMO) study
    • Based on approximately 130,000 HMO members
    • 461 had new onset knee joint osteoarthritis (age and sex standardized incidence rate 240/100,000 person-years)
    • 195 had new onset hand osteoarthritis (age and sex standardized incidence rate 100/100,000 person-years)
    • 173 had new onset hip joint osteoarthritis (age and sex standardized incidence rate 88/100,000 person-years)
    • All types of osteoarthritis increased with age up to 80 years, and were higher in women (especially after age 50 years)
    • Reference - Arthritis Rheum 1995 Aug;38:1134

 

  • hip pain common in elderly
    • 14.3% adults > 60 years old reported significant hip pain on most days over past 6 weeks in 6,596 interviews
    • Reference - J Fam Pract 2002 Apr;51(4):345

 

  • hip osteoarthritis relatively uncommon in Chinese elderly
    • based on study of 1,506 persons > 60 years old in Beijing, China
    • crude prevalence of radiographic hip osteoarthritis at ages 60-89 was 0.9% in women and 1.1% in men
    • this finding was 7% to 22% of the prevalence found in various studies in the United States
    • symptomatic hip osteoarthritis found in only 1 patient (35 were expected)
    • Reference - Arthritis Rheum 2002 Jul;46(7):1773in JAMA 2002 Nov 13;288(18):2237

 

Causes and Risk Factors

Causes:

  • causes of degenerative joint disease
    • traumatic (repetitive stress)
    • prior inflammatory or septic arthritis
    • congenital abnormalities of joints
    • endocrine disorders (acromegaly, hyperparathyroidism, diabetes)
    • metabolic disorders (ochronosis, hemosiderosis, Wilson disease)
    • neuropathic disorders (diabetes, syphilis)
    • avascular necrosis
    • Paget's disease

Pathogenesis:

  • primarily a disease of cartilage
    • deterioration of articular cartilage over many years
    • synovial membrane intact
  • change in cartilage collagen network with multiple theories regarding pathogenesis
    • biomechanical - stress and aging derange chondrocytes
    • biochemical - inflammatory reaction to stress, lytic enzymes, decreased keratan sulfate, increased chondroitin sulfate
    • aging theories - decreased proteoglycan aggregation, loosening of type II collagen, wear and tear
    • body reacts to cartilage destruction by bone formation, calcium pyrophosphate deposition, increased collagen turnover, secondary synovitis, damaged chondrocytes release proteases and collagenases (IL-1, tumour necrosis factor-alpha catabolic), transforming growth factor-beta and fibroblast- anabolic (also insulin-like growth factor 1)
  • initial stages of increased production and degradation of proteoglycan and collagen - increased thickness of cartilage, increased water content, decreased glycosaminoglycan content, cellular division and clustering of chondrocytes (transient proliferative response), increased matrix metalloproteinase activity
  • later stage with dropout of chondrocytes - fibrillation leading to deep clefts and ulceration of cartilage surface, shearing forces with thinning of cartilage, bony sclerosis, osteophyte formation
  • bone-on-bone contact in joint leads to more rapid deterioration in movement and function

Likely risk factors:

  • previous hip disease or trauma
  • hip injury associated with increased risk for hip osteoarthritis
    • based on prospective cohort study
    • 1,321 medical students (mean age 22 years) followed for median 36 years
    • 141 participants reported joint injuries (16 with hip alone, 14 with knee and hip) and 96 developed osteoarthritis (27 with hip alone, 5 with knee and hip)
    • comparing participants with hip injury vs. participants without hip injury
      • incidence of hip osteoarthritis 3.2 per 100,000 person-years (95% CI 0.9-11.5) vs. 0.7 per 100,000 person-years (95% CI 09.5-1)
      • patients with hip injury associated with increased risk of hip osteoarthritis (adjusted relative risk 6.01, 95% CI 1.4-25.86)
    • Reference - Ann Intern Med 2000 Sep 5;133(5):321
  • Osteoarthritis of hands predicts future osteoarthritis of hip or knee
    • based on cohort study
    • 1,235 subjects without osteoarthritis of hip or knee at baseline who had x-rays of hands at baseline and x-rays of hips and knees at baseline and 6.6 years later
    • 12.1% subjects developed hip or knee osteoarthritis
    • osteoarthritis of hands associated with
      • increased risk of future hip osteoarthritis (OR 3) with further increase if family history of osteoarthritis
      • increased risk of future knee osteoarthritis (OR 1.6) with further increase if overweight
    • Reference - Arthritis Rheum 2005 Nov;52(11):3520
  • excess body weight
    • overweight associated with increased incidence of hip osteoarthritis
      • based on cohort study
      • 27,960 men and women (mean age 58.3 years) had baseline measures of body mass index (BMI), waist circumference, waist-hip ratio, weight and body fat percentage
      • mean follow-up 11 years
      • 2% participants developed hip osteoarthritis
      • hip osteoarthritis associated with high BMI and waist circumference
      • Reference - Ann Rheum Dis 2009 Apr;68(4):490
    • BMI ≥ 32 kg/m2 associated with 2-3 times risk of total hip replacement
      • based on cohort study
      • 1,152,006 Norwegian persons ages 18-67 years
      • Reference - Arthritis Rheum 2006 Mar;54(3):802

Possible risk factors:

  • high physical workload may contribute to hip osteoarthritis
    • based on systematic review of observational studies
    • systematic review of 2 retrospective cohort studies and 14 case-control studies evaluating influence of physical workload on incidence of hip osteoarthritis
    • 9 studies assessed career type and 5 studies assessed occupation-related activities
    • heavy physical workload (for example, farming as career, lifting weights > 25 kg [55 pounds] as occupation-related activity) was associated with osteoarthritis in all 16 studies (odds ratio about 3)
    • Reference - J Rheumatol 2001 Nov;28(11):2520
  • physical stress at work and major musculoskeletal injuries associated with increased risk of hip osteoarthritis
    • based on cohort of 840 participants without hip osteoarthritis at baseline followed for 22 years
    • hip osteoarthritis diagnosed in 4.9%
    • Reference - Rheumatology (Oxford) 2009 Jan;48(1):83

 

  • family history
    • increased incidence of radiographic hip osteoarthritis in twins
      • based on cross-sectional population-based study
      • 135 monozygotic and 277 dizygotic twins ≥ 50 years old had pelvic radiographs assessed for overall osteoarthritic grade using modified Kellgren and Lawrence scheme
      • significant heritability of osteoarthritis 58% and 64% for joint space narrowing
      • Reference - Arthritis Rheum 2000 Nov;43(11):2410 in Cortlandt Forum 2001 Oct;14(10):21
    • siblings of patients with history of hip replacement for osteoarthritis are at substantially increased risk for hip osteoarthritis
      • based on case-control study
      • 604 siblings of 392 index patients who had hip replacement to 1,718 controls undergoing IV urography, odds ratios (OR) for hip osteoarthritis in siblings was 4.9 (95% CI 3.9-6.4) for probable hip osteoarthritis and 6.4 (4.5-9.1) for definite hip osteoarthritis based on x-rays, results not significantly altered by adjusting for other risk factors (BMJ 2000 Nov 11;321(7270):1179)
    • siblings of patients with history of hip replacement for osteoarthritis may have increased risk for having total hip replacement
      • based on population-based study in Iceland
      • Reference - Arthritis Rheum 2000 Dec;43(12):2785
    • genetics may have significant role in hip osteoarthritis but not knee osteoarthritis
      • based on case-control study
      • study of siblings of 635 probands undergoing total hip replacement, siblings of 486 probands undergoing total knee replacement and siblings of 787 spouses
      • familial aggregation observed for hip arthroplasty but not knee arthroplasty
      • Reference - Arthritis Res Ther 2006;8(1):R25
    • 5 genome-wide significant loci associated with osteoarthritis
      • based on genetic analysis of 7,410 unrelated patients of European descent with severe hip or knee osteoarthritis (80% with total joint replacement) and 11,009 unrelated controls
      • loci replicated in independent cohort of up to 7,473 cases and 42,938 controls
      • genome-wide significant loci associated with osteoarthritis
        • chromosome 3 with rs6976
        • chromosome 9 close to ASTN2
        • chromosome 6 between FILIP1 and SENP6
        • chromosome 12 close to KLHDC5 and PTHLH
        • chromosome 12 close to CHST11
      • all variants were common and had small effects
      • Reference - arcOGEN study (Lancet 2012 Sep 1;380(9844):815)

Complications and Associated Conditions

Associated conditions:

  • trochanteric bursitis common in patients with hip joint disease and generally more treatable (J Rheumatol 1996 Dec;23(12):2104 in QuickScan Reviews in Fam Pract 1997 Jun;22(3):17)
If you suffer from hip pain, and live in or around Centennial, Littleton, Highlands Ranch areas please contact our office to schedule an appointment with us today at 720 515-8002. We will gladly answer any of your questions and provide you with the best treatment options available to you. 

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