Arthritis Pain of the Hip

Abstract

Arthritis of the hip is commonly encountered in clinical practice. The hip joint is susceptible to the development of arthritis from various conditions that have the ability to damage the joint cartilage. Osteoarthritis is the most common form of arthritis that results in hip joint pain; rheumatoid arthritis and posttraumatic arthritis are also common causes of hip pain. Less frequent causes of arthritis-induced hip pain include the collagen vascular diseases, infection, villonodular synovitis, and Lyme disease. Acute infectious arthritis is usually accompanied by significant systemic symptoms, including fever and malaise, and should be easily recognized; it is treated with culture and antibiotics rather than injection therapy. Collagen vascular disease generally manifests as polyarthropathy rather than as monarthropathy limited to the hip joint, although hip pain secondary to collagen vascular disease responds exceedingly well to the treatment modalities described here.

Most patients presenting with hip pain secondary to arthritis complain of pain localized around the hip and upper leg. Most patients with intrinsic hip disorders have a positive Patrick-FABERE (flexion, abduction, external rotation, extension) test result. Patients may initially present with ill-defined pain in the groin; occasionally, the pain is localized to the buttocks. Activity makes the pain worse, whereas rest and heat provide some relief. The pain is constant and is characterized as aching; it may interfere with sleep. Some patients complain of a grating or popping sensation with use of the joint, and crepitus may be noted on physical examination.

Keywords

hip pain, osteoarthritis, rheumatoid arthritis, synovitis, torn meniscus, villonodular synovitis, total knee arthroplasty, monoarthropathy, Patric-FABRE test, Lyme disease

ICD-10 CODE M16.9

The Clinical Syndrome

Arthritis of the hip is commonly encountered in clinical practice. The hip joint is susceptible to the development of arthritis from various conditions that have the ability to damage the joint cartilage. Osteoarthritis is the most common form of arthritis that results in hip joint pain; rheumatoid arthritis and posttraumatic arthritis are also common causes of hip pain. Less frequent causes of arthritis-induced hip pain include the collagen vascular diseases, infection, villonodular synovitis, and Lyme disease. Acute infectious arthritis is usually accompanied by significant systemic symptoms, including fever and malaise, and should be easily recognized; it is treated with culture and antibiotics rather than injection therapy. Collagen vascular disease generally manifests as polyarthropathy rather than as monarthropathy limited to the hip joint, although hip pain secondary to collagen vascular disease responds exceedingly well to the treatment modalities described here.

Signs and Symptoms

Most patients presenting with hip pain secondary to arthritis complain of pain localized around the hip and upper leg ( Fig. 98.1 ). Most patients with intrinsic hip disorders have a positive Patrick-FABERE (flexion, abduction, external rotation, extension) test result ( Fig. 98.2 ). Patients may initially present with ill-defined pain in the groin; occasionally, the pain is localized to the buttocks. Activity makes the pain worse, whereas rest and heat provide some relief. The pain is constant and is characterized as aching; it may interfere with sleep. Some patients complain of a grating or popping sensation with use of the joint, and crepitus may be noted on physical examination.

In addition to pain, patients often experience a gradual decrease in functional ability caused by reduced hip range of motion that makes simple everyday tasks such as walking, climbing stairs, and getting into and out of a car quite difficult. With continued disuse, muscle wasting may occur, and a frozen hip secondary to adhesive capsulitis may develop.

Testing

Plain radiography is indicated in all patients who present with hip pain. Based on the patient’s clinical presentation, additional testing may be warranted, including a complete blood count, erythrocyte sedimentation rate, and antinuclear antibody testing. Magnetic resonance and ultrasound imaging of the hip are indicated if aseptic necrosis or an occult mass or tumor is suspected or if the diagnosis is in question ( Figs. 98.3, 98.4, and 98.5 ).