Osteoarthritis of the Hip (Hip Arthritis): "Degenerative Joint Disease" can cause pain, stiffness, and cartilage breakdown

Edited By: Seth S. Leopold, M.D.
Last updated Friday, January 18, 2008

Figure 7 - Hip pain in the lower back and/or buttocks area is often from spinal stenosis (spine arthritis), rather than from the hip joint itself.

Figure 8 - Hip pain over the outside of the hip is often from bursitis, which not related to arthritis of the joint at all.

Symptoms

Anatomy

Osteoarthritis of the hip occurs when the joint surface cartilage (also called hyaline cartilage, or articular cartilage) becomes worn away, leaving the raw bone beneath exposed. The cartilage normally serves as a "pad" or a bearing in the joint, and under normal conditions, the cartilage bearing is even slicker than a hockey puck on ice. When the bearing wears away, the result is a roughed joint surface that causes the pain and stiffness that people associate with osteoarthritis.

The typical pain from hip arthritis is located in the groin, thigh, or buttock; the pain is generally worse with weight bearing (walking, standing) or twisting.

Initial symptoms

Pain and stiffness are the main symptoms of hip arthritis. When it becomes more advanced, joint deformities and leg-length differences can result.

The typical pain from hip arthritis is located in the groin, thigh, or buttock; the pain is generally worse with weight bearing (walking, standing) or twisting.

Symptoms

Pain, stiffness, and joint deformity are the main symptoms of arthritis of the hip. Some patients, in particular, report "start-up" pain – an especially bad discomfort upon standing after being seated for a prolonged period of time. This sometimes works itself out after a few steps.

Progression

Early in the course of arthritis, the symptoms can be intermittent, perhaps related only to particular activities or sustained activity. At that point, usually rest and avoiding the precipitating activity will improve the symptoms.

The typical pain from hip arthritis is located in the groin, thigh, or buttock; the pain is generally worse with weight bearing (walking, standing) or twisting.

As the arthritis worsens, the symptoms can become more persistent or more severe, such that simply walking on level ground can result in pain.

Conditions with similar symptoms

A number of conditions that are not actually related to the hip joint can cause symptoms in the "hip" area. These include

1. Spinal stenosis (arthritis of the lower back). This condition most commonly causes pain in the buttock, low back, and back of the upper thigh (See Fig 7). This condition is really a lower-back problem, not a hip problem, even though people identify the buttock area as part of the “hip.”
2. Greater trochanteric bursitis. This causes pain over the “point” of the hip (imagine the part of the hip that would touch the ground if one were to lie directly on one’s side (See Fig 8). It also causes tenderness, and sensitivity to pressure. Although this, too, seems like a “hip” problem, it is a problem well away from the joint itself, related to an inflammation in a “lubrication point” called a bursa, and is not a joint problem (and only rarely is it a surgical problem).
3. Very occasionally, non-orthopaedic conditions can cause pain in the groin that masquerade as hip joint symptoms – ovarian cysts, hernias, and other intra-pelvic conditions can sometimes cause pain that is mistaken for hip joint pain.

In addition, other forms of arthritis can cause similar symptoms to osteoarthritis of the hip; in particular, post-traumatic arthritis and avascular necrosis (osteonecrosis) are almost indistinguishable in many cases from osteoarthritis of the hip.

Rheumatoid arthritis, the next most common cause of arthritis, can also affect the hip. It tends to cause other joints to be involved, and often causes more of an inflammatory set of symptoms (swelling and warmth, as well as pain), and can in fact effect other organ systems as well.

Surgery for hip arthritis at the University of Washington

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