Hip osteoarthritis (OA) is a form of arthritis in the hip joint that usually develops slowly over many years. People with hip OA often have pain that affects daily activities, such as walking or dressing. We don’t know precisely what causes hip OA but mechanical overload (high or excessive load, impact, or force within the joint) is considered critical. We know there are local factors, such as anatomical abnormalities of the joint (e.g., FAI), and systemic factors, such as body weight and physical activity that likely play an important role in the development of hip OA.

Many diseases and injuries may cause hip or groin pain, for example, arthritis, tendinitis, bursitis, hip fracture, groin injuries, hernia, and others. Back pain may also radiate to the hip. In some studies, risk factors for hip pain, other than physical activity, included obesity and prolonged sitting. Structural abnormalities such as femoroacetabular impingement (FAI) and hip dysplasia may also cause hip pain.

From conducting research, we believe femoroacetabular impingement (or FAI) may lead to hip OA. FAI typically starts in adolescence and young adulthood. It occurs when extra bone grows along one, or both, of the bones that form the hip joint. This causes the bones to fit together imperfectly and create extra friction. The friction may worsen with certain physical activities and eventually lead to damage or OA in the hip joint.

The relationship between hip pain and hip OA is complex. First, it’s important how you diagnose hip OA. There’s imaging and there’s clinical exam; they’re not the same. You can have changes on X-ray or MRI (magnetic resonance imaging) that indicate hip OA, but that may not necessarily mean you have hip OA. This is possible because cartilage has no nerves and can be damaged while the patient doesn’t feel anything. Other tissues, like bone and the synovial lining, which can get inflamed, do cause the pain of hip osteoarthritis. So, clinical diagnosis is key in addition to a careful history and a physical exam. This is particularly important because pain may be present at the hip but unrelated to hip OA even when there are changes on the X-ray which indicates hip OA.

To avoid hip replacement, the first thing is to get a thorough history and physical examination from an experienced clinician. And make sure of the diagnosis. Don’t just rely on the imaging. Then, gain and maintain range of motion. Hip OA stiffens the joints, so even a little bit of gain in the range can make a big difference. And then, build and maintain strength around the hip joint – but not just the hip, the core, and the knee are important too. Practice good movement mechanics, see a good physio, to teach and help you mitigate hip pain happening from hip OA.

Exercise is medicine! This has shown repeatedly in research to help prevent replacements from hip OA. It may be necessary in some cases though to avoid certain movements that cause pinching to occur or pain to occur.

1. It’s relatively easily and quickly detectable:

• groin pain, plus
• simple office clinical test, and if indicated
• hip radiographs (standard AP pelvis and Dunne view)

2. Early identification can facilitate successful treatment of groin pain and possibly prevent labral tears, cartilage damage and hip OA.

3. Rehabilitation with orthopaedic / sports medicine-trained physiotherapist.

More studies are required. Currently it looks like certain forms of CAM FAI may be more likely to cause damage / hip OA. There are multiple types of pincer, some of which are likely benign and some not.

We have studied the frequency of X-ray changes typical for FAI, as well as the frequency of hip symptoms and FAI signs on physical examination among White people in Vancouver. However, we need studies in other ethnic groups and geographical areas. Furthermore, studies using MRI (magnetic resonance imaging), and especially open MRI, will allow us to identify any abnormalities in the hip joint more precisely.

Yes, in our study, people who were more active reported more hip pain. Please find the answer to this question by viewing the webinar recording of the Arthritis Research Education Series – Episode #3: The Puzzle of Hip Pain and Hip Osteoarthritis.

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It varies by individuals. Please refer to the webinar recording for general principles covered in the session. Beyond that it would require a more detailed history and exam so that stretches and exercises can be tailored to the individual patient.

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Please find the answer to this question by viewing the webinar recording of the Arthritis Research Education Series – Episode #3: The Puzzle of Hip Pain and Hip Osteoarthritis.

Read More

Potentially, it’s a blurry line sometimes and the clinical features can overlap. Usually imaging together with a good history and physical exam will be of value to help determine if one, or both, is present.

My best recommendation would be to see an orthopaedic or sports medicine clinician, whether surgeon, sports medicine doctor, rheumatologist, or physiotherapist.

Arthroscopic surgery is generally reserved for people with symptomatic FAI unresponsive to conservative treatment and without hip OA. It varies by surgeon and region/country in some cases, but generally arthroscopic criteria are met by relatively younger patients.

Hip replacement is the ultimate surgical option, usually when FAI has progressed to hip OA.

Anterior hip pain can still occur after a total hip replacement, but the reasons for it would require a full medical history and exam to determine cause.

Yes, in some cases it can. If you are experiencing lower back pain, you may wish to discuss with your family doctor, physiotherapist or other medical professional.

This is a broad question and difficult to speak to in a general way. There is a lot of individual variation, and the reason for the hip pain and its progression would require an individual assessment.

I haven’t witnessed this myself with FAI, but have seen those problems in other settings. Likely another process is at play if this is the case. An orthopaedic surgeon or a rheumatologist could provide a better answer.

This is still being studied. A surgeon or surgical researcher may be better suited to seek an answer for this question.

We appreciate receiving all your questions. However, some of the questions are specific to an individual situation and would require more history and a full exam to respond appropriately. May we suggest with the questions below that you seek guidance from your family doctor or other medical professional.

• I have OA in my knee and now find I am waking up at night with pain in the groin area on the same leg — could this be related?
• I had hip replacement 1 1/2 years ago successfully. Why do I now still get hip pain after I walk about one mile?
• What happens to the hips in a woman who once lived in high heel shoes — is there a way to correct the hip issues now that apparently I have OA to avoid surgery?