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The Connection Between Hip Pain and Hip Osteoarthritis (OA) Is Complex

It’s often thought hip problems only affect older people – that is not the case! While there are many reasons for hip pain, femoroacetabular impingement (FAI) is among the most common causes, particularly in active young and middle-aged adults. Through research, our scientists believe this bone abnormality (FAI) may lead to hip OA later in life.

Below are some of the more frequently asked questions, related research articles, videos, and general information that may be helpful in understanding the role of FAI in hip pain and hip osteoarthritis. We hope that building public awareness and knowledge will encourage people to be proactive in the early detection of hip pain in order to prevent it from worsening over time and potentially leading to osteoarthritis.

Frequently Asked Questions

What is hip osteoarthritis (OA)?

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.

What are some causes of hip pain?

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.

What is femoroacetabular impingement (FAI) and its role in hip pain and OA?

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.

What is the connection between hip pain and hip OA?

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.

What are some options to prevent hip damage and avoid hip replacement surgery?

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.

What are some important things that health care providers need to know about FAI? What interventions or treatments would be best?

1. Its 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.

Is there evidence to show that the ‘combined type of FAI’ causes more damage than that experienced by individuals with either one kind or another?

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.

What kind of information is currently missing and would be most helpful in helping researchers answer how common FAI is in the general population?

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.

Does an increase in physical activity increase the likelihood of experiencing hip pain?

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.

What key stretches or exercises can delay and prevent this?

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.

In addition to physical activity contributing to FAI, how much does sitting over the long term contribute as well?

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.

Can FAI be misdiagnosed as OA? What type of medical professional is best equipped to diagnose FAI?

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.

Do you still find that arthroscopic surgery is reserved for the very young?

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.

I didn't see hip replacement (new ball and socket) as a surgery option. Would it not?

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

Can you still have symptoms of FAI 10 years after a total replacement surgery?

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.

Can lower back pain be associated with hip pain?

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.

Can you speak to runners and hip pain and progression of hip OA?

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.

Could FAI ever cause a hairline fracture, or disintegration, of the femoral head if left untreated? Is there a connection with osteonecrosis?

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.

Years ago there was some research done on growing cartilage, is this research still going on?

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 walking 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?

Related Articles

Hip and Knee Replacements in Canada: CJRR Annual Statistics Summary, 2018–2019

New Study Holds Hope for Osteoarthritis Prevention

Understanding the Prevalence of Femoroacetabular Impingement (FAI) Syndrome in the General Population

Can You Prevent Hip Osteoarthritis?

IMPAKT-HiP: Finding the Cause of Hip Pain Will End the Suffering

S.U.C.C.E.S.S. in Health Research for Different Ethnic Populations

Informational Videos

What is Femoroacetabular Impingement (FAI)? Dr. John Esdaile Explains

Understanding the Prevalence of Femoroacetabular Impingement (FAI)

Osteoarthritis in His 40's - Firefighter Kelly Barber Shares Hip Replacement Journey

Hip Replacements - Surgical Techniques Compared

Weighing in on Osteoarthritis

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