What are the stages of hip osteoarthritis?
Hip joint osteoarthritis is commonly seen in middle-aged and older people. The knee and hip joints are commonly involved with osteoarthritis as they are the primary load-bearing joints within the body. Osteoarthritis of the hip refers to the wear and tear changes that result in thinning and loss of the articular cartilage. The cartilage is the protective tissue that covers the bones at the joints, and it is responsible for smooth and frictionless movement. In osteoarthritis, loss of the cartilage will result in the bones becoming bare (exposed) and may rub against each other. This can result in significant joint pain, swelling and reduced function. In severe cases, there might be crepitus (a grating sensation due to bone-on-bone rubbing). To find out more, please see our article about hip osteoarthritis.
How is hip osteoarthritis diagnosed?
Imaging is very useful and usually needed to confirm the diagnosis of knee osteoarthritis. A hip X-ray is usually the first scan to assess the degree of joint space narrowing. If required, more advanced imaging like a hip MRI scan, can provide more information about the state of the articular cartilage. Ultrasound is also very useful in assessing the presence of fluid within the hip joint (called a joint effusion) and guiding injections around the hip.
What are the stages of hip joint osteoarthritis?
There are 4 stages of osteoarthritis
In this stage, there is usually very little thinning to the articular cartilage. The symptoms are usually very mild, with an occasional “twinge”.
Stage 2 (mild)
In this stage, there is a slightly higher degree of thinning to the articular cartilage, but the cartilage remains to cover the bone ends within the joint (no exposed bone). The symptoms at this stage usually consist of mild generalised pain and stiffness, especially after inactivity in the morning. The pain can get worse with activities like walking or using the stairs.
Stage 3 (moderate)
The cartilage loss here is more advanced, and there is usually a few areas of full-thickness chondral fissuring resulting in small areas of exposed bone. The x-ray will show prominent findings of arthritis in terms of narrowing of the joint space and formation of small areas of bone overgrowth at the joint (referred to as osteophytes). The symptoms will be more advanced than stage 2, and occasional grating sensations (crepitus) might occur. The knee joint may swell due to fluid accumulation within the joint (joint effusion).
Stage 4 (severe)
This is the most advanced stage of the disease. Significant areas of complete loss of the articular cartilage will result in complete exposure of the bone surfaces, and the bones will start to rub against each other. This usually results in severe pain that could be experienced at rest and can also interfere with sleep. This stage is usually associated with significant limitations of function.
How to treat hip joint arthritis?
Hip osteoarthritis treatment usually starts with physiotherapy. People with mild osteoarthritis usually respond very well to a combination of physiotherapy and a progressive rehabilitation program. Anti-inflammatory tablets are also used in the management of knee osteoarthritis. Other treatment options would be weight loss, activity modification and education on arthritis. The last resort would be to consider a hip joint replacement.
Will I benefit from a hip joint injection for my arthritis?
if your hip arthritis is significant and not responding to the management above, an injection may be indicated. This can be very useful in reducing pain, allowing you to undertake an effective physiotherapy program. One injection option is an ultrasound-guided steroid injection. This can provide rapid pain relief and is usually followed by a course of physiotherapy to utilise the window achieved by the injection. Hyaluronic acid can provide an alternative to steroid injections and has been shown as an effective treatment option for hip arthritis. It is usually used to treat mild to moderate hip osteoarthritis in active individuals.
In ultrasound-guided hip joint injections, the ultrasound visualises the needle, guiding it accurately to the target site. Plenty of evidence shows that ultrasound-guided injections are more accurate, less painful and produce better results than non-guided injections.
Hip conditions and treatments