Hip osteoarthritis.

The degree of osteoarthritis does not always determine the degree of symptoms. People may experience relatively few symptoms with substantial osteoarthritis of the hip. There may also be many complaints and pain with little osteoarthritis in the hip. The degree of pain depends on many different factors such as; strength of the muscles around the knee, degree of physical activity or physically demanding work. Cartilage itself has little to no pain sensors and thus cannot cause the pain. The pain you feel is caused by an inflammatory process leading to irritation of the capsule, synovial fluid (synovium) and muscles and tendons around the knee. This is what also causes pain in osteoarthritis and thus not the cartilage itself.

Currently, we have three locations. Our first physical therapy practice is located in Tilburg Center, at Veldhovenring 57. Our second location is located in Tilburg Reeshof, at Spaubeekstreet 89 at the Basic-Fit gym. Our third location is located in a health center in Tilburg West, at the Professor Verbernelaan 37-D.

Anatomy and function of cartilage in the hip

The hip forms the connection between the femur and the pelvis. The upper leg (femur) together with the socket of the pelvis (acetabulum) form the hip joint. Between these bone parts is cartilage that allows the hip to move smoothly. The hip joint is a ball and socket joint. This means the hip naturally has a lot of range of motion. The hip is passively stabilized by ligaments. The labrum provides additional stability in the hip. The labrum is a large, cartilaginous ring that seals the hip tightly. The labrum of the hip passes into the cartilage portion of the socket of the hip. We have different types of cartilage in our bodies: hyaline, elastic and fibrous cartilage. Hyaline cartilage is the most common in our body and is also found on the end of our bones. In particular, the function of cartilage is to keep the joint moving smoothly and acts as a shock absorber of the hip joint. Osteoarthritis in the hip is also called coxarthrosis in the medical world.

Symptoms in hip osteoarthritis

Osteoarthritis in the hip can cause a variety of symptoms:

• Groin pain especially after an extended period of activity.
• Clicking of the hip during flexion.
• A limitation in mobility. Especially toward stretching and turning the hip inward.
• (groin) pain when sitting and standing.
• Shortening of the muscles around the hip. This makes the leg appear shorter. This is not really so but is optical deception.

Physical tests in hip osteoarthritis

Hip osteoarthritis can be tested using a cluster of different tests. We do this using a clinical prediction rule. A clinical prediction rule is a model that helps Physical Therapist to make the right choices in the treatment process. The more of these tests are positive the more likely the diagnosis of hip osteoarthritis is. Clinical prediction rule in hip osteoarthritis: 

Squat test
The person stands with both feet on the ground in front of a 20 cm strip. The feet are outside the line of the strip. The person makes as deep a knee bend as possible with the hands on the hips. The heels should not come off the ground. The test stops when the person cannot lower further due to symptoms in the hip(coxarthrosis). This test is also used to assess the situation over time. A decrease in mobility probably means that the degree of coxarthrosis is increasing.

Scour test
The person lies on his or her back. The hip is flexed through the examination to 90 degrees. The knee is brought to opposite shoulder and pressure is applied toward the treatment couch. The test is positive when a recognizable groin pain is elicited. 

Independent hip flexion
The person lies on his or her back on the treatment couch. The leg is brought to a neutral position. The person independently flexes the knee and hip as far as possible at that time. The test is positive with recognizable pain in the hip region. This test is also used to assess the situation over time. A decrease in mobility probably means that the degree of coxarthrosis is increasing. A well-known phenomenon during this test is a Drehmann sign. The hip will then move outward (exorotation) during flexion due to the limited mobility of the joint. 

Passive endorotation of the hip 
The person lies on his or her stomach on the treatment couch. The knee is flexed 90 degrees. The hip is brought to maximum endorotation by the examiner. The test is positive when the endorotation is less than 25 degrees in the hip. This test can also be used to assess the situation over time. A decrease in mobility probably means that the degree of coxarthrosis is increasing. 

Active extension of the hip
The person lies on the treatment couch on his or her stomach. With an extended knee, the person raises the leg as far up as possible. The front of the pelvis should remain in contact with the treatment couch. Also, the back should remain in a neutral position to create the cleanest possible movement in the hip joint. The test is positive with recognizable pain in the hip region. 

The different degrees of hip osteoarthritis

There are four grades of hip wear and tear, increasing in severity:

Grade I: The cartilage has softened and its springiness is reduced. Sometimes a single osteophyte (bone protrusion) is visible at the edges of the hip joint. This grade I damage is often not detectable on an X-ray.

Grade II: There are cracks and irregularities in the surface of the cartilage. However, this damage is often superficial and does not yet extend to the bone. Also, the cartilage layer has not yet become thinner due to the wear and tear damage. Sometimes clear osteophytes are visible on X-rays. Grade II damage is also not always detectable on an X-ray.

Grade III: The aforementioned cracks have left deep grooves or holes in the cartilage. This damage extends deeper toward the bone, but the bone is often not yet exposed. However, a narrowed area of the joint is sometimes visible on the X-ray. Also, the edges of the bone ends are often affected.

Grade IV: In a grade IV lesion, the cartilage is (almost) completely gone and the underlying bone is exposed. The joint space has narrowed considerably and sometimes almost completely disappeared. Also, large bone protrusions have often formed and the ends of the bone parts are deformed.

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