Hip Osteoarthritis

Training with knee pain

The fast facts:


  • There are nearly 30,000 new cases of diagnosed hip osteoarthritis each year in the Netherlands
  • Groin pain is a common symptom of hip osteoarthritis
  • Hip osteoarthritis is more common in men than in women 
  • Number of people with hip osteoarthritis increases with age
  • Each year, about 18,000 people receive a new hip
  • Osteoarthritis in the hip is also called coxarthrosis

Causes of hip arthritis

 Exactly how osteoarthritis forms is not entirely clear. What we do know is that osteoarthritis increases with age. We distinguish between different forms of osteoarthritis. Osteoarthritis can occur as a result of natural aging. We call this degenerative osteoarthritis. Osteoarthritis may also occur as a result of an accident; this is called post-traumatic osteoarthritis. The joint is then damaged, for example, by a fall. Osteoarthritis may also occur as a result of an autoimmune disease such as rheumatoid arthritis (RA). In degenerative osteoarthritis and osteoarthritis due to RA, there is often osteoarthritis in multiple joints. Cartilage is normally a smooth structure. During aging or damage, the quality of the connective tissue decreases. As we age, cartilage cannot repair itself properly like, say, a muscle can. The reason for this is that cartilage is poorly supplied with blood. The degree of arthritis does not always determine the degree of complaints. It may be that people experience relatively few symptoms with a severe osteoarthritis of the hip. There may also be a lot of symptoms and pain with little osteoarthritis in the hip. The degree of pain depends on many different factors, such as the strength of the muscles around the knee, the level of physical activity or physically demanding work. Cartilage itself has little or no pain sensors and therefore cannot cause the pain. The pain you feel is caused by an inflammatory process that leads to irritation of the capsule, synovial fluid (synovium) and muscles and tendons around the knee. This is what also causes pain in osteoarthritis and not the cartilage itself.

Cruciate ligament injury

Anatomy and function of cartilage in the hip

The hip forms the connection between the femur and the pelvis. The thighbone (femur) together with the socket of the pelvis (acetabulum) form the hip joint. Between these bone parts is cartilage that ensures that the hip can move smoothly. The hip joint is a ball and socket joint. This means that the hip naturally has a lot of freedom of movement. The hip is passively stabilized by means of ligaments. The labrum provides additional stability in the hip. The labrum is a large, cartilage-like ring that seals the hip securely. The labrum of the hip transitions into the cartilage portion of the bowl 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. The function of cartilage is mainly 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 community.

Symptoms of hip osteoarthritis

Osteoarthritis in the hip can lead to a variety of symptoms: 

  • Groin pain especially after a prolonged period of activity. 
  • Clicking of the hip during bending. 
  • A limitation in mobility. Particularly toward stretching and turning the hip inward.
  • (Groin) pain when sitting and standing. 
  • Shortening of the muscles around the hip. This makes the leg look shorter. This is not really so but is optical deception.

Physical testing 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 the deepest knee bend possible with the hands on the hips. The heels should not come off the ground. The test stops when the person cannot sink further due to complaints 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 bent to 90 degrees by the examination. The knee is brought to opposite shoulder and pressure is given toward the treatment table. 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 into a neutral position. The person independently bends the knee and hip as far as possible at that time. The test is positive when there is 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 make an outward movement (exorotation) during bending because of 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 bent 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 the knee extended, 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 make the cleanest possible movement in the hip joint. The test is positive when there is recognizable pain in the hip region. 

Surgical intervention or conservative treatment

Surgical intervention: a new hip

When you have osteoarthritis in the hip, it does not immediately mean that you need surgery. But when the symptoms only increase and the treatments no longer have the desired effect, a hip prosthesis or a new hip can offer a solution. This choice, however, depends very much on the individual. It really depends on the experienced pain and the experienced limitation in daily life. Together with an orthopedic surgeon the choice can be made to replace the hip. 

Conservative treatment: counseling, exercise therapy, and adaptations to daily living

With conservative policies, the main focus is on how to make adjustments in daily life. An example of this is to start cycling more. Bicycling is a no-load movement. There is little pressure in the hip joint but you are still moving. A structured exercise program will be set up to train the muscles and other connective tissue around the hip. Medication can possibly ensure that the irritation in the joint is reduced. If this is not enough, in consultation with the doctor a corticosteroid injection can be placed for a local analgesic effect. 

Knee Osteoarthritis
Kevin van Geel

An x-ray of the hip

The different degrees of hip osteoarthritis

A distinction is made between four degrees of hip wear, increasing in severity:

Grade I: The cartilage has softened and the springiness is reduced. Sometimes a single osteophyte (bone protrusion) is visible at the edges of the hip joint. This grade I damage is often undetectable on an X-ray.

Grade IIThere are cracks and irregularities in the surface of the cartilage. However, this damage is often superficial and does not yet extend to the bone. The cartilage layer has not yet been thinned by the wear and tear damage. Sometimes clear osteophytes are visible on X-rays. Also grade II lesions are not always detectable on an X-ray.

Grade III: The aforementioned tears have left deep grooves or holes in the cartilage. This damage extends deeper toward the bone, but the bone is often not exposed yet. 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 IVThe cartilage in a grade IV lesion has (almost) completely disappeared and the underlying bone is exposed. The joint space has narrowed considerably and sometimes almost completely disappeared. Also, often large bone protrusions have formed and the ends of the bone parts are deformed.

Rehabilitation at Fysio Fitaal

Complaints from osteoarthritis of the hip can be very annoying. Of course we cannot take away the complaints related to osteoarthritis. However, we can teach you to deal with your symptoms in a responsible manner. The therapists of Fysio Fitaal are specialized in the treatment and rehabilitation of osteoarthritis-related complaints. Our specialists will guide you as best as possible and motivate you where necessary. The combination of our extensive expertise in the field of orthopedic rehabilitation together with an extensive facility makes Fysio Fitaal the right place for you!

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