Hip Osteoarthritis (Coxarthrosis): Symptoms and Treatment

The Most Common Misconception: Pain Is Felt in the Groin

Many patients expect hip problems to cause pain over the outer buttock, which delays diagnosis. In fact, pain arising from the hip joint is typically felt in the groin and radiates to the front and inner thigh, sometimes as far as the knee. Because of this referred pain, some patients are treated for a knee problem for a period of time.

Symptoms

• Groin pain radiating to the front of the thigh or the knee
• Stiffness on rising in the morning or after prolonged sitting
• Difficulty tying shoes, putting on socks and cutting toenails
• Restricted ability to move the leg outward and to rotate it
• Shortening walking distance and a limp that becomes obvious later in the day
• In advanced disease, night pain and a sense of leg shortening

Restriction of movement often precedes pain. Without realising it, the person moves the leg less and attributes this to ageing. This silent loss is usually the first finding on examination.

Causes, Diagnosis and Treatment

• Age, excess weight and family predisposition
• Undiagnosed childhood hip dysplasia — a frequent basis for early osteoarthritis
• Femoroacetabular impingement
• Previous fracture or dislocation; avascular necrosis of the femoral head

Diagnosis rests on examination — restricted rotation with groin pain — and weight-bearing X-rays. Treatment begins with exercise for the hip muscles, weight management, activity modification and a walking stick held in the opposite hand, which substantially reduces load on the painful hip. When conservative treatment is no longer sufficient, total hip replacement is considered.