Practice Clinical updates

Hip osteoarthritis

BMJ 2016; 354 doi: http://dx.doi.org/10.1136/bmj.i3405 (Published 06 July 2016) Cite this as: BMJ 2016;354:i3405
  1. Nick Aresti, specialist registrar in trauma and orthopaedic surgery and National Medical Director’s clinical fellow1,
  2. Jamila Kassam, lead orthopaedic research physiotherapist1,
  3. Nick Nicholas, patient with hip osteoarthritis and consultant gynaecologist2,
  4. Pramod Achan, clinical director and consultant orthopaedic surgeon1
  1. 1Barts Health Trauma and Orthopaedics, Royal London Hospital, London E11BB, UK
  2. 2The Hillingdon Hospitals NHS Foundation Trust, London, UK
  1. Correspondence to: N Aresti email{at}nickaresti.com

What you need to know

  • Hip osteoarthritis is a huge burden on the NHS and affects almost 2.5 million people in England

  • The main investigation used to diagnose hip osteoarthritis is plain radiography

  • Weight loss, activity modification, and physiotherapy form the mainstay of non-pharmacological treatment

  • Paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly used analgesics

  • Total hip replacement is a successful surgical option in the treatment of osteoarthritis

Osteoarthritis is a degenerative joint disease that causes progressive damage to articular cartilage and surrounding structures. The hip is the second most commonly affected joint (after the knee), and around 11% (2.46 million) of people in England are affected.1 This review updates readers on current management options for hip osteoarthritis.

Sources and selection criteria

We searched PubMed and Google using the terms “hip OA” and “hip osteoarthritis.” We used NICE and OASRI guidelines to provide up to date recommendations on treatment options, and independently evaluated references from the guidelines.

Who gets osteoarthritis of the hip?

Risk factors can be divided into general, intrinsic, and extrinsic. General factors include age, sex, and genetics. Hip osteoarthritis is almost twice as common in women than in men,1 2 and genetic studies show a 50% heritability caused by European genetic variants. Intrinsic factors include incongruency (such as dysplasias) and joint laxity: they cause abnormal wear and loading, and therefore accelerate articular degeneration. Extrinsic factors such as increasing body mass index, high levels of certain exercise, and heavy manual labour are thought to increase the incidence and progression of hip osteoarthritis.3 4 5

Most often the cause of hip osteoarthritis is multifactorial.6 A series of risk factors lead to instability, malalignment, increased joint load, microtrauma and structural damage. The joint responds through subchondral and synovial inflammation, and bone hypertrophy. This is visible on radiographs as narrowed joint space, sclerosis, and cyst or osteophyte formation.7

Hip …

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