Education And Debate

Fortnightly Review: Management of hip osteoarthritis

BMJ 1995; 311 doi: (Published 30 September 1995) Cite this as: BMJ 1995;311:853
  1. Paul Dieppe, ARC professora
  1. a Rheumatology Unit, Department of Medicine, Bristol Royal Infirmary, Bristol BS2 8HW
  • Accepted 24 July 1995

Summary points

  • Hip osteoarthritis is a common cause of regional pain, but care must be taken when making the diagnosis

  • Patients should be encouraged to live as normal a life as possible: a healthy lifestyle (keeping slim and active) is also good for joints

  • Common treatable difficulties that can arise from hip osteoarthritis include problems with dressing, sexual difficulties, and inadequate foot care

  • Shock absorbing shoe insoles and walking sticks can be of great benefit, while physio- therapy and hydrotherapy should be considered for more severe cases

  • If drugs are used simple analgesics such as paracetamol should be considered before non- steroidal anti-inflammatory drugs

  • Joint replacement should be considered for patients with severe pain or disability and if the disease has a major impact on work or social activities

Osteoarthritis of the hip is a common disorder of white (but not black) people with a roughly equal incidence in both sexes. Although more common in elderly people, it may start at any age from the second or third decade. Most cases are idiopathic, even among younger people, though a minority are secondary to a congenital or childhood hip disorder (acetabular dysplasia, congenital dislocation, slipped epiphysis, or Perthe's disease) or to an inflammatory arthropathy.1 Other risk factors for osteoarthritis may include inequalities in leg length and certain occupations or patterns of use of the hip: for example, there is a strong association between farming and hip osteoarthritis in European men.2 The condition has a chronic, variable course and often causes considerable pain and disability. Good management depends on the doctor's ability to diagnose the condition early, appreciate factors that may affect the prognosis or complicate the disease, and make effective use of the many treatment methods available.

Presentation, diagnosis, and prognosis

The start of symptomatic hip osteoarthritis is usually insidious, although in a few cases …

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