Causes

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Osteoarthritis is caused by the inflammation, breakdown, and eventually, the loss of cartilage in the joints.

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In healthy joints, the ends of the two bones that come together to form the joint (known as the articular surfaces) are covered in a specialised tissue known as articular cartilage. This cartilage is very dense, smooth and slippery and allows for friction free movement and load transmission in the joint, basically acting as padding to prevent the bones from rubbing against each other. Unfortunately, this cartilage does not have a good nerve or blood supply so does not have the ability to heal and repair like other soft tissues. In joints with osteoarthritis, the cartilage becomes damaged which leaves the bones unprotected and vulnerable to further damage, eventually leading to damage & the breakdown of the other tissues in the joint.

 

Risk Factors

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These factors can increase your risk of developing osteoarthritis:

• Age – OA becomes more common with increasing age.

• Previous joint injury or damage – Includes infections, fractures, ligament or tendon injuries that can cause instability or alter the biomechanics of the joint often leading to uneven or increased wear

• Overuse of the joint – For example, osteoarthritis of the hip may be more common in people who have jobs involving repetitive heavy lifting or squatting

• Overweight / Obesity – Knee and hip osteoarthritis are more likely to develop, or be more severe, in people who are overweight or obese. This is because there is an increased load on the joints

• Sex – Women are more likely than men to develop osteoarthritis.

• Family history – There is often a genetic link to certain types of arthritis. This can be due to the shape, size or structure of joints meaning you may be more likely to develop arthritis if other family members have the condition.

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Signs & Symptoms

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Symptoms of OA can vary from person to person, and also depend on which joints are affected. The signs and symptoms can include:

• Joint pain worse during and after activity, better with rest (Pain at rest or at night can start as the condition progresses).

• Joint stiffness, usually worse in the mornings, eased by movement

• Tenderness on or around the joint

• Crepitus (Clicking, crackling or grating noises or feelings in the joint)

• Swelling around the joint

• Changes to the shape of the joint (Eg bowing of the knees or enlarged joints caused by bony growths)

• Loss of range of movement

• Inability to carry out normal activities

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Hip OA is characterised by a deep pain in the hip which often refers into the groin or down the thigh. Aggravating factors are often internal rotation of the hip (turning the hip inwards or moving it across the body), squatting, standing up from a sitting position & climbing stairs.

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OA can become very debilitating if left untreated, so it is always best to seek advice as soon as symptoms present.

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Diagnosis

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The initial diagnosis is often made clinically on the history of the complaint and the presenting symptoms. It is easily confirmed with X-rays which can give good information on the extent of the damage.

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Treatment

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While the bony changes of OA are not reversible, initial treatment should focus on slowing progression of the disease and allowing the patient to better manage their condition. Some of the biggest strategies here will include education, weight loss if required and the commencing of an exercise program. Exercise programs will usually consist of a mix of home-based strengthening exercises and hydrotherapy which is a great way to strengthen around the joint whilst also reducing the impact and load on hip. Often an early intervention program can prevent the need for further invasive treatments such as surgery.

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A recent study from 2017 found that patients with confirmed hip OA who completed a 12 week physiotherapy led exercise program saw an average of 30% improvement in hip strength, 35% reduction in pain levels and an overall improvement in their quality of life scores.

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Manual therapies such as joint mobilisations and soft tissue release techniques may be used in conjunction with the exercise program to provide symptom relief as required.

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Surgical Management

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In some cases the OA can progress to a point where the pain and disability starts to negatively affect quality of life. In these cases, surgery may be required. Depending on which surfaces of the joint are affected a hemi arthroplasty (half joint replacement eg ball or socket only), or more commonly a total hip replacement may be carried out. Whilst fairly major surgeries, these are now very common with over 50,000 hip replacements performed in Australia last year, with the techniques and prosthetics used today also making the procedure much less traumatic than previously. Research shows that both pre-operative and post-operative rehab are important in ensuring the best possible recovery outcomes are met in hip surgeries.