LE - hip (OA + THA)

What is Hip Osteoarthritis (OA)?

A chronic degenerative condition and the most common hip disorder characterized by progressive joint space narrowing and osteophyte formation.

Normal joint space:

3-5 mm.

Moderate DJD

<2.5mm

Severe DJD

<1.5 mm

What does a joint space narrowing of <2.5 mm indicate?

Moderate degenerative joint disease (DJD).

What does a joint space narrowing of <1.5 mm indicate?

Severe degenerative joint disease (DJD).

What is the significance of losing >0.5 mm of joint space per year?

It indicates rapid progression and poor prognosis of hip OA.

What are the primary risk factors for Hip OA?

Age >50, leg length discrepancy, limb malalignment, obesity, prior hip injury/surgery, genetic component, heavy lifting occupations, femoral cam lesions, and congenital hip dysplasia.

What symptoms may occur during weight-bearing activities in Hip OA?

Symptoms may result from compressive forces of body weight and strain on capsuloligamentous structures.

What is a common history of symptoms for Hip OA?

Gradual onset of hip/groin pain with gait, stairs, and squatting, morning stiffness lasting less than 1 hour, and pain after prolonged activity.

What are the primary diagnostic criteria for Hip OA?

Hip pain along with hip internal rotation (IR) of 24 degrees or below, hip flexion (Flx) 15 degrees less than the non-painful side or less than 115 degrees if bilateral, and morning stiffness lasting less than an hour.

What are common exam findings in Hip OA?

Loss of motion, passive range of motion (PROM) limited by pain or spasm, bony capsular endfeel, reduced hip flexor length, and strength deficits in glutes, quads, and hamstrings.

What special tests are likely to be positive in Hip OA?

Scour and FADIR tests, and the Faber test for loss of motion with and without hip/groin pain.

What is the cornerstone of care for Hip OA?

Physical therapy.

How can weight loss impact hip joint stress in Hip OA?

A 10 lbs reduction in body weight can result in a 60 lbs decrease in hip joint stress.

What types of exercises are recommended for Hip OA?

Stretching, manual therapy, strengthening exercises for glutes and quads, aquatic therapy, and non-weight-bearing low-impact aerobic exercises like cycling, swimming, and walking.

What pharmacological interventions are used for Hip OA?

COX-2 inhibitors (e.g., Celebrex), NSAIDs (e.g., Mobic), and intra-articular steroid injections.

What are the expected outcomes for patients with Hip OA?

Improvements in impairments and function, though it is a progressive condition.

What should be done for patients failing conservative interventions for Hip OA?

They should be referred to an orthopaedist.

What limitations in motion are typically observed in Hip OA?

Limitations in flexion and internal rotation are greater than limitations in abduction and extension.

What is the importance of footwear assessment in Hip OA management?

Footwear should be assessed for safety and shock absorbance.

What role do balance exercises play in Hip OA treatment?

Balance exercises should be included and progressed to individual or group activities like tai chi.

What are some differential diagnoses for Hip OA?

Rheumatoid arthritis (RA), labral pathology, and hip dysplasia without OA.

OA Can result in a deficient_______________, _______________________, &/ or an ________________

acetabular roof

abnormal femoral torsion

abnormally shaped femoral head

Early:

pain end of day, after prolonged activity that loads the hip

Later:

rest pain, night pain, reduced sleep quality

pts may report

- Crepitus, locking, catching

Primary Diagnostic criteria for hip OA are hip P! along w/:

- Hip IR

24 deg or below

Primary Diagnostic criteria for hip OA are hip P! along w/:

- Hip Flx ____________ less than the nonpainful side or less than __________ if bilateral

15 deg,115 deg

Primary Diagnostic criteria for hip OA are hip P! along w/:

- P! w/

passive hip IR

What is the most common disorder of the hip joint?

OA

What congenital condition is most important to consider with Hip OA?

Hip dysplasia

What pattern is typical in early Hip OA symptom progression?

End-of-day pain after activity

Which of the following is not a classic symptom of advanced Hip OA?

Morning stiffness >2 hours

3 multiple choice options

What two muscles are key focus areas for strengthening in Hip OA rehab?

Quads and Glutes

What non-pharmacologic intervention significantly reduces joint stress?

10 lb weight loss

-Assisted device maybe needed short & long term to

unload the joint & assist w/ balance

- Stretching & Manual therapy to improve capsular mobility

can improve motion, gait deviations, & functional activities, Like dressing