Overview

 

Arthritis literally means "inflammation of a joint." In some forms of arthritis, such as osteoarthritis, the inflammation arises because the smooth covering (articular cartilage) on the ends of bones wears away. In other forms of arthritis, such as rheumatoid arthritis, the joint lining becomes inflamed as part of a systemic disease.



The three most common types of inflammatory arthritis that affect the hip are:

Basic Hip Anatomy:

This article is a review of the anatomy of the hip. It covers the bones, ligaments, muscles and other structures that make up the hip joint.

The hip joint is a ball and socket joint. The ball is formed by the top of the thigh bone (the femur) and is called the "head" of the femur. The socket is formed by the bones of the pelvis and is called the acetabulum. Muscles, ligaments and tendons help hold the head of the femur in the acetabulum (the ball in the socket).

Articular cartilage is a smooth shiny material that covers the head of the femur and the acetabulum. Articular cartilage covers the bony surfaces wherever they come into contact with each other. Articular cartilage allows the head of the femur to move easily inside the acetabulum as the leg moves. Fluid also helps the head of the femur move easily inside the acetabulum. This fluid (called synovial fluid) provides nourishment and lubrication to the hip joint.

The hip joint is surrounded by a strong "bag" called a joint capsule. Ligaments are like strong ropes that help connect bones and provide stability to joints. Ligaments reinforce the capsule and connect the head of the femur to the acetabulum. These ligaments help prevent the head of the femur from coming out of the acetabulum. Larger, stronger ligaments also provide stability to the hip joint.

The acetabulum has a ring of tissue around it called the labrum. The labrum also helps provide stability to the hip.

Tendons connect muscles to bone. There are many muscles that surround the hip joint. These muscles and their tendons provide stability to the hip joint when the leg is moved. These muscles are also necessary for activities such as walking, running and jumping.

The hamstring muscles (at the back of the leg) act with the gluteus maximus (the "butt muscle") to move the leg backwards at the hip. The hip flexors (iliopsoas and rectus femoris) move the leg forward at the hip. The groin muscles (adductor magnus and longus) move leg toward the midline of the body. The abductor group (gluteus medius, gluteus minimus and tensor fascia lata) move the leg away from the body and are also responsible for stabilizing the hip joint during weight bearing activities.

Finally, a bursa (pl. bursae) is a small sac of fluid which decreases friction between tendons, muscles and bones. The main bursa of the hip joint is the bursa of the greater trochanter. This bursa is outside of the hip joint. It can become injured by direct contact (falling directly onto the outside of the hip), or irritated from overuse.

Hip Pain Info's links section has additional information on osteonecrosis of the hip. Links have been provided to other websites as well as online medical journals. Visit Joint Pain Info for information on other joint injuries and problems.

Signs and Symptoms

The classic sign of arthritis is joint pain. Inflammatory arthritis of the hip is characterized by a dull, aching pain in the groin, outer thigh, or buttocks. Pain is usually worse in the morning and lessens with activity; however, vigorous activity can result in increased pain and stiffness. The pain may limit your movements or make walking difficult.

Diagnosis

During the physical examination, your physician may ask you to move your hip in various ways to see which motions are restricted or painful. Your physician will want to know if you walk with a limp, if one or both hips are painful, and if you experience pain in any other joints. X-rays (radiographs) and laboratory studies will be needed. The x-rays will show whether there is any thinning or erosion in the bones, any loss of joint space, or any excess fluid in the joint. Laboratory studies will show whether a rheumatoid factor or other antibodies are present.

Treatments Available :

Nonsurgical Treatment

Anti-inflammatory medications, such as aspirin or ibuprofen, may help reduce the inflammation.

Corticosteroids are potent anti-inflammatories, part of a drug category known as symptom-modifying antirheumatic drugs (SMARDs). They can be taken by mouth, by injection, or as creams applied to the skin.

Methotrexate and sulfasalazine may be prescribed to help retard the progression of the disease. These medications are part of a drug category called disease-modifying antirheumatic drugs (DMARDs). For example, tumor necrosis factor is one of the substances that seem to cause inflammation in people with arthritis. Newer drugs that work against this factor seem to have a positive effect on arthritis in some patients as well.

Physical therapy may help you increase the range of motion, and strengthening exercises may help maintain muscle tone. Swimming is a preferred exercise for people with ankylosing spondylitis.

Assistive devices, such as a cane, walker, long shoehorn, or reacher, may make it easier for you to do daily living activities.

Surgical Treatment

The most common surgical procedures performed for inflammatory arthritis of the hip include:

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