In addition to the bones, muscles, tendons, and ligaments, the cartilage is what lines the joints and basically it is what gives us shock absorption, good shock absorption, and within the hip joint, the cartilage lines the ball of the ball-and-socket joint, and provides good cushioning, a padded cushion of absorption. When in osteoarthritis, this cushion starts to break down, and that’s where the degenerative process begins when we begin to lose cartilage.
Symptoms of hip pain that are coming from arthritis can be intermittently dull and intermittently sharp. Patients will typically describe pain that begins, and is worse in the morning lasts around less than 30 minutes. Typically the pain, they’ll feel some anterior pain in the groin and some anterior thigh pain. It can be worse with going up and down stairs, it can be worse with bending over, it can be worse with sitting for prolonged periods.
That varies more specifically when, with each of the patients’ symptoms. Occasionally, the patient can also feel some buttock pain. It can be throbbing or sore in nature; there may or may not be associated lower back pain. Typically, pain from the hip does not radiate beyond the knee.
In diagnosing hip pain that’s coming from arthritis, typically when the patient comes in, they will tell us what their symptoms are. It’s important to assess how long the symptoms have been going on for, when did they begin, their intensity, how bad does the pain get, what is it currently, and how bad does it get at worst, how long has been lasting for, are there any movements that make the pain better or any movements that make it worse, does the patient describe the pain as dull and aching, do they describe it as sharp or stabbing, is there any radiation of the pain, or is it more localized?
After the interview and the history, then we do a good physical exam. And that physical exam involves testing the strength of the muscles, including the back, the legs, going down to the feet, testing the patient’s sensation, testing the reflexes, and doing a few provocative maneuvers that are good at ruling out whether the pain is coming from arthritis versus, pain coming from, intrinsically within the hip joint versus pain that’s coming from ligaments, tendons, muscles, or something that’s not arthritic.
Following the physical examination for arthritis, a radiograph is usually the first test we would order. The actual diagnosis of osteoarthritis is done by radiographs. And from the radiograph (which is an X-Ray), you can tell the condition of the bones and the health of the bones, and also the degree of the arthritis. If there is any question of any other additional soft tissue involvement, whether we’re looking at the actual capsule of the joint, or any of the surrounding muscles, tendons, or ligaments, then we can do an MRI. But typically, the radiograph is sufficient to diagnose hip arthritis.
There are no actual lab tests that are diagnostic of hip arthritis, osteoarthritis. Unless we’re suspecting something that is more systemic such as rheumatoid arthritis, or other systemic diseases, such as lupus, ankylosing spondylitis (which may present in a similar fashion), normally we don’t by default order lab work.