Hip osteoarthritis, medically referred to as coxarthrosis, is a condition of the hip joint in which the articular cartilage and other joint structures progressively change. As the condition progresses, the bone near the joint, the joint capsule, and the surrounding musculature may also be affected.

The symptoms and the course can vary greatly from person to person. Therefore, for treatment, not only changes on the X-ray are decisive, but above all the pain, mobility, and limitations in everyday life. Coxarthrosis is among the conditions that can be treated as part of an individually planned osteoarthritis therapy.

Hip osteoarthritis can develop without a clearly identifiable single cause. Often, several factors act together:

• advancing age;
• congenital or acquired hip malalignments;
• Hip dysplasia;
• hip impingement;
• previous injuries or surgeries;
• inflammatory joint diseases;
• circulatory disorders of the femoral head;
• familial predisposition;
• long-standing improper or excessive strain;
• overweight.

With hip dysplasia or other changes in the shape of the joint, the load may be distributed unevenly. As a result, individual areas of the hip joint may be subjected to greater stress.

Zu Beginn treten die Beschwerden häufig nur bei stärkerer oder längerer Belastung auf. Im weiteren Verlauf können sie auch bei alltäglichen Bewegungen oder in Ruhe vorkommen.

Typische Beschwerden sind:

• Schmerzen in der Leiste;
• Schmerzen im Oberschenkel oder Gesäß;
• Anlaufschmerzen nach längerem Sitzen;
• Beschwerden beim Gehen oder Treppensteigen;
• eingeschränkte Beweglichkeit;
• Probleme beim Anziehen von Schuhen und Socken;
• Schmerzen beim Ein- und Aussteigen aus dem Auto;
• Steifheit nach längeren Ruhephasen;
• verändertes Gangbild oder Hinken;
• Ruhe- und Nachtschmerzen in fortgeschrittenen Stadien.

Schmerzen im Hüftbereich müssen nicht immer direkt aus dem Hüftgelenk stammen. Auch die Lendenwirbelsäule, das Sakroiliakalgelenk, Muskeln, Sehnen oder Schleimbeutel können ähnliche Beschwerden verursachen. Deshalb ist eine genaue Untersuchung erforderlich.

Medical consultation

First, the type, duration, and location of the symptoms are discussed. Also important are limitations in daily life, previous injuries or surgeries, and treatments already performed.

Physical examination

During the examination, the following points, among others, are assessed:

• Range of motion of the hip joint;
• Pain location;
• Muscle strength;
• Leg length;
• Gait;
• Range of motion of the lumbar spine;
• possible symptoms of adjacent joints and structures.

Imaging studies

X-rays can show typical changes such as a narrowing of the joint space, bone spurs, or changes in the bone near the joint.

An MRI scan is not required for every case of hip osteoarthritis. However, it can be useful for specific questions concerning cartilage, bone, tendons, or other soft tissues. Ultrasound can additionally be used to assess effusions and superficial structures.

Treatment depends on the severity of symptoms, mobility, changes in the hip joint, and personal requirements in everyday life.

In many cases, conservative measures are used first. These include in particular exercise therapy, physiotherapy, adjustment of load, and, if needed, medication. Surgery is considered when there are severe symptoms and significant limitations and nonoperative measures do not help sufficiently.

Gezielte Bewegung ist ein zentraler Bestandteil der Behandlung einer Hüftarthrose. Das Gelenk sollte nicht dauerhaft geschont, sondern im individuell verträglichen Umfang bewegt und belastet werden.

Die Physiotherapie kann unter anderem folgende Ziele verfolgen:

• Verbesserung der Hüftbeweglichkeit;
• Kräftigung der Gesäß- und Oberschenkelmuskulatur;
• Stabilisierung des Beckens;
• Verbesserung des Gangbildes;
• Training von Gleichgewicht und Koordination;
• Erhalt der Selbstständigkeit im Alltag;
• Vorbereitung auf eine Operation oder Rehabilitation danach.

Das Trainingsprogramm sollte an die persönlichen Beschwerden und die körperliche Belastbarkeit angepasst werden. Therapeutische Übungen werden in aktuellen Leitlinien als grundlegender Bestandteil der Arthrosebehandlung empfohlen.

Strenuous movements and activities can be temporarily adjusted without completely immobilizing the hip joint.

Possible measures are:

• appropriate forms of exercise and training;
• adjustment of occupational or sports-related demands;
• crutches when appropriately indicated;
• assessment of leg length discrepancies;
• orthopedic aids;
• weight reduction in cases of overweight.

In cases of overweight, weight reduction can be recommended as part of the overall treatment plan. It should be combined with physical activity and a dietary adjustment that can be implemented in the long term.

Depending on the severity of the symptoms, pain-relieving or anti-inflammatory medications can be used.

The choice depends on possible pre-existing conditions, other medications, and individual risks. Dosage and duration of use should be coordinated with a physician. Nonsteroidal antirheumatic drugs can temporarily improve pain and function in suitable patients.

For selected complaints, an infiltration of the hip may be considered. In this procedure, a selected medication is specifically introduced into the hip joint or to a pain-causing structure.

Because the hip joint lies relatively deep and important vessels and nerves are located in its vicinity, the injection can be performed under ultrasound or X-ray guidance.

Intra-articular corticosteroid injections can provide a temporary improvement in pain and joint function in symptomatic hip osteoarthritis. Whether such treatment is suitable must be decided after an individual benefit-risk assessment.

During a hyaluronic acid therapy for the hip hyaluronic acid is injected directly into the hip joint. Placement can be image-guided due to the location of the joint.

For hip osteoarthritis, hyaluronic acid is not recommended as a routine standard treatment in current medical guidelines, as no reliable benefit over a placebo injection has been demonstrated to date. A guaranteed effect or duration of effect should therefore not be assured. Whether the method is nevertheless discussed in an individual case requires a thorough explanation by a physician.

During PRP therapy, the patient's own blood is first drawn and processed. The platelet-rich plasma obtained from it is then injected into the intended treatment area.

Whether PRP therapy is an option for hip osteoarthritis is decided individually based on the findings, the symptoms, and the previous treatment. A specific effect cannot be guaranteed.

A single measure is not sufficient for all patients. Depending on the findings, various treatments can be combined:

• Exercise and physiotherapy;
• Modification of physical activity;
• Weight management;
• Pain medication;
• Targeted injections;
• orthopedic aids;
• Follow-up assessments;
• Surgical treatment for advanced osteoarthritis.

The treatment plan can be adjusted over time if symptoms or physical capacity change.

Surgical treatment can be considered if severe pain, marked movement limitations, and significant problems in everyday life are present and conservative measures do not provide sufficient improvement.

The X-ray alone is not decisive. In particular, the following are taken into account:

• Severity and duration of pain;
• Limitations in walking and daily life;
• Resting or nighttime pain;
• Mobility of the hip joint;
• Effect of previous treatments;
• General state of health;
• Personal expectations and treatment goals.

Artificial hip joint

In advanced coxarthrosis, the damaged hip joint can be replaced by a hip endoprosthesis. In the process, the diseased joint surfaces are replaced by artificial components.

Before the operation, a detailed explanation, medical preparation, and a joint weighing of the possible benefits and risks take place. After the procedure, structured rehabilitation is required.

Joint-preserving operations

In younger patients with certain misalignments or shape changes, joint-preserving procedures can be considered in selected cases.

Which operation is an option depends on the cause of the symptoms, the extent of joint damage, and the anatomical conditions. 

When making the treatment decision, the following factors, among others, are taken into account:

• Severity and frequency of pain;
• Range of motion of the hip joint;
• Walking distance and weight-bearing capacity;
• Limitations in daily life;
• Changes in the X-ray image;
• Age and general health status;
• Comorbidities;
• Previous treatments;
• Personal goals.

Hip osteoarthritis is therefore not treated the same way in all patients.