This condition occurs when there is degeneration in the hip causing damage to the joint surface (figures 1 and 2). There are numerous different causes but the most common is osteoarthritis and this is most often seen in the older patient. However, it can occur earlier due to abnormalities within the hip. This may be due to a previous injury, childhood hip disease, femero-acetabular impingement or problems with the blood supply to the hip.
Commonly, this causes groin pain often going down the thigh to the knee. The hip is stiff, and the patient walks with a limp. As the arthritis becomes more widespread and severe, the pain becomes more constant, it may occur at night and be associated with increasing stiffness, decreased mobility and activity.
X-rays of the hip to confirm the diagnosis are taken as standard. More complex scans such as CT or Magnetic Resonance may be needed to aid surgical planning.
To begin with, simple measures are tried such as painkillers, weight loss and activity modification. Oral supplements such as glucosamine and chondroitin may benefit some patients, especially with early arthritis. Occasionally, steroid injections may be used to either confirm the source of the pain (e.g. if the patient also has back pain) or in those patients who are not fit for a joint replacement.