Osteoarthritis (OA) also called degenerative arthritis can affect people from young adulthood to the elderly. Osteoarthritis is basically explained as wear and tear of the joint surface. This wear and tear commonly affects the articular cartilage of the hip and knee joints. The articular cartilage is the smooth white surface that covers the end of bones making the joint smooth with reduced friction for movement. When cartilage layer becomes disrupted and the joint surfaces deteriorate this leads to bone on bone arthritis. Bone on bone arthritis can lead to severe pain in some patients.

The cause of osteoarthritis in the hip and knee is unknown but most experts believe there is some genetic predisposition. In addition to genetics, osteoarthritis can be caused from hip dysplasia (the hip socket does not form properly), knee dysplasia (the knee joint does not form properly), avascular necrosis (disruption of the blood supply to the bone), trauma, bleeding into the joint and infection.



Post-traumatic arthritis occurs after a serious injury: dislocation or fracture. The injury causes damage to the cartilage, which can lead to hip or knee pain, stiffness and even arthritis over time. The symptoms basically are the same as those described from OA.



Inflammatory arthritis differs from osteoarthritis in that the arthritis is a systemic disease that can affect multiple joints at once. There are many forms of inflammatory arthritis that include rheumatoid arthritis, ankylosing spondylitis, systemic lupus and others. Rheumatoid arthritis is by far the most common form. The systemic reaction leads to an inflammatory response in the joint that attacks the synovium (lining) of the joint. This leads to increased pain in the hip joint as well as other joints with activity.

The diagnosis of an inflammatory arthritis is by history, physical exam, X-rays, blood tests and possible joint aspiration. The treatment depends on the type and severity of the arthritis. Conservative treatment measures include a variety of medications to control the progression of the systemic disease and the local joint treatments are similar to those used for osteoarthritis. These joint treatments include anti-inflammatories, cortisone injections and viscosupplementation. When the joint becomes resistant to conservative measures the treatment is total joint arthroplasty.



Avascular necrosis of the hip occurs when the blood supply to the femoral head (ball) is disrupted. AVN can occur for many reasons including injury, excessive alcohol use, steroid use, scuba diving, patients with other systemic diseases but most times the cause is idiopathic or unknown. Patients with AVN can have a wide range of symptoms that range from asymptomatic to severe pain. Left untreated AVN can lead to collapse of the ball and eventually arthritis. AVN commonly presents in the age group of 45-60 years old with patients having increasing hip pain. The diagnosis of AVN starts with an X-ray but may include an MRI. There are many stages of AVN and the stage will determine the treatment options that range from observation, medicines and even surgery. Surgical treatments include core decompression, vascularized fibula graft and total hip replacement.



Some patients present having increasing pain around their hip and they have trochanteric bursitis. Trochanteric bursitis occurs when the bursa overlying the part of the hip bone called the greater trochanter becomes inflamed. The greater trochanter is where the large buttocks muscles insert and so that they slide over the bone the body forms a bursa (fluid sac) to lubricate the area. The bursa is always there but sometimes becomes inflamed for multiple reasons including walking, running, trauma, lying on your side but most often the cause is unknown. Trochanteric bursitis commonly presents with gradual increasing pain on the outside of the hip that may radiate down the outside of the thigh. The pain is commonly described as burning pain or just pain when lying on your side in bed or walking/running. The diagnosis is usually made by history and physical exam with an X-rays to evaluate the hip joint.

Trochanteric bursitis treatment options range from observation to surgery. The vast majority of the time trochanteric bursitis responds to conservative treatments like rest, cortisone injections, physical therapy, stretching, anti-inflammatories, or a combination of these modalities. More often it may take more than one round of treatments for complete resolution of the symptoms. In rare circumstances if the bursitis is resistant to multiple rounds of treatments, surgical management may be required for relief. Surgery entails removing the bursa overlying the hip either through a small incision or arthroscopically.

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