Features October 2017 Issue

Hip Osteoarthritis: Test Yourself

Take this quiz to find out how much you know about hip osteoarthritis.

Take our quiz

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Over 54 million American adults suffer with arthritis. Most have osteoarthritis, and the hip joint is commonly affected. If you have hip osteoarthritis or think you might, take this quiz to find out how much you know about this condition. Cleveland Clinic orthopaedic surgeon Michael J. Star, MD, provides the answers.

1. Osteoarthritis in the hip is caused by:

A) Inflamed bursae near the hip joint

B) Wearing down of cartilage

C) Irritation of a tendon near the hip

D) A nerve getting squeezed

2. Which of the following is associated with risk for osteoarthritis?

A) Older age

B) Previous trauma

C) Obesity

D) Genetics

E) All of these

3. Which symptom is typical of hip osteoarthritis?

A) Pain and numbness on the outer thigh

B) Pain on the outside of the hip and outside of the thigh

C) Pain in the groin

D) Pain in the sacroiliac area

(the back of the pelvis) and buttock

4. Which is the safest initial pain medication for hip osteoarthritis?

A) Hydrocodone

B) Tramadol (Ultram®)

C) Cyclobenzaprine (Flexeril®)

D) Acetaminophen (Tylenol®)

5. Glucosamine and chondroitin reverse the progression of osteoarthritis.



6. Exercise should be avoided because it can worsen arthritis.



7. An ambulatory aid, such as a cane or walker, can be helpful.



8. What is the most commonly performed injection therapy for short-term benefit?

A) Corticosteroids

B) Hyaluronic acid

C) Stem cells

D) Platelet-rich plasma

9. Which of the following prevent the progression of hip osteoarthritis?

A) Weight loss

B) Exercise

C) Fish oil supplements

D) None of the above

10. The best time to consider hip replacement surgery is:

A) Before there is too much damage

B) When X-rays show significant arthritis

C) When symptoms are severe enough to interfere with daily activities despite nonsurgical treatment

Quiz Answers—­

1|B: With osteoarthritis, there is a loss of cartilage in joints. At the hip joint, a ball at the top of the thigh bone fits into a socket in the pelvis. The surfaces of these bones are covered with cushioning cartilage.

As cartilage wears down, bone can become irregular. The membrane that lines the joint (synovium) can get damaged, as can ligaments that surround the joint. These changes all add up to the possibility of pain and disability.

2|E: “While there’s no known cause of osteoarthritis, all of these factors have been implicated in increasing the risk for developing it,” says Dr. Star. Osteoarthritis becomes more common with age. Having had an injury earlier in life can set you up for having osteoarthritis later.

Obesity is a proven risk factor for osteoarthritis in the weight-bearing joints, such as hips and knees. Genetics also plays a role.

3|C: “While symptoms may be variable, hip osteoarthritis commonly causes pain in the groin,” says Dr. Star. Sometimes the pain goes down the front or inside of the thigh as far as the knee. “It typically does not refer down below the knee,” he says. Another symptom is stiffness.

Pain accompanied by numbness usually indicates a pinched nerve. When these symptoms occur on the outer side of the thigh the cause is likely a condition called meralgia paresthetica.

Pain on the side of the hip that may go down the outer thigh (without numbness) suggests the problem may be bursitis.

Pain in the sacroiliac area and buttock usually indicates a problem stemming from the lower spine.

4|D: “We usually start with acetaminophen,” says Dr. Star. If that doesn’t help, nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen (Aleve®) and ibuprofen (Advil®, Motrin®), are also good medications. However, they have a higher risk for side effects and complications, including gastrointestinal upset and worsening kidney problems.

Narcotic medications, such as hydrocodone and tramadol, and muscle relaxants, such as cyclobenzaprine, are not used for primary treatment of arthritis.

5|False: In their natural form, glucosamine and chondroitin exist in joints, where they help to keep cartilage intact. Several studies have looked at whether taking them as supplements can help. One large study found that they were not better at relieving pain than placebo. But a subgroup of patients with moderate-to-severe pain did get pain relief. “Some studies indicate they may provide symptomatic relief,” says Dr. Star. “But it’s never been shown that they prevent progression of the disease.”

6|False: Exercising an arthritic joint can be painful, which discourages some people from even trying. But physical therapy and appropriate exercise are very beneficial for relieving pain and improving function. Activities should be low impact (such as swimming). A physical therapist can recommend specific exercises that help to maintain flexibility and strengthen muscles to support the joint.

7|True: “Using a cane or walker can unload the pressure on the joint, alleviating pain,” says Dr. Star.

8|A: If physical therapy, pain medication and an ambulatory aid are not adequate to alleviate symptoms, your doctor may try an injection of a corticosteroid (a powerful anti-inflammatory) into the joint. But these are not done as often for hips as they are for other joints, such as knees. Some people get short-term relief with these injections.

Injections of hyaluronic acid, which is a natural component in joints, are FDA-approved only for knees. Injections of stem cells and platelet-rich plasma are still experimental.

9|D: “Weight loss for those who are overweight and exercise are absolutely recommended to diminish symptoms and to keep you moving with minimal pain for as long as possible,” says Dr. Star. But nothing can prevent osteoarthritis from worsening over time. The speed of progression varies from person to person.

10|C: Hip replacement surgery is considered only after all other treatments have failed to provide enough relief to allow you to continue with normal daily activities. Just having evidence of arthritis on X-rays is not sufficient. “There’s not always a good correlation between X-ray evidence of arthritis and pain and dysfunction,” says Dr. Star. “We base our treatment on the whole picture of pain, limitations, physical examination and imaging studies.”

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