Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2016 Nov;33(11):1921-1946.
doi: 10.1007/s12325-016-0409-3. Epub 2016 Sep 26.

Hip Osteoarthritis: Etiopathogenesis and Implications for Management

Nicholas J Murphy  1 , Jillian P Eyles  1 , David J Hunter  2
Affiliations
Review

Hip Osteoarthritis: Etiopathogenesis and Implications for Management

Nicholas J Murphy et al. Adv Ther. 2016 Nov.

Abstract

Highly prevalent among the elderly, hip osteoarthritis (OA) carries a heavy burden of disease. Guidelines for the management of hip OA are often extrapolated from knee OA research, despite clear differences in the etiopathogenesis and response to treatments of OA at these sites. We propose that hip OA requires specific attention separate from other OA phenotypes. Our understanding of the etiopathogenesis of hip OA has seen significant advance over the last 15 years, since Ganz and colleagues proposed femoroacetabular impingement (FAI) as an important etiological factor. This narrative review summarizes the current understanding of the etiopathogenesis of hip OA and identifies areas requiring further research. Therapeutic approaches for hip OA are considered in light of the condition's etiopathogenesis. The evidence for currently adopted management strategies is considered, especially those approaches that may have disease-modifying potential. We propose that shifting the focus of hip OA research and public health intervention to primary prevention and early detection may greatly improve the current management paradigm.

Keywords: Etiology; FAI; Femoroacetabular impingement; Hip; Management; Osteoarthritis; Rheumatology; Risk factors; Therapy.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Risk factors for hip osteoarthritis
Fig. 2
Fig. 2
Developmental dysplasia of the hip (DDH). The femoral head is less stable within the shallow acetabulum (image on left), causing the distribution of shear forces that damage the articular cartilage and predispose to labral tears (image on right) [31] (reprinted by permission from Macmillan Publishers Ltd)
Fig. 3
Fig. 3
Cam impingement. The cam lesion abuts against the labrum, pushing it outwards and compressing the acetabular cartilage inwards. The labrum separates from the cartilage and the acetabular cartilage delaminates from the bone [46] (reproduced with permission from Springer)
Fig. 4
Fig. 4
Pincer impingement. Owing to acetabular over-coverage, the femoral neck abuts against the hip labrum, damaging the labrum and eventually the underlying cartilage. A contre-coup lesion can also occur, where continued flexion of the hip, after the femoral neck is already abutting against the acetabular rim, causes subtle joint subluxation and damage to the acetabular cartilage. The labrum separates from the cartilage and the acetabular cartilage delaminates from the bone [46] (reproduced with permission from Springer)
Fig. 5
Fig. 5
Diagnosis of FAI morphology. The a alpha angle and b lateral center edge angle are two of the imaging parameters commonly used to classify FAI morphology. The alpha angle (a), shown here on a modified Dunn X-ray view, is the angle formed by the femoral neck axis and a line connecting the center of the femoral head to the point at which the head–neck contour becomes aspherical. Greater than 50° or 55° is often considered suggestive of cam morphology. The lateral center edge angle (b), measured on an AP pelvic X-ray, is the angle formed by a vertical line connecting the center of the femoral head with the lateral edge of the acetabulum. Greater than 40° is often considered suggestive of pincer morphology
Fig. 6
Fig. 6
The genes responsible for the development of OA have been proposed to exist on a continuum related to joint morphology. Some defective genes are expressed in markedly abnormal joint morphology, such as in some chondrodysplasias, causing early-onset OA. Other more common genetic defects are expressed in subtle morphological aberrations that cause late-onset OA, previously considered primary OA [31] (reprinted with permission from Macmillan Publishers Ltd)
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Murphy LB, Helmick CG, Schwartz TA, et al. One in four people may develop symptomatic hip osteoarthritis in his or her lifetime. Osteoarthr Cartil. 2010;18(11):1372–1379. doi: 10.1016/j.joca.2010.08.005. - DOI - PMC - PubMed
    1. Culliford DJ, Maskell J, Kiran A, et al. The lifetime risk of total hip and knee arthroplasty: results from the UK general practice research database. Osteoarthr Cartil. 2012;20(6):519–524. doi: 10.1016/j.joca.2012.02.636. - DOI - PubMed
    1. Neogi T, Zhang Y. Epidemiology of osteoarthritis. Rheum Dis Clin N Am. 2013;39(1):1–19. doi: 10.1016/j.rdc.2012.10.004. - DOI - PMC - PubMed
    1. Gold GE, Cicuttini F, Crema MD, et al. OARSI clinical trials recommendations: hip imaging in clinical trials in osteoarthritis. Osteoarthr Cartil. 2015;23(5):716–731. doi: 10.1016/j.joca.2015.03.004. - DOI - PMC - PubMed
    1. Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2012;64(4):465–474. doi: 10.1002/acr.21596. - DOI - PubMed

LinkOut - more resources

  NODES
twitter 2