Hip Osteoarthrits

Related Pathologies and Etiology of Symptoms

Osteoarthritis (Degenerative Joint Disease)

Osteoarthritis is the most common arthritic disease of the hip joint. The etiology may be the aging process, joint trauma, repetitive abnormal stresses, obesity, or disease. The degenerative changes include articular cartilage breakdown and loss, capsular fibrosis, and osteophyte formation at the joint margins.40 These effects usually occur in regions undergoing the greatest loading forces, such as along the superior weight-bearing surface of the acetabulum. A restriction in the capsular tissues leading to joint hypomobilities as well as tightness in the surrounding periarticular tissues may occur anytime the joint is immobilized after a fracture or surgery.

Physio Guideline


Common Impairments

Pain experienced in the groin and referred along the anterior thigh and knee in the L3 dermatome.

Stiffness after rest. Limited motion with a firm capsular end-feel. Initially, limitation is only in internal rotation; in advanced stages the hip is fixed in adduction, has no internal rotation or extension past neutral, and is limited to 90_ flexion. Antalgic gait usually with a compensated gluteus medius

(abductor) limp. Limited hip extension leading to increased extension forces on the lumbar spine and possible back pain. Limited hip extension preventing full knee extension when standing or during gait leading to increased knee stresses. Impaired balance and postural control.

Common Functional Limitations/Disabilities

Hip joint impairments interfere with many weight-bearing activities and ADL.

Early stages. There is progressive pain with continued weight bearing and gait or at the end of the day after repetitive lower extremity activities. The pain may interfere with work (job-specific) or routine household activities that involve weight bearing, such as meal preparation, cleaning, and shopping.

Progressive degeneration. The individual experiences increased difficulty arising from a chair, climbing stairs, squatting, and other weight-bearing activities, as well as restricted routine ADL such as bathing, toileting, and dressing (putting on pants, hose, socks).

Management: Protection Phase

 Faulty hip mechanics may be caused by conditions such as obesity, leg-length differences, muscle length and strength imbalances, sacroiliac dysfunction,30 poor posture, or injury to other joints in the chain. The following goals and interventions are emphasized during the acute stage of tissue healing and the protection phase of nonoperative management.

Decrease Pain at Rest

Apply grade I or II oscillation techniques with the joint in the resting position. Have the patient rock in a rocking chair to provide gentle oscillations to the lower extremity joints as well as a stimulus to the mechanoreceptors in the joints.

Decrease Pain During Weight-Bearing Activities

Provide assistive devices for ambulation to help reduce stress on the hip joint. If the pain is unilateral, teach the patient to walk with a single cane or crutch on the side opposite the painful joint.

If leg-length asymmetry is causing hip joint stress, gradually elevate the short leg with lifts in the shoe.

Modify chairs to provide an elevated and firm surface, and adapt commodes with an elevated seat to make sitting down and standing up easier.

Decrease Effects of Stiffness and Maintain Available Motion

Teach the patient the importance of frequently moving the hips through their ROM throughout the day. When the acute symptoms are medically controlled, have the patient perform active ROM if he or she can control the motion or with assistance if necessary. If a pool is available, have the patient perform ROM in the buoyant environment. Initiate nonimpact activities such as swimming, gentle water aerobics, or stationary cycling.

Management: Controlled Motion and Return to Function Phases

As healing progresses and symptoms subside, the emphasis of management includes the following

goals and interventions.

Progressively Increase Joint Play and Soft Tissue Mobility

Joint mobilization techniques. Progress joint mobilization to stretch grades (grade III sustained or grade III and IV oscillation) using the glides that stretch restricting capsular tissue at the end of the available ROM. Vigorous stretching should not be undertaken until the chronic stage of healing.

Passive stretching, neuromuscular inhibition, and selfstretching

 Stretch any range-limiting tissues.

Improve Joint Tracking and Pain-Free Motion

Mobilization with movement (MWM) techniques  may be applied through the use of a mobilization belt to produce a pain-free inferolateral glide and then superimposing motion to the end of the available range. As with all MWM techniques, no pain should be experienced during application of the technique.


 

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