Hip OA

Question 1

Ticket muscles

Answer 1

Quads, GMa

Question 2

Risk factors

Answer 2

1. Previous hip joint injury (FAI)
2. Previous hip joint pathology
3. Metabolic disease
4. Genetic profile
5. Previous serious LL injury

Question 3

Pathophysiology steps (listed)

Answer 3

1. loss of articular cartilage
2. synovial inflammation
3. capsular thickening
4. sub-chondral bone sclerosis
5. osteophyte formation
6. joint space narrowing
7. muscle weakness
8. pain and OA

Question 4

Pathophysiology steps (detailed)

Answer 4

1. Loss of articular cartilage: articular cartilage composed of collagen and proteoglycans, with hip OA - 1) collagen fibres breakdown and become disorganised and 2) decrease in proteoglycan content within cartilage
2. Synovial inflammation: without the protective effects of articular cartilage degradation of tissue occurs. As breakdown products from collagen degradation are released into synovial joint, the synovium responds to remove the tissue and heal. This results in synovial inflammation (synovitis)
3. Capsular thickening: prolonged and repeated synovitis results in thickening of articular capsule. Reduced ROM of joint
4. Sub-chondral bone sclerosis: sub-chondral bone vol increases (the bone swells) but becomes less mineralised (weaker)
5. Osteophyte formation: New bone outgrowths on the joint margins. Decrease joint loading, increase in SA (osteophytes)
6. Joint space narrowing: as the joint degrades the joint space progressively reduces which affects joint mechanics
7. Muscle weakness: muscle weakness increases joint loading
8. Pain and OA: tissue source of nociceptive pain is: 1) synovitis which stimulates chemical nociceptors within the joint. 2) subchondral bone

Question 5

symptoms

Answer 5

1. Located in groin region, C-sign- where pt grabs their hip in characteristic fashion, buttock area and thigh
2. ache or stiffness
3. morning stiffness - eased with gentle mvt and heat
4. prolonged sedentary positions lead stiffness

Question 6

Capsular pattern

Answer 6

recognises that if a joint has an active pathology within it (eg OA), then certain movts will be affected more than others
For OA: flexion, adduction and internal rotation

Question 7

Physical features

Answer 7

• On completion of palpation, you won’t have reproduced the symptoms
• Hip flexion and FABERs
• hip IR overpressure and hip quadrant

Question 8

Initial Management

Answer 8

optimal loading (4/10), avoid aggravating factors, remain as active as possible, glut massage, IR mobilisation, Hip flex/IR MWM, hip flexion MET