Treatment Options for Degenerative Joint Disease of the Hip
Degenerative joint disease (DJD) of the hip is a common cause of atraumatic hip pain in the older patient. Diagnosis is made by history, physical exam, and radiography. Nonoperative nonpharmacologic management includes exercise, weight loss, patient educa
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Treatment Options for Degenerative Joint Disease of the Hip Adam T. Liegner, Heather M. Gillespie, and William W. Dexter
Clinical Pearls • Strength training and aerobic exercise can reduce pain and improve function and health status in patients with hip degenerative joint disease and should be recommended for all patients. • Current pharmacologic treatment is focused on symptom control and should be seen as adjunctive to nonpharmacologic therapies. • Although widely considered as first line pharmacologic therapy for hip degenerative joint disease, recent evidence challenges the efficacy of acetaminophen. • Intra-articular corticosteroid injections are an effective, low-risk therapy for pain associated with degenerative joint disease of the hip. • After all conservative measures are exhausted, pain and function are the primary determinants for surgery.
14.1
Case Presentation
The patient is a 40-year-old nurse and aerobics instructor with a history of depression and fibromyalgia who presents with hip pain, increasing over a period of 2 years. She describes a dull, achy pain on the lateral hip that radiates to the groin. A.T. Liegner, MD, MPH Maine Medical Center, Department of Sports Medicine, Portland, ME 04101, USA e-mail: [email protected] H.M. Gillespie, MD, MPH, FACSM (*) Maine Medical Partners, Orthopedics and Sports Medicine, South Portland, ME 04106, USA e-mail: [email protected] W.W. Dexter, MD, FACSM Maine Medical Center, Department of Sports Medicine, Portland, ME 04101, USA e-mail: [email protected] © Springer International Publishing Switzerland 2017 P.H. Seidenberg et al. (eds.), The Hip and Pelvis in Sports Medicine and Primary Care, DOI 10.1007/978-3-319-42788-1_14
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Fig. 14.1 Right hip DJD with joint space narrowing and subchondral sclerosis
The pain is worse with activity and limits her range of motion; however, she has been able to remain active with bicycling. On examination, she has a body mass index (BMI) of 24, no tenderness to palpation over the hip, but pain is reproduced with hip internal rotation. She has decreased range of motion in internal rotation of the right hip compared to the left. Radiographs show a mild amount of joint space narrowing and subchondral sclerosis (Fig. 14.1).
14.2
Epidemiology
Degenerative joint disease (DJD) is the most common cause of musculoskeletal pain and disability. A progressive and debilitating disease, DJD affects over 15 % of the world’s population [1] and is a major cause of morbidity and health care expenditures. One longitudinal population-based study evaluating over 3000 subjects has estimated the lifetime risk of hip DJD as 25 % [2]. Likewise, data from the Center for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System shows that risk to increase to 35 % for those over the age of 50 and further to more than 55 % for those over the age of 70 [3]. One study ranked hip and knee DJD as the 11th highest contributor to global disability of 291 conditions studied [4]. As the population continues to age a
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