Hip Pain
If you are looking for the cause of your hip pain or you do not know exactly what is causing your hip pain, let us guide you through our hip pain diagnostics and arrive at the most likely diagnosis. Hip arthrosis (synonyms: hip joint arthrosis, coxarthrosis) is a degenerative disease of the hip joint, which is characterized by the slow progressive destruction of the cartilage in the hip joint. It proceeds in several stages.
In principle, three stages can be used in hip joint arthrosis: The general classification of all types of arthrosis into three stages, plus a radiological classification specific to coxarthrosis and a clinical classification for which various scores are available. Each form of arthrosis can be divided into stages: Depending on the stage, a distinction is made between different symptom triad: In the early stage, this consists of initial pain, fatigue and stress pain, in the late stage of permanent pain, night pain and muscle pain. In the early stages, radiating pain can be added (in the case of hip joint arthrosis, this is usually knee pain), while in the late stages, pain is often accompanied by limited mobility in the joint.
- Stage 1 denotes a clinically silent arthrosis. It does not cause any symptoms in patients and therefore usually goes unnoticed for a long time. Therefore, a diagnosis in this early stage is usually a chance finding, for example if a joint is x-rayed for another reason and the changes in the cartilage that are characteristic of osteoarthritis are discovered.
How long a patient remains in stage 1 hip arthrosis before it progresses to the next stage varies from person to person.
- Stage 2 is then characterized by the pain in the joint area typical of arthrosis, which is why a doctor is usually consulted. One speaks of an activated arthrosis, which means that an inflammatory process has begun which is responsible for the pain. However, this pain is not yet permanent and can sometimes be treated without drug therapy.
- Finally, in stage 3, a clinically manifest arthrosis is present, characterized by permanent pain and a reduction in function and movement of the affected joint.
These are caused by the moderate to severe inflammatory reaction. Due to the intensity of the pain, stage 3 requires drug therapy, physical therapy and/or surgical treatment. Once an arthrosis has progressed to stage 2, it will always move on to stage 3 sooner or later if early therapy is not carried out.
Radiological staging of hip osteoarthritis is usually done according to the Kellgren and Lawrence classification.
It is based on the findings shown in the X-ray image and is divided into grades from 0 to 4, whereby from the second grade onwards, the diagnosis of hip joint arthrosis can be considered certain. Although the X-ray findings for hip joint arthrosis are very reliable, they must nevertheless be evaluated with caution, as they do not always correlate with the extent of the patient’s complaints.
- Grade 0: normal findings, no signs of arthrosis are visible.
- Grade 1: Small osteophytes are present, but their relevance is still unclear at this stage.
Osteophytes are degenerative changes of bones, which are typical for arthroses. They are new bone formations in the form of small offshoots on the edge of a bone. In arthroses, they represent the body’s attempt to increase the bearing surface in the joint in order to reduce the pressure exerted.
In the case of coxarthrosis, the acetabulum is widened and thus loses its original spherical shape. At this stage, arthrosis is suspected.
- Grade 2: The osteophytes are clearly visible, but the joint space is still normal, although one speaks of a slight hip arthrosis.
- Grade 3: This finding is assessed as moderate coxarthrosis. Even a slight narrowing of the joint space is noticeable, and there are also cysts of debris.
These are signs of wear and tear in the joint and correspond to depressions in the bone, which are filled with synovial membrane, pieces of cartilage, scar tissue and/or fluid.
- Grade 4: This is a severe hip joint arthrosis. The joint space is massively reduced, which can be explained by the advanced loss of cartilage tissue. In addition, bony deformities in the joint are visible.
In addition, subchondral sclerotherapy is evident. This is the result of long-term, excessive mechanical stress on the joint, to which the bone reacts with structural compression. The deformities can result in an axial malposition of the hip joint, which leads to instability in the joint, which is therefore sometimes known as a “ball and socket joint”.
In this final stage, in the worst case, a stiffening (ankylosis) of the entire joint can occur.
The clinical stages of coxarthrosis are classified using different scores. The so-called “Harris Hip Score” is particularly popular. In this classification, points are awarded for various factors, so that a value between 0 and 100 can ultimately be achieved.
If less than 70 points are obtained, this result is classified as bad, everything above 80 points counts as good. The subgroups represented here are: The score according to Merle d’Aubigné and Postel is also frequently used. In this score, points are awarded in the areas of pain, mobility and walking ability, which can be divided into 7 degrees of severity (from 0 to 6).
In the calculated score, a distinction is made between absolute values, where only the points for pain and ability to walk are added up to a maximum of 12 (where anything below 7 is considered critical), and relative values. The relative values are intended to enable the patient’s condition before and after surgery to be compared. The points for pain and walking ability are doubled in this case.
Anything above 7 is considered good here, a value below 3 indicates that the operation has failed. There is also the score according to Lequesne, which evaluates pain, maximum walking distance and everyday activities. Although this score correlates very well with the clinical symptoms of the patient, it correlates rather poorly with the findings of an X-ray.
Last but not least, the SF-36 questionnaire is sometimes used, which is the only one that not only deals with the patient’s clinical complaints but also analyzes their quality of life. In general, it should also be noted that all stage classifications are primarily used to monitor the progress of hip arthrosis. Although they can also contribute to the decision making process for a suitable therapy for hip arthrosis, they should never be the primary point of reference in order to choose a certain treatment path, as they do not provide enough information about the individual suffering of the patient.
- Pain
- Daily activities (such as climbing stairs or putting on shoes and stockings by yourself)
- The ability to walk and finally
- Deformities or incorrect posture
