Coxarthrosis (hip osteoarthritis)

Hip joint – structure and function

The hip joint is a ball-and-socket joint: the femoral head of the thigh bone (femur) lies in the hip socket (acetabulum) of the pelvis. A smooth layer of cartilage covers the joint surfaces and enables low-friction movement. The labrum, a fibrocartilaginous ring on the lip of the socket, increases the contact surface and stabilizes the joint. The joint capsule with the synovial membrane produces synovial fluid as a “lubricant” and source of nutrients for the cartilage.

• Cartilage: absorbs loads and distributes pressure evenly.
• Labrum: improves seal and stability of the hip socket.
• Joint fluid: nourishes cartilage, reduces friction.
• Muscles/tendons (especially gluteal muscles): guide and stabilize movement.

What is coxarthrosis?

Coxarthrosis refers to the progressive wear and tear of the hip joint cartilage with accompanying changes to the bone (subchondral sclerosis, cysts, osteophytes) and soft tissue (capsule, synovium, muscles). The cartilage loses elasticity and thickness, the ability to glide decreases, and friction and peak loads increase. This can result in pain, stiffness and loss of function.

A distinction is made between primary (without a clear cause, often age-related) and secondary osteoarthritis, which occurs e.g. B. is promoted by hip dysplasia, femoroacetabular impingement (FAI), previous injuries, inflammation or metabolic diseases.

Causes and risk factors

• Age and genetic predisposition
• Malpositions/structural variants (e.g. hip dysplasia, FAI)
• Previous injuries or operations on the hip joint
• Excessive weight and high mechanical stress
• Inflammatory or metabolic diseases (e.g. rheumatism, gout)
• Circulatory disorders of the femoral head (femoral head necrosis)
• Muscular insufficiency and inadequate trunk/pelvic stability

Not every risk factor necessarily leads to osteoarthritis. It is often the interaction of several factors. Early advice and targeted prevention can have a positive influence on the course.

Typical symptoms

• Groin pain, often radiating to the thigh, knee or buttocks
• Start-up pain after rest, later pain on exertion
• Morning stiffness (usually less than 30 minutes)
• Restriction of movement (especially internal rotation, flexion)
• Difficulty putting on shoes/stockings, getting into the car
• Rubbing noises or “blocking feeling”
• Changed gait (limping), decreasing walking distance

What can look similar? Differential diagnoses

Not all groin pain comes from the hip joint. Depending on age, history and findings, there are other possible causes that should be differentiated.

• Femoroacetabular impingement (FAI) or labral lesion
• Hip dysplasia (overloading of the socket rim)
• Joint capsule irritation/synovitis or inflammatory coxitis
• Trochanteric bursitis, tendon attachment irritation (gluteal tendons)
• Lumbar spine problems (e.g. nerve root irritation), pelvic problems
• Circulatory disorder of the femoral head (femoral head necrosis)

Diagnostics in our practice

We begin with a detailed discussion (pain history, restrictions in everyday life, previous illnesses, medication) and a structured physical examination. Important information is provided by mobility tests, pain provocation (e.g. FADIR, FABER), gait, leg length, muscle strength and signs of capsular irritation.

• X-ray (pelvic overview, AP and Lauenstein/axial): assessment of joint space, osteophytes, sclerosis, cysts; Detection of dysplasia/FAI.
• Sonography: Evidence of effusion, tendon and bursa changes; Control of injections.
• MRI (if necessary): Clarification of accompanying pathologies (labrum, cartilage damage, edema, necrosis), especially a. if the X-ray findings are unclear or there is atypical pain.
• Laboratory: Only if inflammation/infection or systemic diseases are suspected.

Important: The extent of radiological osteoarthritis does not always correlate with the severity of pain. That's why we weigh imaging and clinical findings together.

Severity and course

The radiological severity is often classified according to Kellgren–Lawrence (grade 0–4): from inconspicuous (0) to severe (4) with significantly narrowed joint space and large osteophytes. The course and symptoms are individual: Some people affected remain stable for a long time, others experience faster progression. Pain peaks often occur in phases.

Conservative therapy – what really helps?

Our goal is to reduce pain, improve everyday function and enable an active lifestyle. The most effective strategy is multimodal: education, exercise therapy, load control, weight management, if necessary medication and - selectively - injections.

• Patient education: understanding of mechanics, pain triggers and self-management.
• Active physiotherapy: strengthening the hip abductors/extensors, core stability, mobility work.
• Load adaptation: Low-pain, rhythmic activities (cycling, swimming, walking), avoiding sudden shock and twisting loads.
• Weight reduction if you are overweight: reduces joint forces and can noticeably relieve pain.
• Aids: walking stick (contralateral), non-slip shoes, if necessary slightly elevated chair/toilet seat, handrails.
• Physical measures: Heat for muscular tension, cold for acute irritation; TENS and acupuncture can be tried in addition.
• Medication (if necessary): Short-term anti-inflammatory painkillers; prefer topical preparations. Weigh the benefit-risk individually (stomach, kidney, heart).

Medications should be used in the lowest possible effective dose and not on a long-term basis without medical supervision. We advise on sensible intake periods and alternatives.

Physiotherapy, exercises and training

Regular, measured training is a core component. It improves muscle balance, joint control and resilience. The start should be pain-adapted - “feeling some muscle work” is okay, persistent joint pain is not.

• Strengthening: side support variations, hip abduction (side position/mini band), bridge, hip hinge.
• Flexibility: hip flexor and glute stretches, mobilizing leg axis exercises.
• Coordination: one-legged stance, controlled weight shifts.
• Endurance: Cycling (saddle and handlebar height, easy gears), aqua jogging, cross trainer.

Individual programs are developed in physiotherapy and adjusted regularly. On “worse” days, easier mobilization and warmth make sense; On “better” days you can train more intensively.

Injections and regenerative procedures – useful for whom?

Injections can temporarily reduce pain in selected patients and make active therapy easier. We carry them out under ultrasound control to increase precision and safety. Important: They do not replace exercise therapy, but complement it.

• Cortisone injection: Can provide short-term relief of pain and swelling in the event of inflammatory irritation/effusion. limit numbers and distances; Weigh the benefit and risk individually.
• Hyaluronic acid: The aim is to improve joint lubrication. Studies show mixed results; In selected cases, noticeable, temporary relief can be achieved.
• PRP (Platelet Rich Plasma): Autologous blood product that contains growth factors. The evidence is increasing but is heterogeneous; Indication after careful examination, v. a. for mild to moderate symptoms.

Possible side effects (e.g. temporary increase in pain, bruising, infection - rare) are discussed in advance. There can seriously be no guarantee of effect or duration.

Everyday life, work and sport – practical tips

• Exercise instead of rest: Short, frequent breaks from activity instead of sitting/standing for long periods of time.
• Ergonomics: Select the seat height so that the hip joint does not flex significantly below 90°; Use armrests.
• Stairs: Use the handrail, “healthy” leg up first, “affected” leg down first (relief principle).
• Suitable sports: cycling, swimming/supine, Nordic walking, cross-country skiing; Rather avoid: intensive jogging on hard surfaces, deep squats with a load, sudden changes of direction.
• Shoes: good cushioning, non-slip profile; If necessary, inserts in case of axis instability.
• Warmth before activity, cold after exercise in a state of irritation.

When should surgery be considered?

If severe pain, significant loss of function and impairment of everyday life persist despite consistent conservative measures, a surgical solution may make sense. The decision is individual and takes into account complaints, activity goals, comorbidities and imaging.

• Total endoprosthesis (TEP): Standard procedure for advanced coxarthrosis with good pain reduction and functional recovery in many cases.
• Corrective osteotomies: For selected deformities (e.g. dysplasia) at younger ages.
• Arthroscopy: Rarely helpful for pure osteoarthritis; more likely for specific accompanying problems (e.g. FAI/labrum) in early stages.

As a conservative practice, we advise on benefits, risks and alternatives and, if desired, provide support with preparation (“prehab”) and postoperative rehabilitation. We work with experienced clinics for surgical procedures.

When should you seek immediate medical attention?

• Sudden severe hip pain with inability to bear weight (e.g. after a fall).
• Redness, warmth, fever or general feeling of illness (suspected infection/coxitis).
• Rapidly increasing pain at rest or at night without an explainable cause.
• Newly occurring sensory disturbances/weakness in the leg or significant swelling.

How we can help you in Hamburg

We take the time to provide a clear diagnosis and a realistic, personalized treatment concept. Our focus is on conservative orthopedics with active physiotherapy, individual training planning, sensible everyday adjustments and – where appropriate – targeted, ultrasound-assisted injections.

Location: Dorotheenstraße 48, 22301 Hamburg (Winterhude). You can easily receive appointments online via Doctolib or by email. We provide understandable, evidence-based advice and no promise of cure.