Are mild degenerative changes of the hip always indicative of osteoarthritis (Degenerative Joint Disease)?

From the Guidelines

Mild degenerative changes of the hip are not always indicative of osteoarthritis, as they can also represent normal age-related wear and tear that doesn't progress to symptomatic disease. While degenerative changes can be an early sign of osteoarthritis, they may not necessarily lead to osteoarthritis, and the presence of these changes alone is not sufficient for a diagnosis of osteoarthritis 1. Radiographic findings such as minor joint space narrowing, small osteophytes, or minimal subchondral sclerosis can be present without causing pain or functional limitations. For a diagnosis of osteoarthritis, clinical symptoms like pain, stiffness, and reduced range of motion should accompany these imaging findings. Many people over 50 have degenerative changes visible on X-rays but remain asymptomatic. The distinction matters because asymptomatic degenerative changes typically don't require treatment, while symptomatic osteoarthritis might need management with physical therapy, weight loss if appropriate, analgesics like acetaminophen, or NSAIDs such as ibuprofen, or in advanced cases, consideration of intra-articular injections or surgical interventions.

Key Considerations

• The presence of degenerative changes on imaging does not necessarily mean that the patient has osteoarthritis, as these changes can be asymptomatic and not progress to symptomatic disease 1.
• Clinical symptoms such as pain, stiffness, and reduced range of motion are necessary for a diagnosis of osteoarthritis.
• Asymptomatic degenerative changes typically do not require treatment, while symptomatic osteoarthritis may require management with various interventions.
• The management of osteoarthritis should be individualized and based on the patient's specific needs and circumstances, as outlined in the EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis 1.

Management Options

• Physical therapy to improve range of motion and strength
• Weight loss if appropriate to reduce stress on the joint
• Analgesics such as acetaminophen (500-1000mg every 6 hours as needed)
• NSAIDs such as ibuprofen (400-800mg three times daily with food)
• Intra-articular injections or surgical interventions in advanced cases.

From the Research

Definition and Diagnosis of Osteoarthritis

• Osteoarthritis (OA) is the most common disease of the hip joint seen in adults, and its diagnosis is based on a combination of radiographic findings of joint degeneration and characteristic subjective symptoms 2.
• The chronological sequence of degeneration includes joint space narrowing, development of osteophytes, subchondral sclerosis, and cyst formation 2.

Relationship Between Mild Degenerative Changes and Osteoarthritis

• Mild degenerative changes of the hip are not always indicative of osteoarthritis, as there can be cases where plain radiographs show minor changes, but the clinical suspicion of early disease can be confirmed with more sophisticated imaging methods 2.
• A study found that among patients with hip dysplasia and impingement, degenerative change occurred earliest in patients with developmental dysplasia of the hip (DDH), whereas the natural history of patients with femoroacetabular impingement (FAI) was quite similar to structurally normal hips 3.

Radiographic Parameters and Osteoarthritis

• Radiographic parameters such as femoral head lateralization, femoral head extrusion index, acetabular depth-to-width index, lateral center-edge angle, and Tönnis angle can predict differential rates of degenerative change 3.
• A study using the EOS® system found significant differences in pelvic, acetabular, and femoral parameters between healthy and osteoarthritis groups, but also considerable overlap amongst individuals 4.

Etiology and Symptoms of Osteoarthritis

• Osteoarthritis of the hip can be divided into radiologic classes, including hypertrophic, destructive, and mixed types, and into three grades of severity 5.
• The prevalence of osteoarthritis of the hip correlates with the patient's age, sex, occupation, and strenuousity of work, among other factors 5.