The most common form of arthritis is osteoarthritis.
Osteoarthritis is caused by the premature wearing
away of cartilage, the gristle that caps the ends of
long bones.Osteoarthritis has a predilection for
weight-bearing joints such as the neck, low back,
hips, and knees.
One of the areas that has gained a lot of
interest in recent years because of its apparent
increased incidence and prevalence, is
osteoarthritis of the hip. Unlike osteoarthritis of
the knee, there is very little correlation with
obesity as far as the initiation of disease.
However, once osteoarthritis has developed,
worsening of symptoms occurs with increasing
There is also a correlation with prior trauma to
the hip as well as the presence of congenital
abnormalities that may predispose the hip to early
Among these include a history of Legg-Calve-Perthes
disease, hip dysplasia, and prior fracture.
That being said, with the growing number of Baby
Boomers, particularly active Baby Boomers,
osteoarthritis of the hip is a significant
contributor to activity restriction.
The hip is a ball and socket joint. The ball is
the head of the femur and the socket is the
acetabulum of the pelvis. Both the acetabulum as
well as the head of the femur are covered with a
layer of hyaline cartilage. The hip is constructed
such that multiple ligaments and muscles provide
stability for the joint.
Unfortunately, the peculiar angulation of the hip
contributes to steady worsening of osteoarthritis
once abnormal forces come into play and cartilage
begins to wear.
The progression of osteoarthritis often leads to
the formation of bony spurs called osteophytes.
These osteophytes may eventually cause what is
termed “femoroacetabular impingement” or FAI.
These osteophytes develop in two distinct
locations: either at the outside rim of the
acetabulum or at the junction between the ball and
neck of the femur. When spurs develop on the
acetabulum and cause pinching with hip movement this
is called a “pincer” deformity. When the spurs on
the femoral head/ neck cause pinching, this is
called a “CAM” deformity.
Symptoms of osteoarthritis of the hip include
pain in the groin and/or buttock that is aggravated
by internal rotation of the hip such as occurs with
walking. Pain may also radiate down the front of the
thigh to the knee. As pain progresses, nighttime
discomfort becomes an issue. Shortly thereafter,
restriction of range of motion develops.
Treatment, to date, has been primarily
symptomatic including analgesic and
glucocorticoid injections, massage, chiropractic,
and physical therapy.
Surgical remedies have included osteotomy (where
a wedge of bone is removed to line the joint up
better), resurfacing (a modified replacement), and
total joint replacement. While surgical treatments
are by and large effective, they are irreversible
and they do carry attendant risks, some
So the search has been to develop treatments that
will be effective but also preserve the joint. One
such approach is the use of autologous stem cells.
In our hands, the procedure which involves the use
of autologous stem cells (a patient’s own stem
cells) along with autologous fat, and growth factors
has been relatively successful. [At the same time,
osteophytes are trimmed using a special fenestration
Quite frankly, so far, our hip results have not
been as good as with the knee. There may be a number
of factors involved including patient selection, the
difference in joint mechanics, the fact that the
iliopsoas bursa- a large cushioned sack- sits in
front of the joint and stem cells may dump out into
the bursa rather than staying in the joint,
inability to go at complete non weight-bearing after
the procedure, and so on.
We are continuing to modify our approach to this
technique and our patient results are now beginning
to approach what we initially hoped.
Nonetheless, the procedure needs to undergo
constant improvement to eventually achieve the
results we want and the patient deserves.
Nathan Wei, MD, FACP, FACR is a rheumatologist and
Director of the Arthritis Treatment Center
more info: Arthritis Treatment [http://www.arthritis-treatment-and-relief.com/arthritis-treatment.html]