The Science of Hip Osteoarthritis
Hip osteoarthritis is a dynamic process involving the entire joint structure, not simple "wear and tear." The story of hip osteoarthritis rarely begins with a bang - it's a slow burn that often starts as a subtle, deep, groin-area ache noticed after a long walk that might be dismissed as a simple muscle strain. The most pervasive and damaging misconception about OA is that it's a simple "wear and tear" disease where the joint is worn out and nothing can be done. This is not the full picture. OA is a dynamic process involving the entire joint structure, and it does not mean your active life is over. It begins with articular cartilage breakdown (the smooth, white, slippery tissue covering bone ends), followed by subchondral bone changes, osteophyte formation ("bone spurs" - bony lumps growing in response to inflammation), and joint space narrowing. The process involves inflammatory mediators, altered biomechanics, and compensatory muscle weakness. Critically, pain is not directly proportional to radiographic changes - I have seen countless patients with "severe" OA on imaging who have minimal pain and excellent function, and vice versa. Your experience of pain is real, but it is not solely dictated by what an X-ray shows. The hip joint doesn't exist in isolation - when it becomes stiff and painful from OA, the body makes compensations. The most common is increased movement and strain on the lumbar spine and sacroiliac (SI) joint, which is why so many people with hip OA also develop low back pain. The knee can also take a hit - a stiff hip changes the way you walk, altering forces that travel down through the knee and ankle. Living with persistent pain is exhausting and can lead to fear of movement, anxiety, and feeling of fragility. This is where pain centralization comes in - over time, the nervous system can become sensitized, essentially "turning up the volume" on pain signals. Gentle, graded movement can help recalibrate the nervous system. Hip osteoarthritis may coexist with other hip conditions such as greater trochanteric pain syndrome or hip bursitis, and can develop secondary to previous conditions like femoroacetabular impingement (FAI) or hip labral tears.