To make sound clinical decisions when treating patients with hip disorders, it is necessary to understand the various pathologies, surgical procedures, and associated precautions and identify presenting impairments, functional limitations, and possible disabilities. Conservative and postoperative management of these conditions is also described in this section.

Joint Hypomobility: Nonoperative Management

Osteoarthritis (Degenerative Joint Disease)
Osteoarthritis is the most common arthritic disease of the hip joint. The etiology may be the aging process, joint trauma, repetitive abnormal stresses, obesity, or disease. The degenerative changes include articular cartilage breakdown and loss, capsular fibrosis, and osteophyte formation at the joint margins. These effects usually occur in regions undergoing the greatest loading forces, such as along the superior weight-bearing surface of the acetabulum.

Other Joint Pathologies
Rheumatoid arthritis, aseptic necrosis, slipped epiphyses, dislocations, and congenital deformities can also lead to degenerative changes in the hip joint.

Postimmobilization Hypomobility
A restriction in the capsular tissues leading to joint hypomobilities as well as tightness in the surrounding periarticular tissues may occur anytime the joint is immobilized after a fracture or surgery.

Common Impairments

• Pain experienced in the groin and referred along the anterior thigh and knee in the L3 dermatome.
• Stiffness after rest.
• Limited motion with a firm capsular end-feel. Initially, limitation is only in internal rotation; in advanced stages the hip is fixed in adduction, has no internal rotation or extension past neutral, and is limited to 90° flexion.
• Antalgic gait usually with a compensated gluteus medius (abductor) limp.
• Limited hip extension leading to increased extension forces on the lumbar spine and possible back pain.
• Limited hip extension preventing full knee extension when standing or during gait leading to increased knee stresses.
• Impaired balance and postural control.

Common Functional Limitations/Disabilities

Hip joint impairments interfere with many weight-bearing activities and ADL.

Early stages. There is progressive pain with continued weight bearing and gait or at the end of the day after repetitive lower extremity activities. The pain may interfere with work (job-specific) or routine household activities that involve weight bearing, such as meal preparation, cleaning, and shopping.

Progressive degeneration. The individual experiences increased difficulty arising from a chair, climbing stairs, squatting, and other weight-bearing activities, as well as restricted routine ADL such as bathing, toileting, and dressing (putting on pants, hose, socks).

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