Hip Arthrosis (coxarthrosis) and Rehab

What is hip arthrosis (coxarthrosis)?

The disease hip osteoarthritis (coxarthrosis or arthrosis of the hip joint) describes the wear and tear of the hip joint, which usually brings older people to the doctor’s or orthopaedist’s office. The hip joint is loaded with the entire body weight for a long time in life and is therefore exposed to a high risk of wear. Pain is usually the main symptom. X-rays of the joint are an important part of the diagnostic process. They show the doctor how pronounced the wear is and whether neighboring bone structures have already been attacked. If medication and physiotherapy no longer help the patient, the diseased joint can be replaced with an artificial prosthesis.

General facts about the disease hip osteoarthritis

The hip joint connects the leg to the trunk. It is made up of the socket in the pelvic bone and the joint head of the femur. The purpose of the articular cartilage is to prevent direct friction between the bony parts of the joint. If the protective cartilage wears out in old age or as a result of incorrect loading, malposition or injury, the bone is increasingly exposed and arthrosis develops. The process evolves over many years. There is a long way to go before pain and a noticeable limitation in movement occur. Often the wear on the hip joint begins in the middle of the fourth decade of life. The first symptoms, depending on the circumstances of life, appear in old age.

A few numbers on the subject

Coxarthrosis is a common disease in USA. Around six percent of the female and five percent of the male population are affected. Around a quarter of USA show signs of hip joint wear on an X-ray. Symptoms such as pain are only reported by less than 50 percent of those affected, who therefore suffer from a so-called clinically defined coxarthrosis. One in every 1,000 inhabitants in USA receives a hip prosthesis.

Causes of hip arthrosis

The basis of coxarthrosis is the wear and tear of articular cartilage. If the protective cartilage layer tears, becomes thinner and roughened, the distribution of the load changes. In this way, healthy areas are actually damaged. The cartilage shrinks and the bone suffers. The bony structure changes visibly in the X-ray image. Excesses on the edge of the joint (osteophytes) try to compensate for the increasing mechanical stress.

The signs of wear can have different causes:

  • Hip dysplasia (congenital malformation of the hip joint)
  • Leg misalignments (bow legs or x legs)
  • Injuries to the hip joint
  • chronic incorrect stress in work or sport
  • strong overweight
  • rheumatism
  • gout
  • hereditary disposition

Possible symptoms of hip arthrosis (coxarthrosis)

A first indication of coxarthrosis can be so-called start-up pain in the morning or after getting up from sitting. The complaints subside after the first steps. In the course of the pain episodes become more frequent and difficulties arise when climbing stairs, bending down, turning and spreading the leg. In the late stage of hip arthrosis, those affected also suffer from pain at night and at rest, which can radiate from the groin to the knees.

The special form of activated hip arthrosis

An existing arthrosis of the hip joint can lead to inflammation if the joint is severely overloaded. In this case, doctors speak of activated hip arthrosis. The clinical picture is characterized by reddening, swelling and overheating of the affected joint, which is accompanied by severe pain at rest and when under stress.

Hip arthrosis (coxarthrosis): examinations & diagnosis

The most important steps on the way to diagnosis are the patient consultation (medical history), the clinical examination of the joints by the doctor as well as the taking and evaluation of X-ray images of the hip joints. In case of doubt, further imaging procedures or laboratory tests of blood and synovial fluid can confirm the diagnosis.

Medical history and physical examination

For the doctor, previous illnesses, the living conditions (job, sport) and already known osteoarthritis diseases in the family are interesting. The physical exam focuses on the joints, posture, and motor mobility. The doctor palpates the joints and looks for signs of inflammation as well as restricted movement and bony changes. He also checks the function of muscles and nerves.


During the anamnesis interview, the doctor can use questionnaires that illustrate the stage of the disease of coxarthrosis. The questions deal with pain, malpositions, the function and restricted movement of the hip joint. The subjective quality of life is also of interest. The questionnaires are evaluated using a points system. They serve the doctor as a follow-up and as an aid in the choice of therapy.

Sample questions:

  • How many meters can you walk in one go?
  • Can you pick something up off the floor?
  • Can you climb stairs?
  • Do you have problems lying down?
  • Are you struggling with the budget?
  • Can you travel on public transportation?


The next diagnostic step is to take x-rays of the hip joints. The important articular cartilage can only be assessed indirectly because it is not calcareous and therefore not visible. Radiologists and orthopedists are therefore guided by the joint space. If it is narrower than expected, this sign indicates arthrosis. Bone growths (osteophytes) and a conspicuous bone structure (sclerotherapy) also indicate joint wear.


The ultrasound examination of the hip joint optimally complements the classic X-ray image, since the doctor can also use it to examine the soft tissues and synovial fluid.

Magnetic Resonance Imaging

If the doctor needs a very detailed representation of the hip joint to rule out differential diagnoses in the room, magnetic resonance imaging is used. This procedure does not expose the patient to radiation and represents cartilage, ligaments and muscles in addition to the bone.

Blood tests

In some cases it is unclear whether the patient has arthrosis or inflammatory arthritis (rheumatism). Inflammation parameters in the blood (blood count, blood cell lowering rate and C-reactive protein) provide information here. In the case of a rheumatic disease, the body also produces certain antibodies, which can also be determined in the blood. An increased uric acid level can indicate gout disease.


If the doctor has identified a joint effusion during the examination, he can puncture the affected joint under ultrasound control with a fine needle. The joint fluid obtained in this way is examined in the laboratory for signs of inflammation and pathogens. In addition, the pressure in the joint drops and the patient may feel pain relief.

Hip arthrosis (coxarthrosis): therapy & rehab

If the hip arthrosis is only moderately pronounced, medication and physiotherapy help further and may delay the wear of the joint somewhat. In the advanced stage, orthopedic surgeons usually recommend an operation in which the destroyed joint is either partially or completely replaced by a so-called hip endoprosthesis. After the procedure, follow-up treatment (rehab) takes place, which supports the patient in healing and leads them back to everyday life. Using an endoprosthesis is a major operation that scares many patients. Find out about the procedure and follow-up treatment. The better you know what to expect, the calmer you will feel.


The operation is performed under general anesthesia or with spinal cord anesthesia. Discuss which form of anesthesia is suitable for you in advance with the specialist. Not everyone feels able to experience this rather “manual” intervention while awake. The endoprosthesis is firmly cemented into the bone during the operation and does not have to wax in first. Various materials are available. Endoprostheses can be made of metal, plastic or ceramic. Depending on the condition of your bone, your weight, your age and your underlying disease, the surgeon will recommend the appropriate surgical method. Today, an average hip prosthesis lasts approximately 15 years.

Physiotherapy in clinic and rehab

You will likely be mobilized the day after the operation. Together with a physiotherapist, you can strain the operated hip joint. Physiotherapy is the key to success. It starts in the hospital and continues in rehab. The prosthesis stabilizes throughout the first year after the procedure and the muscles around the hip joint build up. Many patients experience muscle weakness due to pain by sparing the affected joint. Take a few precautions to make the healing phase as uncomplicated as possible.

  • Only bend the operated joint up to an angle of 90 degrees. Avoid deep seating and put on shoes with a shoehorn while standing.
  • Never cross your legs
  • If you sleep on your side, put a flat pillow between your knees.
  • At the beginning, only turn the new joint carefully and do not bend it at the same time to avoid dislodging.
  • Refrain from fast sports with jerky movements such as squash, tennis, ball sports and skiing after the operation.

Rehabilitation in general

Follow-up treatment after hip surgery can be done on an outpatient or inpatient basis in a rehabilitation clinic. Muscle building through targeted physiotherapy is particularly important. Specially trained physiotherapists and doctors carry out orthopedic rehab. You will receive coordination and endurance training individually and in groups. Swimming and walking are the first recommended sports that you can continue to practice at home. For example, hiking and cycling are added later. You also benefit from massages and natural mud healing mud packs.

Return to everyday life

In the rehabilitation clinic, the treatment team attaches particular importance to preparing patients for the return to everyday life. Depending on your personal needs, you can train showers, climb stairs, use walkers or even use an escalator. Social workers also advise you on practical and financial support that you can be entitled to.

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