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As the new season is getting underway, FIFPro and its Chief Medical Officer Dr. Vincent Gouttebarge also kick off a new series of blogs. Today Dr. Gouttebarge discusses hip osteoarthritis: what causes hip osteoarthritis, what are the consequences and what is the rate of players suffering from this joint disease?

In two previous blogs published on the website of the World Players' Union (FIFPro), knee osteoarthritis as well as ankle osteoarthritis among retired professional footballers was discussed.

Known worldwide as the leading cause of pain of the musculoskeletal system (bones, muscles, tendons, joints, ligaments), osteoarthritis is a joint disease caused by the overuse of joint cartilage. Osteoarthritis results in irreversible cartilage change and damage in the affected joint that can lead to different symptoms and signs such as pain, stiffness, reduced function, instability, deformity, and activity impairments. The rate of knee and ankle osteoarthritis among retired professional footballers was found to be high compared to the general population (matched for age and gender): up to 80 % of retired players suffer from knee osteoarthritis (15-25 % in the general population) and nearly 20 % of retired players suffer from ankle osteoarthritis (1 % in the general population). In parallel with the knee and ankle joints, the hip joint is also particularly affected by this severe joint disease.

The rate of hip osteoarthritis among retired professional footballers

VG-hip-OA-1000In a recent overview of scientific literature initiated by FIFPro, the rate of osteoarthritis in former elite athletes from all sport disciplines was explored (Gouttebarge 2014). Only four studies published between 2000 and 2014 were exclusively devoted to how many retired professional footballers suffer from hip osteoarthritis, endorsing the lack of research about negative long-term health effects as a consequence of a football career. In one out of these four studies, the rate of hip osteoarthritis among retired professional footballers was found to be between 2 and 4 % only. Based on the other three studies, it was shown that 13 % up to 18 % of former players having played professional football for 13 to 20 years (Sweden and United Kingdom) suffered from hip osteoarthritis at an age from 45 years old. In order to establish whether this rate of hip osteoarthritis is low or high, a comparison can be made with the general population or with former elite athletes from other sport disciplines.

The rate of hip osteoarthritis in other population groups

The rate of hip osteoarthritis found among retired professional footballers (up to 18 %) can be put in some perspective when compared with former elite athletes from other sport disciplines or with the general population. By contrast to knee and ankle osteoarthritis, the rate of hip osteoarthritis among retired professional footballers does not appear higher than in other groups. The rates of hip osteoarthritis in former elite athletes from other sport disciplines and the general population is shown below (Gouttebarge 2014).

 

Comparison groups (age matched)           Rate of hip osteoarthritis (%)
General population 8 – 25
Athletics 10-58
Cross-county skiing 27
Long-distance running 12
Power sports (boxing, weight lifting)  20
Handball 15-60
Ice Hockey 20
Football 2-18

 

Potential causes of hip osteoarthritis

For the development of osteoarthritis, several risk factors have been identified among which are age, gender, obesity, life style, joint injury and abnormal joint load (Hunter 2008; McWilliams 2011). As with knee and ankle osteoarthritis, hip osteoarthritis in retired professional footballers might be attributed to the occurrence and recurrence of hip/groin injury during a football career (Kerkhoffs 2014). However, traumatic hip joint injuries are not very common. In European professional football, hip/groin injuries account for approximately 14 % of all injuries, of which only 6 % are specifically related to the hip joint (Werner 2009). In Japanese professional football, ligament or cartilage injury of the hip joint account for less than 1 % of all injuries in the lower limbs (Aoki 2012). Consequently, hip injury does not seem to be solely responsible for the occurrence in the long term of hip osteoarthritis. The combination with the sustained load on the hip joints resulting from intense and prolonged physical activities (running, sprinting, jumping and landing, dribbling and passing, duel forms with opponents) during both training and competition might be relevant for the onset of hip osteoarthritis.

The consequences of hip osteoarthritis for quality of life

In a latest literature overview of the scientific literature, the adverse consequences of osteoarthritis (including hip osteoarthritis) in retired professional footballers were explored (Gouttebarge 2014). More than 12 years ago, two surveys were conducted in the United Kingdom among up to 285 retired professional footballers who had played professional football on average for nearly 14 years. Of them, 138 suffered from osteoarthritis in a lower limb joint (hip, knee, ankle and/or foot), of which 18 from osteoarthritis in the right hip and 24 from osteoarthritis in the left hip. From the former players suffering from osteoarthritis (not solely of the hip), nearly 90 % reported having moderate or severe joint pain and discomfort, while around 33 % indicated experiencing moderate or severe problems with mobility and performing everyday activities (work, study, house etc.). In addition, nearly 40 % of them reported moderate or severe problems with anxiety/depression because these players were facing such a severe medical condition. These findings endorse once more that mental illness is highly prevalent in retired professional footballers.

The management of hip osteoarthritis

As osteoarthritis in the knee or ankle joints, the management of hip OA should involve a multidisciplinary approach striving to relieve symptoms and improve joint function (Roos 2012; Semanik 2012). Therefore, it might rely on strategies related to conservative treatment and surgical treatment. Conservative treatment might involve medication, judiciously timed intra-articular injection, physical therapy, specific exercises and healthy life style, while surgical treatment should be reserved for those with severe symptoms and quality of life impairments (Rao 2010; Sinusas 2012).

In conclusion, a specific self-management programme for retired professional footballers suffering from (hip) osteoarthritis is lacking and should be developed, based of course on scientific evidence. The development of such a self-management programme is currently having FIFPro's attention.

 

Key points

  • Despite the lack of scientific studies, it has been suggested that a professional football career might cause negative long-term health effects, especially osteoarthritis of the joints in the lower limbs.
  • 2 % to 18 % of retired players having played professional football for more than 13 years suffer from hip osteoarthritis at an age from 45 years old.
  • By contrast to knee and ankle osteoarthritis, the rate of hip osteoarthritis among retired professional footballers is not likely to be higher than the rate in the general population (8-25 %) or in former elite athletes from other sport disciplines (athletics 10-58 %; long-distance running 12 %; handball 15-60 %; ice hockey 20 %).
  • Up to 90 % of the retired professional footballers suffering from osteoarthritis in the lower limbs (including hip) reported having moderate or severe problems related to joint pain, discomfort and impaired mobility.
  • 37 % of the retired professional footballers suffering from osteoarthritis in the lower limbs (including hip) reported moderate or severe problems related to anxiety/depression because of their medical condition.
  • Conservative and surgical treatment might be applied to hip osteoarthritis. Also, a specific self-management programme for retired professional footballers suffering from (hip) osteoarthritis is lacking and needs to be developed.

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