Hip osteoarthritis
What is hip osteoarthritis?
Hip osteoarthritis, also called coxarthrosis, is a degenerative disease of the hip joint. It is characterized by the progressive degradation of the articular cartilage that covers the bony surfaces of the head of the femur and the acetabulum. This degradation leads to inflammation, pain, stiffness and loss of function of the joint.
Hip osteoarthritis
What are the mechanisms of knee osteoarthritis?
The causes of hip osteoarthritis can be varied and include:
Mechanical Factors
Natural Wear and Tear: Natural aging and wear of the joint over time are the most common causes.
Overweight and Obesity: Excess weight increases pressure on the hip joints, accelerating cartilage degeneration.
Trauma: History of fractures, dislocations or repetitive injuries can damage cartilage and promote osteoarthritis.
Congenital and Developmental Factors
Hip Dysplasia: Developmental abnormalities of the joint can predispose to early osteoarthritis.
Legg-Calvé-Perthes disease: A childhood condition where the femoral head loses its blood supply, which can lead to deformity and subsequent osteoarthritis.
Genetic Factors
Family history of osteoarthritis may increase the risk.
Inflammatory diseases
Rheumatoid Arthritis: Autoimmune disease that can damage hip cartilage.
What are the symptoms of knee osteoarthritis?
Symptoms of hip osteoarthritis can vary in intensity and include:
Pain
Pain in the groin, thigh, or buttocks, often worsened by activity and relieved by rest.
Pain upon waking or after prolonged periods of rest (unlocking pain).
Stiffness
Morning stiffness or after periods of inactivity.
Decreased range of motion of the hip.
Crepitation
Cracking or rubbing sensation in the joint during movement.
Weakness and Instability
Feeling of weakness or instability in the hip.
Lameness
Lameness due to pain and stiffness.
Possible Treatments
Treatment for hip osteoarthritis aims to relieve pain, improve joint function, and slow the progression of the disease. Treatment options include
Non-Surgical Treatments
Medications: Analgesics (acetaminophen), nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids to reduce pain and inflammation.
Physiotherapy: Exercises to strengthen the muscles around the hip, improve flexibility and reduce pain.
Weight Loss: Reducing weight to decrease pressure on the hip joint.
Mobility Aids: Use of canes, crutches or walkers to reduce the load on the hip.
Injections
Corticosteroid Injections: To reduce inflammation and pain.
Hyaluronic Acid Injections: To lubricate the joint and improve mobility.
Surgical Treatments
Osteotomy
Realignment of bones to reduce pressure on the joint.
Arthroscopy: To remove fragments of damaged cartilage or bony growths.
Total Hip Replacement: Replacement of the hip joint with an artificial prosthesis in cases of severe osteoarthritis that does not respond to other treatments.
Hip osteoarthritis is a painful degenerative condition that affects quality of life. An approach that combines non-surgical treatments, injections, and in severe cases, surgery, can help manage symptoms and improve joint function. Consultation with a healthcare professional is essential to determine the most appropriate treatment for each patient.
Total hip replacement surgery
Indications
The main indications for a PTH include:
Severe osteoarthritis (coxarthrosis)
Rheumatoid arthritis
Avascular necrosis of the femoral head
Femoral neck fractures
Hip dysplasia
Disabling pain and loss of mobility despite conservative treatments
Benefits and Risks
Benefits
Significant pain relief
Improved mobility and joint function
Improving the quality of life
Risks
Infection
Deep vein thrombosis (blood clots)
Dislocation of the prosthesis
Periprosthetic fractures
Wear or loosening of the prosthesis over time
Total hip replacement is a common and generally successful procedure to treat severe degenerative hip conditions. Although risks exist, advances in surgical techniques and prosthetic materials have significantly improved outcomes and implant longevity. Proper preparation and rigorous rehabilitation are essential to optimize patient outcomes and recovery.
Total Hip Replacement Procedure
Preoperative Preparation
Medical Evaluation: Complete medical examination including blood tests, ECG, X-rays and MRI of the hip.
Risk and Benefit Discussion: The surgeon explains the risks and benefits of the procedure and answers the patient's questions.
Patient Preparation
Preoperative instructions, such as fasting, stopping certain medications, and preparing the home for post-surgical recovery.
Anesthesia
General or Regional Anesthesia: The patient receives general anesthesia (complete sleep) or regional anesthesia (spinal or epidural) to numb the lower part of the body.
Incision and Exposure of the Joint:
Incision
An incision is made on the side or front of the hip.
Exposure: The muscles and tissues are spread apart to expose the hip joint.
Removal of Damaged Joint:
Femur Head and Neck: The surgeon cuts and removes the damaged femoral head and neck.
Acetabulum: The damaged cartilage of the acetabulum is removed and the cavity is prepared to receive the prosthesis cup.
Insertion of the prosthesis
Acetabular Cup: A metal or ceramic cup is inserted into the prepared acetabulum.
Femoral Stem: A metal rod is inserted into the medullary canal of the femur. A metal or ceramic head is attached to the end of the rod.
Fixation: Components can be fixed with or without surgical cement, depending on the technique and type of prosthesis used.
Closure:
Realignment
The prosthetic components are adjusted to ensure correct articulation.
Sutures and Dressings: Muscles, tissues, and skin are sutured, and a dressing is applied.
Postoperative Recovery
Recovery Room: The patient is monitored in the recovery room before being transferred to a room.
Pain Management: Pain medications are given to manage postoperative pain.
Physiotherapy: Rehabilitation begins quickly to help restore mobility and strength. Specific exercises are prescribed to prevent complications and enhance recovery.
Medical Follow-up: Follow-up visits are necessary to monitor healing, remove sutures, and assess the function of the new hip.