Hip osteoarthritis

Osteoarthritis of the hip
Clinical features
- Morning stiffness
- Inguinal pain or pain above greater trochanter
  - Can refer to the thigh and knee
- Contractures (reduced ROM)
  - First movement affected: internal rotation
- Limp
- Muscle atrophy around hip and thigh
- Limb length difference
Diagnosis
- By conventional x-ray
- AP view and Lauenstein (frog-leg) view x-ray
  - Narrow joint line
  - Subchondral sclerosis
  - Subchondral cysts
  - Osteophytes
Treatment
- Conservative
  - Frequent exercise
    - Especially joint-friendly exercises, like swimming, cycling
  - Weight loss
  - Physical therapy
  - NSAIDs
  - Orthopaedic shoes
  - Crutch on affected side
- Surgical
  - Only if conservative treatment isn’t sufficient (late stage)
  - Total hip replacement
  - Hip arthroplasty is one of the most successful orthopaedic operations
    - > 90% satisfaction rate
    - 1,5 million procedures every year
  - Can be used in any joint destruction
    - Mostly in osteoarthritis or osteonecrosis of hip joint
    - But contraindicated in case of ongoing local or systemic infection
      - The prosthesis has no blood supply and antibiotics therefore can’t reach it -> provides good base for infection
  - (Partial hip replacement)
    - NOT used in orthopaedics -> only used in treatment of hip fractures
    - Femoral head is replaced with prosthesis
    - Acetabulum is preserved
  - Total hip replacement (THR)
    - Used in orthopaedics
    - Femoral head is replaced with prosthesis
    - Acetabulum is replaced with prosthesis
  - Postoperative DVT prophylaxis