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