Hip osteoarthritis

From greek.doctor
  • 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