Arthrosis of the hip: what is it?
The main disease that can afflict the hip is osteoarthritis of the hip or coxarthrosis.
The hip is a joint that serves as a junction between two bones: the femur and the acetabulum (hollow of the pelvic bone); its movement is only possible if, between these two bones, there are lubricated surfaces that allow it to slide.
Osteoarthritis of the hip is a degenerative process that affects the joint: the movement that results from the mutual sliding of the surfaces of the acetabulum and femoral head is impaired by wear and tear of the cartilage. Thus, an inflammatory state occurs that not only causes pain but also results in progressive tissue destruction.
Arthrosis of the hip: the causes
There are several causes regarding hip osteoarthritis.
The most common cause leading to “natural” cartilage’s wear isprimary arthrosis (without a known preponderant cause), which is more or less promoted by anatomical changes or malformations of the joint such as femoro-acetabular impingement (FAI).
The second most frequent cause, which mainly affects the elderly and the female sex, is the outcomes of fracture of the proximal femur (the portion of the bone closest to the body trunk) particularly due to epiphyseal necrosis resulting from it.
Other causes may be degenerative joint disease related to rheumatoid arthritis or other autoimmune forms (seropositive or seronegative), aseptic osteonecrosis of the primary or secondary femoral epiphysis (e.g., following corticosteroid therapy), or post-traumatic arthritic forms (outcomes of fracture-luxations of the hip and/or acetabulum);post-traumatic arthrosis is, often, consequent to serious traffic accidents.
Finally, arthrosis secondary to childhood diseases such as congenital hip dysplasia, Perthes disease, or outcomes of epiphysiolysis should not be forgotten. Rare causes may be bone neoplasms located close to the coxofemoral joint.
Hip screening: can it be done?
To date, there are no screening programs that can anticipate the hypothesis of hip osteoarthritis development until before the onset of symptoms.
Even in known situations such as coxofemoral pathologies of childhood or an altered morphologic anatomy (as in the case of FAI), the patient can at best be recommended to maintain a proper weight-bearing: weight, in fact, along with age, are the two main risk factors for the development of hip osteoarthritis.
Arthrosis of the hip: the initial symptoms
The symptoms of hip osteoarthritis can be many, including:
- Pain during movement, usually located in the anterior region of the thigh or groin area;
- Limitation of hip movements, especially if very wide;
- pain after standing still for a while, especially in the sacrum area;
- difficulty in walking that results, often, in a limp or fall;
- Pain in the lower back;
- Lower limb length difference (especially as an outcome of childhood pathology);
- Pain at night or at rest.
How to diagnose hip osteoarthritis
Orthopedic examination and specific tests
To diagnose osteoarthritis of the hip, it is necessary to undergo an orthopedic examination; in fact, a careful clinical and radiographic evaluation must be performed to determine the exact cause of the pain.
Before performing any surgical intervention, it is important to perform an assessment of the function of the gluteal muscles with specific tests (e.g., the Trendelenburg test); these muscles, in fact, are deficient in the case of congenital dysplasia or in people, often elderly, who have degenerative detachment of the abductors (small and middle gluteal muscles) from the trochanter.
The x-ray of the hip
Imaging evaluation begins (and often ends) with an X-ray of the hip.
Radiography should be performed in two projections:
- the entire pelvis antero-posteriorly, which will also serve to evaluate the contralateral joint and rule out any pathology of the pelvis itself;
- axillary projection of the affected hip alone to assess the amount of residual cartilage. Its disappearance with contact between its bony surfaces is indicative of complete wear of cartilage, and thus arthrosis of the hip.
Magnetic resonance imaging
A second evaluation, especially if the cartilage was more or less preserved, will look at the shape of the femoral epiphysis, searching for any signs of necrosis of the head: in this case, analysis of the patient’s previous pathologies and an MRI become essential to be able to place a correct diagnosis of the disorder.
surgical treatment
When cartilage wear has reached the bone and the Patient manifests severe pain and subsequent functional limitation in daily activities such as walking or climbing and descending stairs, the treatment of choice is the hip replacement.
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