The hip is one of the most important joints in the human body.
It is formed by the head of the femur that fits inside the acetabulum of the pelvis. These structures are able to slide smoothly over each other due to cartilage, ensuring fluidity of movement.
Thanks to the hip, it is possible to walk, run, jump and perform all the movements necessary for daily life; however, sometimes we encounter hip disorders.
The main pathologies of the hip can be grouped into three categories
ARTROSIS OF THE HIP or COXARTROSIS.
The main pathologies afflicting the hip involve degeneration or wear and tear of cartilage, often due to natural joint aging, other times due to congenital anatomical changes more or less known to the Patient.
The most common affliction leading to “natural” cartilage consumption is primaryarthrosis (i.e., without a known preponderant cause), which is more or less promoted by anatomical alterations.
The second most frequent cause, which most often affects older people and the female sex, concerns the outcomes of proximal femur fractures (particularly subcapitated fractures).
Other causes may be degenerative joint disease related to Rheumatoid Arthritis or other autoimmune forms (positive or negative on rheumatological tests), aseptic osteonecrosis of the primary or secondary femoral epiphysis (e.g., following corticosteroid therapy), or posttraumatic arthritic forms (fracture-luxation outcomes of the hip and/or acetabulum).
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.
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FAI (FEMORO-ACETABULAR IMPINGEMENT)
Recently, an anatomical anomaly termed “femoro-acetabular impingement” (FAI) has been identified. This anomaly is caused by the lack of anatomical symmetry of the hip between the femoral head and the acetabular cup.
This abnormality can be divided into two subgroups: PINCER-type (pincer) FAI due to bony alterations in the cotyloid portion or CAM-type (cam) FAI due to a protrusion (called “bump”) in the junction between the femoral head and neck.
Both precisely create a joint conflict between the femoral head and the acetabular cavity as shown in the figure.
FAI can cause already in young people (20-30 years) alterations in joint structure (rupture of the cotyloid rim) or early cartilage wear. Such pathology, if recognized in time, can be treated with minimally invasive arthroscopic surgery.
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HIP ARTHROPLASTY
In case the cartilage wear is in a very advanced state and the patient manifests severe pain and difficulty in walking, prosthetic joint replacement surgery, i.e., HIP PROSTHESIS, can be considered.
Hip replacement surgery involves replacing the femoral head with a small stem and head positioned in the proximal part of the femur. They articulate with the prosthetic cup, housed in the acetabulum (lateral socket deputed to house the femoral head). This allows geometric stability of the implant.
Thanks to modern minimally invasive surgical techniques , postoperative pain is very low and there is a significant speeding up of rehabilitation (“fast track” rehabilitation) and thus a reduction in hospitalization.
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