Disorders of hip joint in adults

Aetiology:
Posttraumatic (following fracture of acetabulum)
Non traumatic abnormality of the hip joint due to changes in anatomy,
ie. Deformities

Inflammatory disorders (eg. rheumatoid arthritis, tuberculosis,gout)

leading to destruction of articular cartilage
Avascular necrosis of femoral head (posttraumatic, STEROID INDUCED
NECROSIS!)
Etiology:
NON TRAUMATIC ABNORMALITY OF THE HIP JOINT due to changes in
anatomy, ie. deformities:
Childhood disorders, if healed with deformity (Perthes, CDH, slipped
epiphysis)
Changes of collo-diaphyseal angle (coxa vara, coxa valga)- causing abnormal
pressure on joint surface
Acetabular protrusion
Inflammatory disorders (eg. rheumatoid arthritis, tuberculosis,gout) leading
to destruction of articular cartilage:
Rheumatoid arthritis (PCP- polyarthritis chronica progressiva) with multiple
joint involvement
Gout (arthritis urica)
tbc
Tuberculotic infection of hip severe destruction of both joint surfaces
end result is often ankylosis!!
Idiopathic degenerative osteoarthritis or arthrosis of hip
(COXARTHROSIS) in most cases
Symptoms and signs:
Pain - depending on stage of disease:
morning pain,
- pain at weight bearing,
- pain at rest
Limitation of hip movements (flexion contracture at first!)
Limping gait

Hugh Owen Thomass sign! Intermalleolar distance

PELVIC SAGGING (pic w/ old man)

Ankylosis is a stiffness of a joint due to abnormal adhesion and rigidity of the bones of the
joint

Pathological changes IN OSTEOARTHRITIS - ARTHROSIS

1. Joint cartilage (degeneration destruction)
2. Bone structure (destruction or resorption of bony trabeculae)

X-ray signs not too convincing, but patient had severe pain: see extensive
cartilage destruction of femoral head (OSTEOARTHRITIS OR ARTHROSIS
with severe inflammation see PANNUS
(red piece of femoral head)
Treatment of hip osteoarthritis
CONSERVATIVE until quality of life is not severely affected (pain at rest is too
late!)
Medication non-steroids (NSAID)
Gentle, regular exercises
Physiotherapy (antiinflammatory methods)
Use walking aids
OPERATIVE:
Correction of preexisting deformities, before too late (depending on clinical
and radiological symptoms, signs)

Prerequisite: sufficient movement in hip (min.90), no pain at rest, moderate

XR changes

OPERATIVE:
Correction of preexisting deformities either on the acetabular, or the femoral
side
Pelvic osteotomy: Chiari-osteotomy (can be don in adults too)
Femoral osteotomy: varus or valgus intertrochanteric osteotomy
Avascular necrosis of femoral head- aseptic necrosis
Cause:
Idiopathic (mostly)
Posttraumatic (dislocation of hip!!)
Severe burns
Certain toxins (car paint, terpentine!)
Alcohol abuse
STEROIDS
Age: mostly in younger age group
Clinical presentation: rapidly increasing pain
X-ray presentation: best seen on MR at The earliest stage
Ficat- stages
1. Only slight symptoms, nothing on XR
2. Slight structural disorder of femoral head
3. Collapse of fe,oral head
4. Total destruction of joint , with arthrosis
Treatment
Early stage try to stop the progression drill holes into femoral head, to drain
venous blood
Later: endoprosthesis
Treatment of hip osteoarthritis
OPERATIVE:
prosthetic replacement of hip joint (total hip replacement TEP)
Introduction. 1962, Prof.John Charnley, Wrightington, UK
Material: metal head, polyethylene socket
Low friction principle moves like natural joint
Types of hip prostheses
1. Cemented conventional . Mostly above 60 yrs
2. Uncemented titanium implants, with microporous surface for younger
patients, with good bone stock

Fixation of prosthetic components with cement

- PMMA (polymethylmetacrylate) stable fixation
Air of the OR (opereating room) must be germ free (sterile) see LAMINAR AIR
FLOW SYSTEM, germ free air into OR, exhaled air is removed through The tubes
Uncemented socket, with screw threads + polyethylene inlay.
Alternative: microporous surfaces on femoral and acetabular components
press fit prosthesis, must be hammered into bone!
Uncemented prosthesis
Aim of implantation : full ingrowth of bone (OSSEOINTEGRATION) first
seen in dental implants
Hip prosthesis:
New trends:
Minimally invasive
Be prepared for exchange of prostheses (expected life span between 1520 yrs (with improved technique may be better)
Cemented or uncemented:if it is done well, both
provide long lasting, good results (15-20 years)