Hip Osteoarthritis (Degenerative Arthritis of the Hip)

• Total Hip Arthroplasty with Anterior Minimal Invasive Surgery AMIS

  What Is Osteoarthritis?

  

  Arthritis means "joint inflammation." It causes pain and swelling in body's joints such as knees or hips. There are many types of arthritis but osteoarthritis is the most common. Also known as degenerative joint disease or age-related arthritis, osteoarthritis is more likely to develop as people get older.

  Osteoarthritis occurs when inflammation or injury of a joint causes a breaking down of cartilage tissue. In turn that breakdown causes pain, swelling, and deformity. Cartilage is a firm rubbery material that covers the ends of bones in normal joints. It is primarily made up of water and proteins. The primary function of cartilage is to reduce friction in the joints and serve as a "shock absorber." The shock-absorbing quality of normal cartilage comes from its ability to change shape when compressed. It can do this because of its high water content. Although cartilage may undergo some repair when damaged, the body does not grow new cartilage after it is injured.

  Arthritis Pain and Sleep:

  The pain of arthritis makes it tough for many people to get a good night’s sleep. If people with arthritis can improve the quality of their sleep they can usually reduce their day-to-day pain.

  The two main types of osteoarthritis are:

  Primary: More generalized osteoarthritis that affects the fingers, thumbs, spine, hips and knees

  Secondary: Osteoarthritis that occurs after injury or inflammation in a joint.

  

  How Does Osteoarthritis Affect the Hip Joint?

  Patients who have osteoarthritis of the hip sometimes have problems walking. Diagnosis can be difficult at first. That's because pain can appear in different locations including the groin, thigh, buttocks, or knee. The pain can be stabbing and sharp or it can be a dull ache and the hip is often stiff.

  What Causes Osteoarthritis of the Hip Joint?

  The causes of osteoarthritis of the hip are unknown. Factors that may contribute include joint injury, increasing age and being overweight.

  In addition osteoarthritis can sometimes be caused by other factors such as

  • joint diformities
  • genetic (inherited) defects of the cartilage
  • extra stress on joints, either by being overweight or through activities that involve the hip

  
  

  

  What Are the Symptoms of Osteoarthritis of the Hip?

  If you have any of the following symptoms of hip osteoarthritis talk to your doctor:

  • Joint stiffness that occurs as you are getting out of bed
  • Joint stiffness after sitting for a long time
  • Any pain, swelling, or tenderness in the hip joint
  • A sound or feeling ("crunching") of bone rubbing against bone
  • Inability to move the hip to perform routine activities such as putting on your socks

  
  

  

  How Is Osteoarthritis of the Hip Diagnosed?

  There is no single test for diagnosing osteoarthritis. Your doctor will take your medical history and perform a physical examination. This will include a check of your hip function. Your doctor may also order X-rays or other additional tests including blood tests.

  How Is Osteoarthritis of the Hip Treated?

  The main goal of treating osteoarthritis of the hip is to improve the person's mobility (ability to get around) and lifestyle. Part of this goal involves improving the function of the hip and controlling pain.

  Treatment plans can involve:

  • Rest and joint care
  • Use of a cane to take weight off the affected hip
  • Nondrug pain relief techniques to control pain
  • Losing excess weight
  • Exercise
  • Medications, a non-steroidal anti-inflammatory drug or a prescription pain medication
  • Surgery

  
  

  What Is Hip Replacement Surgery?

  The hip joint is a ball-and-socket mechanism. The ball is located at the top of the thigh bone (femur). Total hip replacement surgery replaces the damaged ball with a metal ball. The hip socket is resurfaced using a metal shell and a plastic liner.

  

  WHY AN AMIS TOTAL HIP REPLACEMENT?

  

  The AMIS technique causes less surgical trauma than other techniques because NO MUSCLES ARE CUT which aids in rapid recovery.

  AMIS can potentially provide you with the following benefits:

  • REDUCED SCAR SIZE : with AMIS the skin incision is often shorter.
  • DECREASED POST-OPERATIVE PAIN: as muscles are not cut.
  • LESS BLOOD LOSS : transfusions are rare
  • SHORTER HOSPITAL STAY
  • FASTER RETURN TO DAILY ACTIVITIES: depending on your general condition and with the approval of a surgeon, some AMIS patients may be driving in 8 -10 days.
  • REDUCED RISK OF DISLOCATION

  
  

  How Can Osteoarthritis of the Hip Be Prevented?

  Μία μέθοδος για την πρόληψη της οστεοαρθρίτιδας του ισχίου είναι να διατηρηθεί ένα υγιές βάρος .

  One method for preventing osteoarthritis of the hip is to maintain a healthy weight. In addition you should exercise. Exercise strengthens muscles around joints. Such strengthening can help prevent wear and tear on cartilage in a joint.

• Contusions & Muscles Injuries

  

  Hamstring strain

  This common injury is often the result of sudden stretch on the musculotendinous junction during sprinting. These injuries can occur anywhere in the posterior thigh. Treatment is supportive, followed by stretching and strengthening. To prevent recurrence, return to play should be delayed until strength is approximately 90% that of the opposite side.

  Quadriceps contusions

  This can result in hemorrhage and late myositis ossificans. Acute management includes cold compression and immobilization in flexion. Close monitoring for compartment syndrome is indicated in the acute phase.

  Rectus femoris strain

  Acute injuries are usually located more distally on the thigh, but chronic injuries are usually nearer the muscle origin. Pain is elicited with resisted hip flexion or extension. Treatment includes ice and stretching/strengthening.

  

  Athletic pubalgia/ “sports hernia”- Gilmore’s groin

  Common in sports such as soccer, these injuries must be differentiated from subtle hernias. Injury to the muscles of the abdominal wall or adductor longus produce anterior pelvis and/or groin pain without the classic physical findings of a true inguinal hernia. This injury can result from acute trauma or microtrauma associated with overuse of the affected muscle. Rule out other causes of pain with an x-ray, bone scan, and/or MRI. Treat nonoperatively for 6-8 weeks with rest and therapy. Repair or reinforcement of the anterior abdominal wall is indicated after failed conservative measures and after other causes have been excluded.

  

  Iliac crest contusions (“hip pointer”)

  Direct trauma to this area can occur in contact sports. Treatment consists of ice, compression and pain control.

  

• Bursitis

  Ischial bursitis

  Caused by direct trauma or prolonged sitting and hard to distinguish from hamstring injuries.

  

  Iliopsoas bursitis

  A cause of anterior hip pain in athletes and often associated with mechanical irritation of the iliopsoas tendon.

  

  Trochanteric bursitis

  Occurs frequently in female runners. Treatment includes oral anti-inflammatory drugs, stretching, and rest.

  

• Nerve entrapment syndromes

  Lateral femoral cutaneous nerve entrapment

  Can lead to a painful condition known as meralgia paresthetica. Tight belts and prolonged hip flexion may exacerbate symptoms. Release of compressive devices and NSAIDs are usually curative.

  

  Obturator nerve entrapment

  Can lead to chronic medial thigh pain, especially in athletes with well-developed hip adductor muscles (e.g., skaters). Treatment is usually supportive.

  

  Sciatic nerve entrapment

  Can occur anywhere along the course of the nerve, but the two most common locations are at the level of the ischial tuberosity and by the piriformis muscle, known as “piriformis syndrome.”

  

  Ilioinguinal nerve entrapment

  Hyperextension of the hip may exacerbate the pain . Surgical release is occasionally necessary.

• Snapping hip

  

  Condition in which the iliotibial band abruptly catches on the greater trochanter or the iliopsoas impinges on the hip capsule. The iliotibial condition (external snapping hip) is more common in females with wide pelvises and prominent trochanters and can be exacerbated by running on banked surfaces. The snapping may be reproduced with passive hip flexion from an adducted position. Stretching/strengthening, modalities such as ultrasonography, and occasionally surgical release may relieve the snapping. This condition must be differentiated from the less common snapping iliopsoas tendon (internal snapping hip), which can be diagnosed with extension and internal rotation of the hip from a flexed and externally rotated position. Arthrography may also be helpful in making the diagnosis

• Intra-articular Disorders

  Femoroacetabular impingement (FAI)

  A frequent initiator of arthritis in the nondysplastic hip. Impingement may be caused by acetabular retroversion; an old slipped capital femoral epiphysis (SCFE); a nonspherical head; Treatment options include open or arthroscopic procedures depends the cause.

  

  Chondral injuries

  Articular surface injury is often a cause of mechanical hip pain. Microfracture is effective in the treatment of focal lesions.

  

  Loose bodies

  These often result from trauma or diseases such as synovial chondromatosis. They must be removed, either open or arthroscopically, to prevent third-body wear.

  

  Labral tears

  Often a cause of mechanical hip pain presenting with vague symptoms. Arthroscopic labral débridement has shown good short- and mid-term results.

  

• Fractures and Bone Disorders

  Osteitis pubis

  Repetitive trauma can cause an inflammation of the symphysis. It occurs frequently in soccer players, hockey players, and runners. Conservative management is usually curative.

  

  Stress fractures

  A history of overuse, an insidious onset of pain, and localized tenderness and swelling are typical. A bone scan can be diagnostic, even with normal plain radiographs. MRI is the most specific test for detecting stress fractures. Treatment includes protected weight bearing, rest, analgesics, and therapeutic modalities. There are several especially problematic stress fractures.

  • Femoral neck stress fractures—may require operative stabilization.
  • Femoral shaft stress fractures—Usually respond to protected weight bearing but can progress to complete fractures if unrecognized.
  • Pelvic stress fractures—Stress fractures to the sacrum and pubis are rare but can occur.

  
  

  

  AVN - Traumatic hip subluxation

  Traumatic hip subluxation can disrupt the arterial blood supply to the hip and result in avascular necrosis. Early recognition of these injuries, which are seen in football players, is essential.