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Osteoarthritis of the Hip

Introduction

Osteoarthritis of the hip is a common cause of pain and disability. It typically affects middle age and elderly patients, but can occur in the young adult after as a sequelae of trauma, infection or after inflammatory arthropathy.

Osteoarthritis can cause a wide spectrum of symptoms which can vary in severity between individuals.

Treatment needs to be proportionate, effective, and meet the needs of the patient.

History

End stage osteoarthritis is easy to diagnose on the history alone. It causes chronic pain classically in the groin, worse on activity. There is often associated stiffness which typically causes difficulty with reaching the toes for chiropody and dressing. There tends to be gradual functional deterioration, with difficulty walking, climbing stairs and with activities of daily living.

Examination

The patient often has an antalgic or lurching (trendelenburg) gait. They may have a leg length discrepancy. The hip is typically irritable and stiff with a fixed flexion deformity as evidenced by a positive Thomas’ test.

Special Investigations

Hip X-ray Showing OsteoarthritisPlain Ap and lateral Xrays are diagnostic in advanced cases. MRI can be helpful in the early stages of disease if XRay is normal. Diagnostic local anaesthetic injection can be helpful to differentiate between hip pain and referred pain from the spine.

Natural History

The natural history tends to be rather indolent with gradual deterioration of pain and function over time. The disease can plateau, but if it deteriorates, there can be a gradual reduced level of mobility.

Conservative Treatment

Conservative treatment is recommended as first line, especially for the young and in patients with early stage disease.

Analgesia and non-steroidal anti-inflammatory drugs should be prescribed unless contraindicated. Physiotherapy has been shown to be effective and can help with secondary abductor inhibition and stiffness. Weight loss should be recommended in obese patients. Steroid or viscosupplementation injections have a limited role.

Operative Treatment

Hip X-ray Showing Hip ReplacementsFor patients with advanced stage disease and significant symptoms, joint replacement is often required.

Resurfacing arthroplasty has re-ignited an historic interest in metal articulations, but its applicability is limited.

Total hip replacement is the gold standard, and has excellent long term results.

hip and pelvis conditions

problem area

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Spine and Coccyx
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