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The final chapter in
this three part series about the hip and pelvis will conclude
with a discussion about degenerative diseases of the hip.
Though not as common as
degeneration of the knee, hip osteoarthritis (OA) is a very
common and debilitating condition that affects millions of
Americans. It can be especially bothersome in a sports medicine
population because of the significant lifestyle modifications
that must be made during the progression of this disease.
Recall that the hip
joint is made up of a ball and a socket. The ball is formed by
the long bone of the thigh called the femur. Specifically, the
femoral head articulates with the socket which is formed by the
bones of the pelvis called the acetabulum.
Unlike the shoulder,
the hip is a very stable ball and socket joint. The socket
portion called the acetabulum is very deep and does an excellent
job of enveloping the femoral head.
We talk about the bones
of the hip as though they articulate directly. In actuality,
there is a layer of specialized cartilage that covers the
femoral head and the acetabular wall which allows the hip to
glide smoothly through its range of motion. It is this cartilage
that first begins to show signs of degeneration early in the
disease.
As the degeneration
progresses, the articular cartilage will eventually wear away
completely and the femoral head will come into direct contact
with the acetabulum. This is extremely painful.
Another anatomical
consideration to take into account when talking about hip
degeneration is the blood supply to the femoral head. The artery
that brings blood the femoral head comes in through the ligament
that holds the hip in the socket. Knowing this, its easy to
understand that any condition that causes an anatomical
disruption of the joint may disrupt the blood supply.
If the blood supply is
compromised, the joint may deteriorate fairly rapidly. This
condition is known as avascular necrosis. Conditions where this
may be a concern include hip dislocation and slipped capital
femoral epiphysis as discussed in previous articles.
Also, several medical
and metabolic conditions may cause the blood supply to the joint
to endangered. These include chronic alcoholism, long term
steroid use and others.
Symptoms of
degeneration of the hip include pain in and around the groin
area, pain with walking or activity and general stiffness.
When degenerative joint
disease of the hip is initially identified, conservative
measures are tried to slow the progression of the disease. These
include oral medicines, physical therapy, physical modalities
and activity modification.
Unfortunately, unlike
knee degeneration, there are few therapies in-between the
measures mentioned above and a total hip replacement.
Although it is
technically possible to scope the hip, this procedure isn't very
successful in treating hip degeneration and is not routinely
done.
Also, steroid or fluid
injections into the hip joint are not very successful and are
also not part of standard practice.
The gold standard for
the treatment of advanced hip degeneration is hip replacement.
This procedure may be done in several ways but involves
replacing the femoral head and articular surface of the
acetabulum with artificial components.
Though this is a fairly
invasive procedure, it is highly successful in returning
patients to an active lifestyle.
Naturally, the
postoperative period is filled with physical therapy and home
rehabilitation in order to ensure optimal results.
When total hip
replacement first became available the lifespan of an implanted
prosthetic averaged in the single digits. Today's prosthetics
can be expected to last significantly longer in the average
patient and provide many years of activity.
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