Hip

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Coxarthrosis (Hip arthrosis)

Coxarthrosis or Hip arthrosis is the result of wear and tear on the cartilage of this joint. Locally, there is disorganization of the collagen matrix and a decrease in proteoglycans, which have a chondro-protective effect, calling water by osmosis to its interior. As a result of the reduced osmotic effect of proteoglycans, the water content of the cartilage is reduced, as well as its thickness, and then osteoarthritis occurs.

Hip arthrosis is, together with knee arthrosis, one of the most frequent arthrosis in the body. It affects 10-20% of the population after the age of 60, with a higher incidence in men up to 45 years old and in women after this age.

Primary coxarthrosis is one that has no apparent (ideopathic) cause, other than joint wear and degeneration. However, coxarthrosis can have other causes and is then called secondary coxarthrosis.

The most frequent causes are the following:

  • Traumatic (fractures and dislocations);

  • Femoral-acetabular conflict and hip dysplasia;

  • Avascular necrosis of the femoral head;

  • Sequelae of congenital hip dislocation and childhood Perthes disease;

  • Rheumatological and infectious diseases.

Hip osteoarthritis or osteoarthritis causes the following symptoms:

  • Pain in the hip, with a mechanical character, that is, that worsens with movements, sometimes with irradiation to the groin, thigh or knee;

  • Crackling, joint stiffness and limited range of motion;

  • Claudication during the march, which sometimes requires the support of Canadians;

  • Muscle atrophy due to disuse;

  • Progressive reduction of gait perimeter without pain.

In bilateral coxarthrosis, symptoms cause more marked functional impotence, and may even interfere with personal hygiene and activities of daily living.

One of the ways to control the symptoms of hip arthrosis may be the use of appropriate physiotherapy.

 

Trochanteric Bursitis

Bursitis results from an inflammation of the synovial pouches (or bursae). A synovial pouch (or bursa) is a small bag filled with a gelatinous (liquid) fluid. The bursae are located between the bone and the tendons / muscles and allow to reduce friction. In other words, they work as “shock absorbers” to reduce impacts, that is, as a kind of “cushion” to reduce friction. In addition to the hip, we can find synovial pouches all over the body (shoulders, knees, heel, etc.).

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Trochanteric bursitis (or trochanteritis) is the inflammation of the trochanteric bursa that is located in the trochanteric region (between the greater trochanter of the femur and the ilio-tibial band and the tendon of the middle gluteal muscle).

The symptoms are characterized by tenderness and pain in the lateral region of the thigh (“part of the side and outside the hip”), which sometimes radiates to the inguinal region (groin area). See superior images to better understand where the trochanteric bursa is located. Pain tends to intensify with activity (walking, walking up or down stairs, etc.). Patients, as a rule, find it difficult to lie "on their side" under the affected hip, often causing difficulty sleeping at night.

Femoro-acetabular conflict

It is a set of pathologies that are characterized by a mechanical block to normal hip movement, causing progressive lesion of the labrum and articular cartilage, which can result in arthrosis. It is characterized by changes in bone anatomy, which favor traumatisms that are repeated with the movements, until the appearance of the lesions. Generally, there are two types of deformity that can arise independently or together: the CAM type and the PINCER type.

Labral injury can occur without changes in bone anatomy. In these cases, its appearance is often associated with the practice of sport (football, handball, basketball, ballet, golf, athletics, etc.), due to movements of greater joint amplitude.

What are the patient's complaints?

Complaints vary with the course of the disease. Initially, the pain can be quite localized and appear with a specific movement (for example: pain in the groin whenever the hip is flexed at a given rotation). “C” pain is very common, which is characterized by a pain located between the buttock and the groin.

Conservative treatment should always be the first approach. It consists of physical therapy, anti-inflammatory painkillers and reduced activity that causes symptoms. Surgery is reserved for cases of failure in well-conducted conservative treatment

Hip Arthroplasty 

Hip Arthroplasty is an operation performed with an incision of 10-12 cm, and through which the femoral head and acetabulum cartilage are resected to allow its replacement by a metal implant (prosthesis).

Hip prostheses can be attached to the bone by applying a special cement (cemented prostheses), which adheres and hardens after a few minutes, allowing patients to load immediately after surgery. It is ideal for older patients, with more osteoporotic bone, or who have worse bone stock due to rheumatismal pathology. Cementless prostheses are applied under pressure (press-fit). They are produced with a rough and porous surface, usually coated with hydroxyapatite, to allow a process of incorporation by bone growth into the interior of your pores, allowing a very firm and lasting fixation.

Hip Arthroplast is a surgery that has undergone a great evolution. Its application is possible by mini-invasive techniques, which provide the patient with better and easier recoveries.

Recovery after performing an Hip Arthroplast is increasingly quick and simple for the patient, as surgeries are less invasive, pain control is more effective and rehabilitation protocols are faster.

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Objectives of a rehabilitation program:

  • Improving mobility and joint movement

  • Relief from pain and inflammation

  • General physical reconditioning

  • Teaching and counselling of support products (orthotics, splints, etc.)

  • Return to work activities , daily life and sports activities  

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