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There are 5 main causes for hip degeneration. Osteoarthritis is the most common one according to the Swedish National Hip Arthroplasty Hip Register, but there are important differences by age distribution.
This is a degenerative process which directly results in the wearing out of cartilage on the joint surface. Over time, the joint surface slowly erodes, resulting in a painful joint when it moves and bears weight. There might be a fixed position of the hip in flexion. Pain is mostly localised in the groin and/or thigh region (front, inner or outer side) and may refer to the knee as well. There even may be low back pain. Pain is gradually worsening in intensity and duration and becomes finally permanent, even at night. The range of motion of the hip joint becomes really disabling when one is not able anymore to put on socks or knot shoelaces.
2. Arthritis (rheumatoid) This is a disease of the immunity system which results in the joint becoming inflamed (hot, swollen and painful) and after a certain delay stiff and deformed. The initiating cause is unknown, but is thought to be an allergic reaction against the own body's defence. It causes degeneration of the joint as well, resulting in pain and disability of the joint.
3. Avascular necrosis (AVN) This is another form of a hip joint problem where the blood supply to the femoral head (ball portion) of the joint is reduced or obliterated. This causes this portion of the bone to die, which leads to the collapse of the effected bone and femoral head
surface. There are numerous causes for avascular necrosis such as use of corticosteroids, over consumption of alcohol, fat disorders, nitrogen (divers !) embolism, and other conditions. If the condition does not heal and has not had prosthetic surgery, the joint will wear out and give osteoarthritis.
4. Trauma/Fracture Trauma such as dislocation and fracture around the joint may cause rapid degeneration of the joint as well. In the elderly in case of fracture just below the femoral head (subcapital fracture), a total hip replacement or a bipolar replacement will be done. In the young age osteosynthesis will be the first choice.
5. Developmental dysplasia of the hip This is a congenital deformity of the hip with many gradations ranging from a minor displacement of the ball out of the centre of the socket to a complete dislocation of the ball out of the socket. This should be treated adequately shortly after birth to reduce the risk for early degeneration of the joint. Many different procedures, called osteotomies are done in the younger, adolescent or more adult age.
Other reasons for hip pain 1. Tendonitis of the adductors of the hip Minor trauma or repetitive activity may lead to local inflammation of the tendons localised at the inner side of the thigh. Pain is localised in the groin where the tendons insert. Treatment is conservative: rest, medication and physiotherapy. 2. Trochanteric bursitis Patients complain of pain and tenderness over the region of the greater trochanteric bursa caused by inflammation of the bursa and/or associated tendons. Pain is localised over the outer aspect of the hip and may refer to the knee as well. Frequently, patients can identify a specific point that is tender. Treatment is initially conservative, consisting of rest, medication, physiotherapy, infiltration with corticosteroids and more recently shockwave therapy. Only in persisting situations, resection of the bursa may be necessary. 3. Snapping hip syndrome Patients will complain of a palpable popping sensation around the hip. The snapping hip syndrome may be rarely uncomfortable or acutely painful. It is most frequently caused by thickening of the iliotibial band, as it repeatedly snaps over the greater trochanter (palpable at the outer side of the thigh). This is NOT a dislocation of the hip! No treatment is necessary. This is a benign condition. Last updated: 06.01.2006 |
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