Hip Joint Anatomy

Read about the Anatomical Structure of the Hip Joint – Click here

 

Causes of hip pain

  • Osteoarthritis: It is the the common cause of pain in the hip region. Osteoarthritis the is characterized by the wearing and eventual loss of hip cartilage. Cartilage act as a cushion between the bones of joint.Gradually the pain get worse . patient experiences inflammation and stiffness of joints. Osteoarthritis usually associated with old age (above 50)
  • Rheumatoid arthritis: It is an autoimmune disease(body’s immune system mistakenly attacking it’s own tissue). Rheumatoid affects the joint lining tissue, causing pain and inflammation around the joint. There is no cure for rheumatoid arthritis. Physiotherapy and antirheumatoid medications plays important role in management of symptoms.
  • Bursitis: Bursitis is the inflammation of bursa. Bursa is the fluid filled sac(bag) located in bones, tendons and muscles around the joint. Bursitis is commonly caused by repetitive activities that irritates the bursa
  • Tendenitis: Inflammation(swelling) of tendon is called tendinitis. Tendon is thick Fiber that connect muscle to bone. Caused by repetitive stress from overuse.
  • Hip fracture: Hip fracture is commonly among elder people because of gradual weakening and thinning of bone due to age. In patients with osteoporosis, bone becomes brittle and spontaneous fracture occurs. Pathological fracture may occurs in patient with bone cancer, cyst, benign tumor, inherited disease of bone(Legg calve perches disease) .
  • Hip labial tear: Labrum is a ring of cartilage that surround the hip socket.Besides cushioning, it helps holding the femur head inside the acetabulum . it is highly prevalent among high impact sports like ice-skating, and football. Tear of labrum causes pain, stiffness and clicking sensation in the joint.
  • Infection: Viral or bacterial infection may cause inflammation around hip joint(lymes disease)
  • Sprain and strain: Strain and strains are injuries of soft tissues. Injury to the ligaments are called sprains. Ligaments are structures that connect bone to the soft tissue. Strains are stretching or tearing of muscle or tendon.
  • Post traumatic arthritis: Fracture of bone, or tear of surrounding structures, which may later damage the cartilage results in pain and limiting normal mobility of knee joint
  • Avascular necrosis: Avascular necrosis also known as osteonecrosis is more common in hip region. It is a painful condition characterized by the death of bone due to disruption of blood supply. Disruption of blood supply might be due to Fracture of hip or dislocation or from long term use of corticosteroids.

Management

  • Rest
  • Exercise
  • Reduce body weight
  • Medication
    • NSAIDS – non- steroidal anti-inflammatory drugs relieves pain end reduce inflammation of joint
    • Corticosteroids – anti Inflammatory drugs
    • Antirheumatic drugs(DMARDS) – for patients with rheumatic arthritis
    • Injecting corticosteroids directly into joint. It reduces inflammation, pain and improves the range of motion. But pain relief may be temporary.
    • Injecting hyaluranate directly in the joint. It lubricate the joint and reduces pain
  • Physiotherapy
  • Alternative therapy
  • Osteotomy Surgery: The diseased portion of hip joint is removed and the joint is reshaped to align properly. Osteotomy is often considered for young patients who are too active for total hip replacement.
  • Hip resurfacing surgery: Unlike total hip replacement, hip Resurfacing involves reshaping of femur head and attached with a metal covering that fit into acetabulum.

Total hip replacement surgery

The diseased portion of joint is removed and replaced with artificial prosthesis. Total hip replacement is the second most joint replaced after knee replacement. The goal of the hip replacement surgery is to enable the patient to resume their normal activities without pain.

 

Indications: when a hip replacement surgery is needed?

  • If the conventional treatments failed to relieve symptoms
  • Patients is unable to perform daily activities
  • Osteoarthritis
  • Rheumatoid arthritis
  • Post traumatic arthritis
  • Trauma and fracture of hip joint

Total Hip Replacement surgery, Step by step procedure

(Click on above images for a larger view)

Prior to surgery the doctor will perform a complete physical examination, blood test and other investigations to make sure the patient is medically fit for surgery. Just Minutes before the surgery either general anesthesia is administered to the patient by anesthetist. patient’s vitals are monitored continuously by the anesthetist till the surgery is complete.

An incision is made on the side of the hip joint, soft tissues are retracted to fully expose the hip joint.

Now surgeon will dislocate the head of femur (upper thigh bone) from acetabulum (socket on pelvis bone). Head or ball of femur bone is removed. Femur bone is prepared to receive prosthesis. Prosthetic ball with narrow stem is fitted to femur. Stem provides stability to prosthesis. Prosthetic ball serves as femur head.

Surgeon now prepares acetabulum to receive the cup shaped prosthesis. Acetabulum prosthesis is cemented to reshaped surface. Surgeon now fits Prosthetic ball into acetabulum prosthesis. Spacer is inserted in-between ball and socket for smooth movement of artificial prosthesis.

Recovery

You might be hospitalized for 2 to 3 weeks after surgery. Physiotherapy will be started within a day or two after surgery. Physiotherapist will guide you to improve the strength of the hip and improve range of moments. Physiotherapy will be continued for one or two months after surgery.  Complete recovery takes about the 4 to 6 months.

Prognosis

Total hip replacement surgery has an excellent success rate, almost most of the patients can return to their normal routine life without pain. About 85 percent prosthesis last for 20 years.

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