Osteoarthritis

This is a degenerative disease of the hip joint that initially starts in the cartilage and later affects other joint structures. The causes of the disease are divided into primary and secondary.

Description of the disease

Primary:

a) age-related changes (wear and tear, endocrine disorders, metabolic changes);

b) circulatory disorders (when there is acute ischemia (insufficient blood flow) – aseptic necrosis of the femoral head develops; when chronic ischemia occurs – arthritis develops;

c) nerve disorders – spondyloarthrosis, canal stenosis, radiculopathy;

Secondary:

a) hip joint dysplasia (abnormal joint development);

b) Legg-Calve-Perthes disease;

c) septic arthritis;

d) epiphysiolysis of the femoral head;

The main principle of disease development is incongruence (mismatch) of joint surfaces.

Symptoms

Increasing pain due to inflammation, increased intraarticular pressure. The pain is of moderate intensity, localized in the groin, hip (side of the hip), and knee joint areas. This pain radiates down the leg. The pain starts at night or during the “start” when standing up after sitting or lying down, and subsides with rest.

Limping, morning stiffness, limb shortening, and forced position occur with this condition. Restricted movements result not only from pain but also from contractures, where the joint contracts and cannot extend due to adhesions. Noticeable joint deformity and crepitus can be felt when moving the joint.

Diagnosis

The doctor evaluates posture, gait, range of motion, and X-ray data. Assess gait by observing Trendelenburg’s sign (waddling when walking) and limping, which can result from limb shortening or pain. X-ray examination of the hip joint shows narrowing of the joint space, bone spurs, subchondral bone sclerosis, bone cysts; magnetic resonance imaging shows increased fluid in the joint, radioisotope scanning detects increased isotope uptake. Arthroscopy can also be performed.

Treatment

Apply conservative treatment at the onset of the disease, prescribing nonsteroidal anti-inflammatory drugs, analgesics, drugs that improve microcirculation, sedatives, and neutrophilic drugs. Recommend physiotherapy as well.

In cases of advanced disease or ineffective conservative treatment, opt for surgical treatment. Perform arthrodesis for unilateral processes in young individuals with healthy other joints. Consider endoprosthesis for elderly individuals with altered spine and other leg joints.

Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology