Hip




HIP JOINT:

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The hip joint is one of the most important joints of the human body and represents the joint between the head of the femur (thigh bone) and the acetabulum (the hip socket).  It is a ‘ball and socket’ type of joint which allows mobility and  stability.  The surface of the ball and the socket are covered by specialised lining; the hyaline cartilage or articular cartilage.  Arthritis develops when the articular cartilage (lining) gets damaged due to various causes.  Osteoarthritis or wear and tear is a condition where there is progressive thinning and loss of this joint lining.  In extreme cases the lining is completely lost with a bone on bone joint which can be very symptomatic and disabling.  Hip joint arthritis can also occur secondary to inflammatory conditions such as rheumatoid arthritis, ankylosing spondylitis, gout etc.  This joint has a precarious a blood supply and not uncommonly the ball of the ball and socket joint loses its blood supply causing a condition known as avascular necrosis.  Avascular necrosis can lead to secondary osteoarthritis.  Hip joint arthritis can also be caused as sequelae to childhood hip disorder such as Perthes disease, trauma SUFE and aspherical articulation and subsequent impingement.  Fractures around the hip can also lead to secondary osteoarthritis of the joint.





 

SYMPTOMS AND SIGNS:

Patients with hip arthritis would suffer from pain typically in the groin, thigh and buttock area.  Occasionally hip arthritis can present as knee pain.  Patients with hip arthritis would struggle to walk a reasonable distance and find it difficult to negotiate stairs.  In worsening cases, patients may lose their ability to ambulate independently and may become reliant on a walking stick and crutches.  They would find it difficult to bend down and tie their shoe laces and clip their toe nails on the affected side and would walk with a pronounced limp in the later stages.  Hip arthritis could have a significant impact on a patients ability to carry out routine day to day activities.  







ASSESSMENT:

A detailed assessment and history is initially obtained to find the cause of hip arthritis.  On clinical examination the gait, any leg length discrepancy and range of motion of the hip joint is assessed.  A diagnosis is most commonly confirmed by a routine plain x-ray of the affected hip.  Occasionally in borderline cases or in cases where there is discrepancy between clinical symptoms and x-ray appearance an anaesthetic arthrogram (injection of the joint with local anaesthetic under radiological control) is carried out to confirm diagnosis.  



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