Osteoarthiritis Of The Hip

Question 1

what is osteoarthritis ?

Answer 1

degenerative joint disease characterised by loss of articular cartilage

Question 2

What are the systemic and local risk factors for hip OA?

Answer 2

Systemic

• age
• female
• genetics
• vit D deficient

Local

• obesity
• history of hip trauma
• anatomical abnormalities
• muscle weakness
• joint laxity
• participation

Question 3

What are the clinical features of OA?

Answer 3

• dull aching pain around the hip, aggravated by activity and relieved by rest.
• evidence of muscle wasting and reduced power around the hip joint
• leg length discrepancy or fixed flexion deformity may be present
• may be antalgic or trendelenberg pattern gait
• crepitus felt and reduced ROM

Question 4

What are the differential diagnoses for neck of femoral shaft fractures?

Answer 4

• trochanteric bursitis
• glut mediums tendinopathy
• sciatica
• avascular necrosis of femoral head
• femoral neck fractures

Question 5

What can be seen on a plain radiograph of a hip with OA?

Answer 5

• narrow joint space
• osteophytes
• subchondral sclerosis
• subchondral cysts

Question 6

What is the initial management of OA?

Answer 6

Pain control using WHO analgesic ladder

Lifestyle modifications e.g weight loss, smoking cessation.

Physiotherapy to slow disease progression and improve joint mechanism

Question 7

What is the long term management of hip OA?

Answer 7

• surgical intervention needed if conservative fails
• definitive treatment is a hip replacement, either with total hip replacement = arthoplasty (femoral head and acetabulum) or hemiarthoplasty (just femoral head).

Question 8

What are the surgical approaches for management of OA?

Answer 8

Posterior approach - most common. Abductor mechanism is preserved however risk of damage to sciatic nerve.

Anterior - preserves abductor mechanism = fast recovery. However risk of sensory deficit in field of lateral cutaneous nerve.

Lateral approach - affects abductors. Can get pain and weakness post operatively and has a slower recovery than the others.

Question 9

What are the complications of hip replacements?

Answer 9

Last for 15-20yrs but depending on age of at tie of replacement may never need revising

Surgical risks include

• thromboembolic disease
• bleeding
• dislocation
• infection
• loosening of prosthesis
• leg length discrepancy