HIP

1. Arthritis

Hip arthritis commonly describes the most common form of hip arthritis, which is known medically as hip osteoarthritis.
Hip osteoarthritis is a joint disease that mostly affects your hip joint cartilage. Articular cartilage is the hard slippery surface that covers the sections of bones that move against each other in your hip joint.
Healthy articular cartilage allows your hip joint bones to smoothly and painlessly glide over each other and also helps to absorb any shock forces not dispersed by your hip muscles.

Symptoms of Hip Arthritis?

Hip arthritis results in hip pain, joint weakness, joint instability, and restrictions of movement that interfere with your most basic daily tasks such as walking, climbing stairs or driving.

Your symptoms can develop suddenly or slowly and may include:

• Hip joint pain or tenderness that comes and goes. Typically there will be sharper pains in the groin, and sometimes an ache in the front of the thigh.

• Hip joint swelling or deformity can be hard to detect because of the location of the hip joint.

• Hip joint movement is difficult, especially inward rotation, movement of the leg across the body and hip extension.

• Hip stiffness, particularly early morning stiffness.

• Weak hip muscles, especially during sit to stand, squatting and stair climbing.

2. AVN avascular necrosis

Avascular necrosis is the death of bone tissue due to a lack of blood supply. Also called osteonecrosis, it can lead to tiny breaks in the bone and the bone’s eventual collapse.
A broken bone or dislocated joint can interrupt the blood flow to a section of bone. Avascular necrosis is also associated with long-term use of high-dose steroid medications and excessive alcohol intake.
Anyone can be affected, but the condition is most common in people between the ages of 30 and 50.

Symptoms

Many people have no symptoms in the early stages of avascular necrosis. As the condition worsens, your affected joint might hurt only when you put weight on it. Eventually, you might feel the pain even when you’re lying down.
Pain can be mild or severe and usually develops gradually. Pain associated with avascular necrosis of the hip might centre on the groin, thigh or buttock. Besides the hip, the areas likely to be affected are the shoulder, knee, hand and foot.
Some people develop avascular necrosis on both sides (bilaterally) — such as in both hips or in both knees.

What are the Causes:

Avascular necrosis occurs when blood flow to a bone is interrupted or reduced. Reduced blood supply can be caused by:

• Joint or bone trauma. An injury, such as a dislocated joint, might damage nearby blood vessels. Cancer treatments involving radiation also can weaken bone and harm blood vessels.

• Fatty deposits in blood vessels. The fat (lipids) can block small blood vessels, reducing the blood flow that feeds bones.

• Certain diseases. Medical conditions, such as sickle cell anemia and Gaucher’s disease, also can cause diminished blood flow to bone. For about 25 percent of people with avascular necrosis, the cause of interrupted blood flow is unknown.

Risk factors

Risk factors for developing avascular necrosis include:

• Trauma. Injuries, such as hip dislocation or fracture, can damage nearby blood vessels and reduce blood flow to bones.

• Steroid use. Use of high-dose corticosteroids, such as prednisone, is a common cause of avascular necrosis. The reason is unknown, but one hypothesis is that corticosteroids can increase lipid levels in your blood, reducing blood flow.

• Excessive alcohol use. Consuming several alcoholic drinks a day for several years also can cause fatty deposits to form in your blood vessels.

• Bisphosphonate use. Long-term use of medications to increase bone density might contribute to developing osteonecrosis of the jaw. This rare complication has occurred in some people treated with high doses of these medications for cancers, such as multiple myeloma and metastatic breast cancer.

• Certain medical treatments. Radiation therapy for cancer can weaken bone. Organ transplantation, especially kidney transplant, also is associated with avascular necrosis.

Complications

Untreated, avascular necrosis worsens with time. Eventually, the bone can collapse. Avascular necrosis also causes bone to lose its smooth shape, potentially leading to severe arthritis.

Prevention

To reduce your risk of avascular necrosis and improve your general health:

• Limit alcohol. Heavy drinking is one of the top risk factors for developing avascular necrosis.

• Keep cholesterol levels low. Tiny bits of fat are the most common substance blocking blood supply to bones.

• Monitor steroid use. Make sure your doctor knows about your past or present use of high-dose steroids. Steroid-related bone damage appears to worsen with repeated courses of high-dose steroids.

• Don’t smoke. Smoking increases the risk.

3. Acetabulum Reconstruction

Fractures of the acetabulum are challenging orthopaedic injuries to repair, at times leaving multiple small fragments of fractured bone and cartilage. Compounded by the location in a region challenging in which to work and fraught with risk, these “puzzle pieces” must be brought back together to restore hip function and mobility.
The acetabulum, commonly thought of as the socket of the ball-and-socket hip joint, may break in one of 10 different pattern.
Relative to hip fracture, acetabular fracture is uncommon. These fractures occur in two distinct patient populations:

* In younger patients, high-energy injuries cause the break, such as motor vehicle or bike accidents, or falls from significant height.

* In older patients with osteoporosis, low-energy injuries such as falls from standing height prompt the fracture.

Patients’ pain levels vary widely and are related to the injury pattern and mechanism of injury.

Risks with acetabular fracture

This fracture puts patients at considerable risk of developing post-traumatic arthritis, which may result in the need for hip replacement. Post-traumatic arthritis occurs due to damage to the articular surface of either the acetabulum or femoral head. Another potential complication with acetabular fracture is avascular necrosis, in which the blood supply to the femoral head is sufficiently damaged or stretched from dislocation that the bone subsequently dies and collapses, resulting in hip pain.
Acetabular fractures are commonly associated with multiple other injuries, such as to the abdomen, chest or head. With isolated acetabular fracture, the risk of shock is low, but concomitant injuries must be identified and treated appropriately.
Surgical treatment of acetabular fracture is complex and can result in complications and poor outcomes. While the infection risk is similar to that of other hip procedures, body mass index (BMI) is a predictor of infection and complications of operative treatment.

Fracture management

When patients with suspected acetabular fracture arrive at any hospital, the first order of business is to determine if the hip is reduced or dislocated. If dislocated, providers should perform urgent closed reduction prior to any transfers, as this procedure is crucial to preventing future complications.
If the hip is unable to be reduced or appears widely displaced, consult with a higher level trauma centre for transfer.
Physical exams for patients who have potentially suffered this injury are minimal, usually differentiating between acetabular or hip fracture.

4. Total HIP replacement

Hip replacement (total hip arthroplasty) is surgery to replace a worn out or damaged hip joint. The surgeon replaces the old joint with an artificial joint (prosthesis). This surgery may be a choice after a hip fracture or for severe pain because of arthritis.
Various types of arthritis may affect the hip joint:

• Osteoarthritis. This is a degenerative joint disease that affects mostly middle-aged and older adults. It may cause the breakdown of joint cartilage and adjacent bone in the hips.

• Rheumatoid arthritis. This type of arthritis causes inflammation of the synovial lining of the joint. It causes extra synovial fluid. It may lead to severe pain and stiffness.

• Traumatic arthritis. This is arthritis is caused by an injury. It may also damage the hip cartilage.

The goal of hip replacement surgery is to replace the parts of the hip joint that have been damaged. It also helps relieve hip pain that can’t be controlled by other treatments.
A traditional hip replacement involves an incision several inches long over the hip joint. A newer approach uses 1 or 2 smaller incisions to do the surgery. This is called minimally invasive hip replacement. But the minimally invasive procedure is not suited for all people who need hip replacement. Your healthcare provider will figure out the best procedure for you.

When do I require hip replacement surgery?

Hip replacement surgery is a treatment for pain and disability in the hip. Osteoarthritis is the most common reason for hip replacement surgery.
Osteoarthritis causes loss of joint cartilage in the hip. Damage to the cartilage and bones limits movement and may cause pain. People with severe pain from degenerative joint disease may not be able to do normal activities that involve bending at the hip. These activities include walking and sitting.
Other forms of arthritis such as rheumatoid arthritis and arthritis that results from a hip injury can also damage the hip joint.
Hip replacement may also be used to treat certain hip fractures. A fracture is an injury often from a fall. Pain from a fracture is severe. Walking or even moving the leg causes pain. Your healthcare provider may have other reasons to recommend a hip replacement surgery.

5. Revision HIP replacement

When a replacement joint wears out, loosens or develops a problem, it can be resurfaced or replaced in a joint revision operation. Using regular X-ray examinations, the orthopaedic surgeon can detect and monitor any changes, and plan for revision surgery before a major problem develops.
Revision hip surgery requires the removal of the previous prosthesis, the cement, the surrounding tissue and the dead bone before a new prosthesis can be inserted.
Postoperative care for revision hip surgery is the same as that for total hip replacement surgery. Patients receive a combination of home healthcare, physical and occupational therapy home health care and other forms of rehabilitation.
Complications from this procedure, in addition to the risks associated with any major surgery, are similar to those for original joint replacement surgery. However, the success rate for revision surgery is usually lower than that for the original surgery because the bone is weaker.