Arthritis of the hip (coxarthrosis)
It is a degenerative, non-inflammatory affection of hyaline hip joint cartilage, manifested initially by pain in movement and stiffness of the joints. Later, resting pain appears. Typical is also starting pain at the beginning of the movement and in the morning. Arthrosis of the hip affects over 10% of the population.
Primary coxarthrosis – arises from a metabolic disorder of cartilage
Secondary coxarthrosis – the cause of arthrosis is not primarily on the metabolic background.
The cause may be
- Developmental dysplasia of the joint
- Rheumatoid arthritis, Bechterew’s disease
- Post-traumatic disability after infectious complications
- Conditions following aseptic necrosis (Perthes, corticosteroids)
On X-ray imagery, arthrosis is manifested by gradual narrowing of the joint, increased peripheral osteophytes, subchondral sclerosis, sometimes through the formation of subchondral cysts with the possibility of bone necrosis.
We divide arthrosis by four-stage X-ray according to Kellgren and Lawrence (1957):
- Stage I: narrowing of joint medically, beginning of osteophyte formation
- II. Stadium: certain reduction of the articular slit inferiorly, distinct osteophytes
- III. Stadium: articular slit markedly narrowed, osteophytes, sclerotic changes of detritus cysts, deformation of the head shape and acetabula
- IV. Stage: Clearing of the joint with sclerosis and cysts, advanced deformation
Treatment of coxarthrosis
In the early stages of coxarthrosis, we mainly use pharmacological and rehabilitation procedures. We emphasize the adjustment of sports activities. Cycling and swimming are particularly suitable. It is important to keep the patient’s optimum weight so that the supporting joints are not overloaded. Drugs are recommended in medication especially for a range of non-steroidal anti-inflammatory drugs.
At advanced stages of hip arthritis, it is important to evaluate the clinical condition and consider the possibility of surgical procedures. Consider the arthroscopic treatment of femoroacetabular impingement (syndrome of obstruction of rounded outbursts) or osteotomy of the upper extremity of the femur. In the advanced stage of arthritic hip disease, it is often necessary to undergo total endoprosthesis (TEP) implantation.
Artificial joint – alloplasty – total endoprosthesis (TEP)
Alloplasty of the hip joint is a replacement of the damaged joint with an implant, replacing the acetabulum well with the femoral head.
- bone cement fixed polyethylene well
- bone cement fixed stem
- uncemented well – usually titanium
- bone cement fixed stem
- well uncemented
- shank uncemented
An insert that forms a sliding surface is inserted into the anchor well and the endoprosthesis head is attached to the stem of the stem. The materials used to make the sliding surfaces are especially CrMoCo steel, polyethylene, ceramics, and oxinium.
The patient should be thoroughly preoperatively examined before joining alloplastics. On the way to our Grand Class ambulance, we perform standard preoperative examinations (ECG, laboratory examinations, heart and lung x-rays), dental examinations, gynecological and urological examinations. In the preoperative period, it is necessary to modify the medication that affects blood clotting. The patient is provided with underarm crutches and medications to prevent thromboembolic disease.