Common hip conditions found in the Thai population are osteoarthritis of the hip (OA), developmental hip dysplasia (DDH), avascular necrosis, and rheumatoid osteoarthritis of the hip linked to prolonged steroid use, drinking and congenital abnormalities. Often, these conditions are found when the person is around 40-65 years of age.
Osteoarthritis of the hip is a commonly disease in older people. When young, the surfaces of the hip joints are smooth and glossy, but when older, these surfaces become worn along with cartilage, tendons and bones that make up the joints. As a person becomes older, the person usually also has a heavier body weight and begins to develop structural abnormalities in their joints, which can cause joint disorders such as the following:
- Wear or loss of smoothness of the surfaces of the hip joints, leading to feelings of the joints being stuck, friction or loud noises like sand paper rubbing against each other when moving the joints.
- Abnormal load distribution on the bones and abnormalities in the joint surfaces, with some areas being more heavily affected while others less affected. The abnormal load distribution causes increased sensitivity and pain.
- Cartilage irritation and inflammation and increased production of synovial fluid, leading to pain and swelling.
- Reduced strength of the muscles surrounding the joints, leading to increased impacts on the joint surfaces.
- Stretching of some of the ligaments of the joints, leading to increasing swinging and looseness of the joints and more abnormal movements.
- Structural changes to the bones around the joints, with bone growths inside the joints, leading to reduced movement due to most patients walking less. As a result, the bones of the hip joints and surrounding areas become thinner.
Symptoms
- Pain accompanied by difficulty moving the joint.
- If osteoarthritis of the hip is not quickly treated, bone spurs might develop around the joint or joints if the supporting cartilage has completely worn away.
- There might be severe pain when bones rub against each other, while the leg on the affected side becomes shorter.
- If pain symptoms are so severe that the patient has to remain still and can no longer turn or extend the hip, weakness in the muscles controlling the hip joint due to reduced usage might lead to leg weakness.
Treatment
Diagnosis of osteoarthritis of the hip includes a review of the patient’s history and illness symptoms such as physical examination, x-ray and additional tests such as MRI and computer tomography. The aim of treatment for osteoarthritis of the hip is to reduce pain, prevent locked joints and increase functionality, while preliminary preventive self-care techniques include losing weight if the person is overweight, avoiding use of the hip such as when lifting heavy objects, etc., using a walking stick and exercising and stretching to prevent locked joints. The person needs to also follow the doctor’s treatment guideline, take medications and undergo physical therapy. In the event that severe pain persists despite the aforementioned treatment, surgery is an additional treatment option, of which many techniques are available depending on the severity, cause of degeneration, age and nature of use.
Surgical Treatment
- Hip arthroscopy.
- Hip osteotomy to surgically turn the joint surfaces that are normally in contact. This procedure is used when one particular part of the joint is damaged, but other areas are still normal.
- Hip replacement surgery to replace the damaged bone and cartilage with an artificial hip joint.
- This treatment is popular for the cartilage on the side of the hip joint socket and the femoral head, since the materials used to manufacture artificial hip joints have been improved from before to have a longer service life.
