Hip osteoarthritis or hip arthritis is the degenerative disease of the hip. The hip is a ball and socket joint that admits very little variations within its anatomy in order to be able to offer its function normally. When osteoarthritis affects the hip, the smooth and slippery surface (called articular cartilage) that covers the head of the femur and the acetabulum (socket) wears out becoming rough, therefore leading to mechanical problems and swelling that initially present as outbreaks or episodes. These events translate into stiffness and pain, located mainly around the groin and buttock area. Over time, the cartilage becomes thinner and the disability and pain increase, making it necessary to replace the joint by a hip prosthesis.
Hip osteoarthritis usually affects patients of mid or advanced age. In some cases, there is an identifiable cause responsible for the articular wear, as a previous fracture, a femoroacetabular impingement or a hip dysplasia. In many others, there is no known cause for the arthritis, even though there is always some degree of natural wear associated with aging.
The earliest treatment for hip osteoarthritis consists of modifying lifestyles that may be influencing over the onset of the arthritic process, like overweight and certain medical conditions. Physiotherapy and pain-killers may help initially in controlling stiffness and pain. When these are not effective any more, intraarticular injections can relieve symptoms during a certain period of time. In advanced stages of the articular disease or when previous treatments don’t work, the preferred treatment is the surgery by performing a total hip replacement.
Hip osteoarthritis and sports:
Lately, the diagnosis of hip arthritis amongst young patients has increased, due to several reasons. One of the most common is the presence of a previous femoroacetabular impingement, which has been related with the practice of certain sports. As a result, there are many patients below the age of 45-50 who require a hip replacement today. New designs meant to satisfy younger people functional needs and preserve greater bone stock for future surgical revisions have been developed (hip resurfacing and short femoral stems respectively). In addition, minimal invasive approaches allow for a better and faster recovery.
This specific kind of hip replacement offers maximal bone preservation with a greater postoperative function, especially thought for younger and more active patients. Nevertheless, there are intrinsic limitations related with its design and material, which preclude its use in some patients with hip arthritis; therefore, it is important to select properly the candidates for this kind of replacement. In addition, this design offer advantages in case it needs a conversion to a total hip replacement.
Direct anterior approach to the hip
Even though it was described a while ago, the direct anterior approach to the hip (Hueter approach) has shown important advantages when used to perform a hip replacement, due to the main fact that there is no need to cut any muscle. It consists of approaching the hip through its anterior part, i.e. the groin area. Using a smaller incision than standard approaches, the surgeon can access the hip through an inter-nervous plane (i.e. without trespassing the anatomy corresponding to a certain nerve, therefore avoiding its damage). This allows performing the joint replacement in a safe way, with minimal surgical dissections and preserving the function of muscles and ligaments around the hip, hence minimizing the risk of dislocation. This approach is also beneficial with respect postoperative pain control and recovery, allowing for a normal life within a few weeks.
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