The most common disease of the hip is degenerative joint disease. It is mostly seen in middle and advanced ages. It is divided into primary or idiopathic and secondary. Osteoarthritis shows different radiological findings that show the pathophysiology of the disease. Joint space narrowing, osteophyte formation, subchondral sclerosis, subchondral cyst and malalignment in the joint are typical findings of the disease. Hip dislocations that are neglected and not treated in time, structural disorders of the hip joint that do not cause symptoms and are overlooked due to their very mildness, and traumatic events predispose to coxarthrosis in advanced ages. Sometimes, even if treated well, patients with developmental hip dysplasia may develop coxarthrosis at advanced ages. Secondary coxarthrosis causes include rheumatoid arthritis, seronegative spondyloarthropathies, crystal arthropathies, avascular necrosis and infections.
Clinical findings: The first symptom of hip arthrosis is a discomfort and stiffness in the hip joint. This discomfort initially occurs with waking up and getting out of bed. The pain increases with movement and load on the joint, and it relaxes a little at rest. As the disease progresses, pain and other complaints do not go away with rest. The patient reduces their activities due to pain. The joint space becomes very narrow. Hip movements are restricted and limping occurs. The pain can sometimes hit the knee. Therefore, patients with knee pain should definitely be evaluated in terms of hip joint.
Diagnosis: Direct radiography is sufficient for diagnosis. However, sometimes CT and MRI examinations can be performed for differential diagnosis.
Treatment: If the pain is in the early period and the pain is within tolerance, medical treatment is applied. Conservative treatment options include the use of a cane (on the healthy side), weight loss, physiotherapy, viscosupplementation, antirheumatic and anti-inflammatory drugs, and spa treatments. In cases with advanced arthrosis, if the age of the patient is appropriate, if there is no medical problem, the best treatment is surgery. Joint-sparing osteotomies can be used as surgical options in young patients. Osteotomies can be performed in the proximal femur and / or pelvic bone. With this method, the loads on the hip joint are rearranged and / or the load bearing area is expanded by bringing the solid surfaces of the joint to the load-bearing areas. Arthroplasty may be considered more prominently in older patients. In young patients, cementless prostheses and ceramic head and ceramic insert should be used for less wear and long survival. In elderly patients, the first choice should be cementless acetabular and femoral component with metal head and polyethylene insert. Bone structure of the femur or acetabulum; If primary stability is insufficient, cementitious components should be preferred. Since complications such as infection, thromboembolism and implant loosening can be seen in arthroplasty, patients should be carefully prepared and selected. With a successful and uncomplicated surgical intervention, very satisfactory results are obtained in terms of functional results and pain after arthroplasty.
