The hip joint is a joint formed between the femoral head and the pelvic acetabulum.
– It carries body weight.
– It provides the function of walking.
– It provides the movement function of the trunk on the legs.
The capsule of the hip joint is strong and thick. Unlike the shoulder, it is extremely important in the stability of the hip joint. It wraps around the femoral head like a glove and adheres under the femoral neck. While the femoral neck is intracapsular, the greater and lesser trochanters are extracapsular.
Each 1 kg. weight gained is reflected as 3 kg. on the hip.
Body weight on the hip joint;
– Five floors on the run,
– 4-7 times when standing up,
– When going up and down stairs, 7 times the weight is reflected.
The most common causes of hip pain:
– Congenital hip dislocation
– Acetabular dysplasia
– Legg-Perthes Disease
– Slipped epiphysis of the femoral head
– Congenital coxa vara
Walking is also in our hips;
– Walking causes repetitive stretching of the hip capsule, ligaments, fascia and flexor muscles of the hip joint.
– Each successive step in walking requires the leg to be in full extension.
– In normal walking, the femur rotates over the pelvis and the tibia rotates over the femur.
Joint Diseases:
– Degenerative joint diseases: Osteoarthritis, DISH
– Inflammatory diseases: Rheumatoid arthritis, AS
– Infections: Septic arthritis, tbc
– Metabolic Joint diseases: Gout, pseudogout, ochronosis
– Tumors: Pigmented villonodular synovitis, synovial chondromatosis, synovial sarcoma
– Childhood diseases: Transient synovitis, Juvenile chronic arthritis
Periarticular Diseases:
– Bursitis : Trochanteric, iliopectineal, ischiogluteal
– Tendinitis: Adductor tendinitis
– Heterotropic ossification
– Snapping hip syndrome
Bone Structure Diseases:
– Bone lesions: Fractures, stress fractures, metabolic bone diseases, neoplasms
– Childhood bone diseases: Congenital hip dislocation, coxa vara, slipped epiphysis of the femoral head,
– Legg-Calve-Perthes Disease
Other Causes:
– Neurological diseases: Compression neuropathies (meralgia paresthetica)
– Vascular diseases: Atherosclerosis of the iliac vessels
– Reflected pains: Thoracolumbar spine diseases, pain originating from intra-abdominal structures
Hip Osteoarthritis: (Calcification of the hip)
– Hip osteoarthritis can be seen in a wide age distribution.
– There is a slight male predominance.
– It is divided into two groups as primary and secondary coxarthrosis.
– Although underlying etiologic factors such as congenital hip dislocation, Perthes disease, leg length discrepancies and acetabular dysplasia can be identified, there is no cause in 80% of cases.
Etiologic Factors
– Idiopathic
– Instability: DDH, hip dysplasias
– Excessive load on the joint and disturbance of load balance: Epiphyseal shift, Perthes sequelae, bony deformity, coxa vara, anteversion
– Avascular necrosis
– Direct cartilage trauma
– Mechanical causes: Leg shortness etc.
Risk Factors:
– Although the prevalence is higher in men, gender alone is not a risk factor.
– Advanced age (over 55 years)
– Obesity
– There is an increased relative risk in those with a body mass index greater than 35.
– Stereotypical repetitive use (farming)
– Excessive physical activity during puberty.
– The form involving the upper pole is the most common. Superolateral displacement of the femoral head is common. 60
– Medial pole involvement is less common and causes medial displacement of the femoral head and protrusion of the acetabulum. 25%
– The form in which the whole joint participates is called a concentric pattern. 15%
Symptoms
– pain
– Short-term morning stiffness is usually present (less than 30 minutes)
– There may also be short-term stiffness following inactivity during the day.
– Limitation of movement.
– They have difficulty with movements that require bending, such as putting on socks and shoes.
Symptoms:
– There may be tenderness in the groin area and anterior aspect of the joint.
– Antalgic gait may be noticeable.
– Lateral tenderness may also be present due to trochanteric bursitis.
– Passive motion in the joint is restricted and pain develops when the limit of motion of the joint is reached during examination.
– Internal rotation is usually the first movement to be affected and the limitation is most prominent.
Clinical course;
– One in 8 radiologically osteoarthritic hips never developed pain.
– Pain decreased in 2/3 of those who initially complained of pain.
– Functional limitation increased at 10 years follow-up.
– 1/3 of the patients were able to use assistance in their daily lives.
Treatment:
– The principles of treatment are generally the same as for osteoarthritis of other joints.
– The main aim of treatment is to reduce pain and improve quality of life by maintaining or increasing range of motion.
Principles of osteoarthritis treatment:
– Education: Ensuring that the patient’s condition is well understood by the patient, relatives and caregivers and that they are informed about how they can help the patient.
– Improvement of symptoms: Controlling pain, stiffness and other symptoms and preventing the risks they pose to the patient.
– Minimizing the handicap: Minimizing functional disability and handicap with appropriate rehabilitation techniques.
Treatment methods applied in the treatment of osteoarthritis can be categorized into 3 groups:
– Non-drug treatment
– Drug treatment
– Surgical intervention
Physical Therapy and Rehabilitation Methods:
– Pain: Hot and cold applications, acupuncture, TENS, whirlpool, canedian support, use of insoles in leg length inequalities.
– Joint Range of Motion Protection: Flexion, extension, rotational stretching exercises, prone lying.
– Muscle Weakness and Atrophy: Isometric exercises (abductor and quadriceps)
– Activities of Daily Living: Adaptive devices, ensuring proper performance of occupational and other daily activities.
Physical Therapy and Rehabilitation Methods:
– Pain: Hot and cold applications, acupuncture, acupuncture, TENS, whirlpool, canedian support, use of insoles in leg length inequalities.
– Joint Range of Motion Protection: Flexion, extension, rotational stretching exercises, prone lying.
– Muscle Weakness and Atrophy: Isometric exercises (abductor and quadriceps)
– Activities of Daily Living: Adaptive devices, ensuring proper performance of occupational and other daily activities.
– Warm application: Pain and muscle spasm decrease, collagen elasticity increases, joint range of motion is facilitated. Muscle contraction ability increases.
– Cryotherapy: Slows circulation, reduces edema and pain in acute inflammation (cold pack and cold spray).
– Hydrotherapy: Provides a suitable environment for exercise by eliminating gravity. Provides relaxation and proprioceptive feed back. Venous ponding is prevented
– Electrotherapy: Medium and low frequency currents are used for analgesic purposes. The most commonly used modality is TENS. Diadynamic currents and interferential currents are also used.
– Massage and mobilization: 1-In cases where joint and soft tissue mobilization is limited, it is based on forcing the joint to a point more than the active range of motion. 2-It should not be applied in the presence of inflammation. 3-Massage may be useful in resolving muscle spasm.
– Exercise:
- The main goal of exercise therapy is to reduce pain while increasing function.
- The balance of rest, relaxation and exercise should be well balanced.
- Exercise maintains or increases range of motion, increases strength, endurance and joint stability, decreases fatigue and improves well-being.
- Movement contributes to joint and cartilage nutrition and toxin removal.
- In the presence of acute inflammation or severe muscle weakness, exercises that place major stress on load-bearing joints are avoided and passive exercises and rest are recommended.
- Exercise provides inhibition of afferent pain pathways. It contributes to relaxation and breaks the vicious cycle of pain and tension.
Exercises applied:
– Isometric exercises: Provides contraction while maintaining immobilization. It creates less mechanical stress on the joint. Recommended during inflammation and at the beginning of exercise.
– Dynamic exercises: Recommended in the chronic period. They are isotonic and isokinetic exercises.
– Stretching and ROM exercises: They should be performed with caution in the presence of inflammation.
– In-water exercises: With the elimination of gravity and buoyancy of water, the load on the joint decreases. It is useful in training patients with muscle weakness.
– Aerobic exercises: Patients with OA have low endurance. Walking, cycling, swimming are recommended.
Occupational Therapy:
– Patients are evaluated for necessary equipment for activities of daily living and work activities.
– Joint protection and energy conservation are taught. The patient may be advised to live in a one-story house and avoid painful climbing.
– Toilet riser seats, assistive devices for putting on socks, wall bars in the bathroom and toilet are recommended.
– Walking transfer aids: Cane: It is the tool that contributes the least to load transfer. Its advantage is that it allows rapid mobilization. Canedian and Crutches: They are more stable than the cane. Walker: The most stable walking aid. It is the most difficult to mobilize.
Medical Treatment:
– Drugs used in the treatment of osteoarthritis are given to support non-drug treatment.
– The main treatment in osteoarthritis is non-drug treatment. Better results can be obtained when non-drug treatment is combined with drug treatment.
– Although there is no drug treatment that prevents osteoarthritis, methods are being tried to slow down joint damage or the development of side effects.
– Anelgesic (paracetamol)
– Anti-inflammatories (NSAIDs)
– Tramadol is a centrally acting opioid agonist with analgesic effect. It is preferred in patients who have not responded to medical treatment or in patients with reduced renal function in whom NSAIDs are contraindicated.
– Chondropretective drugs are drugs that stimulate cartilage matrix production and/or inhibit matrix degradation.
– They stimulate proteoglycan synthesis in vitro and inhibit metalloproteinases.
Examples: Negatively charged highly sulfatic protein molecules, SP-54, glycosaminoglycan polysulfate (Arteparon), glycosaminoglycan peptide complex (Rumalon).
Intraarticular therapies
– Glucocorticoids
– Hyaluronic acid
– Morphine