Degenerative arthritis of Hip Bone Bangalore. Prof Sharath Rao Head, Dept. of Orthopaedics KMC Manipal

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1 Degenerative arthritis of Hip Prof Sharath Rao Head, Dept. of Orthopaedics KMC Manipal

2 Hip joint Classical Synovial joint

3 Biomechanics of hip Force coincides with trabecular pattern

4 Hip joint

5 Acetabulum

6 Hip joint Acetabulum

7 Acetabulum

8 Hip joint Acetabulum

9 Neck shaft angle

10 Neck shaft angle

11 Neck shaft angle

12 Neck shaft angle

13 Neck shaft angle

14 Neck shaft angle

15 Neck shaft angle

16 Anteversion of neck

17 Anteversion of neck

18 Anteversion of neck

19 Anteversion of neck

20 Definition Chronic joint disorder in which there is progressive softening and disintegration of articular cartilage and bone at the joint margin (osteophytes) and capsular fibrosis

21 Etiology Increase frequency with age Reduced proteoglycan Loss of elasticity Decrease in breaking strength Cartilage matrix changes Crystal deposition disease Ochronosis Genetic defect in type II collagen

22 Etiology Inflammatory disorders Enzymatic leaching of proteoglycans Il-i mediated suppression in synthesis Increased mechanical stress Increased load Reduced articular contact area Idiopathic

23 Types Primary osteoarthrosis No obvious antecedent cause Secondary osteoarthrosis Following a demonstrable abnormality

24 Pathogeneisis Dysplasia instability spectrum Femoro acetabular impingement Both

25 Pathogeneisis Structural damage to Articular cartilage Chondro labral complex

26 Pathogeneisis Actabular dysplasia Femoral head is inadequately covered Instability Shearing forces on the edge of acetabulum & head

27 Femoro acetabular impingement - FAI Cam type Pincer type Mixed

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29 Cam type of impingement

30 Cam type of impingement

31 Pincer type of impingement

32 pincer type of impingement

33 Cam & pincer type of impingement

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35 Pathogenesis Progressive cartilage destruction Subarticular cyst formation Sclerosis of surrounding bone Osteophyte formation Capsular fibrosis

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42 Prevalence Commonest of all joint diseases Equal in both sexes Hip is second most involved in Indian population. Opposite in the European countries

43 Risk factors Joint dysplasia Trauma Occupation Bone density Obesity Family history

44 Causes ABNORMAL STRESS SUBLUXATION COXA MAGNA COXA VARA MINOR DEFORMITY PROTRUSIO DEFECTIVE CARTILAGE INFECTION RHEUMATOID CALCINOSIS ABNORMAL BONE FRACTURE NECROSIS PAGETS OTHERS

45 Clinical features Pain Groin Radiation to knee Stiffness Limp Increased after rest Early manifestation Shortening

46 Pain Pain worsening after activity Trochanteric pain abd muscle fatigue Pain on prolonged sitting & groin pain FAI

47 Clinical features Passive hip extension, adduction & external rotation Hip 90 degrees flexion adduction & intenal rotation

48 Clinical features Hip is flexed, Abducted & externally rotated and then extended and internally rotated There is a snap

49 Clinical features Look Feel Shortening Scars Sinuses Temp Joint line tenderness Move Deformity

50 Deformity Primary osteoarthrosis Flexion Abduction External rotation Secondary osteoarhtrosis Depending on the condition

51 Investigation Radiograph Pelvis with both hips AP Frog or translateral Special veiws

52 Investigation Reading of x-ray A. Alingnment B. Bone quality C. Cartilage / joint space

53 Investigation Complete blood work Bone scan Ct scan MRI

54 Treatment Early Maintain movement Muscle strenghtening Protect joint from overload Pain relief Activity modification

55 Treatment

56 Treatment Joint preserving Acetabular osteotomy Femoral osteotomy Safe surgical dislocation Arthroscopy

57 Acetabular osteotomy

58 Acetabular osteotomy

59 Acetabular osteotomy

60 Femoral osteotomy

61 Safe surgical dislocation

62 Arthroscopy labral tear

63 Arthroscopy FAI

64 Treatment Late / operative treatment indication Progressive increase in pain Rest pain Restriction of activity Marked deformity Progressive loss of movement Radiological evidence of joint destruction

65 Operative management Joint debridment Excision arthroplasty Arthrodesis Replacement Arthroplasty