PATHOLOGIES

The relationship between our skeletal bones is through a specific connection called a joint

These link in some cases two or more bones with extreme mobility, such as for example those of the limbs; in other cases they unite between themselves  bones with relatively little mobility such as the bones of the spine; in other cases still connecting absolutely motionless bones, like those of the cranium.

The joints, especially those most involved in movement and subject to load, can be afflicted with diseases which can lead to the need for a joint replacement intervention.

These diseases are multiple, can be different in nature and highly disabling.

ARTHRITIS

Osteoarthritis is a degenerative disease process of the joint involving the entire joint (bone, cartilage, joint capsule).

It is a very common condition that typically occurs between 50 and 60 years of age, but can also occur in younger ages. It is classified as primary osteoarthritis when the source is not known, or as secondary when it occurs as a result of inflammatory processes (arthritis), endocrine (diabetes or gout), congenital (dysplasia) or trauma, that alter the morphology and joint function.

An arthritic pathology manifests itself through wear and gradual resorption of articular cartilage, thinning of the joint space, production of abnormal bone (osteophytes), deformation of the joint, thickening the capsule forming calcifications, resulting in acute pain and severe limitation in movement. Diagnosis is easily recognized based on symptoms and a simple x-ray, therapy is planned based on the severity of the disease.

 

The joints most affected are those of the hip (coxarthrosis), knee (gonarthrosis) and shoulder (omartrosis).

The most effective therapy for the treatment of osteoarthritis is surgery with prosthetic replacement of the articular heads concerned. Drug therapies, physiotherapy, cortisone infiltration or any other therapy may temporarily relieve pain but are not a permanent solution.

RHEUMATOID ARTHRITIS

Rheumatoid arthritis is a chronic and progressive inflammatory polyarthritis of autoimmune pathology in the synovial joints.

It differs from arthritis because it initially focuses on the synovial membrane and not the cartilage, it attacks less frequently and at a younger age than osteoarthritis.  Women are most affected (3: 1 ratio). It affects 1-2% of the population and the number of cases increases with age, it affects 5% of women over the age of 55. Onset is mainly observed towards at the end of adolescence or between 4th and 5th decade of life; a second peak is observed between 60 and 70 years. An early variant of RA consists of childhood   rheumatoid arthritis. Hip arthritis: cox arthritis.  Arthritis of the knee: gonarthrosis.

Femoral neck fractures

Fracture of the femoral neck is common in the elderly, since, evidence shows that with age there is a decrease in the bone mechanical strength resistance especially in this anatomical area

Fractures typically occur for stress in rotation, rather than from direct hip trauma, so that the subject, slipping or moving the lower limb incorrectly determines an abrupt rotation, which results in fracture of the neck and subsequently, a fall from the lack of support.

Because of the peculiar characteristics of femoral head vascularization, (terminal end or receives blood only from the neck and a fracture such as this can stop the blood flow to the head), these fractures can easily move towards pseudo arthritis or a nonunion.

For this reason it is preferable to treat older patients (above 70-75 years biological) immediately with a prosthesis, in order to avoid long and dangerous periods of bed confinement without a valid guarantee of success.

CEPHALIC OSTEONECROSIS

An important chapter of the major causes of arthroplasty is ascribed to cephalic osteonecrosis or aseptic necrosis of the femoral head.

This pathology can often be idiopathic, sometimes due to pharmacological use or post-traumatic. Independently from the cause, the most common, well documented factor is vascular insufficiency of the femoral head and consequently a necrosis (usually in the greater stress areas) which weakens the supporting structure at the sub-chondral bone (immediately under the cartilage), following weight bearing, with the appearance of secondary arthrosis.

Symptoms begin with pain in the groin area directly related to the load, and then radiates down to the knee at a later stage. There is also limited hip motion, at first analgesic  (pain caused by) and after that joint incongruity.

OSTEOPOROSIS

Osteoporosis is a degenerative process of the bone structure, which normally occurs in the elderly, following insufficient cell turnover (the production of new cells is less than that of the cells that are destroyed by the normal process of cell regeneration).

It follows an increase in bone fragility which are more easily prone to fracture.

CONGENITAL DISEASES

Hip dysplasia.

Dysplasia of the hip is represented by an incomplete or non-formation of the acetabular cavity that does not allow normal articulation with the femoral head, which in turn consequently undergoes morphological alteration.

It is often associated with or arising from congenital hip dislocation (when the head of the femur is retained within its anatomical site).

 

Knee Varus / Valgus

 In a normal situation, the joints of the lower limb (hip, knee and ankle) should be aligned on a common axis, called Mechanical axis or axle load. This axis in the tibia corresponds to the diaphysis axis (Anatomical Axis) while in the femur the anatomical axis deviates from the mechanical axis forming a+/- 6 degree angle (physiological valgus angle). If this alignment is changed it creates a pathological situation with axis deviation, resulting in abnormal biomechanics that over time lead to wear of the areas under load.

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