HIP JOINT PATHOLOGIES
The bone surfaces of our skeleton interface with each other through the joints.
The joints can be of different types depending on the relative movement between the bones that compose them: in some cases they connect two or more bones with extreme mobility, such as the hip, the knee, the shoulder; in other cases they joins together bones with limited mobility, such as the bones of the spine; in other cases they join absolutely immobile bones, such as those of the skull.
The joints, especially those subject to load and more involved in the movement, can be afflicted by pathologies that can lead to the need for joint replacement surgery.
These pathologies are multiple, they can be of different nature (degenerative, traumatic, congenital) and highly disabling.
OSTEOARTHRITIS
Osteoarthritis is a degenerative pathological process of the articular surfaces that involves the entire joint (bone, cartilage, joint capsule).
It is a very common condition that usually occurs between the ages of 50 and 60, but can also occur at a younger age. It is classified as “primary” osteoarthritis when the origin is not known, or as “secondary” when it arises as a result of inflammatory processes (arthritis), endocrine (diabetes or gout), congenital (dysplasia) or traumatic, which alter morphology and joint function.
The arthritic pathology manifests itself with the wear and the gradual reabsorption of the articular cartilage, thinning of the articular space, anomalous production of bone (osteophytes), deformation of the articular edges, thickening of the capsule with formation of calcifications, resulting in acute pain and severe limitation in the movement.
The diagnosis is easily recognizable based on the symptoms and a simple radiographic examination. Therapy is planned based on the stage of progress.
The most affected joints are those of the hip (coxarthrosis), of the knee (gonarthrosis) and of the shoulder (omarthrosis).
The most effective therapy for the treatment of osteoarthrosis is surgery, with the prosthetic replacement of the articular edges involved. Pharmacological therapies, physiotherapy treatments, cortisone infiltrations or anything else can temporarily relieve pain but do not constitute a definitive solution.
RHEUMATOID ARTHRITIS
Rheumatoid arthritis is a chronic and progressive inflammatory polyarthritis with autoimmune pathogenesis of the synovial joints.
It differs from arthritis because it initially affects the synovial membrane and not the cartilage, it affects with less frequency and at a more youthful age compared to osteoarthritis. Women are more affected (3: 1 ratio). It affects 1-2% of the population and the number of cases increases with age, in fact 5% of women over 55 are affected. Onset is mainly observed at the end of adolescence or between the 4th and 5th decade of life; a second peak is observed between 60 and 70 years.
An early variant of RA consists of rheumatoid arthritis of childhood.
FEMORAL NECK FRACTURES
The fracture of the femoral neck is frequent in the elderly, since, as is known, over the years there is a decrease in the characteristics of mechanical strength of the bone, especially in this anatomical district.
The fracture usually occurs due to rotational stress, rather than due to direct traumas to the hip, so that the subject, sliding or supporting the lower limb incorrectly determines a sharp rotation, which results in the fracture of the neck and, only afterwards, the fall due to lack of support.
Because of the peculiar vascularization characteristics of the femoral head (that receives the spraying only through the neck and a fracture of this can interrupt the blood flow to the head) these fractures often undergo pseudoarthrosis, or failure to consolidate.
For this reason it is preferable to treat older patients (over 70-75 years) directly with a prosthesis, in order to avoid long and dangerous periods in bed without a valid guarantee of success.
CEPHALIC NECROSIS
Cephalic osteonecrosis (i.e. cell death of bone tissue of the femoral head) can often be idiopathic (from unknown causes), sometimes induced by drug abuse (cortisone) or post-traumatic. Regardless of the cause, a common factor it concerns an insufficient vascularization of the femoral head and consequent necrosis (usually in the region of greatest load) which weakens the structure leading to the collapse of the subchondral bone (which is immediately below the cartilage) following to load bearing, with subsequent appearance of secondary arthrosis.
The first symptoms are groing pain directly related to the load, which radiate to the knee at a later stage. A limitation of hip mobility caused by pain may also arise.
OSTEOPOROSIS
Osteoporosis is a systemic and metabolic disease of the skeletal system, which occurs in the elderly and with greater incidence in women. It is characterized by low mineral density and deterioration of the structure of bone tissue.
The result is an increase in the fragility of bones that are more easily subject to fractures.
HIP DISPLASIA
Hip dysplasia is represented by an incomplete or failed formation of the acetabular cavity that does not allow normal articulation with the femoral head, which consequently undergoes a morphological alteration.
It is often associated with or deriving from congenital dislocation of the hip (when the femoral head is not retained within its anatomical site).
