Many diseases of hip joint may be encountered from birth to death. The most common hip diseases will be explained in this section.
Developmental dysplasia of the hip (hip dislocation)
It is one of the most common orthopedic hip diseases encountered after birth. The causes are known as genetic (consanguineus marriage), posture defects and swathing. Early period diagnosis has vital importance. Diagnosis is made by orthopedicians or through the suspicion of the paediatrician. Asymetry on the skin curves around the hip, shortness on limb on the affected side, difficulty in lateral movement and click sound on hip are the important findings. Ultrasonography imaging will provide the diagnosis. Pavlik-bandage will provide succesful outcomes in treatment. In late diagnosis, various surgeries are required. A good surgery will also provide excellent results.
Congenital femoral shortness
The most severe form is the proximal femoral focal deficiency (PFFD). Femoral lengthening can be used for simple femoral shortness however, PFFD patients require more severe treatment procedures and they are prone to complications. Accompanying hip and knee pathologies must be treated before lengthening in those patients. The femoral lengthening surgeries are completed in several operations with the surgical techniques that Dr. Dror Paley defined as ‘super hip’ and ‘super knee’ after hip and knee pathologies are treated. Because the shortness is about 25-30cm in those patients.
Acquired pediatric diseases ( Septic arthritis, Perthes, Slipped capital femoral epiphysis)
The paediatric hip infections are defined as septic arthritis. Generally, the infections develop by the settlement of bacteria on hip joint and may rarely develop following the upper respiratory tract or urinary tract infections. Fever, hip pain and limping causes discomfort in patients. The blood tests (leukocyte, CRP and sedimentation) are elevated. The identification of the bacteria from hip puncture and reproducing in laboratory environment will provide the final diagnosis. The treatment is surgical drainage where the hip infection is discharged.
Perthes is the most prevalent paediatric disease The etiology is unknown. The disease is most frequent between the ages of 4 to 8. The disease has 4 stages and lasts approximately in 1.5 to 2 years. The disease manifest with insidious hip pain and gait abnormalities in the beginning and then contractures on the muscles in hip region and shortness develops. The hip growth plaque is completely affected in this period The disease may rarely recover without leaving any sequelas. Partial or total dislocation may develop on hip joint because generally the growth plaque is damaged. Therefore, the patients must be monitored by orthopedicians until the disease disappears. Exercises for hip region is recommended.in the early period of disease The connection between the femoral head and acetabulum is corrected by surgical treatment in late period.
One of the other most frequent disease is the slipped capital femoral epiphysis. Generally those children have endocrine problems and femoral head moves from neck to the lateral side. The primary symptoms are insidious hip pain and gait abnormalities. The pain relieves but irremedable damage develops on hip with the progress of the disease. Therefore, early diagnosis is important. Diagnosis will be possible through X-ray imaging particulary on lateral graphy. The treatment procedure is to correct the relation between the head and neck by surgery and by nailing to prevent reoccurrence of the disease.
Avascular necrosis of femoral head
One of the important hip diseases which develop in adults. However, the etiology is not known, the most frequent cause is the use of cortison for treatment of various diseases. The physicians confirm that the disease is more frequent in patients with bone marrow edema, overconsumption of cigarette and alcohol, lipid storage diseases and oracle cell anemia. Scintigraphy and MRI will provide the exact diagnosis in early period. The disease has 4 stages. The treatment may vary in accordance with the stage of the disease. Total prosthesis is performed in the most severe cases.
The friction between the anterior end of acetabulum and anterosuperior surface of femoral head during movement is defined as femoro-acetabular impingement. Acetabulum(pincer) or femoral head(cam) type lesion may be present. Labrum tear may also be frequent in those patients. The structures, which cause impingement, are removed by arthroscopic or open surgery methods.
Fractures may develop on hip joint by even small trauma in advanced ages because the bones lose mechanic resistance due to osteoporosis. The most frequent fractures are femoral head fractures. The fractures generally develop due to trauma during indoor daily activities. Although, the osteosynthesis methods are used in treatment to support the reunion, generally hip prosthesis is replaced due to reunion problems. The carpets must be removed in the house and bathroom must be easy to reach for patients in this group as precautionary measures.
Coxarthrosis ( Hip Joint Osteoarthritis)
One of the most frequent diseases of people over 60 years. The etiology is unknown but physicians assume that genetics, eating habits, environmental factors and life style have an impact. In addition, hip joint arthrosis may also develop due to rheumatoid disease, hematologic, metabolic diseases and trauma.There is damage on joint cartilage. Although, bone instruction surgeries may be used in proper cases, prosthesis is preferred in most patients. Prosthesis provides comfort for the patient and can be used for years thanks to the modern technologies.