Walking upright is something we are born with. But to be able to stand upright, we need strong joints, especially in the hips and knees. Joint arthrosis and wear and tear on the cartilage layer, however, are on the rise in our society. This is partly due to the fact that we are getting older and older and that often such diseases develop with age. But more and more young people are also living with an artificial hip joint. On average, implants last ten to 15 years before they need to be replaced. Ceramic prostheses are best for young patients with hip osteoarthritis.
What is hip joint osteoarthritis?
Hip joint arthrosis is called coxarthrosis in medical parlance and is a degenerative disease of the hip joint. In particular, the cartilage surfaces of the acetabulum and femoral head are affected. Wear and tear of the joint usually occurs at an advanced age. Hip joint arthrosis represents the most common type of arthrosis in Germany. In the case of hip joint arthrosis, the cartilage layer in the joint becomes thinner over time and recedes. Due to the degradation of cartilage mass, the joint space narrows increasingly until the bones rub against each other.
Cause of osteoarthritis in the hip joint lies in the genes
Human hip joints are subjected to incredible stresses. When running or carrying loads, they have to absorb many times our body weight. Diseases of these important pivots in our body are therefore not uncommon. Osteoarthritis, for example, can affect even young people and is not a simple symptom of old age.
Other causes of osteoarthritis of the hip joint
Almost every second German over the age of 60 complains of arthritic joints, especially the hip and knee joints. Joint wear and tear is subject to numerous factors and a complex disease process. The causes include a genetic predisposition and advanced age. However, accidents or continuous heavy strain during sports or at work can also lead to hip joint arthrosis. Other factors that can promote osteoarthritis in the hip joint are:
- Overweight
- Diabetes mellitus
- Inflammatory joint diseases such as gout
- Hereditary deformities of the hip joint (hip dysplasia).
If several of these factors come together, the risk of joint wear in the hip increases. However, it is not always possible to define an exact cause. But one thing is certain: osteoarthritis is not a simple wear and tear disease, but a serious disease. The slow degradation of the joint cartilage cannot yet be stopped. But the accompanying symptoms such as pain and swelling can be alleviated by the doctor.
Problems in joint metabolism
In the course of osteoarthritis, the build-up and breakdown processes in the articular cartilage become unbalanced. The cartilage loses its function as a shock absorber and no longer adequately cushions the affected joint. The surrounding bone is overloaded and tries to reinforce itself by growing irregularly. In the process, the joint head is literally walled in by the excessive bone production.
How does osteoarthritis of the hip joint make itself felt?
Osteoarthritis of the hip joint develops over years and becomes noticeable only gradually. In the early stages, the first steps after getting up are not as easy as usual and may hurt a little. This quickly subsides, but occurs more and more often. As the condition progresses, pain develops with certain movements, such as bending over, getting out of a car or descending stairs.
Osteoarthritis of the hip joint: symptoms in advanced stages
In the advanced stage of osteoarthritis, the hip joint may then hurt a lot even when at rest, such as when sitting or lying down, and mobility becomes increasingly limited. In summary, the following signs indicate hip joint osteoarthritis:
- Start-up pain in the hip is discomfort that occurs at the beginning of a movement, for example in the morning after getting up or after prolonged sitting. After some time, the pain subsides again
- Hip joint pain during prolonged exercise or when descending stairs.
- Groin pain may also radiate down the thigh to the knee
- Altered gait (limping): due to the one-sided joint wear and to keep pain low, many affected people move away restricted
- Pain at rest when sitting or lying down
- Limited mobility: the thigh can hardly be stretched, bent, splayed or rotated and only with pain
The right diagnosis leads to the right therapy
Anyone who fears suffering from joint arthritis, should be referred by his family doctor to an orthopedist. With the help of blood tests and X-rays, the orthopedist can determine whether the joint disease is present and, if so, what it is. After all, gout and rheumatism are not uncommon in our society. At the beginning of the examination, the doctor asks the patient about his medical history, lifestyle and possible similar cases in the family (anamnesis). This is followed by a physical examination. Here, the patient’s gait and posture are checked for possible deformity, and joints are palpated for tenderness and swelling. The mobility of the joint is also examined to determine how far the arthrosis has progressed. However, the most important examination for finding the diagnosis is the X-ray examination. This is because an X-ray can show, for example, whether and to what extent the joint space is narrowed and whether outgrowths have formed on the bones (osteophytes). Other signs of hip joint arthrosis are holes in the bone surface (boulder cysts) or compacted bone substance below the joint surfaces (subchondral sclerosis). As a rule, these examinations are sufficient as diagnostic measures. To rule out other diseases in the hip joint or to detect damage to soft tissues such as ligaments and muscles, other imaging techniques such as ultrasound or magnetic resonance imaging (MRI) may be used.
Conservative therapy for osteoarthritis of the hip joint
Osteoarthritis is not curable. However, the progression of the disease can be slowed and pain can be relieved. Particularly in the early stages, the affected person can actively help keep osteoarthritis at bay. Conservative therapy focuses on pain relief and mechanical relief of the hip joint. In addition to treatment with medications such as painkillers or non-steroidal anti-inflammatory drugs (NSAIDs), targeted physiotherapeutic exercises can reduce joint blockages and maintain or even significantly improve the mobility of the joint.
Surgical therapy for osteoarthritis of the hip joint.
However, if the osteoarthritis is too advanced, often only surgery can help. Here, there are two surgical procedures.
- Osteotomy: This procedure corrects the position of the joint surfaces and is usually used for malpositions. However, the chances of success decrease with increasing age and advanced stage of osteoarthritis. Therefore, this operation is performed rather rarely today.
- Endoprosthesis: The implantation of an artificial hip joint is by far the more common therapeutic measure. With a total hip endoprosthesis (hip TEP), both the joint head and the socket are replaced. With a partial prosthesis, on the other hand, only the femoral head is replaced.
Artificial hip joints for young and old.
As yet, there is no material that is as resilient and efficient as the natural joint. But on average, hip joint prostheses last more than 15 years. Whether to take a prosthesis made of ceramic, metal or plastic depends on many factors and must therefore be decided individually. The durability of a hip prosthesis depends largely on how well it is anchored in the femur. In older people, this is often no longer as stable, which is why the artificial hip joint is connected to the bone with a special cement. In younger patients, the prosthesis can grow more easily into the thigh, which is why cement-free fixation is often used here. In addition, the artificial joint can be better replaced in such cases if necessary.
The right material for every patient
Artificial hip joints also have to withstand a lot. Especially in younger, active patients. While diseases such as articular arthrosis are often the cause of a damaged hip joint in older patients, in younger people this important joint is mainly damaged by serious accidents during sports or in road traffic. Cancer can also lead to the need for an artificial hip joint. Proven implants are made of plastics and/or metals. They last an average of 15 years before they loosen and a new operation becomes necessary.However, ceramic seems to be a particularly suitable material for young patients. In a five-year study, U.S. researchers from Chicago observed the artificial joints of more than 1,000 hip joint patients. Their measurements showed that ceramic hips were up to 400 times more resilient than plastic-metal-based implants. With plastic sockets, tiny amounts of the material constantly rub off, causing inflammation around the implant and resulting in loosening. Ceramic, on the other hand, is resistant to abrasion.
Exercise even after surgery the best way to achieve permanent mobility
If the diseased joint needs to be replaced, the patient can begin mobilization exercises just a few days after surgery. Then, in rehab, the patient learns to cope with the new mobility. It is important to build up the muscles around the new joint so that it is adequately supported. Regular examinations by the orthopedic surgeon determine whether the implant fits properly. X-rays show even the smallest change around the artificial joint, and often, with early intervention, the life of the artificial hip can be significantly extended.
