Hip Osteoarthritis

1- Positive diagnosis:

A- Clinic:

* Pain seat in the groin and anterior thigh. Sometimes gonalgia isolated (knee). Pain causes lameness

* Half the time the infringement is bilateral

* Attitude vicious in flexion and external rotation and adduction (late sign)

* Atrophy of the thigh.

* The earlier limited passive movements: internal rotation and extension as well as cross flexion (knee -> nipple contralateral)

B- Radiography:

* Simple frontal radiograph is usually sufficient. The Lequesne false profile (for misleading forms, posterior).

* Radiography is sufficient for the diagnosis

* The pinch is typically more polar; sometimes later (Lequesne false profile)

* Osteophytes at the acetabulum and the femoral head

* Sometimes sclerosis and subchondral geodes

2- Differential diagnosis and etiology:

A- Differential diagnosis:

– coxitis

– Aseptic necrosis of the femoral head (egg shell in appearance)

– Tendinitis of the gluteus medius (or trochantérite or hip periarthritis)

– Algodystrophie hip (osteoporosis without joint space narrowing)

– Synovial tumors (chondromatose, villonodular synovitis)

B- Etiology:

+ Luxante dysplasia of the hip (40% of hip osteoarthritis) with acetabular protrusion, excess éntéversion and opening of the neck-shaft angle.

+ Deformation:

– Coxa retrorsa (sequelae of slipped capital femoral epiphysis)

– Coxa plana (sequelae of osteochondritis)

– Post-traumatic (in 5-10 years)

NB:

* Any knee pain without detectable damage to the owner must examine the hip

* The toe is not always easy to say but the presence of osteophytes indisputable is sufficient for diagnosis

* The causes of osteonecrosis of the femoral head are alcoholism, corticosteroid therapy, fracture and hip dislocation, radiotherapy, decompression sickness, sickle cell anemia, Gaucher disease.

* The osteoarthritis of rapid evolution (toe> 1 mm / year) is similar clinically to coxite with discretion or lack of osteophytes;: it represents 10% of osteoarthritis. The VS can be high. Diagnosis depends on examining joint fluid known (<1000 GB / mm3, <50% PNN)

* Total varus osteotomy or the acetabular bearing targets young subjects with osteoarthritis beginner or unsophisticated about dysplasia. Its goal is to slow the progression of the lesions. Total hip replacement (available from 60 years) to a more beneficial effect on the symptoms for 15 years (PTH life).