Development dislocation of the hip, The dysplastic hip, The irritable hip – Transient synovitis, Perthes disease, Tuberculosis, Primary osteoarthritis of the hip, Secondary osteoarthritis of the hip, Rheumatoid arthritis, Acute pyogenic arthritis of the hip, Slipped femoral epiphysis
There are mainly eight diseases or disorders of the hip joint. They are given in a flowchart manner below. Then we have discussed one by one further.
The diseases are :
1. Developmental dislocation of the hip (DDH):
I. Definition :
The femoral head is displaced relative to the acetabulum in this disease, which impairs the normal development of the hip joint if left untreated.
II. Epidemiology :
- The ratio of the disorder is – 1:1000 live births.
- Occurrence is higher in females
- 20% cases are bilateral
- Malpresentation is most commonly seen in first-born female children.
III. Clinical features :
- Female child will present with abnormal thigh and hip folds
- Vascular sign of Narath : This is inability to feel the pulsations of femoral artery against the femoral head.
- Barlow’s test : Adduction of the hip –> Dislocatable hip –> Head dislocated.
- Ortolani test : Adduction of the hip –> Femoral head goes inside the acetabulum.
- Allis test/Galeazzi test : Flexion and holding the hip and knee of the child –> Affected side appears lower compared to the normal side.
- X-Ray : Disrupted shenton’s line, head of femur in upper and outer quadrant, Acetabular angle is more than normal.
IV. Management :
A. Diagnosis :
- X-Ray
- CT Scan
- MRI
- Arthrography
- USG
X-Ray findings :
- Shenton’s line
- Perkins line
- Acetabular index
- Widened acetabular tear drop
- Centre-edge angle of Wilberg
B. Treatment :
The main aim of the treatment is to restore head of femur inside the acetabulum. The treatment protocol depends upon the age of presentation.
- <6 months : We use Pavlik harness brace, and Von rosen splint.
- 6 months : 18 months : First we should attempt closed reduction. If not possible then open reduction by the Smith Peterson Approach.
- 18 months : 36 months : We do Femoral osteotomy – VDRO
- >3 years : VDRO + Pelvic osteotomy —> Salter and Pemberton’s osteotomy
- >10 years : We do total hip replacement
2. The dysplastic hip :
I. Definition :
The medical word for a hip socket that does not entirely enclose the ball section of the upper thighbone is hip dysplasia. The hip joint might become partially or totally dislocated as a result of this. Hip dysplasia is a disorder that most people are born with.
II. Clinical features :
- Hip discomfort.
- Hip joint that is loose or unstable.
- Walking with a limp.
- Leg lengths that aren’t the same.
III. Management :
A. Diagnosis :
- X-Ray
- CT Scan
- MRI
B. Treatment :
- Treatment can be by orthopaedic devices like Orthopaedic cast and Prosthesis
- Medicine treatment can be done by sedation, analgesia and providing reduction, traction.
- Mainly three types of surgery can be done – Arthroplasty, tendon release, and Arthrodesis.
3. The irritable hip :
I. Definition :
There are mainly three reason which causes the irritable hip, and they are – Transient synovitis, Perthes disease, and Tuberculosis.
The syndrome of acute hip discomfort, joint stiffness, limping, or non-weightbearing is known as irritable hip syndrome, and it is caused by an underlying ailment such as transitory synovitis or orthopaedic infections (like septic arthritis or osteomyelitis).
II. Clinical features :
- Patient can present with pain and a limp in one side of the hip, but sometimes the patient can also present with both side affected.
- The pain can range from minor to severe, and it usually appears out of nowhere. It usually affects one hip, although it can also affect the groyne, thigh, and knee on the affected side.
- The patient also can present with mild fever.
III. Management :
A. Diagnosis :
- X-Ray
- Blood test
B. Treatment :
- NSAID – Non steroidal anti inflammatory drugs, or acetaminophen for pain relief.
- Aspirin is contraindicated for children below the age of 16 years.
4. Primary osteoarthritis :
I. Definition :
- The degradation of cartilage, a rubbery material that reduces friction in your joints, causes primary osteoarthritis.
- It can affect any joint, however it is most common in the fingers, thumbs, spine, hips, knees, and big toes. Osteoarthritis is more common in persons over the age of 50.
II. Clinical features :
- Pain – It is possible that the affected joints will pain during or after movement.
- Tenderness – When you apply light pressure to or near your joint, it may become tender.
- Swelling – This could be due to inflammation of the soft tissues around the joint.
- Stiffness – Joint stiffness may be more obvious when you first wake up or after a period of inactivity.
- Flexibility loss – It’s possible that you won’t be able to move your joint completely across its range of motion.
III. Management :
A. Diagnosis :
- X-Ray
B. Treatment :
- Pain relievers like acetaminophen
- NSAIDs – Nonsteroidal anti-inflammatory drugs
5. Secondary osteoarthritis :
I. Definition :
It is a synovial joint illness that occurs as a result of a predisposing condition that has harmed the joint tissues (eg, trauma to articular cartilage or subchondral bone).
II. Clinical features :
- Pain that gets worse when you don’t do anything.
- Swelling and rigidity of the joints.
- Muscle mass loss is a common occurrence.
- Range of motion loss (difficulty moving affected joints)
- Crepitus is the sound of grating or cracking in the joints.
- Tenderness and warmth in the afflicted joints.
III. Management :
A. Diagnosis :
- Blood test
- X-Ray
B. Treatment :
- NSAIDS – Non steroidal anti-inflammatory drugs
6. Rheumatoid arthritis :
I. Definition :
Rheumatoid arthritis is a long-term inflammatory condition that affects more than your joints. The illness can harm a range of body systems in some people, including the skin, eyes, lungs, heart, and blood vessels.
II. Clinical features :
- Swelling.
- Fever.
- Fatigue.
- Pain.
- Stiffness in the morning.
- Stiffness of the joints.
- Tingling and numbness
III. Management :
A. Diagnosis :
- Blood test
- ESR test
- X-Ray
B. Treatment :
- NSAIDS – Non steroidal anti inflammatory drugs
7. Acute pyogenic arthritis :
I. Definition :
Bacteria are the most common cause of septic arthritis, also known as infectious arthritis. A virus or fungus can also be to blame. Inflammation of a joint induced by infection is the condition. Septic arthritis usually affects a single big joint in the body, such as the knee or hip. Septic arthritis can affect numerous joints in rare cases.
II. Clinical features :
- Chills.
- Fatigue and a general feeling of weakness
- Fever.
- Inability to move the affected joint on the afflicted limb.
- Severe pain, especially with movement, in the afflicted joint.
- swollen (increased fluid within the joint)
- Temperature (the joint is red and warm to touch because of increased blood flow)
III. Management :
A. Diagnosis :
- Blood test
- MRI
- X-Ray
B. Treatment :
- Fluid drainage
- Antibiotics
8. Slipped femoral epiphysis :
I. Definition :
Also known as SCFE (slipped capital femoral epiphysis) is an adolescent growth plate condition in which the femoral head shifts relative to the remainder of the femur. While the head of the femur remains in the hip joint’s cup, the remainder of the femur shifts.
II. Clinical features :
- Pain
- Stiffness
- Deformity
III. Management :
A. Diagnosis :
- X-Ray
- MRI
B. Treatment :
- In situ fixation of the problem